October 2021

AAOS Updates Clinical Practice Guideline for Osteoarthritis of the Knee

The American Academy of Orthopaedic Surgeons (AAOS) issued an update to the Clinical Practice Guideline (CPG) for Management of Osteoarthritis of the Knee (Non-Arthroplasty), which replaces the 2nd edition released from 2013. This 3rd edition of the CPG provides updates to 19 of the 29 evidence-based recommendations included in the previous guideline. The guidelines were developed to include only treatments which are less invasive than knee replacement surgery to provide pain relief and improve the patient’s functioning.

Approximately 33 million Americans are affected by osteoarthritis (OA), a common condition that occurs when the cartilage that cushions and protects the ends of the bones gradually wears away. OA, also known as “wear and tear” arthritis can affect any joint in the body but is prevalent in the knee and commonly occurs in people who are 50 years of age or older. Knee OA can be a leading cause of physical disability.

“Knee osteoarthritis is a highly prevalent, disabling joint disease commonly associated with aging and obesity,” said Robert Brophy, MD, FAAOS, co-chair of the clinical practice guideline workgroup and member of the AAOS Committee on Evidence-Based Quality and Value. “Considering the rising prevalence of knee osteoarthritis in the U.S. population, the AAOS felt it was important to update the guidelines in terms of the best evidence on how to manage these patients, particularly when they have early stages of the disease. The update represents a substantial investment by the AAOS over nearly 3 years to develop consensus around the latest research and offer recommendations regarding various treatment options for patients with knee osteoarthritis.”

Consistent with the previous edition, the guideline suggests that patients with symptomatic OA of the knee receive one of the following analgesics for pain (unless there are contraindications to this treatment):

  • Acetaminophen (not to exceed 3,000 mg per day)
  • For short-term pain relief, intra-articular corticosteroids
  • Oral anti-inflammatory drugs (NSAIDs)

It does not recommend the following treatments or reports that evidence is inconsistent/limited:

  • Custom-made lateral wedge insoles
  • Glucosamine and/or chondroitin sulfate or hydrochloride
  • Needle lavage (aspiration of the joint with injection of saline) and/or debridement

“We know that treatment for osteoarthritis is not a one-size-fits-all approach, and fortunately there are a number of treatment options for orthopaedic surgeons to consider with their patients to help alleviate pain and increase mobility,” added Brophy. “The updated guideline includes recommendations for patients across the spectrum of disease severity, regarding a variety of nonsurgical treatments based on the current evidence. It is important for both surgeons and patients to remember that these are guiding principles, not prescriptions, on how to care for symptomatic knee osteoarthritis.”

Development of this CPG was a collaborative effort between representatives from the American Association of Hip and Knee Surgeons, The Knee Society, the American Academy of Family Physicians, the American Physical Therapy Association, the Arthroscopy Association of North America, the International Cartilage Repair Society, the American Medical Society for Sports Medicine, and the American Society of Regional Anesthesia and Pain Medicine.

The full Clinical Practice Guideline for Management of Osteoarthritis of the Knee (Non-Arthroplasty) is intended for reference by orthopaedic surgeons and other physicians, and available through AAOS’ OrthoGuidelines website and free mobile app. For more information, visit aaos.org.


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