Published 9/1/2013

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.

Obviously, these injections will not improve the radiographs, or dramatically change range of motion, but if delaying or preventing major surgery is the outcome, I believe appropriately placed injections can make a difference. I look forward to additional high quality studies and better CPGs in the future.
David E. Rojer, MD

Linden, N.J.

Editor’s note: The complete CPG on treatment of osteoarthritis of the knee, as well as other AAOS CPGs, can be accessed at www.aaos.org/guidelines

You made it!
Although S. Terry Canale, MD, may not have made the top 100 list in either the Journal of Bone and Joint Surgery—British or Clinical Orthopaedics and Related Research (
“In the Top 100 Classic Articles, Where’s Mine?AAOS Now, January 2011), I wanted him to know that his landmark talus article “Fractures of the neck of the talus: Long-term evaluation of seventy-one cases” (JBJS-A March 1978) made “Rapid Reference Review in Orthopaedic Trauma.”

Due to the ever-expanding amount of medical literature, I developed this text to provide readers with the most important articles, so they didn’t have to try to figure out which of the 539 PubMed hits they should review.

A sports medicine version is in the works, and eventually a full series covering all subspecialties will be available.

Congratulations for finally receiving just-deserved recognition.
David J. Hak, MD, MBA, FACS