Last updated March 14, 2022

Non-Surgical Management of Hip & Knee Osteoarthritis

Recommendations

Diagnosis

We suggest against obtaining magnetic resonance imaging for the diagnosis of osteoarthritis of the hip and knee.
Weak Recommendation against
6731

Self management

We suggest a self-management program, including exercise and weight loss for osteoarthritis of the hip and knee, and bracing for osteoarthritis of the knee.
Weak Recommendation
6731

Physical Therapy

We suggest offering physical therapy as part of a comprehensive management plan for patients with osteoarthritis of the hip or knee.
Weak Recommendation
6731

Pharmacotherapy

Topical Pharmacotherapy

We recommend offering topical non-steroidal anti-inflammatory drugs for patients with pain associated with osteoarthritis of the knee.
Strong Recommendation
6731
There is insufficient evidence to recommend for or against the use of topical non-steroidal anti-inflammatory drugs for patients with pain associated with osteoarthritis of the hip.
6731
We suggest offering topical capsaicin for patients with pain associated with osteoarthritis of the knee.
Weak Recommendation
6731
There is insufficient evidence to recommend for or against the use of topical capsaicin for patients with pain associated with osteoarthritis of the hip.
6731

Oral Pharmacotherapy

We suggest offering acetaminophen and/or oral non-steroidal antiinflammatory drugs for pain associated with osteoarthritis of the hip and knee.
Weak Recommendation
6731
We suggest offering duloxetine as an alternative or adjunctive therapy for patients with an inadequate response or contraindications to acetaminophen or non-steroidal anti-inflammatory drugs for pain associated with osteoarthritis of the knee.
Weak Recommendation
6731
We suggest against initiating opioids (including tramadol) for pain associated with osteoarthritis of the hip and knee. For patients already on long-term opioid therapy, refer to the current VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain.
Weak Recommendation
6731
We suggest offering an intra-articular corticosteroid injection for patients with persistent pain due to osteoarthritis of the knee inadequately relieved by other interventions.
Weak Recommendation
6731
We suggest offering an intra-articular, image-guided corticosteroid injection for patients with persistent pain due to osteoarthritis of the hip inadequately relieved by other interventions.
Weak Recommendation
6731
We suggest offering intra-articular viscosupplementation injection(s) for patients with persistent pain due to osteoarthritis of the knee inadequately relieved by other interventions.
Weak Recommendation
6731
We suggest against the use of intra-articular viscosupplementation injection(s) of the hip.
Weak Recommendation against
6731

Orthobiologics

There is insufficient evidence to recommend for or against plateletrich plasma injections for the treatment of osteoarthritis of the hip or knee.
6731
We suggest against stem cell injections (e.g., mesenchymal, adiposederived, and bone marrow-derived) for the treatment of osteoarthritis of the knee.
Weak Recommendation against
6731

Complementary and Integrative Health, Dietary Supplements, and Nutraceuticals

There is insufficient evidence to recommend for or against the use of the following dietary supplements or nutraceuticals for the treatment of osteoarthritis of the hip or knee:
• Avocado and soybean extract
• Boswellia serrata
• Cannabidiol (CBD oil)
• Chondroitin
• Curcumin (active component of turmeric)
• Collagen
• Glucosamine
• Glucosamine plus chondroitin
• Methylsulfonylmethane
• Omega-3 fatty acid
• Pycnogenol (pine bark)
• Rosehip
• Traditional Chinese medicine
• Vitamin D
• Vitamin E
• Willow bark extract
6731
There is insufficient evidence to recommend for or against the use of complementary and integrative health interventions for the treatment of osteoarthritis of the hip or knee, including:
• Acupuncture
• Massage
• Light touch
• Meditation
• Tai chi
• Yoga
6731
There is insufficient evidence to recommend for or against the use of transcutaneous electrical nerve stimulation for the treatment of pain in osteoarthritis of the knee.
6731

Recommendation Grading

Overview

Title

Non-Surgical Management of Hip & Knee Osteoarthritis

Authoring Organization

Publication Month/Year

July 1, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Physical therapist, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D020370 - Osteoarthritis, Knee, D015207 - Osteoarthritis, Hip, D010003 - Osteoarthritis, D014493 - United States Department of Veterans Affairs, D058014 - Veterans Health, D014728 - Veterans

Keywords

osteoarthritis, hip osteoarthritis, knee osteoarthritis