Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Academy of Orthopaedic Surgeons.

Surgical Management of Knee Osteoarthritis

American Academy of Orthopaedic Surgeons

Publication Date: Dec 2, 2022

Page Last Updated: May 5, 2026

Interpreting the Strength of Evidence

Strength of Recommendation
Strength	Overall Strength of Evidence	Description of Evidence Quality
Strong	Strong	Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention.
Moderate	Moderate	Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention.
Limited	Low Strength Evidence or Conflicting Evidence	Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
Consensus*	No Evidence	There is no supporting evidence. In the absence of reliable evidence, the guideline development group is making a recommendation based on their clinical opinion. Consensus statements are published in a separate, complimentary document.

Document Overview

Document Title: Surgical Management of Knee Osteoarthritis

Authoring Society: American Academy of Orthopaedic Surgeons

Endorsing Societies

American Association of Hip and Knee Surgeons

American College of Radiology

American Geriatrics Society

American Society of Anesthesiologists

Document Publication Date: Dec 2, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.aaos.org/globalassets/quality-and-practice-resources/surgical-management-knee/smoak2cpg.pdf

Source Citation: American Academy of Orthopaedic Surgeons on the Surgical Management of Osteoarthritis of the Knee Clinical Practice Guideline. https://www.aaos.org/smoak2cpg.org Published 12/02/2022

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Diagnosis, Management, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D020370 - Osteoarthritis, Knee

Keywords: knee osteoarthritis, partial knee replacement, surgical management, total knee replacement (TKR)

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Emergency Care, Home Health, Hospital, Long Term Care, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Data Supplement Data Supplement

Number of Source Documents: 510

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Surgical Management of Knee Osteoarthritis

Summary of Recommendations

DRAINS

CEMENTLESS FIXATION: CEMENTED FEMORAL & TIBIAL COMPONENTS VS. CEMENTLESS FEMORAL & TIBIAL COMPONENTS

CEMENTLESS FIXATION: ALL CEMENTED COMPONENTS vs. HYBRID FIXATION (CEMENTLESS FEMORAL COMPONENT)

UNICOMPARTMENTAL vs.. TOTAL KNEE ARHTROPLASTY

PERIPHERAL NERVE BLOCKADE (PNB)

PERIARTICULAR LOCAL INFILTRATION

SURGICAL NAVIGATION

TRANEXAMIC ACID

RISK FACTORS: BODY MASS INDEX (BMI)

RISK FACTORS: DIABETES/HYPERGLYCEMIA

TOURNIQUETS

PATELLAR RESURFACING

CRUCIATE RETAINING ARTHROPLASTY

PATIENT SPECIFIC TECHNOLOGY

KINEMATIC VS. MECHANICAL ALIGNMENT

PRE-OPERATIVE OPIOID USE

CEMENTLESS FIXATION: ALL CEMENTLESS COMPONENTS VS. HYBRID FIXATION (CEMENTLESS TIBIAL COMPONENT)

UNICOMPARTMENTAL KNEE ARTHROPLASTY VS. HIGH/PROXIMAL TIBIAL OSTEOTOMY

UNICOMPARTMENTAL KNEE ARTHROPLASTY VS. HIGH/PROXIMAL TIBIAL OSTEOTOMY

BILATERAL SIMULTANEOUS TOTAL KNEE ARTHROPLASTY VS. STAGED

RISK FACTORS: SMOKING

ROBOTICS IN TOTAL KNEE ARTHROPLASTY

ROBOTICS IN UNICOMPARTMENTAL KNEE ARTHROPLASTY

Interpreting the Strength of Evidence

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology