Exercise best treatment for knee osteoarthritis: GP guidelines

Surgery and fad treatments not recommended for knee osteoarthritis: GPs told


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Exercise, not surgery or fad therapies, is the best treatment for knee osteoarthritis.

MANY popular therapies for osteoarthritis of the knee are not recommended and surgery should be a last resort according to new guidelines for Australian GPs.

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KNEE OSTEOARTHRITIS: New guidelines recommend exercise not surgery or popular therapies.

KNEE OSTEOARTHRITIS: New guidelines recommend exercise not surgery or popular therapies.

Produced by the Royal Australian College of General Practitioners the guidelines instead suggest treatments such as exercise, weight loss, cognitive behavioural therapy, Transcutaneous Electrical Nerve Stimulation (TENS), massage, heat packs and using a cane or walker.

Recommended exercise includes walking, tai chi, stationary cycling, Hatha yoga and aqua-exercise.

Therapies which are not recommended include ultrasound, shock wave therapy, laser therapy, interferential therapy, OA marketed footwear, some braces, insoles and kinesio taping.

The guidelines also made strong recommendations against the use of oral and transdermal opiods and said that due to lack of high quality evidence could not recommend a number of treatments including non-steroidal anti-inflammatory creams applied locally, capsaicin for hip OA; collagen, avocado/soybean unsaponifiables, Indian frankincense and turmeric.

Glucosamin and chondroitin neutraceuticals, vitamin D and acupuncture should not be offered GPs have been told.

The guidelines  make “strong” recommendations against surgery such s arthroscopic lavage and debridement, meniscectomy and cartilage repair for people with knee OA unless the person also has signs and symptoms of a ‘locked ‘ knee.

Osteoarthritis is a chronic disease characterised by joint pain, stiffness and swelling and mainly affects the hands, knees and hips. It most often affects people over 55 years with risk factors including joint injury, overweight and older age.

The number of Australians with OA is expected to rise from 2.2 million in 2015 to 3.1 million by 2030.

RACGP President-elect Harry Nespolon noted the need for improved guidelines to cater for Australia’s ageing population, and increasing rates of obesity, with 12% of the population expected to suffer from osteoarthritis by 2030.

“After comprehensive research and review, it’s important the medical profession is updated on how best to approach the growing concern of osteoarthritis,” said Dr Nespolon.

ALARMING: Many knee surgeries may have been carried out with little gain - RACGP's Dr Harry Nespolon.

ALARMING: Many knee surgeries may have been carried out with little gain - RACGP's Dr Harry Nespolon.

“When it comes to management of osteoarthritis, every patient is different, but exercise is the new front runner when it comes to best management, ahead of previous invasive recommendations of surgery and medications.

“When reviewing the statistics, it is alarming how many surgeries may have been completed unnecessarily and with little gain.

“Medication and surgery may still be used for serious cases, but many cases can be assisted with diet and lifestyle changes.

“For many of our patients, the change in direction of management of this illness will provide the opportunity for people to live healthy and active lifestyles for years longer than before,” said Dr Nespolon.

The guidelines, which have been endorsed by the National Health Medical Research Council, are being rolled out to GPs across the country.

One of the lead authors of the guidelines Professor Kim Bennell  said they outlined the importance of long-term management of the condition, with a focus on non-surgical interventions.

More than 100,000 Australians receive hip and knee replacements each year.

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