EXCERPT

1. Introduction

This guide summarizes evidence on the effectiveness and safety of three treatments for osteoarthritis of the knee: use of the supplements glucosamine, chondroitin, or both combined; viscosupplementation (injection of hyaluronan into the knee); and arthroscopic lavage and debridement of the knee joint. The evidence evaluated comes primarily from comparisons of each treatment approach with a placebo. This guide does not address other treatments, such as exercise, physical therapy, pain medications, corticosteroid injections, or knee replacement. 

Clinical Issue 

Osteoarthritis (OA) is the most common form of chronic arthritis worldwide and is a key cause of pain and disability in older adults. In the United States, clinically significant disease affects 10-20 percent of individuals age 60 and over. Osteoarthritis of the knee, about twice as common as OA of the hip, is becoming an increasingly important condition with the aging of the U.S. population. 
Osteoarthritis risk factors include injury, prior joint inflammation, abnormalities of joint shape, and obesity. The natural history of knee OA and the factors leading to its progression are not fully understood. 

The goals of treatment are to reduce pain and improve joint function. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as first-line treatment for OA pain, along with exercise and weight loss. The treatments described in this guide are intended to promote healing of damaged cartilage in the knee or to augment the composition of synovial fluid.

 

 

  Bottom Line: For people with osteoarthritis of the knee, at a "medium" level of confidence*, the following treatments do not lead to clinically meaningful improvement. 

• Glucosamine hydrochloride and chondroitin sulfate
• Viscosupplementation (intra-articular injection of hyaluronan products)  
• Arthroscopic lavage with or without debridement 

<sup>* Confidence Scale

The confidence ratings in this guide are derived from a systematic review of the literature. The level of confidence is based on the overall quantity and quality of clinical evidence.</sup>

Source: 

^{"Effective Health Care" Summary Guide  [free from AHRQ]}