Table 1.
Summary of Studies providing overview of the treatment options for knee osteoarthritis
| Treatment option | Level of evidence (type of trial) | Reference | Study population characteristic | Intervention | Outcome measure | Medium-long term impact on the disease | Non-disease side effects (with potential to last 12 months) |
|---|---|---|---|---|---|---|---|
| Lifestyle | |||||||
| Exercise | |||||||
| II (RCT) | Messier et al. (2004) [8] | 252 patients older than 60 with BMI > 28 | Exercise and diet, diet only, exercise only | WOMAC | Positive | 1 patient tripped with laceration to forehead | |
| II (RCT) | Nejati, et al. (2015) [9] | 56 patients with grade 2–4 Kellgren-Lawrence (KL) | Stretching and leg exercises | VAS and KOOS | Positive | Nil | |
| II (RCT) | Jenkinson et al. (2009) [10] | 389 patients older than 45 with BMI > 28 | Diet and exercise, diet only, exercise only | WOMAC | Positive | Nil | |
| II (RCT) | Kawasaki et al. (2008) [11] | 142 female patients with moderate knee-OA | Exercise with or without glucosamine or risendronate | WOMAC | Neutral | Nil | |
| Weight reduction | |||||||
| III(Prospective Cohort) | Gersing et al. (2017) [12] | 640 patients | Weight loss > 10% or 5–10% | MRI WORMS | Positive | Nil | |
| Pharmacological | |||||||
| Glucosamine and Chondroitin sulphate (CS) | |||||||
| II (RCT) | Pavelká et al. (2002) [13] | 202 patients aged 45–70 | Glucosamine 1500 mg daily for 3 years | WOMAC | Positive | Gastrointestinal side effects | |
| II (RCT) | Reginster et al. (2001) [14] | 212 patients | Glucosamine 1500 mg daily for 3 years | WOMAC | Positive | Gastrointestinal side effects | |
| II (RCT) | Sawitzke et al. (2008) [15] | 572 patients with KL grade 2–3 | Glucosamine or chondroitin | JSW | Neutral | Gastrointestinal side effects | |
| Paracetamol | |||||||
| II (RCT) | Temple et al. (2006) [16] | 571 patients with knee or hip OA | Paracetamol or Naproxen for 6 or 12 months | WOMAC | Positive | Hepatic, renal and gastrointestinal side effects | |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | |||||||
| II (RCT) | Temple et al. (2006) [16] | 571 patients with knee or hip OA | Paracetamol or Naproxen for 6 or 12 months | WOMAC | Positive | Hepatic, renal and gastrointestinal side effects | |
| II (RCT) | Sawitzke et al. (2010) [17] | 662 patients with KL grade 2–3 | Celecoxib 2oomg for 2 years | WOMAC | Neutral | Gastrointestinal side effects | |
| Injectables | |||||||
| Intra-articular (IA) corticosteroids | |||||||
| II (RCT) | McAlindon et al. (2017) [18] | 140 patients with KL grade 2–3 | Triamcinolone 3 monthly for 2 years | MRI cartilage loss | Negative | Facial flushing, injection site pain | |
| II (RCT) | Raynauld et al. (2003) [19] | 68 patients with KL grade 2–3 | Triamcinolone 3 monthly for 2 years | WOMAC | Positive | Nil | |
| Intra-articular hyaluronic acid (IAHA) | |||||||
| III (Prospective cohort) | Benazzo et al. 2016) [20] | 50 patients, older than 40 | 2 x Hymovis 3 ml a week apart, then again at 6 months | WOMAC, JSW | Positive | Increase in knee pain, HA, flu like symptoms, back pain | |
| III (Prospective cohort) | Conrozier et al. (2003) [21] | 155 patients | 3 x intraarticular Hylan GF-20 a week apart | Patient satisfaction and safety | Neutral | Nil | |
| III (Prospective cohort) | Huskin et al. (2008) [22] | 62 patients KL grade 1–2 | 3 x intraarticular Hylan GF-20 a week apart | WOMAC | Positive | Pain, swelling and synovitis | |
| II (RCT) | Jorgensen et al. (2010) [23] | 337 patients | Intra-articular Hyaluron weekly for 5 weeks | LFI, pain on VAS walking > 50 m | Neutral | ||
| II (RCT) | Juni et al. (2007) [24] | 660 patients | 3 intra-articular injections of 3 different HAs | WOMAC | Neutral | Pain, swelling and synovitis | |
| II (RCT) | Navarro-Sarabia et al. (2011) [25] | 306 patients KL grade 2–3 | 5 intra-articular injections at 6 month intervals | OARSI responder criteria | Positive | Pain, swelling, rash and bleeding | |
| II (RCT) | Ozturk et al. (2006) [26] | 24 patients | 3 injections as week apart and then repeat at 6 months with or without triamcinolone | WOMAC | Positive | ||
| II (RCT) | Vaquerizo et al. (2013) [27] | 96 patients | 3 x PRGF-Endoret or 1 x Durolane | WOMAC | Positive | ||
| III (Prospective cohort) | Kearey et al. (2017) [28] | 119 patients | Single intra-articular injection of 6-mL hylan G-F | WOMAC | Positive | ||
| III (Prospective case) | Yan et al. (2015) [29] | 110 knees from 95 patients | Single intra-articular injection of 6-mL hylan G-F | Pain VAS and Likert scales | Positive | Self-limiting pain and swelling over injection site | |
| Platelet Rich Plasma (PRP) | |||||||
| II(RCT) | Filardo et al. (2012) [30] | 144 patients | 3 injections of single or double spinning PRP | IKDC, EQ-VAS and Tegner scores | Positive | Swelling and pain over injection site | |
| II (RCT) | Smith (2016) [31] | 30 patients | 3 weekly leucocyte poor PRP | WOMAC | Positive | Nil | |
| Stem Cells | |||||||
| III (Prospective case) | Emadedin et al. (2012) [32] | 6 patients | Bone marrow MSCs | MRI cartilage mapping | Positive | Nil | |
| III (Prospective case) | Emadedin et al. (2015) [33] | 18 patients | Bone marrow MSCs | WOMAC | Positive | Rash and erythema | |
| III (Prospective case) | Orozco et al. (2013) [34] | 12 patients | Bone marrow MSCs | MRI cartilage mapping | Positive | Nil | |
| II (RCT) | Vega et al. (2015) [35] | 30 patients | Allogenic bone marrow MSCs vs IAHA | MRI cartilage mapping | Positive | Transient joint pain and swelling | |
| III (Prospective case) | Fodor and Paulseth (2016) [36] | 8 knees in 6 patients KL grade 1–3 | Adipose derived SVF cells | WOMAC | Positive | Nil | |
| Surgical | |||||||
| Arthroscopy | |||||||
| III (Prospective cohort) | Rongen et al. (2017) [37] | 4674 patients with 335 meniscectomies | Arthroscopic meniscectomy | Progression to TKA | Negative | Nil | |
| Total Knee Arthroplasty (TKA) | |||||||
| III (Prospective cohort) | Brophy et al. (2014) [38] | 1268 patients | Previous knee surgery | Progression to TKA | Neutral | Nil | |
| III (Prospective cohort) | El-Galaly et al. (2017) [39] | 1421 patients | Post-traumatic fracture TKA | Failure of implant | Neutral | Nil | |
| II(RCT) | Skou et al. (2015) [40] | 95 patients with moderate to severe OA | TKA | KOOS | Positive | Major medical side effects | |
| III(Matched Cohort) | Ansari et al. (2017) [41] | 21 patients with KOA having previous micro fracture | TKA | KSS score | Positive | 1 x arthrofibrosis | |