New Clinical Guidelines for the Treatment of Knee OA

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Government Guidelines for the Treatment of Knee OA (Osteoarthritis of the knee)

Clinical guidelines from the Australian Commission on Safety and Quality in Health Care have recently become available to practitioners.  They relate to the treatment of Osteoarthritis of the knee and how this chronic and difficult to treat condition should be correctly managed.

The complete pamphlet is available from the website of the above organization but I have copied the executive summaries from each of the sections so that you can understand the breadth of their advice to practitioners.

What is most interesting is the emphasis on the importance of conservative management and the inclusion of weight loss and exercise as key components of the management.  No longer are people to be told “you have arthritis, it is incurable and there is nothing you can do.  Come back for a knee replacement when you can’t stand the pain any longer.”  The correct conservative management emphasizes education and guidance on how to build strength and mobility and achieve lasting weight loss.

Here is the shortened version of the guidelines:

A patient with knee pain and other symptoms sugestive of osteoarthritis receives a comprehensive assesment that includes a detailed history of the presenting symtoms and other healt conditions, a physical examination and a psychosocial evaluation that identifies factors that may affect their quality of life and participation in their usual activites.

A patient with knee pain and other symptoms suggestive of osteoarthritis is diagnosed as having knee osteoarthritis based on clinical assessment alone.  X-rays are considered only if an alternative diagnosis is suspected (for example, insufficiency fracture, malignancy).  magnetic Resonanace imaging (MRI) is considered only if there is suspicion of serious pathology not detected by X-ray.

A patient with knee osteoarthritis receives education about their condition and treatments for it, and participates in the development of an individualised self-management plan that addresses both their physical and psychosocial health need

A patient with knee osteoarthritis is offered support to lose weight, if they are overweight or obese, and advice on exercise, tailored to their needs and preferences. The patient is encouraged to set weight and exercise goals and is referred to services to help them achieve these, as required.

A patient with knee osteoarthritis is offered medicines to manage their symptoms according to the current version of Therapeutic Guidelines: Rheumatology (or concordant local guidelines). This includes consideration of the patient’s clinical condition and their preferences.

A patient with knee osteoarthritis receives planned clinical reviews at agreed intervals, and management of the condition is adjusted for any changing needs. If the patient has worsening symptoms with severe functional impairment that persists despite the best conservative management, they are referred for specialist assessment.

A patient with knee osteoarthritis who is not responding to conservative management is offered timely joint-conserving*or joint replacement surgery, depending on their fitness for surgery and preferences. The patient receives information about the procedure to inform their treatment decision. Arthroscopic procedures are not effective treatments for knee osteoarthritis, and therefore should only be offered if the patient has true mechanical locking or another appropriate indication for these procedures.

New Farm Physio and Naturopathy can offer a complete approach in the conservative mangement of knee osteoarthritis.   Thorough assessment with both a physio and a naturopath with a comprehensive plan to restore strength, improve flexibility as well as implement and monitor a healthy weight loss plan.




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