American Academy of Orthopaedic Surgeons (AAOS) Issues New Practice Guidelines for Treatment of Osteoarthritis of the Knee
Osteoarthritis of the Knee
- Leading cause of physical disability
- 33 million Americans affected
- Most common in aged 65 or older
- Affects activities of daily living like climbing
stairs or walking
Symptoms include:
- Pain
- Joint stiffness
- Swelling in knee
Factors that increase a
persons risk of developing osteoarthritis:
- Heredity
- Weight
- Age
- Gender
- Injuries or trauma to the knee
- Poor posture or bone alignment
- Lack of aerobic exercise and muscle weakness
The AAOS Guidelines and Evidence Report Recommendations:
AAOS recommends:
- Patients should be encouraged to begin or
increase their participation in low-impact aerobic fitness.
- Patients who are overweight should lose a
minimum of 5% of their body weight
- Overweight is a body mass index (BMI) of greater
than 25
- you can calculate your own body mass index by multiplying
your weight in pounds by 703 divided by your height in inches
- Weight loss has the highest potential to slow
the progression of osteoarthritis
- AAOS recommends for pain control:
- Tylenol
- NSAIDs (common include ibuprofen and naprosyn)
- Steroid injections into the knee like
depomedrol or cortisone
- AAOS recommends against:
- Glucosamine and or chondroitin sulfate or
hydrochloride
- Drawing fluid from the knee with a needle
- Custom made foot orthotics or foot supports
- Performing a knee arthroscopy (knee scope) as a
clean out procedure for arthritis when no other problems are present like
loose bodies or cartilage tears
- "The
current science shows us that just washing out the joint does not
decrease the patient's osteoarthritis symptoms and can expose the
patient to additional risk," said John Richmond, MD, chair of the AAOS
work group.
- AAOS does not recommend for or against:
- Bracing
- Acupuncture
- Hyaluronic acid injections like synvisc or
hyalgen
"AAOS Issues New Clinical
Practice Guidelines for Osteoarthritis of the
Knee."
American Academy of Orthopaedic Surgeons. 11 DEC. 2008 http://www.aaos.org/home.asp.
Hello Doc,
My question is: Why is the AAOS against foot orthotics? Wouldn't bone misalignment of the foot also be a factor in causing improper wear and tear on the knees and hips?
Thank you for your articles.
Jackie Mastrocesare
Hi Jackie,
Nice to hear from you again!
The AAOS actually does have a subspecialty that focuses on foot and ankle disorders as do podiatrists.
There can be "indirect" effects of disorders of the foot that can effect knees primarily and hips but the reverse is also true as well, i.e., a severe knock-knee deformity can put lots of stress on the ankle and hindfoot.
Orthotics themselves should mainly be used to address foot disorders but not really for the knees and hips. The best advice to protect knees and hips is to make sure that you have footwear that has very good shock absorbers.
Hope that helps and best wishes,
Dr. Tony
Hi Doc,
Thanks for the clarification. I was ordered foot orthotics the first time a diagnosis was made about my knees [by a different orthopaedic MD]. Of course it didn't help. I found on my own that the shock absorption was the best treatment and still is.
Wishing you joy today and always,
Jackie
I would like to know why it's not recommended to take glucosamine-chondroitin pre-op? I have been taking it for years with some relief to joint aches and pains. How long before knee replacement surgery should I stop taking it? Should it ever be taken post-op? Also, what other medicines can be used if Celebrex is not effective?
Thanks,
Carol
Most "vitamin-type" medicines should be discontinued 5-7 days prior to any surgical intervention. Although, as far as I am aware, I do not know of a specific reason why glucosamine-chondroitin should be stopped. It is a sugar-based vitamin though so if you are a diabetic, this medicine can alter your blood sugars. As far as restarting, this should be left to be decided on an individual case by case situation. As always, it's important to discuss the specific medicines with your surgeon and PCP.
There are many forms of anti-inflammatory medicines that you can discuss with your PCP. Although, only Celebrex can be used in the peri-operative period since it does not affect platelet function and therefore, bleeding. We use Celebrex in our program as part of a multi-modal pain management program for post-operative patients because Celebrex is also a pain medicine in addition to its anti-inflammatory effect.
Hope that helps!
Dr. Tony