A Malaysian Delphi consensus on managing knee osteoarthritis

Area of Science:

• Rheumatology
• Orthopedics
• Evidence-Based Medicine

Background:

• Existing guidelines for knee osteoarthritis (OA) management in Malaysia suggest a linear approach.
• Patients with knee OA often necessitate a multimodal strategy to address pain and functional decline.
• This consensus sought to update clinical recommendations for knee OA management.

Purpose of the Study:

• To provide Malaysian physicians with updated, evidence-based, and experience-guided recommendations for managing knee OA.
• To develop a multimodal intervention strategy for knee OA.

Main Methods:

• A multi-speciality expert panel of nine Malaysian physicians was convened.
• The ADAPTE process and a modified Delphi method were employed to review evidence.
• Nine recommendations and a management algorithm were synthesized.

Main Results:

• A multimodal intervention strategy is central to OA management, adaptable over disease progression.
• Core non-pharmacological treatments include patient education, weight loss, and exercise for all patients.
• Pharmacotherapy options range from symptomatic slow-acting drugs and physical therapy to advanced treatments like NSAIDs, intraarticular injections, and short-term opioids, with surgery for severe cases.

Conclusions:

• The consensus presents nine recommendations for an algorithmic approach to knee OA management.
• These recommendations are applicable across primary to tertiary care settings in Malaysia and internationally.