New Guidelines Say Needle Lavage Ineffective for Knee Osteoarthritis
By Kristina Fiore
ROSEMONT, Ill.,27 dec 2008- Needle lavage is ineffective and should not be used to treat patients with osteoarthritis of the knee, according to new guidelines released here.
The treatment may be of some benefit, but only in patients who also have mechanical problems such as loose bodies and meniscal tears, according to new guidelines on the treatment of knee osteoarthritis released by the American Academy of Orthopaedic Surgeons.
"The current science shows us that just washing out the joint does not decrease the patient's osteoarthritis symptoms and can expose the patient to additional risk," said John Richmond, M.D., who chaired the work group that penned the guidelines.
Only treatments less invasive than knee replacement surgery were evaluated for the guidelines.
The writing group also recommended against arthroscopy with debridement or lavage, noting that evidence suggested its effects "were not statistically significant on the vast majority of patient-oriented outcome measures for pain and function."
Other interventions getting a thumbs-down were custom foot orthotics, such as lateral heel wedges, and glucosamine, chondroitin, or their combination. The guidelines cited a comprehensive report by the Agency for Healthcare Research and Quality that concluded "glucosamine hydrochloride, chondroitin sulfate, or their combination provide no clinical benefit in patients with primary osteoarthritis of the knee."
These conclusions were all based on level-1 or level-2 rated evidence.
The guidelines do recommend that patients who are overweight, with a body mass index greater than 25, should lose a minimum of 5% of their body weight.
Level-1 evidence found that weight loss results in a significant effect for functional improvement, and it "has the highest potential to actually slow the progression of the disease," Dr. Richmond said.
The guidelines also recommend encouraging patients to participate in low-impact aerobic exercise, because its effect on pain relief and disability are significant.
Sufficient pain treatment, according to the guidelines, includes the analgesics acetaminophen ( 4 g/day) and NSAIDs, as well as intra-articular corticosteroids for short-term relief.
Patients with increased gastrointestinal risks can take the same dose of acetominophen, topical NSAIDs, nonselective oral NSAIDS plus a gastroprotective agent, or cyclooxygenase-2 inhibitors, the guidelines suggest.
Available evidence did not allow recommendations for or against the use of bracing, acupuncture, and intra-articular hyaluronic acid, the committee noted.