This post is the second part of a discussion focused on the Osteoarthritis of the Knee Clinical Care Standard; part one can be found here. An updated version of the care standard was released in 2024, the document is prepared by the Australian Commission on Safety and Quality in Health Care (ACSQHC) and it serves to distil the knee osteoarthritis (knee OA) research into quality statements that guide healthcare practitioners in the provision of best evidence care.
Knee Osteoarthritis
Osteoarthritis is a chronic, inflammatory disease that affects many of the body’s joints, it affects 2.1 million Australians and approximately 30% of people over the age of 75 years old experience osteoarthritis. Knee OA presents as painful, swollen and stiff knees, these experiences negatively affect physical function of the lower limbs, impacting participation in work, leisure, cultural and social activities. Knee OA is the main reason for people undergoing knee replacement surgery, and people who are overweight or obese are at a greater risk for experiencing knee osteoarthritis.
Below are some interesting observations taken from the Osteoarthritis of the Knee Clinical Care Standard…
Medicines
Quality statement six is very clear when it tells clinicians not to offer platelet rich plasma (PRP) injections to people experiencing knee OA, as the treatment provides no benefit and is costly. The process of a PRP treatment starts by extracting an individual’s blood, then separating the blood plasma from the red blood cells using a centrifuge. Plasma contains proteins that support cell growth, and it’s claimed injecting plasma into a knee will support the osteoarthritic tissues, however there is insufficient evidence to support the claim.
As an Exercise Physiologist working with older people in the active healthcare space, I became aware of PRP being used as a treatment for knee OA approximately 10-years ago. A PRP clinic opened in an adjoining town and in no time multiple clients were receiving treatment(s) for knee OA, outcomes were mixed. Next, the clinic was so busy a second clinic arrived, and almost instantly PRP treatment for people experiencing knee OA became entrenched locally as a valid treatment option. Professionally I struggled to reconcile the limited PRP and knee OA research with local, clinical realities. The 2024 Osteoarthritis of the Knee Clinical Care Standard has examined the available science and brought clarification by classifying PRP as an ineffective treatment for knee OA
Surgery
Quality statement eight addresses surgical approaches for knee OA. The first part of the statement asks that an individual experiencing knee OA only be considered for joint replacement surgery if they’re experiencing severe functional impairment and have unsuccessfully engaged with non-surgical management. The statement is also very clear in its expectation for healthcare providers, when it asks clinicians to only engage with surgical options, if the individual experiencing knee OA has firstly participated in 12-weeks of optimal physical activity/exercise. People experiencing knee OA should engage in 12-weeks of optimal physical activity/exercise (likely with Exercise Physiologist or Physiotherapist support), before speaking with a surgeon.
Quality statement eight also states that knee arthroscopic surgery is not recommended. Arthroscopy is a surgical procedure that involves making a keyhole incision in the knee, into which a small camera is inserted, the camera is then used by the surgeon to perform procedures such as debridement and meniscectomy. While the number of knee arthroscope surgeries for knee OA management are falling, they are still a common surgical procedure. However, the 2024 Osteoarthritis of the Knee Clinical Care Standard has examined the available scientific literature and concluded arthroscopy provides no clinically significant improvements in pain and function for people experiencing knee OA.
If you’re experiencing knee OA and engaging with approaches for management, it would be wise to avoid PRP injections and arthroscopic surgery. A good place to start, should involve 12-weeks of optimal physical activity/exercise with an Exercise Physiologist or Physiotherapist.
Thanks for reading, Warwick (Movement Health, Forster Tuncurry Massage)..
(If you found this article helpful and would like to support my writing, you could, shout me a coffee).
Australian Commission on Safety and Quality in Health Care (2024). Osteoarthritis of the Knee Clinical Care Standard. https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf
Australian Commission on Safety and Quality in Health Care (2024). Osteoarthritis of the Knee Clinical Care Standard – Guide for consumers. https://www.safetyandquality.gov.au/sites/default/files/2024-08/consumer-guide-osteoarthritis-knee-clinical-care-standard.pdf
Harris, I., O’Connor, D., & Buchbinder, R. (2018). Needless procedures: knee arthroscopy is one of the most common but least effective surgeries. The Conversation. https://theconversation.com/needless-procedures-knee-arthroscopy-is-one-of-the-most-common-but-least-effective-surgeries-102705
Nall, R. (2024) What is PRP? healthline. https://www.healthline.com/health/prp
*Disclaimer, this is a discussion and does not represent an exercise prescription, for exercise or injury advice seek an appropriately trained health professional.
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