In December 2008, the American Academy of Orthopaedic Surgeons (AAOS) released 22 treatment recommendations based on evidence-based medicine for patients with osteoarthritis of the knee who are not yet ready for joint replacement, after concluding that some of the treatments currently in common use in the treatment of osteoarthritis of the knee (OA) lack a strong scientific basis. The guidelines are aimed at primary physical therapists and orthopaedic surgeons and do not endorse widely accepted treatments such as nutrition with glucosamine, sulfate or chondroitin hydrochloride and traditional orthopaedic devices like heel wedge pads.
”There is no question that arthroplasty has tremendous value in the treatment of end-stage osteoarthritis, but the more important question is how to treat patients who do not yet need arthroplasty,” said John Richmond, chair of the AAOS Task Force that launched the guideline, and of the 33 million people in the United States with osteoarthritis According to AAOS President Tony Rankin, MD, this guideline is a distillation of the latest research on knee OA.
The guidelines recognize that patient education and lifestyle changes play an important role in the management of OA. Therefore, the guidelines recommend aerobic exercise, strength and low-intensity training, and weight control for patients with a body mass index over 25. Acetaminophen and non-hormonal anti-inflammatory drugs are mainly used for pain relief.
This guideline concludes that arthroscopic surgery is not necessarily superior to physical therapy or medication, and that it is primarily reserved for patients with OA who have meniscal tears or free bodies in the joint cavity, and does not support the widespread use of arthroscopy in other cases.
This guideline also agrees with a 2007 study that concluded that the results of clinical use of viscous substances such as sodium vitrate were inconclusive. The guideline no longer recommends the use of these drugs, which were approved by the FDA more than 10 years ago, and Richmond believes that much of the previous literature on these drugs was funded by the manufacturers and that most of the studies were statistically flawed.
Dr. Ted Epperly, president of the American Association of Family Physical Therapists, said the guidelines are “balanced, fair and accurate” and will be welcomed by physical therapists. The guidelines are also refreshing in that they do not favor an invasive approach.
I. The guidelines recommend effective methods for the treatment of knee OA
1. Patients with a body mass index (weight/height squared) of more than 25 should lose at least 5% of their body weight
2. Aerobic low-intensity adaptive exercise
3, the use of acetaminophen (no more than 4g / d) or non-steroidal anti-inflammatory drugs to relieve pain. In addition, patients at high risk of gastrointestinal distress can use topical NSAIDs, or oral gastroprotective agents and COX-2 inhibitors.
4.For short-term pain relief, intra-articular glucocorticoid injections can be used.
5.Arthroscopic surgery can be performed in case of meniscal injury or free body
6.Patellar support band for short term pain relief
This guideline does not recommend the following therapeutic measures for the treatment of knee OA
1. Puncture irrigation
2. Glucosamine or (and) chondroitin sulfate (hydrochloride)
3. Foot orthopedic brace
4. Arthroscopic washout in the absence of free body or meniscus injury for indeterminate results
III. Treatment of unspecified treatment measures
1.Intra-articular sodium hyaluronate injection for mild and moderate OA
2.Support
3.Acupuncture
(taken from Medical Reference Journal)
Attachment: height and body mass index
BMI (Body Mass Index, also known as Body Mass Index, or BMI for short), is a number derived from dividing body weight in kilograms by height in meters squared, and is a standard commonly used internationally to measure how fat or thin the human body is and whether it is healthy. BMI is a neutral and reliable indicator when we need to compare and analyze the health effects of a person’s weight on people of different heights.
Body Mass Index
This concept was first introduced by Kettler, a Belgian generalist in the mid-19th century. It is defined as follows.
Body Mass Index (BMI) = weight (kg)/height (m) squared.
Statistical significance of BMI values
The BMI was originally designed as a statistical tool for public health research. When we needed to know whether obesity was the cause of a disease, we could convert a patient’s height and weight into BMI and find out if there was a linear correlation between the value and the incidence of the disease. However, with the advancement of technology, the BMI value is now only a reference value. To truly measure whether a patient is obese, it is necessary to use microelectricity to measure the patient’s impedance in order to deduce the thickness of the patient’s fat. Therefore, the role of BMI is slowly changing from a medical use to a slimming indicator for the general public.
BMI values for adults
Body mass index, male, female
Underweight, below 20, below 19
Moderate, 20-25, 19-24
Overweight, 26-30, 25-29
Obese, 30-35, 29-34
Very obese, above 35, above 34
Experts say the ideal body mass index is 22
Because of the error, BMI can only be used as one of several criteria to assess an individual’s weight and health status. The National Institutes of Health (NIH) recommends that physicians evaluate whether a patient is overweight by looking at three factors
BMI Waist circumference – a measure of abdominal fat and risk factors for obesity-related diseases, such as high blood pressure, high LDL (“malignant”) cholesterol, high HDL (“benign”) cholesterol too low, hyperglycemia, and smoking.
Because BMI does not take into account a person’s fat percentage, a person with an overweight BMI may not actually be obese. For example, a person who practices fitness will have a BMI over 30 because they weigh a heavy percentage of muscle. if they have a low percentage of body fat, then they do not need to lose weight.
Asian standards
The traditional WHO adult obesity standard is less than 30, but the Asian adult indicator has recently been changed to 27.5. an Asian adult with a BMI of 23 is now considered overweight, while the ideal index is 18.5 to 22.9. the official indicator for Singapore
BMI values for children
BMI does not apply to adults alone. For growing children, we can also use their BMI values to project whether they are overweight. The above BMI formula is also applicable to people aged 2-20 years old, but their overweight and underweight indicators are not determined by a fixed BMI value. This is because children in different regions have different growth rates, and if a fixed value is used, it is easy to make a wrong judgment.
Many countries and regions have annual height and weight statistics for their children. These statistics can be converted into BMI values, and then the distribution of BMI values of local children can be calculated. Based on this distribution, local health authorities can project the overweight and underweight indicators of local children. Generally, the average BMI and its standard deviation values are used to calculate the highest 5% and lowest 5% of the normal distribution as the overweight and underweight indicators. On the other hand, children with a BMI in the range of 85%-95% of the normal distribution are at risk of being overweight.