Clinical Practice Guidelines for Knee and Hip Osteoarthritis
Preface: As many of you know, I recently finished up my schooling to receive a Doctor of Physical Therapy. This degree emphasized many of Driven’s core beliefs – specifically that education is a lifelong process, as well as that we must always have a reason why we are doing something. As the physical therapy profession progresses with the rest of the healthcare world, there is a demand that all clinicians practice in a manner that is evidence-based. Fortunately, we are blessed with groups that review the current research and put together recommendations on what they feel is the strongest course of action for a given condition. These clinical practice guidelines (CPG) assign grades for all research, as well as grades for recommendations of diagnosis criteria, invasive treatment interventions, non-invasive treatment interventions, and pharmacological agents. Basically, they give grades for how well the research is being done, and how strongly they recommend doing something about it. But enough of this boring mumbo jumbo…on to the goods!
Osteoarthritis (OA) is the wearing down of the protective cartilage in the joints, mostly in the hands, knees, and hips. This wearing down is a normal process in aging, but it tends to be exacerbated by increased demands on the body from activities or lifestyle. While no one wants to receive a diagnosis that their body is wearing down, know that it’s a normal part of aging and there are options to help combat the process. The Royal Australian College of General Practitioners (RACGP) recently released its updated version of its CPG for management of knee and hip osteoarthritis. To spare you from reading the 82 pages of the report, I’ll summarize the findings based on the most current evidence: the only treatment recommendations that the RACGP strongly recommends for knee and hip OA are land-based strengthening exercises for the knee and hip, as well as weight management for individuals with BMI’s over 25. In an even shorter blurb- move more, get stronger, and lose some weight.
The top of the list of treatments that the RACGP strongly recommends against shouldn’t come as a shock: opioids. The CPG goes on to list other pharmacological agents that it strongly recommends against, as well as viscosupplementation injections, stem cell therapy, and arthroscopic debridement, meniscectomy, and cartilage repair. The basis for that recommendation is that the evidence strength is very low in all of those areas. *Disclaimer: this is a generalized review and there is always a case in which one of the previously mentioned treatments might be the most appropriate for that individual, but not the population as a whole*
The report also has recommendations for a slew of other treatments including massage or manual therapy, aquatic therapy, and stationary cycling, just to name a few. However, the suggestion is that all of those be used in conjunction with strengthening and movement therapies in order to manage knee and hip OA with the most success.
In short, movement is almost always the best medicine. Look to movement-based therapies first and foremost when treating and managing OA, understanding that quick fixes are not the best solution for most folks out there.
As always, feel free to reach out to us with any questions you might have!
Dr. Anthony Winn, PT, DPT, LMT, CSCS
The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.