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.

Keywords: conservative care.; knee; osteoarthritis.

Figure 1

Relationship of effect size with degree of support from published guidelines for knee osteoarthritis (OA) treatments. Green shading represents characteristics of an ideal OA treatment, with moderate to large effect size and support from most (>75%) knee OA treatment guidelines. Red shading represents characteristics of an unsatisfactory OA treatment, with trivial to small effect size and support from few (<25%) knee OA treatment guidelines. Yellow shading represents characteristics of equivocal OA treatments, with effect size and knee OA treatment guideline support data not included in categories above. *Effect size not available.