Table 9 |
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|
Guideline recommendations for surgery |
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| AAOS [10] |
Schnitzer/ACR [7] |
EULAR [6] |
|
|
|
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| Surgery |
Recommended for patients with 12 weeks or more of pain not responding to conservative
treatment |
Recommended for patients with severe osteoarthritis limiting their activities of daily
living and not responding to nonpharmacologic and pharmacologic treatments |
Recommended (C) for patients with radiographic evidence of osteoarthritis, refractory
pain and disability |
| Total knee replacement |
Recommended (A) for patients with bi/tri compartmental arthritis if no response from
conservative treatment |
Recommended (C) |
|
| Recommended (A) for patients with medial compartment arthritis not candidate for osteotomy
or unicompartmental knee replacement |
|||
| Recommended (A) for patients with lateral compartment arthritis not candidate for
osteotomy |
|||
| Recommended (B) for older patients if magnetic resonance imaging confirms avascular
necrosis |
|||
| Recommended (B) for older or less active patients with isolated patellofemoral arthritis |
|||
| Recommended (D) if no response from conservative treatment and previous infection |
|||
| Not recommended (D) if active infection |
|||
| Unicompartmental knee replacement |
Recommended (B) for less active patients with medial compartment arthritis |
Recommended (C) |
|
| Recommended (C) for patients with lateral compartment arthritis not candidate for
osteotomy |
|||
| Osteotomy |
Recommended (A) for young, active patients with medial compartment arthritis and varus
alignment if no response from conservative treatment |
Recommended (C) |
|
| Recommended (B) for young, active patients with lateral compartment arthritis |
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| Arthroscopy |
Not recommended (A) if no mechanical symptoms |
Recommended (C) |
|
| Recommended (B) if degenerative arthritis and mechanical symptoms |
|||
| Recommended (B) if gross malalignment/instability, cartilage remaining and localized
symptoms |
|||
| Knee fusion |
Recommended (D) if no response from conservative treatment and previous infection,
or for young patients with a history of chronic infection |
||
| Patellectomy |
Recommended (D) for young, active patients with isolated patellofemoral arthritis |
||
|
|
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|
AAOS, American Academy of Orthopaedic Surgeons; ACR, American College of Rheumatology; EULAR, European League Against Rheumatism. |
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|
Poitras et al. Arthritis Research & Therapy 2007 9:R126 doi:10.1186/ar2339 |
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