Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older. Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur. This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients. Patellofemoral pain is one of the most common of the repetitive strain injuries and is like an early onset of arthritis.
Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound. Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)
- Exercise – strong evidence for effectiveness
- Weight loss – moderate evidence for
- Acupuncture – strong evidence against
- Physical agents (TENS, ultrasound, etc.) – inconclusive
- Manual therapy (chiropractic, massage) – inconclusive
- Valgus-directing force brace – inconclusive
- Lateral wedge insoles – moderate evidence against
- Glucosamine and chondroitin – strong evidence against
- NSAIDs – strong evidence for
- Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
- Intraarticular corticosteroid injections – inconclusive
- Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
- Growth factor injections and/or platelet-rich plasma – inconclusive
- Needle lavage – moderate evidence against
- Arthroscopy with lavage and debridement – strong evidence against
- Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
- Valgus-producing proximal tibial osteotomy – limited evidence
- Free-floating interpositional device – no evidence; consensus against
They apparently didn’t think it was worthwhile even mentioning such things as copper bracelets, magnets, prayer, or supplements like boswellia. Or homeopathy!
Naturopaths and other critics of mainstream medicine claim that MDs don’t recommend lifestyle measures like exercise and weight loss, but here is a mainstream medical organization that clearly does, and even puts them first on its list. Critics who claim doctors are just out to make money, take note: if they were the evil money-grubbers some make them out to be, wouldn’t these surgeons want to promote income-generating arthroscopic lavage and debridement? Wouldn’t they want to suppress information about conservative treatments and keep patients in pain until they were desperate enough to consent to expensive joint replacement surgery? Gee, do you suppose maybe they really are just trying to do what’s best for their patients?
I was glad to see that the AAOS reached the same conclusions we did on SBM regarding acupuncture and glucosamine, but I wasn’t surprised. After all, we are looking at the same published evidence. Unbiased scientific minds think alike. Recommendations on other websites like WebMD and the Mayo Clinic still favor acupuncture and glucosamine. It will be interesting to see if they modify their websites in response to the AAOS report. I’m not holding my breath.
I was curious: if AAOS is an American Academy, why do they spell Orthopaedic the British way? I looked it up: Orthopaedic is the correct medical spelling! So thanks to the AAOS, I learned something about spelling as well as about knees.
This article was originally published in the Science-Based Medicine blog.