AAOS approves AUC for non-arthroplasty treatment of osteoarthritis of the knee

The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors recently approved an AUC to help physicians treat patients with osteoarthritis (OA) of the knee. OA is a slowly progressing and degenerative disease that causes the joint cartilage to wear away.

In 2010, it was estimated that nearly 10 million adults had symptomatic OA of the knee, and risk factors of this condition can increase with age, especially in women. Genetics, high body mass, certain occupations or heredity also may increase one's risk of developing this disease. Typically, patients try non-arthroplasty options for many months or years, before considering a total joint replacement surgery.

"The background for this AUC comes from the 2013 AAOS evidence-based clinical practice guideline on OA of the knee, a comprehensive review of all the available evidence," said Michael Heggenness, MD, an orthopaedic surgeon who served as a non-voting moderator during the voting panel process. "This AUC is a tool that takes that guideline one step further; it marries the available evidence with expert medical opinion and is available at the touch of a web and mobile-based app."

"Physicians outside of orthopaedic surgery also can benefit from this tool," Dr. Heggenness added. "Knee pain is so common today and many patients might see their primary care doctor, rheumatologist or other physician for treatment, so we are hoping that other clinicians across medical disciplines familiarize themselves with this AUC and together we can help optimize patient care."

This web-based app is optimized to work on a wide range of devices, including Smartphones and tablets. It allows a clinician to select a variety of patient characteristics and, once submitted, receive appropriateness recommendations for each of the treatments covered by this AUC.

What is osteoarthritis?

Osteoarthritis is a condition in which the natural cushioning between joints - cartilage - degenerates. Microtrauma (injury at a microscopic level) within the joint triggers an immune reaction, which - in an ill-fated attempt to repair the damage - causes inflammation that leads to a breaking down of cartilage tissue causing pain, swelling and deformity.

Cartilage is a firm rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. The main function of cartilage is to reduce friction in the joints and serve as a "shock absorber". The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed. It can do this because of its high water content.

When the cartilage is damaged - for example in a joint stressed by abnormal weight bearing loads - attempts by the immune system to repair the damaged cartilage cause it to swell. The cartilage becomes thin, soft and cracked, exposing the bone beneath and leading to the formation of small cysts and new outgrowths of bone called osteophytes, which further disrupt the way the joint works and aggravate the problem. The joint space becomes narrowed, further altering the mechanics and adding to the stresses within the joint. Other tissues in the joint such as the surrounding membrane (the synovium) ligaments and tendons may also be affected. This degeneration is a gradual process that may go on over many years, although there are occasional exceptions.