Management of the osteoarthritic knee. New advances in nonoperative therapy

Knee osteoarthritis (OA) is an extremely common cause of pain and disability. As the baby boomer cohort ages, general practitioners will see an increasing number of knee OA sufferers. Many effective nonoperative and operative therapies exist, but forming a coherent management plan is difficult. New therapeutic agents have gained popular interest, including chondroitin sulphate, glucosamine sulphate and viscosupplementation.

This paper outlines seven effective nonoperative therapies that every GP can initiate, discusses the roles of viscosupplementation, glucosamine and chondroitin sulphate and suggests when referral for surgical management is appropriate.

General practitioners are ideally suited to initiate nonoperative therapies, some of which are prophylactic as well as therapeutic. Nonoperative therapies include: education, weight loss, regular paracetamol, glucosamine-chondroitin sulphate, physical conditioning, quadriceps-hamstring strengthening, braces and variable, as required NSAIDs. Referral for surgical treatment is appropriate if the patient has residual pain and disability despite maximal nonoperative therapy.