SBM: Knee Osteoarthritis – Thumbs Down for Acupuncture and Glucosamine

Good article over at Science Based Medicine – Knee Osteoarthritis: Thumbs Down for Acupuncture and Glucosamine. They highlight the American Academy of Orthopaedic Surgeons (AAOS) 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery (see summary).

The report states that there is strong evidence against the use of acupuncture and glucosamine in knee osteoarthritis.

Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)

Exercise – strong evidence for effectiveness
Weight loss – moderate evidence for
Acupuncture – strong evidence against
Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Lateral wedge insoles – moderate evidence against
Glucosamine and chondroitin – strong evidence against
NSAIDs – strong evidence for
Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
Intraarticular corticosteroid injections – inconclusive
Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
Growth factor injections and/or platelet-rich plasma – inconclusive
Needle lavage – moderate evidence against
Arthroscopy with lavage and debridement – strong evidence against
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

Exercise is at the top of the list – no easy shortcut folks!

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