Review Question - QID 214866

According to the AAOS Guidelines for the Treatment of Knee OA, the use of lateral wedge insoles cannot be recommended for symptomatic OA of the knee.

The AAOS Guidelines for the Treatment of Knee OA reports that lateral wedge insoles were found to have no significant improvement in pain, self-reported physical function, or Patient Global Assessment scores, and therefore cannot be recommended for use in patients with symptomatic OA of the knee. They also recommended against the use of acupuncture and glucosamine and/or chondroitin, as well as viscosupplementation, needle lavage, and arthroscopy with lavage, given minimal benefits in patients with symptomatic OA of the knee. Contrastingly, the use of NSAIDs or tramadol, weight loss, and rehabilitation with self-management programs, strengthening, low-impact aerobic exercises, and neuromuscular education had supporting evidence for their use in patients with symptomatic OA of the knee.

Brown et al. published the updated AAOS Guidelines for the Treatment of Knee OA in 2013. In the updated guidelines, the following recommendations had strong supportive evidence: 1) Recommendation for rehabilitation, education & wellness activity; 2) Recommendation for NSAIDs or tramadol; 3) Recommdnation against acupuncture; 4) Recommendation against glucosamine and/or chondroitin; 5) Recommendation against viscosupplementation, and 6) Recommendation against arthroscopy with lavage.

The article by Richmond et al. contains the AAOS clinical practice guidelines. There is Grade A evidence recommending that glucosamine and/or chondroitin sulfate or hydrochloride NOT be prescribed for patients with symptomatic OA of the knee. Each of the other 3 options was given a Grade A recommendation by the workgroup supported with Level 1 or 2 evidence.

Feeley et al. published a review of several non-arthroplasty treatment options for the younger adult with knee OA. They discuss the use of high tibial ostetoomies (HTO) and emphasize that it should not be perceived to be the ultimate solution but rather, a procedure that can delay TKA for many years. Of note, HTO is reported by the AAOS to have limited evidence for its use in patients with symptomatic medial compartment OA of the knee.

Incorrect Answers:
Answer 2: The AAOS reports strong supporting evidence for strengthening and low-impact aerobic exercises for patients with symptomatic OA of the knee.
Answers 3 and 5: The AAOS reports strong supporting evidence for the use of NSAIDs or tramadol for patients with symptomatic OA of the knee, given statistically significant improvements in pain efficacy.
Answer 4: The AAOS reports moderate supporting evidence for weight loss in patients with symptomatic OA of the knee.