From the Guidelines
For an 83-year-old female with non-traumatic left knee pain, the most likely cause is osteoarthritis (OA), and the recommended initial approach is to start with conservative management. The American College of Rheumatology 2012 recommendations suggest that patients with knee OA should use one of the following: Acetaminophen, Oral NSAIDs, Topical NSAIDs, Tramadol, or Intraarticular corticosteroid injections 1.
Initial Management
The initial management of non-traumatic left knee pain in an 83-year-old female should include:
- Rest and activity modification
- Apply ice or heat to the affected knee for 15-20 minutes, 3-4 times daily
- Over-the-counter pain relief: Acetaminophen 650-1000 mg every 6 hours as needed, not exceeding 4000 mg/day, as recommended by the American College of Rheumatology 1
- Topical NSAIDs, such as diclofenac gel 1%, can be considered for additional pain relief, as they are recommended for patients with knee OA 1
Further Management
If pain persists, consider adding:
- Low-impact exercises: Swimming, stationary cycling, or water aerobics for 20-30 minutes, 3-5 times per week
- Assistive devices, such as a cane or walker, to reduce weight-bearing on the affected knee
- Knee brace for additional support
Medical Evaluation
If symptoms don't improve within 2-4 weeks, consult a physician for further evaluation, which may include:
- Physical examination
- X-rays to assess for osteoarthritis or other structural issues
- Possible referral to physical therapy or orthopedic specialist
This approach targets pain relief and improved function while considering the patient's age and potential risks. Conservative management is preferred initially due to the non-traumatic nature of the pain and the patient's advanced age. Topical NSAIDs are recommended rather than oral NSAIDs to minimize systemic side effects in older adults, as suggested by the American College of Rheumatology 1. Exercise and assistive devices can help improve mobility and reduce stress on the knee joint. If conservative measures fail, further medical evaluation is necessary to determine the underlying cause and explore additional treatment options.
From the Research
Possible Causes of Non-Traumatic Left Knee Pain
- Osteoarthritis (OA) is a common cause of knee pain in patients aged 45 years or older, with a high sensitivity of 95% for activity-related knee joint pain with no or less than 30 minutes of morning stiffness 2
- Meniscal tears can also cause knee pain, with a sensitivity of 61% for the McMurray test and 83% for joint line tenderness 2
- Patellofemoral pain is another possible cause, typically affecting people younger than 40 years, but can also occur in older adults 2
- Non-traumatic knee dislocations can occur in patients with severe osteoarthritis of the knee, as reported in a case study of a 68-year-old woman with severe osteoarthritis of the left knee 3
- Metallosis, a condition caused by metallic debris from a prosthetic joint, can also present as knee pain, as seen in a case study of an 81-year-old woman with a history of primary left total knee arthroplasty 4
- Hip arthritis can also present as knee pain, as reported in a case study of a 68-year-old man with severe osteoarthritis of the left hip 5
Diagnostic Considerations
- Clinical examination and radiographic imaging can help diagnose the cause of knee pain, but radiographic imaging is not recommended for all patients with possible knee OA 2
- The McMurray test and joint line tenderness can assist in diagnosing meniscal tears 2
- A thorough musculoskeletal examination, including examination of the hip, can help identify the cause of knee pain, as seen in the case study of a 68-year-old man with hip arthritis presenting as knee pain 5
Age-Related Considerations
- Knee OA is more common in patients aged 45 years or older, while patellofemoral pain typically affects people younger than 40 years 2
- Non-traumatic knee dislocations and metallosis can occur in older adults, as reported in case studies of a 68-year-old woman and an 81-year-old woman, respectively 3, 4