How good are nonsurgical treatments for knee osteoarthritis?

  • DeRogatis M & al.
  • Ann Transl Med
  • 1 oct. 2019

  • de Miriam Davis, PhD
  • Clinical Essentials
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  • A new qualitative review of 5 nonsurgical treatment options (NSAIDs, weight loss, intra-articular injections, physical therapy [PT], and bracing) finds that they are all effective, to varying degrees, for knee osteoarthritis (KOA), but that they are best used not singly, but in combination with one another.

Why this matters

  • There has not been consensus on the efficacy of nonsurgical treatment modalities.

Study design

  • Qualitative review of 43 studies, mostly randomized controlled trials, after a search of PubMed and EBSCO Host.
  • Funding: None disclosed.

Key results

  • NSAIDs:
    • NSAIDs have the strongest efficacy when used continuously. 
    • Most, but not all, studies find approximately 16% relief of pain and dysfunction.
    • Carry adverse effects.
  • Weight loss:
    • A safe and effective method to relieve pain, dysfunction, and stiffness.
    • No adverse effects.
    • Difficult modality for obese patients with KOA by virtue of limited mobility and lack of adherence to a low-fat diet.
  • Intra-articular injections:
    • Good initial results (with corticosteroids and hyaluronic acid), but long-term outcomes are ambiguous.
  • PT:
    • Significant improvements in pain and function, but problems with compliance.
    • Poor compliance may be attributable to high copayments, pain with activities, lack of transportation, and large time commitment.
  • Bracing:
    • Significant relief of pain and dysfunction.
    • Use prolongs time to total knee arthroplasty.
    • Minimal adverse effects.


  • No meta-analysis was performed.