AAOS American Academy of Orthopaedic Surgeons

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. The patient has a diagnosis of osteoarthritis of the knee. This AUC does not address inflammatory arthritis.
3. The patient is symptomatic including pain, instability, stiffness, and/or deformity that leads to loss of function.
4. The patient’s symptoms are consistent with the history, physical exam, and imaging findings.
5. The imaging findings are consistent with osteoarthritis which may include: joint space narrowing, sclerosis, presence of cysts, and/or osteophytes.
6. Patient has failed other relevant appropriate treatments.
7. AP and/or PA-flexion weight-bearing, lateral, and patellar view radiographs are recommended when possible.
8. The physical examination, history, and imaging studies have excluded the following as the main cause 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
9. Shared decision making is encouraged between the patient and surgeon with an emphasis on realistic expectations. 
10. There will be patients not considered in this AUC (e.g. inflammatory arthritis) for whom arthroplasty may be the most appropriate treatment, but the appropriateness of arthroplasty for these patients was not considered in these appropriate use criteria.

PATIENT POPULATION
This AUC is intended for use with adults who have been diagnosed by a physician with osteoarthritis of the knee and are undergoing treatment.

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.