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 |