Nonsurgical Rx of OA: Analyzing the Guidelines
The National Guideline Clearinghouse recently released a comparison of the practice guidelines on nonsurgical management of knee osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) and the Department of Veterans Affairs, Department of Defense (VA/DoD).1-3
Areas of Agreement
The guidelines have many similarities, including the general recommendation that nonsurgical interventions should be used before considering surgery for knee OA (Table). Both guidelines also recommend weight loss for overweight and obese patients, with the VA/DoD suggesting a goal of losing at least 5% body weight.
Use of acupuncture or chondroitin sulfate and/or glucosamine is not recommended. Both groups were unable to recommend for or against chiropractic therapy, and the VA/DoD was unable to make a recommendation for the use of dietary supplements.
Areas of Disagreement
The groups disagree on the use of manual therapy, with the VA/DoD recommending manual therapy as an adjunct to traditional physical therapy and supervised exercise, and the AAOS stating it was unable to recommend for or against manual therapy due to a lack of evidence on the topic.
Regarding pharmacotherapy, the AAOS only recommends NSAIDs (oral or topical) and tramadol, while the VA/DoD makes recommendations according to pain severity.
