Osteoarthritis of the Knee:

A Compendium of Evidence-based Information and Resources

September 2002

Table of Contents
Acknowledgments
Glossary of Terms
Copyright Notice
Contact Information

1. State of the Condition: (PDF 161 Kb)

Understanding the Disease of Osteoarthritis
Etiology and Diagnosis
- Etiology
- Diagnosis
Classification of OA Disease
- Primary OA
- Secondary OA
OA Knee Progression
OA Knee Risk Factors
- Primary Risk Factors
- Secondary Risk Factors
- Additional Risk Factors
- Emerging Knowledge
- Systemic Risk Factors
- Local Biomechanical Risk Factors
Demographics of OA
OA Patient Care
- Ambulatory Care
- Inpatient Care
- Non-Traditional Care
Impact of OA Knee on Physical Well-Being
- Physical Limitations
- Emotional Impact of OA Knee
Cost to Society of OA Knee
References

2. Treatment Options: (PDF 173 Kb)

Methodology and Validation
- Treatment Study Citation Methodology
- Citation Levels of Evidence Rating
OA Treatment Options Strength of Studies
Health and Behavior Modifications Treatments
- Patient Education
- Physical Therapy and Exercise
- Weight Loss
- Knee Bracing
Drug Treatments
- Acetaminophen (simple analgesics)
- NSAIDs (non-selective)
- COX-2 Specific Inhibitors
- Opiate and Oxycodone Drugs
- Glucosamine and/or Chondroitin
- Intra-articular Treatment
- Corticosteroid Injections (Glucocorticoids)
- Hyaluronic Acid and similar
Intra-articular Treatment
- Corticosteroid Injections (Glucocorticoids)
- Hyaluronic Acid (HA) and similar hyaluronan preparations (eg, Synvisc)
Surgical Treatment
- Arthroscopy (including debridement,and lavage/irrigation)
- Osteotomy
- Arthroplasty or Joint Replacement
Alternative Therapy
- Acupuncture
- Magnetic Pulse Therapy
- Alternative Treatment Options Requiring Additional Studies
References

3. Evidence-Based Resources: (PDF 338 Kb)

Evidence-based Medicine/Practice
- The AAOS Evidence-Based Practice Position
Guidelines for Clinical Classification and Medical Management of Knee Pain and OA Knee
- Clinical Classification and Medical Management Guidelines
Outcomes Instruments: Evaluation and Assessment of Severity and/or Functional Status
- Site Specific Instruments
- Disease Specific Instruments
- Arthroplasty Evaluation and Outcomes Indices
- General Health, Pain or Patient-Specific Assessments
- Comparisons Across Instruments
Diagnosis and Assessment
- Initial Consult and Referral Guidelines
- General Diagnosis and Assessment of Osteoarthritis
Imaging Technologies
- Radiography and Joint Spacing Grading
- Magnetic Resonance Imaging (MRI)
- Ultrasonography
- Bone Scans (Scintography) and Radioisotope
- Markers (Bio-, Molecular, Metabolic or Serum Markers)
- Assessing Progression of Osteoarthritis
- Standard Clinical and Radiographic Methodology
Guidelines for Clinical Trials
- Task Force of the Osteoarthritis Research Society International (OARSI)
- Phase III Clinical Trials in Osteoarthritis (OMERACT III)
- Clinical Trials Response Criteria for OA Hip and Knee (OARSI)
- Evaluation of Long-Term Course of Osteoarthritis (Expert Panel)
Additional Resources
References

4. Joint Replacement: (PDF 217 Kb)

Number of Knee Joint Replacements and Who Gets Them
A Brief History of Knee Joint Replacement Designs
- The Earliest Replacement Procedures
- Condylar Implant Designs
- Unicompartmental Knee Arthroplasty
- Mobile-Bearing Designs
- Varus-Valgus Stability Designs
Knee Joint Replacement Outcomes and Patient Satisfaction
- Success and Replacement Survival Rates
- Factors That Impact on Knee Replacement Success
- Patient Satisfaction with Knee Joint Replacement
- Factors That Impact on Patient Satisfaction
- Physical Activity Following Total Knee Replacement
Considerations in Total Knee Joint Replacement
- Unicompartmental vs Tricompartmental (total) Replacement:
- Previous Surgery
- Implant Design
- Cement vs Cementless
- Bone Loss
- Simultaneous Bilateral TKA
Complications in Total Knee Arthroplasty
- Patellofemoral Complications
- Other Joint Replacement Complications
- General Surgical Complications
Total Knee Joint Replacement Wear
- Factors in TKA Failure
- Patient-Related Factors
- Surgical-Related Factors
- Component Design and Characteristics
- Consequences of Wear and Debris
Additional Resources
References

Open a glossary of terms (PDF 48 Kb) for your reference while reading these documents.

Acknowledgments

AAOS Council:

Council on Research, Joshua J. Jacobs, MD, Chairman

AAOS Committee:

Evidence-Based Practice Committee, Michael J. Goldberg, MD, Chairman

Validation Panel:

Nicholas A. DiNubile, MD, Delaware County Memorial Hospital, Drexel Hill, PA : AAOS
Scott F. Dye, MD, University of California, San Francisco, CA: AAOS
David S. Menche, MD, Hospital for Joint Diseases, New York, NY: AAOS
J. Wesley Mesko, MD, Ingham Regional Medical Center, Lansing, MI: AAHKS
Aaron G. Rosenberg, MD, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL: AAOS
Thomas P. Sculco, MD, Hospital for Special Surgery, New York, NY: AAOS

Department:

Department of Research and Scientific Affairs, Marilyn Weisberg, MPH, Director

Research Staff:

Editorial Review:

Nancy Fehr, Mary Ann Porucznik, Elaine Fiedler

Information:

Research Department

Copyright

The material presented in IMCA has been made available by the American Academy of Orthopaedic Surgeons for educational purposes only. This material is not intended to present the only, or necessarily best, methods or procedures for the medical situations discussed, but rather is intended to represent an approach, view, statement or opinion of the author(s) or producer(s), which may be helpful to others who face similar situations.

Copyright © 2002 American Academy of Orthopaedic Surgeons. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Information in this document was compiled by the Research and Scientific Affairs Department, American Academy of Orthopaedic Surgeons, 6300 N River Road, Rosemont, IL. For additional information and reproduction permission for educational purposes only, please contact the Research Department at 847-384-4312 or email at researchinfo@aaos.org.

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