Treatment of knee osteoarthritis

Am Fam Physician. 2011 Jun 1;83(11):1287-92.

Abstract

Knee osteoarthritis is a common disabling condition that affects more than one-third of persons older than 65 years. Exercise, weight loss, physical therapy, intra-articular corticosteroid injections, and the use of nonsteroidal anti-inflammatory drugs and braces or heel wedges decrease pain and improve function. Acetaminophen, glucosamine, ginger, S-adenosylmethionine (SAM-e), capsaicin cream, topical nonsteroidal anti-inflammatory drugs, acupuncture, and tai chi may offer some benefit. Tramadol has a poor trade-off between risks and benefits and is not routinely recommended. Opioids are being used more often in patients with moderate to severe pain or diminished quality of life, but patients receiving these drugs must be carefully selected and monitored because of the inherent adverse effects. Intra-articular corticosteroid injections are effective, but evidence for injection of hyaluronic acid is mixed. Arthroscopic surgery has been shown to have no benefit in knee osteoarthritis. Total joint arthroplasty of the knee should be considered when conservative symptomatic management is ineffective.

MeSH terms

  • Acupuncture Therapy
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Braces
  • Capsaicin / administration & dosage
  • Evidence-Based Medicine
  • Exercise Therapy
  • Glucocorticoids / administration & dosage
  • Glucosamine / therapeutic use
  • Humans
  • Injections, Intra-Articular
  • Ointments
  • Osteoarthritis, Knee / drug therapy
  • Osteoarthritis, Knee / rehabilitation
  • Osteoarthritis, Knee / therapy*
  • Pain / drug therapy
  • Pain / etiology
  • Physical Therapy Modalities
  • Range of Motion, Articular
  • Risk Factors
  • Tai Ji
  • Treatment Outcome
  • Weight Loss

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Anti-Inflammatory Agents, Non-Steroidal
  • Glucocorticoids
  • Ointments
  • Glucosamine
  • Capsaicin