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Table 9 Guideline recommendations for surgery

From: A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

  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   
  1. AAOS, American Academy of Orthopaedic Surgeons; ACR, American College of Rheumatology; EULAR, European League Against Rheumatism.