Treatment Options for Knee Osteoarthritis

Non-Pharmacological Treatments

The American Academy of Family Physicians recommends that patients with knee OA participate in regular strengthening, low-impact aerobic exercise, and neuromuscular education 1, 5
Low-impact aerobic exercises have demonstrated significant effects on pain relief and disability reduction, with an effect size of 0.52 for pain and 0.46 for disability 5
The American College of Rheumatology suggests aiming for 30-60 minutes of moderate-intensity aerobic activity most days of the week 5
Quadriceps strengthening exercises are specifically recommended and show significant improvements in pain and function 5
Weight loss is strongly recommended for patients with knee OA who have a BMI ≥25 kg/m², with a minimum 5% reduction in body weight significantly improving function 3, 5
Combining dietary modification with exercise provides optimal results for weight loss and improved function 5
Patients should participate in self-management educational programs to learn coping skills and activity modifications, with techniques including individualized education packages, phone calls, group education, patient coping skills, and spouse-assisted coping skills training 1, 4, 6, 7
Appliances such as walking sticks, insoles, and knee bracing may provide symptomatic relief 4, 7
Lateral wedge insoles are not recommended, with a moderate strength of recommendation 2, 3

The American College of Rheumatology recommends trying acetaminophen first as an oral analgesic for mild to moderate pain 4, 7
NSAIDs should be considered in patients unresponsive to acetaminophen, with either non-selective NSAIDs with gastroprotective agents or selective COX-2 inhibitors used for patients with increased gastrointestinal risk 1, 3, 4
Tramadol is recommended for patients with moderate to severe pain 1, 3
Topical NSAIDs and capsaicin have clinical efficacy and are safe 4, 7
Intra-articular corticosteroid injections are indicated for flares of knee pain, especially if accompanied by effusion 4, 7
Hyaluronic acid injections may have symptomatic effects, although the American Academy of Orthopaedic Surgeons does not recommend them 1, 3, 4, 7

Joint replacement should be considered in patients with radiographic evidence of knee OA who have refractory pain and disability despite conservative management 4, 7