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Knee osteoarthritis

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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).
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Guidelines

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.
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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,
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or for a trial of physical therapy,
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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.
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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.
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