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Posts Tagged ‘AAOS’

unispacer

unispacer

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

Recommendation 22 – The AAOS does not recommend using a free-floating interpositional device to treat symptomatic unicompartmental osteoarthritis of the knee.

The research team found evidence that suggests high re-operation rates in patients who had a free-floating interpositional devices implanted in their bodies.   Enough said.



Osteotomy

Osteotomy

This post is part of a series of blog posts about the American Academy of Orthopedic Surgeon’s Full Treatment Guideline for Knee Osteoarthritis.

Recommendation 21 – Realignment osteotomy is an option in active patients with unicompartmental OA of the knee with malalignment.

The research team found conclusive evidence that realignment osteotomies had benefits that lasted up to two years after surgery in patients that had knee OA and malalignment issues.




Osteotomy

Osteotomy

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

Recommendation 20 – The AAOS cannot recommend for or against an osteotomy of the tibial tubercle for patients with patello-femoral osteoarthritis.

No studies were available that investigated taking bone wedges from the tibial tubercle for patients with isolated patello-femoral osteoarthritis.  So the research team was unable to reach a definitive conclusion.



meniscectomy

meniscectomy

Recommendation 19 – Partial meniscectomy is an option for patients with knee osteoarthritis.  These patients must also have symptoms indicating a torn meniscus and / or a loose body in their knee joint.

There aren’t any published studies that confirm this recommendation but the expert opinion of the research team concludes that if you have a torn meniscus and knee osteoarthritis, it makes sense to have the tear or loose material removed by arthroscopy.



Knee Arthroscopy

Knee Arthroscopy

This post is one of a series of posts about the American Academy of Orthopedic Surgeons’ (AAOS) Knee Osteoarthritis TreatmentGuideline.

Recommendation 18 – The AAOS does not recommend arthroscopic debridement and lavage in patients with knee oa.

Since the North American Arthroscopy Association helped fund the AAOS Treatment Guideline, this recommendation is a big deal.  This is orthopedic surgeons telling other orthopedic surgeons that one of their bread-and-butter surgeries doesn’t work.

The research team concluded that arthroscopic debridement has no significant benefit for knee osteoarthritis.  Wow.




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.



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.