Hochberg MC, Altman RD, Brandt KD et al.
Arthritis & Rheumatism, 1995;38:1541-1546

The goals of managing patients with osteoarthritis (OA) of the knee are similar to those of OA of the hip. Exercise has been shown to benefit those with OA of the knee. For patients unable to take part in an organized exercise program, the physician should ensure the patient is taught quadriceps strengthening exercises. Canes, shoe inserts, medial taping of the patella and lightweight knee braces may be useful. Patients who are overweight should be encouraged to participate in a weight loss program. Those with an effusion or signs of local inflammation may benefit from intra-articular corticosteroid injections. Joints that are painful and swollen should be aspirated and then a corticosteroid injection administered. For the treatment of symptomatic OA of the knee, acetaminophen, up to 4,000 mg/day, is the initial drug of choice. Acetaminophen has comparable efficacy to ibuprofen and naproxen. Topical analgesics may be useful in those who do not respond to oral analgesics or do not wish to take systemic treatment. If acetaminophen or other oral or topical analgesics are ineffective, then an NSAID is indicated. When nonpharmacologic and pharmacologic therapies are unsatisfactory and if surgery needs to be avoided, the patient should be referred to a rheumatologist for a joint lavage and or arthroscopic debridement. In those in whom surgery is not contraindicated referral to an orthopedic surgeon is indicated for osteotomy or total joint arthroplasty.

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