Non-Surgical Treatment of Knee Osteoarthritis: Multidisciplinary Italian Consensus on Best Practice

Abstract The aim of this document is to provide a set of indications on the national best practice management of knee osteoarthritis based on an analysis of the existing literature and the contribution of experts in the field. During the first phase of the project, in agreement with the multidisciplinary panel of experts, the main guidelines on the topic were selected. Each guideline was assessed through the AGREEII system to identify their strong/weak points and a summary of the recommendations contained in the various documents was drawn up. The panel drew up a list of therapeutic options to be included in the document and some of these topics were selected for in-depth analysis and review. The search strategy for the required literature reviews was constructed using the PICOS approach. The results obtained from the literature reviews, the in-depth analyses conducted by the members of the scientific societies involved and the analysis of the existing guidelines enabled an initial draft of the consensus document to be elaborated. This document was examined at the consensus conference held on 28 May 2019, in the presence of a multidisciplinary group consisting of members of the various scientific societies involved. Single recommendations were discussed in work groups with a view to combining the indications given by the literature examined with the experience of the specialists involved. The recommendations discussed were then put to the vote in a plenary assembly. The final document contains 26 practice recommendations which leading specialists involved in the management of knee OA in Italy agree upon.

[1]  S. Zaffagnini,et al.  Does Bone Marrow Edema Influence the Clinical Results of Intra-Articular Platelet-Rich Plasma Injections for Knee Osteoarthritis? , 2022, Journal of clinical medicine.

[2]  D. Felson,et al.  Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis , 2019, BMC Musculoskeletal Disorders.

[3]  D. Gregori,et al.  Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis , 2018, JAMA.

[4]  A. Judge,et al.  Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England , 2018, The Lancet.

[5]  J. Katz,et al.  Knee replacement , 2018, The Lancet.

[6]  R. Altman,et al.  Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. , 2018, Seminars in arthritis and rheumatism.

[7]  M. Bhandari,et al.  Nonoperative Treatments for Knee Osteoarthritis: An Evaluation of Treatment Characteristics and the Intra-Articular Placebo Effect A Systematic Review , 2018, JBJS reviews.

[8]  C. Perricone,et al.  Efficacy of Spa Therapy, Mud-Pack Therapy, Balneotherapy, and Mud-Bath Therapy in the Management of Knee Osteoarthritis. A Systematic Review , 2018, BioMed research international.

[9]  A. Fioravanti,et al.  Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis , 2018, Rheumatology International.

[10]  M. Bhandari,et al.  Knee osteoarthritis: when arthroscopy can help , 2018, Polish archives of internal medicine.

[11]  M. Benedetti,et al.  Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study , 2017, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[12]  Barbara L. Shay,et al.  Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. , 2017, Physiotherapy Canada. Physiotherapie Canada.

[13]  R. Sabatowski,et al.  Indication Criteria for Total Knee Arthroplasty in Patients with Osteoarthritis – A Multi-perspective Consensus Study Indikationskriterien für den endoprothetischen Gelenkersatz bei Gonarthrose – eine multiperspektivische Konsensstudie , 2017, Zeitschrift für Orthopädie und Unfallchirurgie.

[14]  P. Levinger,et al.  Skeletal muscle vitamin D in patients with end stage osteoarthritis of the knee , 2017, The Journal of Steroid Biochemistry and Molecular Biology.

[15]  Xu-Ren Gao,et al.  The effect of vitamin D supplementation on knee osteoarthritis: A meta-analysis of randomized controlled trials. , 2017, International journal of surgery.

[16]  Raveendhara R. Bannuru,et al.  Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective , 2017, Therapeutic advances in musculoskeletal disease.

[17]  M. Moradi-Joo,et al.  Safety and Effectiveness of Low-Level Laser Therapy in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. , 2017, Journal of lasers in medical sciences.

[18]  R. Rozendaal,et al.  Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank , 2017, Annals of the rheumatic diseases.

[19]  J. Raynauld,et al.  Levels of serum biomarkers from a two-year multicentre trial are associated with treatment response on knee osteoarthritis cartilage loss as assessed by magnetic resonance imaging: an exploratory study , 2017, Arthritis Research & Therapy.

[20]  Chengqi He,et al.  Effects of short-wave therapy in patients with knee osteoarthritis: a systematic review and meta-analysis , 2017, Clinical rehabilitation.

[21]  P. Lehenkari,et al.  Cytokine data obtained from synovial stromal cells of patients with rheumatoid arthritis or osteoarthritis , 2017, Data in brief.

[22]  M. Englund,et al.  Surgical Management of Degenerative Meniscus Lesions: The 2016 ESSKA Meniscus Consensus , 2017, Joints.

[23]  M. Akhtar,et al.  Vitamin D supplementation for the management of knee osteoarthritis: a systematic review of randomized controlled trials , 2017, Rheumatology International.

[24]  D. Hunter,et al.  Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis , 2017, British Journal of Sports Medicine.

[25]  M. Akai,et al.  The effect of balneotherapy on pain relief, stiffness, and physical function in patients with osteoarthritis of the knee: a meta-analysis , 2017, Clinical Rheumatology.

[26]  J. Regnaux,et al.  The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs* , 2017, Clinical rehabilitation.

[27]  J. Regnaux,et al.  The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs* , 2017, Clinical rehabilitation.

[28]  J. Regnaux,et al.  The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs , 2017, Clinical rehabilitation.

[29]  M. Alayat,et al.  Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial , 2017, Lasers in Medical Science.

[30]  T. V. Vliet Vlieland,et al.  Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview , 2016, BMC Musculoskeletal Disorders.

[31]  J. Raynauld,et al.  Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study , 2016, Arthritis Research & Therapy.

[32]  C. Cooper,et al.  The effect of vitamin D supplementation on knee osteoarthritis, the VIDEO study: a randomised controlled trial. , 2016, Osteoarthritis and cartilage.

[33]  J. Raynauld,et al.  Long‐Term Effects of Glucosamine and Chondroitin Sulfate on the Progression of Structural Changes in Knee Osteoarthritis: Six‐Year Followup Data From the Osteoarthritis Initiative , 2016, Arthritis care & research.

[34]  Chengqi He,et al.  Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis , 2016, Clinical rehabilitation.

[35]  R. Altman,et al.  Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee , 2016, The American journal of sports medicine.

[36]  R. Brophy,et al.  The role for arthroscopic partial meniscectomy in knees with degenerative changes: a systematic review. , 2016, The bone & joint journal.

[37]  Charles E Leddon,et al.  Efficacy of Unloader Bracing in Reducing Symptoms of Knee Osteoarthritis. , 2016, American journal of orthopedics.

[38]  B. Koes,et al.  Reducing progression of knee OA features assessed by MRI in overweight and obese women: secondary outcomes of a preventive RCT. , 2016, Osteoarthritis and cartilage.

[39]  A. Françon,et al.  Spa therapy and knee osteoarthritis: A systematic review. , 2016, Annals of physical and rehabilitation medicine.

[40]  R. Starr,et al.  Gait Using Pneumatic Brace for End-Stage Knee Osteoarthritis , 2016, The Journal of Knee Surgery.

[41]  F. Cicuttini,et al.  Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. , 2016, JAMA.

[42]  Jing Chen,et al.  Effectiveness of knee bracing in osteoarthritis: pragmatic trial in a multidisciplinary clinic , 2016, International journal of rheumatic diseases.

[43]  C. Cooper,et al.  A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. , 2016, Seminars in arthritis and rheumatism.

[44]  T. Zantop,et al.  Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136) , 2016, Archives of Orthopaedic and Trauma Surgery.

[45]  E. Roos,et al.  Routine knee arthroscopic surgery for the painful knee in middle-aged and old patients—time to abandon ship , 2015, Acta orthopaedica.

[46]  J. Raynauld,et al.  Impact of disease treatments on the progression of knee osteoarthritis structural changes related to meniscal extrusion: Data from the OAI progression cohort. , 2015, Seminars in arthritis and rheumatism.

[47]  Michael A Mont,et al.  Unloader Bracing for Knee Osteoarthritis: A Pilot Study of Gait and Function. , 2015, Surgical technology international.

[48]  Mansour Babaei,et al.  Restorative Effect of Vitamin D Deficiency on Knee Pain and Quadriceps Muscle Strength in Knee Osteoarthritis. , 2015, Acta medica Iranica.

[49]  J. Arbuthnot,et al.  Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy , 2015, The Journal of Knee Surgery.

[50]  A. Carr Arthroscopic surgery for degenerative knee , 2015, BMJ : British Medical Journal.

[51]  C. Juhl,et al.  Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms , 2015, BMJ : British Medical Journal.

[52]  M. Hochberg,et al.  First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. , 2015, Annals of the rheumatic diseases.

[53]  H Li,et al.  Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. , 2015, Osteoarthritis and cartilage.

[54]  M. Bey,et al.  Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[55]  C. Kwoh,et al.  Effect of Oral Glucosamine on Joint Structure in Individuals With Chronic Knee Pain: A Randomized, Placebo‐Controlled Clinical Trial , 2014, Arthritis & rheumatology.

[56]  Raveendhara R. Bannuru,et al.  OARSI guidelines for the non-surgical management of knee osteoarthritis. , 2014, Osteoarthritis and cartilage.

[57]  M. Cameron Physical agents in rehabilitation , 2014 .

[58]  Dong Zhou,et al.  Electromagnetic fields for treating osteoarthritis. , 2013, The Cochrane database of systematic reviews.

[59]  D. Jevsevar,et al.  Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. , 2013, The Journal of the American Academy of Orthopaedic Surgeons.

[60]  James D. Kang,et al.  Glucosamine Supplementation Demonstrates a Negative Effect on Intervertebral Disc Matrix in an Animal Model of Disc Degeneration , 2013, Spine.

[61]  K. Jeong,et al.  Effects of pulsed electromagnetic field on knee osteoarthritis: a systematic review. , 2013, Rheumatology.

[62]  J. Raynauld,et al.  Total Knee Replacement as a Knee Osteoarthritis Outcome , 2013, Cartilage.

[63]  Bess Dawson-Hughes,et al.  Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. , 2013, JAMA.

[64]  A. Distante,et al.  Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: A 5‐year analysis based on hospitalization records , 2012, Arthritis care & research.

[65]  A. Espeland,et al.  No effect of 6-month intake of glucosamine sulfate on Modic changes or high intensity zones in the lumbar spine: sub-group analysis of a randomized controlled trial , 2012, Journal of Negative Results in BioMedicine.

[66]  J. Railhac,et al.  Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI , 2012, Clinical Rheumatology.

[67]  Gordon Guyatt,et al.  American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee , 2012, Arthritis care & research.

[68]  B. Fullen,et al.  Neuromuscular electrical stimulation in the treatment of knee osteoarthritis: a systematic review and meta-analysis , 2012, Clinical rehabilitation.

[69]  Raveendhara R. Bannuru,et al.  Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. , 2010, Osteoarthritis and cartilage.

[70]  A. Rutjes,et al.  Therapeutic ultrasound for osteoarthritis of the knee or hip. , 2010, The Cochrane database of systematic reviews.

[71]  A. Hofman,et al.  Vitamin D Status, Bone Mineral Density, and the Development of Radiographic Osteoarthritis of the Knee: The Rotterdam Study , 2009, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[72]  L. Martí-Bonmatí,et al.  Glucosamine sulfate effect on the degenerated patellar cartilage: preliminary findings by pharmacokinetic magnetic resonance modeling , 2009, European Radiology.

[73]  Jacques Duysens,et al.  Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace. , 2007, Gait & posture.

[74]  D. Felson,et al.  Relation of Dietary Intake and Serum Levels of Vitamin D to Progression of Osteoarthritis of the Knee among Participants in the Framingham Study , 1996, Annals of Internal Medicine.

[75]  Roland W. Moskowitz,et al.  Osteoarthritis: Diagnosis and Medical/Surgical Management , 1992 .

[76]  L. A. Colby,et al.  Therapeutic Exercise: Foundations and Techniques , 1990 .

[77]  A. Fioravanti,et al.  Balneotherapy in osteoarthritis: Facts, fiction and gaps in knowledge , 2017 .

[78]  F. Taşcioğlu,et al.  Comparison of the symptomatic and chondroprotective effects of glucosamine sulphate and exercise treatments in patients with knee osteoarthritis. , 2015, Journal of back and musculoskeletal rehabilitation.

[79]  K. Briggs,et al.  Current state of unloading braces for knee osteoarthritis , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[80]  İ. Bayrak,et al.  Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: a randomized controlled clinical trial. , 2012, Journal of back and musculoskeletal rehabilitation.

[81]  Ruth Rojahn Transcutaneous electrostimulation for osteoarthritis of the knee , 2011 .

[82]  G. Brüggemann,et al.  The effect of valgus bracing on the knee adduction moment during gait and running in male subjects with varus alignment. , 2010, Clinical biomechanics.

[83]  R. Wheeler,et al.  Published Online First , 2009 .

[84]  A. Verhagen,et al.  Braces and orthoses for treating osteoarthritis of the knee. , 2005, The Cochrane database of systematic reviews.

[85]  W. V. van Blitterswijk,et al.  Bmc Complementary and Alternative Medicine Glucosamine and Chondroitin Sulfate Supplementation to Treat Symptomatic Disc Degeneration: Biochemical Rationale and Case Report , 2003 .

[86]  A. Gibofsky American College of Rheumatology. , 2002, Journal of the Medical Association of Georgia.

[87]  S. Cummings,et al.  Serum vitamin D levels and incident changes of radiographic hip osteoarthritis: a longitudinal study. Study of Osteoporotic Fractures Research Group. , 1999, Arthritis and rheumatism.