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Knee osteoarthritis

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 American Academy of Orthopaedic Surgeons (AAOS 2023; 2022), the American College of Rheumatology (ACR/AAHKS 2023), and the American College of Rheumatology (ACR 2020).


1.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.
Offer oral NSAIDs and acetaminophen, if not contraindicated, to improve pain and function in patients with knee OA.
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  • Opioids

  • Duloxetine

  • Agents with no evidence for benefit

2.Nonpharmacologic interventions

Weight loss: as per AAOS 2023 guidelines, recognize that there is no difference in postoperative functional scores between patients with a BMI < 30 and 30-39.9; however, there may be an increased risk of complications, especially surgical site infections, in patients with morbid obesity (BMI ≥ 40).

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  • Physical therapy

  • Smoking cessation

  • Dietary supplements

  • CBT

  • Self-management programs

  • Assistive devices

  • Footwear

  • Alternative and complementary therapies

3.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.
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  • Other intra-articular injections

  • Therapeutic arthroscopy

  • Dry needling

  • Denervation

4.Perioperative care

Perioperative glucose control: optimize perioperative glucose control (< 126mg/dL) after total knee arthroplasty in diabetic and non-diabetic patients with HbA1c < 6.5, as hyperglycemia can lead to less favorable postoperative outcomes and higher complication rates.

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  • Intraoperative tranexamic acid

5.Surgical interventions

Total knee arthroplasty, timing: consider performing elective knee arthroplasty without delay, rather than delaying for 3 months,
or for a trial of physical therapy,
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.
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  • 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

6.Patient education

Patient education: provide patient education programs to improve pain in patients with knee OA.

7.Follow-up and surveillance

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