From the Guidelines
The most effective treatment for a patient with tricompartmental osteoarthritis, osteophytes, chondrosis, and a protruding lateral meniscus is a multimodal approach, prioritizing conservative management with weight loss, physical therapy, and activity modification, as recommended by the most recent and highest quality study 1.
Key Components of Treatment
- Weight loss, if the patient is overweight, to reduce joint loading and improve symptoms
- Physical therapy focusing on quadriceps and hamstring strengthening
- Activity modification to reduce joint stress
- Medications such as acetaminophen or NSAIDs for pain management
- Topical NSAIDs for relief with fewer systemic side effects
- Intra-articular corticosteroid injections for temporary relief
Surgical Options
- Arthroscopic partial meniscectomy may be considered for patients with mild-to-moderate knee osteoarthritis and a meniscus tear contributing to symptoms, after failing nonsurgical treatments 1
- Total knee arthroplasty is the definitive treatment for end-stage tricompartmental disease
Important Considerations
- The use of oral narcotics, including tramadol, is not recommended due to the notable increase in medication-related adverse effects with no consistent improvement in pain and function 1
- Intra-articular hyaluronic acid injections are not consistently supported by evidence and are not recommended for routine use in patients with knee osteoarthritis 1
- Platelet-rich plasma injections may be considered, but the evidence is inconsistent, and concerns have been raised regarding cost and safety profile 1
From the Research
Treatment Options for Tricompartmental Osteoarthritis
- The patient's condition involves tricompartmental osteoarthritis, osteophytes, chondrosis, and a protruding lateral meniscus, which requires a comprehensive treatment approach 2.
- Conservative treatment is the initial treatment of choice, which includes anti-inflammatory drugs, use of a knee brace, quadriceps-strengthening exercises, physical therapy, and modification of activity 2.
- Surgery is indicated when patients fail to improve after at least 6 months of conservative treatment and are functionally disabled 2.
Knee Brace Recommendation
- A knee brace can be a useful component of conservative treatment for tricompartmental osteoarthritis, as it can help to reduce pain and improve function 2.
- However, the specific type of knee brace recommended is not specified in the available evidence.
Surgical Options
- Total knee arthroplasty (TKA) is indicated in knees with bi- or tricompartmental osteoarthritis 2.
- Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA) 3.
- The choice of surgical procedure depends on the individual patient's condition and the severity of their osteoarthritis.
Prevalence of Tricompartmental Osteoarthritis
- Tricompartmental osteoarthritis is less common than single or bicompartmental disease, occurring in approximately 17% of people with knee OA 4.
- Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA are more common than tricompartmental disease 4.