Knee Osteoarthritis Treatments - Which Works Best?

Focusing on Treatments Less Invasive Than Knee Replacement

Man holding injured knee, cropped
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Which treatments for painful knee osteoarthritis work and which ones are less likely to provide relief? Knee pain can be particularly disconcerting as it affects your mobility and interferes with your ability to perform daily activities. Finding relief becomes a priority, and you don't want to waste time and money and risk complications from a treatment that isn't effective.

The American Academy of Orthopaedic Surgeons (AAOS) makes recommendations pro and con treatments for knee osteoarthritis that are less invasive than knee replacement surgery.

The second edition was approved May 18, 2013. These recommendations are based on evidence from clinical and scientific studies, and they rank them from strong to moderate to inconclusive.

The guidelines are not intended to override an assessment of your individual needs. In other words, your specific situation must be taken into account when you and your doctor decide on your course of treatment. The guidelines show you there is more than one approach to treating knee osteoarthritis -- and they help you learn some basics so you can discuss treatment options with your doctor.

18 Recommendations for Treatment of Knee Osteoarthritis

The recommendations pertain to patients having symptomatic knee osteoarthritis -- meaning, you have symptoms (such as joint pain, stiffness) -- not only X-ray evidence of knee osteoarthritis. The numbering system is from the 2013 Second Edition of the recommendations.

1. Rehabilitation, Education and Wellness Activities: Your participation in self-management educational programs is encouraged, and you should modify your activities when possible to protect your joints (for example, walking is better for the joints than running). Strong Pro Recommendation

2. Weight Loss: If you are overweight (BMI, body mass index, greater than 25), you should lose a minimum of 5% of your body weight and maintain the lower weight through diet and exercise.

Moderate Pro Recommendation

3A. Acupuncture: The use of acupuncture is not recommended. There is now strong evidence that it does not relieve pain related to knee osteoarthritis. Strong Recommendation Against

3B: Physical agents including electrotherapeutic modalities have inconclusive evidence, and they can't recommend for or against them. This includes TENS, shortwave diathermy, inferential current, TAMMEF and ultrasound. Of these, ultrasound had the best evidence, but not convincing. Inconclusive Recommendation

3C: Manual therapy: Inconclusive, they cannot recommend for or against. This includes chiropractic therapy, myofascial release, and Swedish massage. Inconclusive Recommendation

4. Valgus Directing Force Brace: A brace such as a medial compartment unloader gets an inconclusive recommendation, neither for nor against. Inconclusive Recommendation

5. Lateral heel wedges are not suggested if you have medial compartment (the inner compartment of the knee) knee osteoarthritis. Moderate Recommendation

6. Glucosamine and Chondroitin: Glucosamine sulfate, chondroitin sulfate and glucosamine hydrochloride are not recommended by AAOS for symptomatic knee osteoarthritis. Strong Recommendation Against.

7A. NSAIDS: Use of non-steroidal anti-inflammatory drugs (NSAIDs) both oral and topical, or Tramadol gets a strong positive recommendation. Strong Pro Recommendation

7B. Acetaminophen, opioids or pain patches: neither for nor against. Inconclusive recommendation.

8. Intra-articular corticosteroids (injected into the affected joint), neither for nor against. Inconclusive recommendation

9. Viscosupplementation: Cannot recommend intra-articular hyaluronic acid injections. Strong recommendation against

10. Biologic Injections: Neither for nor against injections with growth factor or platelet rich plasma.

Inconclusive recommendation

11. Needle lavage (wash-out of the joint) gets a moderate recommendation, which means practitioners may do it but should be alert for new evidence. The one high-quality study found no measurable benefit.

12. Arthroscopy with debridement or lavage is not recommended to treat symptomatic knee osteoarthritis. Strong recommendation against.

13. Arthroscopic partial meniscectomy: If you have signs and symptoms of a torn meniscus or loose body, they can't recommend for or against this procedure. Inconclusive recommendation

14. Tibial Osteotomy Limited recommendation for performing valgus producing proximal tibial osteotomy in patients with medial compartment osteoarthritis. The studies supporting it are of low quality.

15. Unispacer: A free-floating interpositional device that compensates for lost cartilage should not be implanted if you have symptomatic unicompartmental knee osteoarthritis. This is a consensus recommendation, meaning there aren't enough study results for an evidence-based recommendation, but it is made based on expert opinion of the panel.

Point to Remember on Knee Osteoarthritis Treatment Recommendations

These recommendations from the AAOS are based on different levels of evidence and are offered only as guidelines to treat symptomatic knee osteoarthritis. They stop short of including knee replacement, which may ultimately be the best treatment option for you.

As always, discuss all treatment options with your doctor so the best course of treatment for you can be decided.

To understand the evidence behind the AAOS recommendations, you can read the full guideline.


Guideline on the Treatment of Osteoarthritis (OA) of the Knee. Richmond John MD et al. American Academy of Orthopedic Surgeons. 5/18/2013.

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