New research ranks the effectiveness of nonsurgical treatments for knee osteoarthritis

May 1, 2018, American Academy of Orthopaedic Surgeons

An estimated 45 percent of people are at risk of developing knee osteoarthritis (OA) in their lifetime. According to a network meta-analysis research article published in the May 1, 2018 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the nonsteroidal anti-inflammatory drug (NSAID) naproxen was ranked most effective in individual knee OA treatment for improving both pain and function, and is considered a relatively safe and low-cost treatment method.

Nonsurgical treatments for knee OA supported by previous research evidence include strength training, low-impact aerobic exercises, NSAIDs, and weight loss in individuals with a body mass index over 25. This new research analyzed data from multiple trials to determine the relative effectiveness of various nonsurgical treatments for knee OA. The treatments that were compared and ranked included acetaminophen; ibuprofen; intra-articular (IA) or joint injections of cortisone; platelet-rich plasma (PRP); hyaluronic acid (HA); several NSAIDs, such as , celecoxib, and diclofenac; and both oral and IA placebo.

"This is the first comprehensive mixed-comparison analysis comparing best-evidence scientific research and excluding lower quality studies that can bias the outcomes," said lead author and orthopaedic surgeon David Jevsevar, MD, MBA. "Using a statistical ranking technique, we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function, and we attempted to fill in the gaps in evidence for more inconclusive treatments such as HA, PRP, and corticosteroids."

Authors analyzed 53 randomized controlled trials that examined knee OA treatments for at least 28 days and included a minimum of 30 participants per study group. Knee OA treatments were ranked on a scale of one to five, with one being the most effective. They found the following:

  • For pain reduction, cortisone injections provided the greatest short-term (4 to 6 weeks) pain relief, followed by ibuprofen, PRP injections, naproxen, and celecoxib.
  • Naproxen ranked the highest for probability for improving function, followed by diclofenac, celecoxib, ibuprofen, and PRP injections.
  • Naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by , PRP injections, ibuprofen and celecoxib.
  • HA injections did not achieve a rank in the top five treatments for pain, function, or combined and . An analysis of 12 articles also found that results with HA are not significantly different from those with IA placebo for treatment of knee OA.

"Because knee OA has both a high disease burden and high treatment costs, additional prospective studies using similar outcomes, timelines, and measures of clinically important changes are needed," explained Dr. Jevsevar. "While the information in this analysis is helpful to physicians, patients also can benefit from these findings and use it with their doctors to weigh all possible options."

Although the use of NSAIDs for arthritic conditions such as OA has potential risks, including heart attack and stroke, existing evidence indicates that naproxen has less potential for adverse cardiovascular events.

Explore further: Which pain medication is safest for arthritis patients?

More information: David S. Jevsevar et al. Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis, Journal of the American Academy of Orthopaedic Surgeons (2018). DOI: 10.5435/JAAOS-D-17-00318

Related Stories

Which pain medication is safest for arthritis patients?

April 19, 2018
In a recent Alimentary Pharmacology & Therapeutics study, arthritis patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain plus a stomach acid-reducing medicine called esomeprazole had infrequent gastrointestinal ...

Trial reveals differences in pain-relieving drugs when combined with aspirin

April 16, 2018
A landmark 2016 Cleveland Clinic study of widely used pain-relieving drugs showed that celecoxib (Celebrex) was associated with comparable cardiovascular safety and better gastrointestinal (GI) and kidney safety when compared ...

One-third of costs prior to knee replacement for non-recommended therapies

March 14, 2017
In the year prior to total knee replacement (TKR) surgery, almost one-third of the costs for treatment of arthritis symptoms went toward strategies not recommended by the American Academy of Orthopaedic Surgeons (AAOS), according ...

Weighing nonsurgical treatment options for knee osteoarthritis pain

September 19, 2017
Osteoarthritis (OA) is a progressive "wear and tear" disease of the joint. Osteoarthritis of the knee (knee OA) may not be totally preventable but according to Elizabeth Matzkin, MD, an orthopaedic surgeon specializing in ...

Some benefit for curcuminoids in knee osteoarthritis

May 26, 2017
(HealthDay)—Curcuminoids seem beneficial for knee osteoarthritis (OA), although they are less effective for pain relief than ibuprofen, according to a review and meta-analysis published online May 4 in the International ...

Do pain medications carry different heart risks?

February 22, 2018
Prior studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) may be linked with higher cardiovascular risks, but few have assessed potential different cardiovascular risk between NSAID classes or across ...

Recommended for you

Surprise finding—for very sick elderly, lighter sedation won't drop risk of postoperative delirium, study suggests

August 13, 2018
Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in ...

Dietary carbohydrates could lead to osteoarthritis, new study finds

August 9, 2018
Do your knees ache? According to new findings from the Oklahoma Medical Research Foundation, your diet could be a culprit.

Kidney transplant chains more effective in saving lives

August 9, 2018
New research from the UBC Sauder School of the Business has found that transplant societies which prioritize kidney transplant chains over kidney exchanges can increase the total number of transplants, thereby saving more ...

Joint study raises questions about treatments for arthritis

August 3, 2018
A study examining how molecules are transported into knee-joint tissue could have major implications for understanding and treating arthritis.

Surgical mesh implants may cause autoimmune disorders

July 31, 2018
Surgical mesh implants, often used for hernia or gynecological repair, may be the reason so many patients report symptoms of an autoimmune disorder, according to a University of Alberta rheumatologist.

Surgeons discuss options when the risks of surgery may be too high

July 27, 2018
In an essay published July 26 in the New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.