AAOS American Academy of Orthopaedic Surgeons

OAK AUC ASSUMPTIONS & DISCLAIMER

Before these appropriate use criteria are consulted, it is assumed that:

1. The clinician knows the contraindication to the utilization of certain medications and the anesthetic or important surgical contraindications to operative interventions.
2. Prescription of narcotic medicine for refractory pain (oral or transcutaneous opioids) should be monitored, intermittent or low dose in conjunction with other therapies
3. The patient has a diagnosis of osteoarthritis of the knee.
4. The patient is symptomatic including pain, instability, stiffness, and/or deformity that leads to loss of function.
5. The patient’s symptoms are consistent with the history, physical exam, and imaging findings.
6. The imaging findings are consistent with osteoarthritis (joint space narrowing, sclerosis, and osteophytes).
7. AP and/or PA-flexion weight-bearing, lateral, and patellar view radiographs are obtained.
8. If a patient has a bmi ≥ 30, discussion of and/or referral for weight loss and nutritional counseling is strongly recommended.
9. The physical examination, history, and imaging studies have excluded the following potential causes of knee pain:
   • Referred pain from the spine
   • Ipsilateral hip arthritis
   • Ankle/foot deformity
   • Vascular disease (arterial or venous)
   • Non-articular causes of knee pain including soft-tissue disorders
   • Neoplasm
   • Neuropathy
   • Stress fractures, insufficiency fracture, osteonecrosis, or symptomatic metabolic bone disease
10. The physician has an informed discussion with the patient about the treatment options and that the optimum treatment options may change over time for the patient. Before operative intervention is recommended, the appropriateness and potential efficacy of non-operative intervention has been considered.
12. At the time of the development of these appropriate use criteria, the SNRI were not part of the guideline and were not part of the data analyzed. Therefore, they were not considered as a treatment.
11. There will be patients for whom arthroplasty may be the most appropriate treatment, but the appropriateness of arthroplasty was not considered in these appropriate use criteria.

 
CONDITIONS NOT COVERED IN THIS AUC

1. Inflammatory disorders that are the likely cause of the knee pain.
2. Asymptomatic patients
3. Growth factor injections and platelet rich plasma

 
PATIENT POPULATION
This AUC is intended for use with adults (ages 19 years and older) who have been diagnosed by a physician with osteoarthritis of the knee and are undergoing treatment.
 
SCOPE
The scope of these appropriate use criteria includes nonpharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee as well as operative procedures less invasive than knee replacement (arthroplasty). It does not provide recommendations for patients diagnosed with rheumatoid arthritis, osteoarthritis of other joints, or other inflammatory arthropathies.


Disclaimer
Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options