CPG on OA Knee Treatment Authors Respond

We appreciate and respect the comments by David E. Rojer, MD, on the AAOS clinical practice guideline (CPG) “The Treatment of Osteoarthritis (OA) of the Knee” (“Setting AAOS Now Straight: CPG on OA Knee Disappoints,” AAOS Now, September 2013), and we understand his concerns regarding its use.

A CPG is not a set of rules or protocols and is not intended to be followed in a “cookbook” fashion. Rather, it is a synthesis and synopsis of the best available clinical studies published in peer-reviewed journals or formats. The concept is to systematically (with a protocol) review those thousands of journal articles that Dr. Rojer refers to so that he need not have to do it himself. But, evidence alone does not supplant a physician’s clinical experience or the patient’s values and preferences.

We disagree that the only options are nonsteroidal anti-inflammatory drugs (NSAIDs) or surgery. The CPG supports the use of weight loss, exercise, NSAIDs, acetaminophen, and corticosteroid injections for the conservative management of patients with knee OA. Although several surgical alternatives (including knee arthroscopy for patients with mechanical symptoms or findings and osteotomy) are also supported, the indications for those procedures will be defined in the upcoming appropriate use criteria for this CPG.

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