Implementing AHRQ Effective Health Care Reviews

Helping Clinicians Make Better Treatment Choices

Treatment of Knee Osteoarthritis

 

Am Fam Physician. 2018 Nov 1;98(9):603-606.

Author disclosure: No relevant financial affiliations.

Key Clinical Issue

What are the clinical effectiveness and harms of cell-based therapies, oral glucosamine and/or chondroitin, physical treatment interventions, weight loss, and home-based and self-management therapies for knee osteoarthritis (OA)?

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CLINICAL BOTTOM LINE

Treatment of Knee Osteoarthritis

Intervention/follow-upComparisonNumber of studies (pain/function)FindingsStrength of evidence

Platelet-rich plasma

Medium term

Placebo

4/—

Reduced pain

● ○ ○

Glucosamine with or without chondroitin

Glucosamine plus chondroitin

 Medium term

Analgesic or placebo

3/3

Reduced pain, improved function*

● ● ○

 Long term

Placebo

3/3

No benefit on pain or function†

● ● ○

Glucosamine

Long term

Placebo

3/3

No benefit on pain or function

● ● ○

Chondroitin

Medium term

Placebo

2/—

Reduced pain

● ○ ○

Long term

Placebo

3/2

No benefit on pain or function

● ● ○/● ○ ○

Aerobic exercise

Long term

Inactive control

—/3

No benefit on function

● ○ ○

Strength and resistance training

Short term

Inactive control

5/5

No benefit on pain or function†

● ○ ○

Medium term

Inactive control

—/3

No benefit on function†

● ○ ○

Agility training

Short term

Inactive control

3/3

Reduced pain, no benefit on function‡

Medium term

Active and inactive controls

3/3

No benefit on pain or function

Long term

Active and inactive controls

3/2

Reduced pain and improved function

General/combined exercise

Medium term

Inactive control

2/2

Reduced pain and improved function

Long term

Inactive control

3/—

Reduced pain

Tai chi

Short term

Active and inactive controls

3/3

Reduced pain and improved function

Medium term

Active and inactive controls

2/2

Reduced pain and improved function

● ○ ○

Manual therapy

Short term

Treatment as usual or rehab alone

3/4

No benefit on pain or function†

● ○ ○

Long term

Treatment as usual or rehab alone

2/—

Reduced pain

● ○ ○

Balneotherapy

Medium term

Treatment as usual or active control

2/2

No benefit on pain, improved function

● ○ ○

Pulsed electromagnetic field

Short term

Sham control

3/—

No benefit on pain†

● ○ ○

Transcutaneous electrical nerve stimulation

Short term

Sham control

4/3

Reduced pain, no benefit on function§

● ● ○/● ○ ○

Medium term

Sham control

2/2

No benefit on pain or function

● ○ ○

Whole-body vibration

Short term

Strength training alone

3/—

No benefit on pain

● ○ ○

Medium term

Strength training alone

4/4

No benefit on pain, improved function†§

● ○ ○

Orthoses

Shoe inserts

 Short term

Neutral or no insoles

4/3

No benefit on pain or function†

● ○ ○

 Medium term

Neutral or no insoles

3/4

No benefit on pain or function†

● ○ ○

Weight loss

Medium term

No diet/exercise or no comparator

6/6

Reduced pain and improved function||

● ○ ○/

Long term

No diet/exercise or no comparator

4/—

Reduced pain||

● ○ ○

Home-based and self-management programs

Short term

Usual care

2/—

Reduced pain

● ○ ○

Medium term

Usual care

3/4

Reduced pain and improved function

● ● ○/● ○ ○


Strength of evidence scale

● ● ● High: High confidence that the evidence reflects the true effect. Further research is very unlikely to change the confidence in the estimate of effect.

● ● ○ Moderate: Moderate confidence that the evidence reflects the true effect. Further research may change the confidence in the estimate of effect and may change the estimate.

● ○ ○ Low: Low confidence that the evidence reflects the true effect. Further research is likely to change the confidence in the estimate of effect and is likely to change the estimate.

○ ○ ○ Insufficient: Evidence either is unavailable or does not permit a conclusion.

*—Beneficial effect vs. analgesic or placebo.

†—Pooled analysis.

‡—Compared with placebo but not strength training.

§—Did not meet a minimum clinically important difference.

||—Randomized controlled trials and single-arm trials.

Adapted from the Agency for Healthcare Research and Quality, Effective Health Care Program. Treatment of osteoarthritis of the knee: an update review. Rockville, Md.: Agency for Healthcare Research and Quality; May 2017. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/osteoarthritis-knee-update_research-2017.pdf. Accessed July 19, 2018.

CLINICAL BOTTOM LINE

Treatment of Knee Osteoarthritis

Intervention/follow-upComparisonNumber of studies (pain/function)FindingsStrength of evidence

Platelet-rich plasma

Medium term

Placebo

4/—

Reduced pain

● ○ ○

Glucosamine with or without chondroitin

Glucosamine plus chondroitin

 Medium term

Analgesic or placebo

3/3

Reduced pain, improved function*

● ● ○

 Long term

Placebo

3/3

No benefit on pain or function†

● ● ○

Glucosamine

Long term

Placebo

3/3

No benefit on pain or function

● ● ○

Chondroitin

Medium term

Placebo

2/—

Reduced pain

● ○ ○

Long term

Placebo

3/2

No benefit

Address correspondence to Kenneth W. Lin, MD, MPH, at kenneth.lin@georgetown.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Agency for Healthcare Research and Quality, Effective Healthcare Program. Treatment of osteoarthritis of the knee: an update review. Rockville, Md.: Agency for Healthcare Research and Quality; May 2017. https://effectivehealthcare.ahrq.gov/topics/osteoarthritis-knee-update/research-2017. Accessed July 19, 2018....

2. Zhang Y, Jordan JM. Epidemiology of osteoarthritis [published correction appears in Clin Geriatr Med. 2013;29(2):ix]. Clin Geriatr Med. 2010;26(3):355–369.

3. Ringdahl E, Pandit S. Treatment of knee osteoarthritis. Am Fam Physician. 2011;83(11):1287–1292.

4. American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee: evidence-based guideline 2nd edition. May 2013. https://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf. Accessed June 22, 2018.

5. Jüni P, Hari R, Rutjes AW, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;(10):CD005328.

6. Jevsevar D, Donnelly P, Brown GA, Cummins DS. Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am. 2015;97(24):2047–2060.

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based upon the review. AHRQ's review is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions. For the full review, go to https://effectivehealthcare.ahrq.gov/topics/osteoarthritis-knee-update/research-2017.

This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor.

A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

 

 

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