What is the treatment for tricompartmental osteoarthritis?

Treatment for Tricompartmental Osteoarthritis

A comprehensive treatment approach for tricompartmental osteoarthritis should begin with non-pharmacological interventions, progress to pharmacological management, and consider surgical intervention for refractory cases, with total knee replacement being the definitive treatment for severe disease unresponsive to conservative measures. 1, 2

Non-Pharmacological Interventions (First-Line)

• Exercise therapy: Strongly recommended for all OA patients

  • Low-impact aerobic exercise
  • Muscle strengthening exercises
  • Aquatic exercises
  • Effect size for pain relief: 0.52 (95% CI, 0.34,0.70) 2

• Weight loss: Strongly recommended for patients with BMI >25

  • Target: minimum 5-10% of body weight loss
  • Provides clinically important functional improvement 2

• Physical therapy: For proper exercise instruction and self-efficacy training 2

• Patient education: About the condition, coping strategies, and activity management 2

• Physical modalities:

  • Local heat or cold applications
  • Transcutaneous electrical nerve stimulation (TENS)
  • Manual therapy (manipulation and stretching) 2

• Biomechanical interventions:

  • Orthopedic shoes
  • Knee orthoses 2

Pharmacological Management (Second-Line)

Initial Pharmacological Approach:

• Acetaminophen/paracetamol: First-line pharmacological treatment

  • Regular dosing may be needed
  • Up to 3000 mg/day 2

• Topical NSAIDs: Recommended before oral options for knee OA

  • Lower systemic absorption
  • Fewer adverse effects than oral NSAIDs 2

For Inadequate Response:

• Oral NSAIDs (including naproxen):

  • Use lowest effective dose for shortest possible time
  • Consider individual risk factors (especially age)
  • Monitor for GI, liver, and cardiorenal toxicity
  • Naproxen has been shown to be effective in controlling OA symptoms with fewer GI and nervous system adverse effects compared to aspirin 2, 3

• Intra-articular corticosteroid injections:

  • Effective for flares of knee pain, especially with effusion
  • Provides short-term symptom benefit (1-4 weeks)
  • Evidence level 1B for effectiveness 1

• Hyaluronic acid injections:

  • Not recommended for routine use (moderate strength recommendation) 1

Advanced Interventions for Refractory Cases

Surgical Options:

• Total knee replacement (TKR):

  • Indicated for patients with radiographic evidence of knee OA who have refractory pain and disability
  • Safe and effective in improving quality of life, reducing pain, and improving function
  • Good or excellent outcomes reported in 89% of people up to five years after surgery 1
  • Main indications: severe daily pain and x-ray evidence of joint space narrowing 1

• High tibial osteotomy:

  • May be considered to improve pain and function in properly indicated patients with uni-compartmental knee OA (limited strength recommendation) 1

• Arthroscopy with lavage/débridement:

  • Not recommended for patients with primary diagnosis of knee OA (moderate strength recommendation) 1

Treatments Not Recommended

• Oral narcotics (including tramadol):

  • Result in notable increase of adverse events
  • Not effective at improving pain or function (strong recommendation against) 1

• Glucosamine and chondroitin:

  • Not recommended due to lack of efficacy 2

• Free-floating interpositional devices:

  • Not recommended for symptomatic medial compartment OA of the knee 1

Monitoring and Follow-up

• Reassess after 1-2 weeks of initial treatment
• Evaluate response to treatment after 4-6 weeks
• If significant pain persists, adjust pharmacological treatment accordingly
• Regular monitoring using validated measures such as WOMAC pain scale 2

Common Pitfalls to Avoid

• Relying solely on pharmacological management without adequate emphasis on exercise and weight management
• Failing to consider comorbidities when selecting pharmacological treatments for elderly patients
• Inadequate exercise instruction (physical therapy referral is often essential) 2

Bold text indicates key recommendations based on the strongest and most recent evidence.