Management of Primary Osteoarthritis of the Knee

Pharmacologic Interventions

The American Academy of Orthopaedic Surgeons recommends starting with topical NSAIDs and oral acetaminophen, with a maximum dose of 4,000 mg/day, for improving function and quality of life in patients with primary osteoarthritis of the knee 1, 2, 3
Oral NSAIDs, such as ibuprofen, are strongly recommended when not contraindicated, though topical formulations are preferred initially to minimize systemic side effects 1, 2
The American Academy of Orthopaedic Surgeons strongly advises against the use of oral narcotics, including tramadol, due to the notable increase in adverse events without effectively improving pain or function 1

The American College of Rheumatology recommends land-based cardiovascular and/or resistance exercises, focusing on quadriceps strengthening, as a strongly recommended intervention for improving pain and function in patients with primary osteoarthritis of the knee 5, 6
Aquatic exercise programs are considered equally effective alternatives if the patient has access to a pool 5, 6
Patient education about the diagnosis and appropriate activities has strong evidence for improving pain outcomes, as recommended by the American Academy of Orthopaedic Surgeons 2, 3, 7
Weight loss intervention, if overweight or obese, has moderate evidence for improving pain and function, as recommended by the American Academy of Orthopaedic Surgeons 2, 3, 7

The American Academy of Orthopaedic Surgeons recommends physical therapy referral as the highest priority specialist intervention, with manual therapy combined with supervised exercise having strong evidence for improving pain and function 2, 3, 7
Neuromuscular training, combined with exercise, has moderate evidence for improving outcomes, as recommended by the American Academy of Orthopaedic Surgeons 2, 3

The American College of Rheumatology conditionally recommends against the use of glucosamine and chondroitin due to lack of efficacy evidence 5, 6
The American Academy of Orthopaedic Surgeons strongly recommends against the use of oral narcotics, including tramadol, due to adverse events without benefit 1
Hyaluronic acid injections are not recommended for routine use, as stated by the American Academy of Orthopaedic Surgeons 1