Put Objectives in this section T
Tiers of treatments
Treatment for knee osteoarthritis can be broken down into first, second and third line treatment. As a start, all individuals with knee OA should be offered first line treatment. If the individual is not receiving adequate satisfaction from this, then they may also be offered treatments in the second tier. Subsequently, if they are still not experiencing meaningful results, then they can be offered the consideration of surgery (Skou & Roos., 2017)
Each tier offer a selection of different treatments. Click on the info button in the image below to learn more about each items in the individual tiers.
The third line treatment (surgery) has been discussed previously under the Assessment tab. Click on each of the icons below to learn more about the non-surgical options; first line and second line treatment.
Education on osteoarthritis and what is safe and recommended care as well as self management strategies is an integral component of first line management
Addressing patient beliefs is key to adhering to other management strategies, particularly exercise. Patients commonly believe exercise is unsafe or harmful, hence education regarding safety and efficacy of exercise is important.
Advice on pacing of activity, pain does not equal harm, and imaging findings not correlating with pain/function are also important messages for patients with OA.
Behaviour change and addressing lifestyle factors such as sleep, physical activity levels, smoking are also areas to be addressed
The most effective method of providing education is yet to be determined, and can be face to face, telehealth, one on one, group or reading materials.
Definition of exercise vs physical activity:
Physical activity is defined as any body movement produced by skeletal muscles that results in energy expenditure [116].
Exercise is a category of physical activity that is planned, structured and repetitive [116].
Exercise is recommended as a core first line management strategy for all patients with hip and knee osteoarthritis regardless of age, pain or severity of changes on imaging.
Exercise is safe and effective.
The effect size for exercise improving pain in both knee and hip OA is LARGER than the effect size for NSAIDS and acetaminophen (paracetamol)
The effect size for exercise with reducing pain and improving function with knee OA is slightly greater than for hip OA.
Exercise can include resistance, NEMEX, or aerobic; and if required aquatic exercise. The type and dose is yet to be determined with all showing benefit; and some evidence that a minimum 12 supervised sessions is required.
Exercise and physical activity benefits at least 26 chronic conditions including mental health conditions, cardiovascular diseases and musculoskeletal disorders, as well as osteoarthritis
Obesity is a known modifiable risk factor for the development of knee osteoarthritis, with the risk twice as high in people with a body mass index (BMI) over 25 to 30 compared to those with a BMI less than 25; and even higher for obese people (BMI ≥30).
The effect of weight is believed to be not solely due to mechanical load, with increasing evidence of systemic effects including elevated adipocytokine levels and inflammatory effects.
Weight loss for people with a BMI over 25 is recommended by all guidelines as a first line management strategy
Losing 5% of body weight can reduce pain by 30%
Losing 10% of body weight can reduce pain by up to 50%