From the Guidelines
Management of tricompartmental knee osteoarthritis should prioritize a comprehensive approach, including non-pharmacological, pharmacological, and potentially surgical interventions, with a strong recommendation for exercise and weight loss in overweight or obese patients, as supported by the 2019 American College of Rheumatology guideline 1. The initial management should focus on:
- Weight loss (if applicable) to reduce the load on the knee joint
- Physical therapy emphasizing quadriceps and hamstring strengthening
- Low-impact aerobic exercises like swimming or cycling to improve joint mobility and reduce pain Assistive devices such as canes or knee braces can help reduce load on the affected joint. For pain management,
- Topical NSAIDs like diclofenac gel (1% applied four times daily) are recommended for knee OA, offering localized relief with fewer systemic effects 1
- Intra-articular corticosteroid injections (typically methylprednisolone 40-80mg or triamcinolone 40mg) can provide temporary relief for 1-3 months
- Oral NSAIDs can be used for short periods during flares, with caution regarding gastrointestinal and cardiovascular risks Viscosupplementation with hyaluronic acid injections may benefit some patients. For those with severe pain unresponsive to conservative measures, total knee arthroplasty represents a definitive treatment option, offering substantial pain relief and functional improvement, as seen in the patient's decision to proceed with surgical management after discussion of the risks and benefits 1. The management approach should be tailored to the patient's age, activity level, comorbidities, and disease severity, with treatment escalation as symptoms progress.
From the Research
Management Options for Osteoarthritis (OA) in a Tricompartmental Knee
The management of osteoarthritis (OA) in a tricompartmental knee involves a range of options, including:
- Non-pharmacological interventions, such as exercise, weight loss, and physical therapy 2, 3, 4
- Pharmacological interventions, such as nonsteroidal anti-inflammatory drugs, acetaminophen, and intra-articular corticosteroid injections 2
- Surgical interventions, such as total joint arthroplasty, which may be considered when conservative management is ineffective 2, 5
Non-Pharmacological Interventions
Non-pharmacological interventions are a key component of OA management, and include:
- Exercise, which has been shown to reduce pain and improve physical function in people with knee OA 6
- Weight loss, which can help to reduce the load on the knee joint and improve symptoms 2, 4
- Physical therapy, which can help to improve mobility and strength in the knee joint 3, 4
Pharmacological Interventions
Pharmacological interventions may be used to help manage OA symptoms, and include:
- Nonsteroidal anti-inflammatory drugs, which can help to reduce pain and inflammation 2
- Acetaminophen, which can help to reduce pain 2
- Intra-articular corticosteroid injections, which can help to reduce inflammation and improve symptoms 2
Surgical Interventions
Surgical interventions may be considered when conservative management is ineffective, and include: