Treatment of Osteoarthritis

-As recommended by The American Academy of Orthopaedic Surgeons

The American Academy of Orthopaedic Surgeons has released a summary of recommendations for the treatment of osteoarthritis. The guidelines are based on the evidence based medical research that is controlled for bias, transparent and is reproducible. The characteristics of studies that make strong evidence include the use of a placebo or control treatment, sufficient numbers of subjects to determine if a true difference exists, and use of appropriate reliable measurement tools.

The following is a summary of there recommendations and the quality of evidence leading to this recommendation;

RECOMMENDED FOR THE TREATMENT OF OSTEOARTHRITIS

 Supervised Physiotherapy aimed at improving strength, balance and, flexibility.

Strong: Quality of the supporting evidence is high.

  • Low impact aerobic exercise (eg cycling, swimming, walking, yoga)

Strong: Quality of the supporting evidence is high. Significant benefit in 5 of 7 high strength studies

  • Weight Loss for those with BMI >25

Strong: Quality of the supporting evidence is high. Beneficial in 3 of 3 studies

  • Non Steroidal Anti-inflammatory drugs (NSAIDs)

Strong: quality of evidence demonstrating effectiveness is high. Mobic, Naprosyn, Arcoxia, Celebrex, Voltaren, Nurofen.

NOT RECOMMENDED FOR THE TREATMENT OF OSTEOARTHRITIS

  • Arthroscopy

Strong: no benefit over physical therapy and medical treatment in 3 of 3 studies

  • Glucosamine and Chondroitin, Fish Oil

Strong: no evidence of clinically important improvements over a placebo in 21 studies

  • Acupuncture

Strong: no benefit over placebo in 8 studies

  • Hyaluronic Acid

Strong: Quality of the supporting evidence is high. No benefit is demonstrated over placebo. 14 studies

  • Lateral wedge insoles

Moderate: potential harm exceeds the benefits. No improvement in 4 of 5 studies

  • Needle Lavage

Moderate: potential harm exceeds the benefits. No improvement in 2 of 2 studies

  • Electrotherapeutic modalities (electrical stimulation)

Inconclusive: lack of compelling evidence that results in unclear balance between benefit and potential harm

  • Medial compartment unloader braces

Inconclusive: lack of compelling evidence that results in unclear balance between benefit and potential harm

  • Corticosteriods

Inconclusive: lack of compelling evidence that results in unclear balance between benefit and potential harm

  • Growth factor injections or Platelet Rich Plasma, Stem Cells

Inconclusive: lack of compelling evidence that results in unclear balance between benefit and potential harm.

For further detail you can go to  http://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf www.leopinczewski
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