Table 9.
Guideline recommendations for surgery
| AAOS [10] | Schnitzer/ACR [7] | EULAR [6] | |
| Surgery | Recommended for patients with 12 weeks or more of pain not responding to conservative treatment | Recommended for patients with severe osteoarthritis limiting their activities of daily living and not responding to nonpharmacologic and pharmacologic treatments | Recommended (C) for patients with radiographic evidence of osteoarthritis, refractory pain and disability |
| Total knee replacement | Recommended (A) for patients with bi/tri compartmental arthritis if no response from conservative treatment | Recommended (C) | |
| Recommended (A) for patients with medial compartment arthritis not candidate for osteotomy or unicompartmental knee replacement | |||
| Recommended (A) for patients with lateral compartment arthritis not candidate for osteotomy | |||
| Recommended (B) for older patients if magnetic resonance imaging confirms avascular necrosis | |||
| Recommended (B) for older or less active patients with isolated patellofemoral arthritis | |||
| Recommended (D) if no response from conservative treatment and previous infection | |||
| Not recommended (D) if active infection | |||
| Unicompartmental knee replacement | Recommended (B) for less active patients with medial compartment arthritis | Recommended (C) | |
| Recommended (C) for patients with lateral compartment arthritis not candidate for osteotomy | |||
| Osteotomy | Recommended (A) for young, active patients with medial compartment arthritis and varus alignment if no response from conservative treatment | Recommended (C) | |
| Recommended (B) for young, active patients with lateral compartment arthritis | |||
| Arthroscopy | Not recommended (A) if no mechanical symptoms | Recommended (C) | |
| Recommended (B) if degenerative arthritis and mechanical symptoms | |||
| Recommended (B) if gross malalignment/instability, cartilage remaining and localized symptoms | |||
| Knee fusion | Recommended (D) if no response from conservative treatment and previous infection, or for young patients with a history of chronic infection | ||
| Patellectomy | Recommended (D) for young, active patients with isolated patellofemoral arthritis |
AAOS, American Academy of Orthopaedic Surgeons; ACR, American College of Rheumatology; EULAR, European League Against Rheumatism.