Knee Osteoarthritis

Elderly F pt h/o obesity, knee injury presents with chronic knee pain. Reports joint pain that is worse with movement and affects activities of daily living. Denies h/o gastric ulcers, GI bleeding. Family h/o knee osteoarthritis. Joint effusion, valgus/varus deformity, lateral instability, and pain/crepitus with passive ROM on exam.

• Obtain baseline BMP

• Knee x-ray shows joint space narrowing, sclerosis, and osteophytosis

• Initial treatment

  • Regular icing for improved range of motion and strength

  • Start naproxen 500mg BID

  • Start acetaminophen; titrate to 1.3g TID as needed for pain control

  • Start topical capsaicin cream

  • Refer for PT and start aerobic/strength training program

• Patient education

  • Pt counseled about importance of exercise-based therapy

  • BMI >25; pt counseled about weight loss to reduce pain

• For refractory pain consider

  • Corticosteroid injections for short-term relief

  • Tramadol 50 mg q6h

  • Referral to orthopedics

Notes

• Icing knees does not improve pain

• Knee arthroscopy

  • Choosing Wisely: Avoid routinely performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee

  • Acute physical therapy is as effective as arthroscopy for improving pain and function

• Rule out history of GI ulcers/bleeding and evaluate renal function (BMP) before starting chronic NSAIDs

• Pain relief from corticosteroid injections lasts approximately 2 weeks

• Lateral wedge insoles, glucosamine/chondroitin supplementation, and hyaluronic acid injections are not recommended for pain control