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Archive for August, 2010

needle-lavage

Needle Lavage

This article is part of a series of blog posts regarding the American Academy of Orthopedic Surgeons’ (AAOS) Full Treatment Guideline For Knee Osteoarthritis.

Recommendation 17 – The AAOS does not recommend needle lavage for patients with symptomatic knee OA.

Needle lavage involves rinsing out the knee joint with saline solution.  4 studies were examined surrounding this treatment option.  In only one of those studies were there statistically significant results showing that needle lavage was effective.  The remaining science said there was little to no effect on needle lavage in relation to pain, swelling, and knee function.



intra-articular hyaluronic acid

intra-articular hyaluronic acid

This post is part of a series about the American Academy of Orthopedic Surgeons’ (AAOS) Full Treatment Guideline for Knee Osteoarthritis.

Recommendation 16 – The AAOS cannot recommend for or against the use of intra-articular hyaluronic acid for patients with mild to moderate knee osteoarthritis.

42 trials examined the effectiveness of viscosupplementation.  The evidence was graded as inconclusive because the importance of the results are clinically unclear.



corticosteroid

corticosteroid

This article is one in a series of blog posts about the American Academy of Orthopedic Surgeons’ (AAOS) Full Treatment Guideline for Knee Osteoarthritis.

Recommendation 15 – The AAOS suggests intra-articular corticosteroidsfor short-term pain relief for patients with symptomatic osteoarthritis of the knee.

The research team looked at three systematic reviews that conclude intra-articular corticosteroids are effective for relieving pain in the short term, (1-3 weeks).  When it comes to long-term pain relief the evidence suggests that corticosteroids have little benefit.



Cox II Inhibitor

Cox II Inhibitor

This blog post is one in a series of articles about the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for Treatment of Knee Osteoarthritis.

Recommendation 14 – The AAOS suggests that patients with symptomatic osteoarthritis of the knee and an increased gastrointestinal risk (patients older than 60), multiple medical conditions, peptic ulcer disease, GI bleeding, concurrent corticosteroid and/or concomitant (at the same time) use of anticoagulants receive one of the following for pain relief:

  • Acetaminophen
  • Topical non steroidal anti inflammatory drugs (NSAIDs)
  • nonselective oral NSAIDs plus gastro-protective agent
  • Cyclooxygenase (Cox II inhibitors)

The AAOS reports that each of these treatment options for osteoarthritis of the knee has a reduced risk of GI complications when compared to the isolated use of oral NSAIDs.  The evidence does not say that one treatment options is more advantageous than another.



acetaminophen

acetaminophen-molecule

This blog post if one in a series of posts about the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for the Treatment of Knee Osteoarthritis.

Recommendation 13 – The AAOS suggests that patients with osteoarthritis of the knee receive either acetaminophen or Non-steroidal anti inflammatory drugs (NSAIDs), unless there are contraindications to these drugs.

The research team looked at evidence suggesting that acetaminophen provides pain relief without a significant risk of toxicity to the patient.  The evidence further demonstrated that NSAIDs provide more pain relief than acetaminophen but with a greater risk of gastrointestinal complications.





glucosamine

glucosamine

This blog post is a continuation of a series of articles from the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for the Treatment of Osteoarthritis.

Recommendation 12 – The AAOS recommends that glucosamine and/or chondroitin sulfate or hydrochloride not be prescribed for patients with symptomatic osteoarthritis of the knee.

This recommendation was based on a report from the Agency for Healthcare Research and Quality.  The report was based on one random controlled trial and six systematic reviews on the use of chondroitin sulfate, and/or glucosamine, or hydrochloride among patients with osteoarthritis of the knee.

The random controlled trial found that glucosamine and/or chondroitin did not have any clinical benefit, though five of the six systematic reviews concluded that glucosamine and/or chondroitin are superior to placebo.

Since the Random Controlled Trial is stronger science than the systematic reviews, the AAOS based their decision on the one study.



acupuncture

acupuncture

This blog post is one of a series from the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for the Treatment of Osteoarthritis.

Recommendation 11 – The AAOS is unable to recommend for or against the use of acupuncture to treat osteoarthritis of the knee.

The research team examined 14 different studies regarding how acupuncture effects arthritic knees.  The results of the studies were conflicting.  That is why the Academy of Orthopedic Surgeons cannot recommend for or against the use acupuncture as a treatment option for osteoarthritis of the knee.  The evidence is inconclusive.



Stride-OA-Knee-Brace

This post is a continuation of a series of articles from the American Academy of Orthopedic Surgeons’ (AAOS) Full Guideline for the Treatment of Osteoarthritis.

Recommendation 10 – The AAOS is unable to recommend for or against the use of knee braces with varus directing forces for patients with lateral uni-compartmental osteoarthritis of the knee.

The reason knee braces for osteoarthritis received a “can’t recommend for or against” rating is because there aren’t any published studies on the subject.  The vast majority of patients with unicompartmental osteoarthritis are affected on the medial or inside compartments of their knees.  In rare cases, usually relating to trauma, osteoarthritis can affect the lateral or outside compartment of the knee.

So to date research teams have been unable to get enough people together with lateral compartment osteoarthritis to put together a study.



Stride-OA-Knee-Brace

This article is part of a series of articles from the American Academy of Orthopedic Surgeons’ Full Guideline for the Treatment of Knee Osteoarthritis.

Recommendation 9 – The AAOS is unable to recommend for or against the use of a knee brace with a valgus directing force for patients with uni-compartmental osteoarthritis of the knee.

The evidence for this treatment option is graded as inconclusive because the research team only looked at two studies.  The Kirkley study proved that knee braces for osteoarthritis reduce pain and increase function in arthritic knees.  The Brouwer study showed that patients do not tolerate knee braces well.

It is because the AAOS looked at one positive study for the use of knee braces and one negative study against the use of knee braces that they decided on a wishy-washy, can’t decide for or against attitude towards knee bracing.  Why didn’t they look at third study and break the tie?



lateral heel wedges

lateral heel wedge

This is a continuation of our series of articles from the American Academy of Orthopedic Surgeons’ Full Guideline for the Treatment of Knee Osteoarthritis.

Recommendation 8 – Lateral heel wedges are not recommended as a treatment option for osteoarthritis of the knee.

A systematic review of literature reveals there is no evidence that lateral heel wedges are more effective than neutral heel wedges at relieving pain associated with knee OA.  In fact there is some data that suggests patients who do not use lateral heel wedges may experience fewer symptoms than those who do.