Conservative management of symptomatic knee osteoarthritis: a flawed strategy?

Abstract

Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden.

Global research trends in stem cells for osteoarthritis: a bibliometric and visualized study

“…Although total knee replacement may serve as an effective alternative for patients with severe knee OA, the risk of surgical complications cannot be completely eliminated. Numerous conservative treatment options in OA, including analgesic medication, physical therapy, unloaded bracing, intra‐articular injections and so on, are currently available, aiming to relieve the symptoms and to delay the surgical intervention . As an innovative therapy, researchers believe that cell therapy is the next logical generation in the progression of surgical intervention .…”

Early knee osteoarthritis management should first address mechanical joint overload

“…On one hand, traditional nonsurgical OA therapies have limited clinical utility since the treatment effect on disease-specific symptom relief is low 3 . Long-term treatment adherence is a concern given the mild and sporadic nature of early knee OA symptoms.…”

“…In the period between initial diagnosis and definitive surgical management, patients may be prescribed numerous nonsurgical management strategies, either alone or concomitantly. Although pharmacological therapy improves knee OA symptoms in many cases, no nonsurgical treatment has been shown to slow disease progression 3 . Paradoxically, conservative therapies may actually encourage OA progression in responders since patients may become more physically active, leading to higher peak adduction moments across the knee joint 4-7 .…”

Intra‐articular platelet‐rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations

“…Although total knee replacement (TKA) may serve as an effective alternative for patients with severe knee OA, the risk of complications of TKA cannot be completely eliminated. Numerous conservative treatment options are currently available, including analgesic medication, physical therapy, unloaded bracing, intra‐articular injections and so on, aiming to relieve pain of the knee joints and delay the TKA intervention …”