Non-Surgical Management of Hip & Knee Osteoarthritis
Publication Date: June 30, 2020
Last Updated: March 14, 2022
Recommendations
Diagnosis
We suggest against obtaining magnetic resonance imaging for the diagnosis of osteoarthritis of the hip and knee.
Weak Recommendation against
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Self management
We suggest a self-management program, including exercise and weight loss for osteoarthritis of the hip and knee, and bracing for osteoarthritis of the knee.
Weak Recommendation
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Physical Therapy
We suggest offering physical therapy as part of a comprehensive management plan for patients with osteoarthritis of the hip or knee.
Weak Recommendation
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Pharmacotherapy
Topical Pharmacotherapy
We recommend offering topical non-steroidal anti-inflammatory drugs for patients with pain associated with osteoarthritis of the knee.
Strong Recommendation
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There is insufficient evidence to recommend for or against the use of topical non-steroidal anti-inflammatory drugs for patients with pain associated with osteoarthritis of the hip.
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We suggest offering topical capsaicin for patients with pain associated with osteoarthritis of the knee.
Weak Recommendation
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There is insufficient evidence to recommend for or against the use of topical capsaicin for patients with pain associated with osteoarthritis of the hip.
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Oral Pharmacotherapy
We suggest offering acetaminophen and/or oral non-steroidal antiinflammatory drugs for pain associated with osteoarthritis of the hip and knee.
Weak Recommendation
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We suggest offering duloxetine as an alternative or adjunctive therapy for patients with an inadequate response or contraindications to acetaminophen or non-steroidal anti-inflammatory drugs for pain associated with osteoarthritis of the knee.
Weak Recommendation
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We suggest against initiating opioids (including tramadol) for pain associated with osteoarthritis of the hip and knee. For patients already on long-term opioid therapy, refer to the current VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain.
Weak Recommendation
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We suggest offering an intra-articular corticosteroid injection for patients with persistent pain due to osteoarthritis of the knee inadequately relieved by other interventions.
Weak Recommendation
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We suggest offering an intra-articular, image-guided corticosteroid injection for patients with persistent pain due to osteoarthritis of the hip inadequately relieved by other interventions.
Weak Recommendation
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We suggest offering intra-articular viscosupplementation injection(s) for patients with persistent pain due to osteoarthritis of the knee inadequately relieved by other interventions.
Weak Recommendation
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We suggest against the use of intra-articular viscosupplementation injection(s) of the hip.
Weak Recommendation against
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Orthobiologics
There is insufficient evidence to recommend for or against plateletrich plasma injections for the treatment of osteoarthritis of the hip or knee.
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We suggest against stem cell injections (e.g., mesenchymal, adiposederived, and bone marrow-derived) for the treatment of osteoarthritis of the knee.
Weak Recommendation against
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Complementary and Integrative Health, Dietary Supplements, and Nutraceuticals
There is insufficient evidence to recommend for or against the use of the following dietary supplements or nutraceuticals for the treatment of osteoarthritis of the hip or knee:
• Avocado and soybean extract
• Boswellia serrata
• Cannabidiol (CBD oil)
• Chondroitin
• Curcumin (active component of turmeric)
• Collagen
• Glucosamine
• Glucosamine plus chondroitin
• Methylsulfonylmethane
• Omega-3 fatty acid
• Pycnogenol (pine bark)
• Rosehip
• Traditional Chinese medicine
• Vitamin D
• Vitamin E
• Willow bark extract
• Avocado and soybean extract
• Boswellia serrata
• Cannabidiol (CBD oil)
• Chondroitin
• Curcumin (active component of turmeric)
• Collagen
• Glucosamine
• Glucosamine plus chondroitin
• Methylsulfonylmethane
• Omega-3 fatty acid
• Pycnogenol (pine bark)
• Rosehip
• Traditional Chinese medicine
• Vitamin D
• Vitamin E
• Willow bark extract
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There is insufficient evidence to recommend for or against the use of complementary and integrative health interventions for the treatment of osteoarthritis of the hip or knee, including:
• Acupuncture
• Massage
• Light touch
• Meditation
• Tai chi
• Yoga
• Acupuncture
• Massage
• Light touch
• Meditation
• Tai chi
• Yoga
6731
There is insufficient evidence to recommend for or against the use of transcutaneous electrical nerve stimulation for the treatment of pain in osteoarthritis of the knee.
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Recommendation Grading
Overview
Title
Non-Surgical Management of Hip & Knee Osteoarthritis
Authoring Organization
Veterans Health Administration / Department of Defense
Publication Month/Year
June 30, 2020
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Physical therapist, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D020370 - Osteoarthritis, Knee, D015207 - Osteoarthritis, Hip, D010003 - Osteoarthritis, D014493 - United States Department of Veterans Affairs, D058014 - Veterans Health, D014728 - Veterans
Keywords
osteoarthritis, hip osteoarthritis, knee osteoarthritis
Source Citation
Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. Mayo Clin Proc. 2021 Sep;96(9):2435-2447. doi: 10.1016/j.mayocp.2021.03.017. PMID: 34481599.