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Knee osteoarthritis

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Updated 2024 EULAR guidelines for nonpharmacological management of knee osteoarthritis.

Guidelines

Key sources

The following summarized guidelines for the management of knee osteoarthritis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2023), the European Committee on Infection Control (EUCIC/ESCMID 2024), the European League Against Rheumatism (EULAR 2024), the American Academy of Orthopaedic Surgeons (AAOS 2023,2022), the American College of Rheumatology (ACR/AAHKS 2023), the European ...
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Medical management

Non-opioid analgesics
As per AAOS 2022 guidelines:
Offer topical NSAIDs, if not contraindicated, to improve function and QoL in patients with knee OA.
A
Offer oral NSAIDs and acetaminophen, if not contraindicated, to improve pain and function in patients with knee OA.
A
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  • Opioids

  • Duloxetine

  • Agents with no evidence for benefit

Nonpharmacologic interventions

General principles
As per EULAR 2024 guidelines:
Offer an individualized, multicomponent management plan including the recommended core nonpharmacological approaches in patients with knee OA.
A
Consider employing elements of behavior change techniques when lifestyle modifications are needed, such as physical activity and weight loss, in patients with knee OA.
B

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  • Weight loss

  • Physical therapy

  • Smoking cessation

  • CBT

  • Self-management programs

  • Assistive devices

  • Footwear

  • Occupational therapy

  • Alternative and complementary therapies

Therapeutic procedures

Intra-articular corticosteroids: as per AAFP 2024 guidelines, consider administering intra-articular corticosteroid injections for the management of pain in patients with knee OA.
C
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  • Other intra-articular injections

  • Therapeutic arthroscopy

  • Dry needling

  • Denervation

Perioperative care

Preoperative decolonization and antibiotic prophylaxis: as per ESCMID/EUCIC 2024 guidelines, consider screening patients for methicillin-susceptible and MRSA before elective orthopedic surgery, according to the local epidemiology.
E
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  • Perioperative glucose control

  • Perioperative tranexamic acid

Surgical interventions

Total knee arthroplasty, timing: as per AAHKS/ACR 2023 guidelines, consider performing elective knee arthroplasty without delay, rather than delaying for 3 months,
C
or for a trial of physical therapy,
C
NSAIDs, intra-articular corticosteroid injections, viscosupplementation injections, or braces and/or ambulatory aids, in patients with radiographically moderate-to-severe OA with moderate-to-severe pain or loss of function eligible for elective total joint arthroplasty decided through a shared decision-making process and completed ≥ 1 trial of appropriate nonoperative therapy.
C
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More topics in this section

  • Total knee arthroplasty (surgical approach)

  • Total knee arthroplasty (bilateral replacement)

  • Total knee arthroplasty (anesthesia)

  • Total knee arthroplasty (prosthesis)

  • Total knee arthroplasty (fixation)

  • Total knee arthroplasty (patellar resurfacing)

  • Total knee arthroplasty (intraoperative tourniquet use)

  • Total knee arthroplasty (intraoperative techniques with no evidence for benefit)

  • Surgeries for medial compartment OA

  • Partial meniscectomy

Patient education

Patient education: as per AAOS 2022 guidelines, provide patient education programs to improve pain in patients with knee OA.
A

Follow-up and surveillance

Discharge from hospital: as per AAOS 2023 guidelines, discharge patients to home, with or without home services, rather than acute rehabilitation facility or skilled nursing facility for fewer adverse events.
B