Management of osteoarthritis of the knee

Osteoarthritis is a chronic disease; management should be patient centred and coordinated, with attention to modifiable risk factors and comorbidities

Focus on conservative non-drug treatment, particularly exercise; for overweight or obese patients weight loss is recommended

Management should be evidence based; do not use interventions with high cost and risk that outweigh their benefits

Use paracetamol or non-steroidal anti-inflammatory drugs for pain relief, with due attention to precautions and contraindications

Refer patients to a physiotherapist for exercise, manual therapy, and gait aids; orthotist for bracing; psychologist for cognitive behavioural therapy; and dietitian for nutritional advice

Do not use arthroscopy for pain management; refer patients for joint replacement only when symptoms are severe and other treatments have failed