Hong Kong College of Orthopaedic Surgeons position statement on management of osteoarthritis of knee: a Delphi study

Abstract

Introduction: Osteoarthritis of knee is one of the commonest causes of chronic pain and disability in Hong Kong. For the benefit of the public, it is the responsibility of the Hong Kong College of Orthopaedic Surgeons to prepare a position statement on management of OA knee. Methods: Taking reference of international guidelines and the practice of orthopaedic surgeons in Hong Kong, 26 potential interventions for management of OA knee are included into the position statement. A literature review was conducted in early 2022. Summaries of the best available evidence were prepared according to the Oxford Centre for Evidence-Based Medicine. A Delphi survey was distributed to an expert panel formed by 106 fellows of the College in June 2022. The results of the Delphi survey form the recommendations of the College in this position statement. Result: The College RECOMMENDS patient education, land-based exercise, water-based exercise, self-management programme, weight reduction, cane, paracetamol, topical NSAID, oral NSAID, high tibial osteotomy, total knee arthroplasty as treatment of OA knee; and does not recommend lateral wedge insole, denervation therapy and arthroscopic lavage. The College is unable to advocate for or against the use of thermotherapy, transcutaneous electrical nerve stimulation, pulsed electromagnetic wave therapy, acupuncture, valgus off-loading knee brace, knee sleeve, opioid analgesics, intra-articular steroid injection, intra-articular hyaluronic acid injection, intra-articular platelet rich plasma injection, oral supplements, and partial meniscectomy. Conclusion: The College presents a position statement on management of osteoarthritis of knee. These recommendations are in line with other international guidelines and represent the best clinical practice in OA knee available in Hong Kong.