Treatment of osteoarthritis of the knee

1234 Pages·2014·8.55 MB·English

by  Patrick Donnelly

TREATMENT OF OSTEOARTHRITIS OF THE
KNEE

EVIDENCE-BASED GUIDELINE
ND
2 EDITION

Adopted by the American Academy of Orthopaedic Surgeons
Board of Directors
May 18, 2013

i
Disclaimer
This clinical practice guideline was developed by an AAOS work group comprised of
volunteer physicians and interdisciplinary clinicians as well as staff researchers with
expertise in systematic reviews and statistical methods used to evaluate empirical
evidence. It is an educational tool that integrates the current scientific literature and the
proficiency and sound judgment that physicians typically acquire in clinical practice. The
recommendations that make up this guideline are not intended to be absolute as patients
vary in how they experience symptoms and respond to treatment interventions. There
may be variability between patients in practice and those who participate in clinical trials.
Medical care should always be based on a physician’s expertise that is individually
tailored to the patient’s circumstances, preferences and rights.
Disclosure Requirement
In accordance with AAOS policy, all individuals whose names appear as authors or
contributors to this clinical practice guideline provided full disclosure of and were vetted
for potential conflicts of interest prior to the introductory meeting.
Funding Source
The American Academy of Orthopaedic Surgeons funded this clinical practice guideline
without any financial support from outside commercial sources.
FDA Clearance
Some drugs or medical devices referenced or described in this clinical practice guideline
may not have been cleared by the Food and Drug Administration (FDA) or may have
been cleared for a specific use only. The FDA has stated that it is the responsibility of the
physician to determine the clearance status of each drug or device prescribed in clinical
practice.
Copyright
All rights reserved. No part of this clinical practice guideline may be reproduced or
stored in a retrieval system or transmitted in any form or by any means (electronic,
mechanical, photocopying, recording, or otherwise) without prior written permission
from the AAOS.
Published 2013 by the American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018
Second Edition
Copyright 2013 by the American Academy of Orthopaedic Surgeons

ii
TABLE OF CONTENTS
Table of Contents ............................................................................................................... iii
List of Tables ..................................................................................................................... ix
List of Figures ................................................................................................................... xv
Summary of Recommendations .......................................................................................... 1
Conservative Treatments: Recommendations 1-6 .............................................................. 1
Recommendation 1 ......................................................................................................... 1
Recommendation 2 ......................................................................................................... 1
Recommendation 3a........................................................................................................ 2
Recommendation 3b ....................................................................................................... 2
Recommendation 3c........................................................................................................ 2
Recommendation 4 ......................................................................................................... 2
Recommendation 5 ......................................................................................................... 3
Recommendation 6 ......................................................................................................... 3
Pharmacologic Treatments: Recommendation 7 ................................................................ 3
Recommendation 7a........................................................................................................ 3
Recommendation 7b ....................................................................................................... 4
Procedural Treatments: Recommendations 8-11 ................................................................ 4
Recommendation 8 ......................................................................................................... 4
Recommendation 9 ......................................................................................................... 4
Recommendation 10 ....................................................................................................... 5
Recommendation 11 ....................................................................................................... 5
Surgical Treatments: Recommendations 12-15 .................................................................. 5
Recommendation 12 ....................................................................................................... 5
Recommendation 13 ....................................................................................................... 5
Recommendation 14 ....................................................................................................... 6
Recommendation 15 ....................................................................................................... 6
Introduction ......................................................................................................................... 7
Overview ......................................................................................................................... 7
Goals and Rationale ........................................................................................................ 7
Intended Users ................................................................................................................ 7
Patient Population ........................................................................................................... 8
Scope ............................................................................................................................... 8
Etiology ........................................................................................................................... 8
Incidence and Prevalence ................................................................................................ 8
Burden of Disease ........................................................................................................... 9
Emotional and Physical Impact ...................................................................................... 9
Potential Benefits, Harm, and Contraindications ............................................................ 9
Differences Between the Present and Previous Guidelines ............................................ 9
Preventing Bias in an AAOS Clinical Practice Guideline ................................................ 11
Methods............................................................................................................................. 14
Formulating Preliminary Recommendations ................................................................ 14
Full Disclosure Information .......................................................................................... 14
Study Selection Criteria ................................................................................................ 14
Best Evidence Synthesis ............................................................................................... 15
Outcomes Considered ................................................................................................... 16
iii
Literature Searches........................................................................................................ 16
Appraising Evidence Quality and Applicability ........................................................... 16
Quality....................................................................................................................... 16
Applicability .............................................................................................................. 18
Minimum Clinically Important Improvement .............................................................. 18
Grade of Recommendation ........................................................................................... 19
Defining the Strength of the Recommendations ........................................................... 20
Wording of the Final Recommendations ...................................................................... 20
Consensus Recommendations ....................................................................................... 22
Voting on the Recommendations .................................................................................. 22
Statistical Methods ........................................................................................................ 23
Network Meta-Analysis ............................................................................................ 23
Placebo Data Regression Analysis............................................................................ 24
Inclusion Criteria .................................................................................................. 24
Statistical Analysis ................................................................................................ 24
Results ................................................................................................................... 25
New To Meta-Analysis In This Guideline: Minimal Important Difference (MID)
Units .......................................................................................................................... 25
Peer Review .................................................................................................................. 26
Public Comment............................................................................................................ 27
The AAOS Guideline Approval Process ...................................................................... 28
Revision Plans ............................................................................................................... 28
Guideline Dissemination Plans ..................................................................................... 28
AAOS Clinical Guideline on Treating Osteoarthritis of the Knee ................................... 31
Guideline Recommendations ............................................................................................ 31
Recommendation 1 ....................................................................................................... 31
Rationale ................................................................................................................... 31
Supporting Evidence ................................................................................................. 32
Quality................................................................................................................... 32
Applicability ......................................................................................................... 34
Final Strength of Evidence.................................................................................... 35
Results ................................................................................................................... 46
Evidence Tables and Figures .................................................................................... 61
Quality and Applicability ...................................................................................... 61
Findings................................................................................................................. 98
Recommendation 2 ..................................................................................................... 138
Rationale ................................................................................................................. 138
Supporting Evidence ............................................................................................... 138
Quality................................................................................................................. 138
Applicability ....................................................................................................... 139
Final Strength of Evidence.................................................................................. 139
Results ................................................................................................................. 141
Evidence Tables and Figures .................................................................................. 146
Quality and Applicability .................................................................................... 146
Findings............................................................................................................... 152
Recommendation 3a.................................................................................................... 159
iv
Recommendation 3b ................................................................................................... 159
Recommendation 3c.................................................................................................... 159
Rationale ................................................................................................................. 159
Supporting Evidence ............................................................................................... 161
Quality................................................................................................................. 161
Applicability ....................................................................................................... 162
Final Strength of Evidence.................................................................................. 162
Results ................................................................................................................. 170
Evidence Tables and Figures .................................................................................. 177
Quality and Applicability .................................................................................... 177
Findings............................................................................................................... 201
Recommendation 4 ..................................................................................................... 228
Rationale ................................................................................................................. 228
Supporting Evidence ............................................................................................... 228
Quality................................................................................................................. 228
Applicability ....................................................................................................... 228
Final Strength of Evidence.................................................................................. 229
Results ................................................................................................................. 230
Evidence Tables and Figures .................................................................................. 234
Quality and Applicability .................................................................................... 234
Findings............................................................................................................... 241
Recommendation 5 ..................................................................................................... 249
Rationale ................................................................................................................. 249
Supporting Evidence ............................................................................................... 249
Quality................................................................................................................. 249
Applicability ....................................................................................................... 249
Final Strength of Evidence.................................................................................. 250
Results ................................................................................................................. 251
Evidence Tables and Figures .................................................................................. 253
Quality and Applicability .................................................................................... 253
Findings............................................................................................................... 256
Recommendation 6 ..................................................................................................... 262
Rationale ................................................................................................................. 262
Supporting Evidence ............................................................................................... 263
Quality................................................................................................................. 263
Applicability ....................................................................................................... 263
Final Strength of Evidence.................................................................................. 263
Results ................................................................................................................. 273
Evidence Tables and Figures .................................................................................. 279
Quality and Applicability .................................................................................... 279
Findings............................................................................................................... 306
Recommendation 7a.................................................................................................... 342
Recommendation 7b ................................................................................................... 342
Rationale ................................................................................................................. 342
Supporting Evidence ............................................................................................... 343
Quality................................................................................................................. 343
v
Applicability ....................................................................................................... 343
Final Strength of Evidence.................................................................................. 344
Results ................................................................................................................. 429
Evidence Tables and Figures .................................................................................. 441
Quality and Applicability .................................................................................... 441
Findings............................................................................................................... 624
Recommendation 8 ..................................................................................................... 747
Rationale ................................................................................................................. 747
Supporting Evidence ............................................................................................... 747
Quality................................................................................................................. 747
Applicability ....................................................................................................... 748
Final Strength of Evidence.................................................................................. 748
Results ................................................................................................................. 752
Evidence Tables and Figures .................................................................................. 754
Quality and Applicability .................................................................................... 754
Findings............................................................................................................... 762
Recommendation 9 ..................................................................................................... 770
Rationale ................................................................................................................. 770
Supporting Evidence ............................................................................................... 771
Quality................................................................................................................. 771
Applicability ....................................................................................................... 771
Final Strength of Evidence.................................................................................. 772
Results ................................................................................................................. 783
Evidence Tables and Figures .................................................................................. 789
Quality and Applicability .................................................................................... 789
Findings............................................................................................................... 813
Recommendation 10 ................................................................................................... 854
Rationale ................................................................................................................. 854
Supporting Evidence ............................................................................................... 854
Quality................................................................................................................. 854
Applicability ....................................................................................................... 854
Final Strength of Evidence.................................................................................. 855
Results ................................................................................................................. 856
Evidence Tables and Figures .................................................................................. 857
Quality and Applicability .................................................................................... 857
Findings............................................................................................................... 860
Recommendation 11 ................................................................................................... 863
Rationale ................................................................................................................. 863
Supporting Evidence ............................................................................................... 863
Quality................................................................................................................. 863
Applicability ....................................................................................................... 864
Final Strength of Evidence.................................................................................. 864
Results ................................................................................................................. 865
Evidence Tables and Figures .................................................................................. 867
Quality and Applicability .................................................................................... 867
Findings............................................................................................................... 871
vi
Recommendation 12 ................................................................................................... 876
Rationale ................................................................................................................. 876
Supporting Evidence ............................................................................................... 877
Quality................................................................................................................. 877
Applicability ....................................................................................................... 877
Final Strength of Evidence.................................................................................. 877
Results ................................................................................................................. 887
Evidence Tables and Figures .................................................................................. 889
Quality and Applicability .................................................................................... 889
Findings............................................................................................................... 913
Recommendation 13 ................................................................................................... 932
Rationale ................................................................................................................. 932
Supporting Evidence ............................................................................................... 932
Quality................................................................................................................. 932
Applicability ....................................................................................................... 932
Final Strength of Evidence.................................................................................. 932
Results ................................................................................................................. 934
Evidence Tables and Figures .................................................................................. 935
Quality and Applicability .................................................................................... 935
Findings............................................................................................................... 937
Recommendation 14 ................................................................................................... 939
Rationale ................................................................................................................. 939
Supporting Evidence ............................................................................................... 939
Quality................................................................................................................. 939
Applicability ....................................................................................................... 939
Final Strength of Evidence.................................................................................. 940
Results ................................................................................................................. 945
Evidence Tables and Figures .................................................................................. 946
Quality and Applicability .................................................................................... 946
Findings............................................................................................................... 956
Recommendation 15 ................................................................................................... 969
Rationale ................................................................................................................. 969
Supporting Evidence ............................................................................................... 969
Quality................................................................................................................. 969
Applicability ....................................................................................................... 969
Final Strength of Evidence.................................................................................. 970
Results ................................................................................................................. 970
Evidence Tables and Figures .................................................................................. 971
Quality and Applicability .................................................................................... 971
Findings............................................................................................................... 972
Future Research .......................................................................................................... 974
Appendix I .................................................................................................................. 976
Work Group ............................................................................................................ 976
Revision Work Group ............................................................................................. 976
Original Work Group .............................................................................................. 978
Appendix II ................................................................................................................. 980
vii
Decision-Makers Who Approve This Clinical Practice Guideline ......................... 980
Appendix III ................................................................................................................ 981
Determining Critical Outcomes .................................................................................. 981
Work Group Participation ....................................................................................... 981
Critical Outcomes Form .......................................................................................... 981
Determining Outcomes ....................................................................................... 981
Appendix IV................................................................................................................ 985
Study Attrition Flowchart ....................................................................................... 985
Appendix V ................................................................................................................. 986
Literature Search Strategies .................................................................................... 986
PubMed/MEDLINE ............................................................................................ 986
Embase ................................................................................................................ 988
Cochrane Library (Wiley Interface).................................................................... 990
Appendix VI................................................................................................................ 992
Quality and Applicability Appraisal ....................................................................... 992
Quality..................................................................................................................... 992
Applicability ........................................................................................................... 997
Appendix VII ............................................................................................................ 1000
Form For Assigning Strength of Recommendation .............................................. 1000
Appendix VIII ........................................................................................................... 1001
Opinion Based Recommendations ........................................................................ 1001
Rules for Making Opinion Based Recommendations ........................................... 1001
Checklist For Voting on Opinion Based Recommendations ................................ 1002
Voting by the Nominal Group Technique ............................................................ 1002
Appendix IX.............................................................................................................. 1003
Structured Peer Review Form ............................................................................... 1003
Appendix X ............................................................................................................... 1007
Participating Peer Review Organizations ............................................................. 1007
Appendix XI.............................................................................................................. 1008
Interpreting the Forest Plots .................................................................................. 1008
Abbreviations Used In This Report ...................................................................... 1008
Appendix XII ............................................................................................................ 1010
Conflict of Interest ................................................................................................ 1010
Appendix XIII ........................................................................................................... 1012
Network Meta Analysis Checks for Consistency ................................................. 1012
Appendix XIV ........................................................................................................... 1022
Confidence Intervals of Treatment Effects that Range in Statistical and Clinical
Signficance ............................................................................................................ 1022
Appendix XV ............................................................................................................ 1023
Bibliography ......................................................................................................... 1023
Additional References ........................................................................................... 1040
Excluded Studies ................................................................................................... 1051
viii
LIST OF TABLES
Table 1. Relationship between Quality and Domain Scores for Treatment Studies ......... 17
Table 2. Relationship between Applicability and Domain Scores for Treatment Studies 18
Table 3. Brief Description of the PRECIS Questions and Domains................................. 18
Table 4. Descriptive Terms for Results with MCII .......................................................... 19
Table 5. AAOS Guideline Language ................................................................................ 20
Table 6. Recommendation Strengths, Descriptions, and Clinical Implications ............... 21
Table 7. Quality and Applicability Summary: Strength Training Versus Control ........... 35
Table 8 Quality and Applicability Summary: Isokinetic Versus Isotonic Versus Isometric
Strength Training .............................................................................................................. 36
Table 9. Quality and Applicability Summary: High Versus Low Resistance Strength
Training ............................................................................................................................. 36
Table 10. Quality and Applicability Summary: Isokinetic Versus Isotonic Versus
Isometric Strength Training .............................................................................................. 37
Table 11. Quality and Applicability Summary: Proprioception Versus Control .............. 37
Table 12. Quality and Applicability Summary: Physical Therapy Versus Control .......... 37
Table 13. Quality and Applicability Summary: Kinesthesia Plus Strengthening Versus
Strengthening Only ........................................................................................................... 39
Table 14. Quality and Applicability Summary: Agility Plus Perturbation Versus Standard
Exercise Therapy .............................................................................................................. 39
Table 15. Quality and Applicability Summary: Self-Management Plus Exercise Versus
Exercise Alone .................................................................................................................. 40
Table 16. Quality and Applicability Summary: Aerobic Exercise Versus Education ...... 40
Table 17. Quality and Applicability Summary: Home-Based Exercise, Self-Management,
and Coping Strategies Versus Usual Care ........................................................................ 41
Table 18. Quality and Applicability Summary: Water Versus Land-Based Exercises .... 44
Table 19. Quality and Applicability Summary: Supervised Walking Versus Usual Care 44
Table 20. Quality and Applicability Summary: Yoga Plus Physiotherapy Versus
Physiotherapy Only ........................................................................................................... 45
Table 21. Quality and Applicability Summary: Standardized Consultation Versus Usual
Care ................................................................................................................................... 45
Table 22. Quality and Applicability: Strength Training Versus Control .................. 61
Table 23. Quality and Applicability: High Versus Low Resistance Training ........... 66
Table 24. Quality and Applicability: Isokinetic Versus Isotonic Versus Isometric
Strength Training............................................................................................................ 67
Table 25. Quality and Applicability: Strength Training Versus Education ............. 68
Table 26. Quality and Applicability: Proprioceptive Versus Control ...................... 69
Table 27. Quality and Applicability: Physical Therapy Versus Control ................... 70
Table 28. Quality and Applicability: Kinesthesia Plus Strengthening Versus
Strengthening Alone ....................................................................................................... 74
Table 29. Quality and Applicability: Agility Plus Perturbation Versus Standard
Exercise Therapy ............................................................................................................ 75
Table 30. Quality and Applicability: Self-Management Versus Control................... 78
Table 31. Quality and Applicability: Supervised Walking Versus Control .............. 84
Table 32. Quality and Applicability: Water Versus Land-Based Exercise ............... 85
Table 33. Quality and Applicability: Aerobic Exercise Versus Education................ 86
ix
Table 34. Quality and Applicability: Weight Bearing and Non-Weight Bearing
Exercise Programs .......................................................................................................... 88
Table 35. Quality and Applicability: Home and Class-Based Exercise Programs ... 90
Table 36. Quality and Applicability: Standardized Structured Physician
Consultation Program (Education) Versus Control .................................................... 93
Table 37. Quality and Applicability: Integrated Exercise, Self-Management, and
Coping Strategies Versus Usual Care ........................................................................... 94
Table 38. Quality and Applicability: Yoga Plus Physiotherapy Versus
Physiotherapy Only ........................................................................................................ 96
Table 39. Strength Training Compared to Control: Pain Outcomes ......................... 98
Table 40. Isokinetic Versus Isotonic Versus Isometric Exercise: Pain ...................... 99
Table 41. Strength Training Versus Control: Functional Measure ......................... 100
Table 42. Strengthening Versus Control: WOMAC Total ....................................... 103
Table 43. High Versus Low Resistance Training: Function ..................................... 104
Table 44. Resistance Strength Training Versus Health Education ......................... 104
Table 45. Physical Therapy Versus Control: Pain Measures ................................... 105
Table 46. Physical Therapy Versus Control: Functional Measures........................ 106
Table 47. Exercise Plus Manual Physical Therapy Versus Non-Therapeutic
Intensity Ultrasound ..................................................................................................... 108
Table 48. Proprioceptive Training Versus Control: Pain Measures ........................ 109
Table 49. Proprioceptive Training Versus No Exercise: Function........................... 109
Table 50. Agility and Perturbation Training Plus Usual Exercise Versus Exercise
Only (Fitzgerald 2011) .................................................................................................. 109
Table 51. Agility and Perturbation Training Plus Usual Exercise Versus Exercise
Only: Odds of Improvement From Baseline for WOMAC Functional Tasks
(Teixeira 2011) ............................................................................................................... 110
Table 52. Kinesthesia Plus Strength Training Versus Strength Training: Function
......................................................................................................................................... 112
Table 53. Weight Bearing and Non-Weight Bearing Exercise ................................. 113
Table 54. Water Versus Land-Based Exercise: Pain ................................................. 115
Table 55. Water Versus Land-Based Exercise: Lequesne Index .............................. 116
Table 56. Home-Based and Hospital-Based Exercise Programs .............................. 117
Table 57. Aerobic Exercise Versus Control: Function .............................................. 120
Table 58. Aerobic Exercise Versus Control: Functional Task ................................. 121
Table 59. Supervised Walking Versus Usual Care: Pain .......................................... 121
Table 60. Supervised Walking Versus Usual Care: Function .................................. 122
Table 61. Supervised Walking Versus Control: Arthritis Impact Measurement Scale
(Medications Use) .......................................................................................................... 122
Table 62. Self-Management Versus Waitlist Control ................................................ 123
Table 63. Self-Management Plus Exercise Versus Usual Care: Pain ....................... 129
Table 64. Self-Management Plus Exercise Versus Usual Care: Function ............... 129
Table 65. Structured Consultation Versus Control: Function ................................ 130
Table 66. Integrated Exercise, Self-Management, and Coping Strategies Versus
Usual Care (Hurley 2007) ............................................................................................. 132
Table 67. Yoga Plus Physiotherapy Versus Physiotherapy Only (Ebenezer 2011) 135
Table 68. Quality and Applicability Summary: Weight Loss Versus Education ... 139
x