CPG on OA Knee Treatment Disappoints

Regarding the latest clinical practice guideline (CPG) from the AAOS on treatment of osteoarthritis (OA) of the knee (“AAOS Approves Updated OA Knee CPG,” AAOS Now, June 2013), I have not been this disappointed since the chest surgeons insisted that I give all my arthroplasty patients blood thinners regardless of their underlying risk of pulmonary embolism. Eventually that was proven wrong, and I believe that eventually this latest CPG from the AAOS will be proven wrong as well.

This CPG states that the only options I should offer patients with OA knee are nonsteroidal anti-inflammatory drugs (and maybe tramadol) or a major high-risk surgery.

I am a community orthopaedic surgeon who performs about 150 arthroplasties a year, and I cannot claim to have analyzed thousands of journal articles for statistical significance. My personal experience in treating patients with injections (including steroids and sodium hyaluronate) is that injections do work to decrease pain and improve function and quality of life. Most importantly, they can help patients live with their arthritic knees until they are ready to have knee replacements. I have patients who come in every 6 months for their “tune-up” injections who have never needed major surgery. These are some of my happiest patients and best referrals.

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