Updated recommendations on knee osteoarthritis management: The Hong Kong College of Orthopaedic Surgeons position statement

Abstract

<strong></strong><p><b>Introduction:</b><br></p><p>To inform the public and medical practitioners about the effectiveness of various management regimens for knee osteoarthritis (knee OA), the Hong Kong College of Orthopaedic Surgeons (HKCOS) published a position statement in 2022. This study aimed to present the findings from expert consensus surveys conducted in 2022 and 2024, which form the basis of the recommendations in the position statement.</p><p><br></p><p><b>Methods:</b><br></p><p>Fellows of the HKCOS, who were listed in the Specialist Register (Orthopaedics and Traumatology) of the Hong Kong Medical Council, were invited via email to participate in online surveys in 2022 and 2024. The surveys collected opinions on 26 interventions for the treatment of knee OA. Expert panellists were instructed to provide their recommendation for each intervention using one of three options: ‘Recommend’, ‘Do not recommend’ or ‘Abstain’. A consensus of opinion was defined as a minimum of 70% agreement among the expert panellists.</p><p><br></p><p><b>Results:</b><br></p><p>A total of 106 expert panellists participated in the 2022 survey, and 28 participated in the 2024 survey. Consensus was reached among the expert panellists for 14 interventions in 2022 and 13 interventions in 2024. In both surveys, the expert panel reached consensus in recommending the following treatments for knee OA: patient education, land-based exercise, water-based exercise, self-management programme, weight reduction, use of a cane, oral paracetamol, topical non-steroidal anti-inflammatory drugs, oral non-steroidal anti-inflammatory drugs, high tibial osteotomy, and joint replacement surgery. Conversely, the expert panel reached consensus in recommending against the use of lateral wedge insoles and denervation therapy.</p><p><br></p><p><b>Conclusion:</b><br></p><p>Findings from both the 2022 and 2024 surveys demonstrated consistent expert consensus on key recommended and non-recommended interventions for knee OA. The recommendations provide evidence-based guidance to the public and medical practitioners regarding the effectiveness of various management strategies for knee OA.</p>

引言： 為了向公眾及醫護人員提供有關膝關節骨關節炎的有效治療方案，香港骨科醫學院於2022年發表了《香港骨科醫學院膝關節骨關節炎治療立場聲明》。本研究旨在報告2022年及2024年進行的專家共識調查結果，這些結果構成了該立場聲明中建議內容的基礎。

方法： 香港骨科醫學院分別於2022年及2024年透過電子郵件，邀請本院院士參與一項為期四週的網上問卷調查。這些院士均具備香港醫務委員會認可的骨科專科醫生註冊資格。調查涵蓋26項治療膝關節骨關節炎的方案，專家小組就每項方案提供意見，並從三個選項中擇一作答：建議、不建議或棄權。當某治療方案獲得70%或以上專家一致意見時，該建議即被視為該方案的專家主流意見。

結果： 共有106位專家小組成員參與了2022年的問卷調查，另有28位成員參與了2024年的問卷調查。在2022年，有14項治療獲得專家共識；在2024年，則有13項治療達成共識。在兩次調查中，專家小組一致建議以下治療方式用於膝關節骨關節炎：患者教育、陸上運動、水中運動、自我管理計劃、體重控制、使用手杖、口服撲熱息痛、外用非類固醇消炎藥、口服非類固醇消炎藥、高脛骨截骨術以及人工關節置換手術。專家小組亦達成共識，不建議使用外側楔形鞋墊和神經阻 斷治療。

結論： 2022年和2024年的問卷調查結果顯示，專家小組就膝關節骨關節炎的主要建議及不建議治療方案達成一致共識。相關建議為公眾及醫療專業人員就各種膝關節骨關節炎管理策略的成效，提供實證為本的指引。