Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100, Bari, Italy.
Biomechanics and Technology Innovation Laboratory, II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
J Orthop Traumatol. 2023 Sep 7;24(1):47. doi: 10.1186/s10195-023-00729-z.
Knee osteoarthritis (OA) is a chronic disease associated with a severe impact on quality of life. However, unfortunately, there are no evidence-based guidelines for the non-surgical management of this disease. While recognising the gap between scientific evidence and clinical practice, this position statement aims to present recommendations for the non-surgical management of knee OA, considering the available evidence and the clinical knowledge of experienced surgeons. The overall goal is to offer an evidenced-based expert opinion, aiding clinicians in the management of knee OA while considering the condition, values, needs and preferences of individual patients.
The study design for this position statement involved a preliminary search of PubMed, Google Scholar, Medline and Cochrane databases for literature spanning the period between January 2021 and April 2023, followed by screening of relevant articles (systematic reviews and meta-analyses). A Società Italiana Ortopedia e Traumatologia (SIOT) multidisciplinary task force (composed of four orthopaedic surgeons and a rheumatologist) subsequently formulated the recommendations.
Evidence-based recommendations for the non-surgical management of knee OA were developed, covering assessment, general approach, patient information and education, lifestyle changes and physical therapy, walking aids, balneotherapy, transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy, pharmacological interventions and injections.
For non-surgical management of knee OA, the recommended first step is to bring about lifestyle changes, particularly management of body weight combined with physical exercise and/or hydrotherapy. For acute symptoms, non-steroidal anti-inflammatory drugs (NSAIDs), topic or oral, can be used. Opioids can only be used as third-line pharmacological treatment. Glucosamine and chondroitin are also suggested as chronic pharmacological treatment. Regarding intra-articular infiltrative therapy, the use of hyaluronic acid is recommended in cases of chronic knee OA [platelet-rich plasma (PRP) as second line), in the absence of active acute disease, while the use of intra-articular injections of cortisone is effective and preferred for severe acute symptoms.
膝骨关节炎（OA）是一种慢性疾病，严重影响生活质量。然而，不幸的是，目前还没有针对这种疾病的非手术治疗的循证指南。鉴于科学证据与临床实践之间的差距，本立场声明旨在根据现有证据和经验丰富的外科医生的临床知识，提出膝骨关节炎的非手术治疗建议。总体目标是提供循证专家意见，帮助临床医生在考虑患者病情、价值观、需求和偏好的情况下管理膝骨关节炎。
本立场声明的研究设计包括对 2021 年 1 月至 2023 年 4 月期间文献的初步搜索，使用 PubMed、Google Scholar、Medline 和 Cochrane 数据库，随后筛选相关文章（系统评价和荟萃分析）。一个 Società Italiana Ortopedia e Traumatologia（SIOT）多学科工作组（由四名骨科医生和一名风湿病医生组成）随后制定了建议。
制定了膝骨关节炎非手术治疗的循证建议，涵盖评估、一般方法、患者信息和教育、生活方式改变和物理治疗、助行器、水疗、经皮神经电刺激、脉冲电磁场治疗、药物干预和注射。
对于膝骨关节炎的非手术治疗，建议的第一步是改变生活方式，特别是管理体重结合体育锻炼和/或水疗。对于急性症状，可以使用非甾体抗炎药（NSAIDs），局部或口服。阿片类药物只能作为三线药物治疗。葡萄糖胺和软骨素也被建议作为慢性药物治疗。关于关节内浸润性治疗，建议在慢性膝骨关节炎（PRP 作为二线）的情况下使用透明质酸，在没有活动的急性疾病的情况下，而皮质类固醇关节内注射对于严重的急性症状有效且首选。
