From the Guidelines
The best management of osteoarthritis (OA) of the knee involves a comprehensive approach combining non-pharmacological and pharmacological interventions, with strong recommendations for exercise, weight loss, and topical NSAIDs. According to the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1, weight loss is essential for overweight patients, with a goal of 5-10% body weight reduction to significantly decrease joint load and pain. Regular low-impact exercise, particularly swimming, cycling, and walking, helps maintain joint mobility and strengthen supporting muscles.
The guideline also recommends the use of topical NSAIDs for knee OA, as they provide localized relief with fewer systemic effects 1. For patients with inadequate response, intra-articular corticosteroid injections can provide temporary relief for 1-3 months. Other interventions such as tai chi, cane use, and tibiofemoral bracing may also be beneficial for some patients.
Key components of the management plan include:
- Weight loss for overweight patients
- Regular low-impact exercise
- Topical NSAIDs for pain management
- Intra-articular corticosteroid injections for patients with inadequate response
- Assistive devices such as knee braces and walking canes to improve stability and reduce pain
- Consideration of surgical interventions, including knee arthroplasty, for severe OA unresponsive to conservative measures. The 2019 guideline published in Arthritis and Rheumatology 1 also supports these recommendations, emphasizing the importance of a comprehensive approach to managing OA.
From the Research
Management of Osteoarthritis (OA) of the Knee
The management of OA of the knee involves a multimodal approach, including non-pharmacological and pharmacological interventions.
- Non-pharmacological interventions include:
- Exercise, which has been shown to be beneficial in managing knee OA, with no optimal exercise modality identified 2
- Weight management, which is strongly supported in the literature for conservative treatment of knee OA 3
- Patient education, which is also strongly supported in the literature for conservative treatment of knee OA 3
- Manual therapy, which may be beneficial when used in conjunction with other interventions 3, 4
- Pharmacological interventions include:
- Symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs) as first-line, background therapy 5
- Intra-articular treatments with SYSADOAs/NSAIDs, which may provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA 5
- Oral analgesics and anti-inflammatories, which are commonly used but may have limited effectiveness for long-term management and significant associated side effects with prolonged use 6
Treatment Approaches
Different treatment approaches may be effective for managing knee OA, including:
- Multimodal/multicomponent approach, which involves a combination of non-pharmacological and pharmacological interventions 5
- Multidisciplinary approach, which involves a team of healthcare professionals working together to manage knee OA 5
- Disease-modifying osteoarthritis drugs, which are being researched as a potential treatment modality to halt or slow disease progression 6
- Intra-articular injectables, such as corticosteroids, hyaluronans, platelet-rich plasma, and stem cells, which may be effective in managing knee OA 6
Surgical Interventions
Surgical interventions may be considered for managing knee OA, including:
- Total knee arthroplasty, which should be utilized only if other strategies have failed 6
- High tibial osteotomy and unicompartmental knee arthroplasty, which may be potential alternatives if only a single compartment is involved 6
- Arthroscopy, which is not generally recommended for managing knee OA due to limited effectiveness 6