Effectiveness of the Guidelines for the Non-Operative Management of Knee Osteoarthritis.

Abstract

Various treatment guidelines exist for the treatment of knee OA which is very common in the tropical countries. A multitude of treatment guidelines creates confusion for the primary physician to manage patients with OA. Therefore, a consensus treatment guideline is necessary to clarify this discrepancy and to manage the patients with evidence-based treatment modalities. Analysis of the six existing guidelines on the management of knee OA, based on the strength of their recommendations was performed. We studied six guidelines regarding various modes of non-operative treatment of knee OA. There is consensus on efficacy of self-management programmes, land-based exercise and weight loss. These guidelines do not recommend the use of acupuncture in OA and there was a mixed opinion for the use of physiotherapy modalities and orthotics. NSAIDS are recommended for pain relief, along with their topical forms, their long term use is not advisable. Role of paracetamol for early disease process and opioids for later part of the disease is debatable and use of Glucosamine and Chondroitin has been discouraged by most of these guidelines. Use of intra-articular steroids for acute pain and inflammation is recommended, but not for Stem cells and Platelet Rich Plasma therapy, by the majority.Use of HA is still debatable. Although there are multiple treatment guidelines described for the management of knee OA, there is no consensus on many treatment modalities. There are periodical changes in the treatment protocol due to new studies available with new results. Despite pharmacological and surgical modalities keep evolving, patient factors have to be considered while recommending the treatment in patients of knee OA.