AAOS Releases Guidelines for Surgical Treatment of Knee OA

    The American Academy of Orthopaedic Surgeons (AAOS) has introduced a new clinical practice guideline (CPG) for adults undergoing surgery to improve motion and relieve pain caused by osteoarthritis (OA) of the knee, focusing on total knee arthroplasty (TKA).

    “Total knee replacement is a safe and effective technique that benefits patients immensely,” said David Jevsevar, MD, MBA, chair of the AAOS Committee on Evidence-Based Quality and Value. “Many of the guidelines in the CPG are strongly recommended because the literature and other evidence of good outcomes was very compelling.”

    This CPG is the first evidence-based guideline for diagnosis, treatment, rehabilitation, and safety of patients with knee OA in whom surgery is warranted, AAOS said.

    The guidelines are timely because TKA is the top procedure – in terms of costs – reimbursed by the Centers for Medicare and Medicaid Services (CMS).

    Effective April 2016, CMS will issue bundled payment for TKA in designated geographic markets. Healthcare institutions can use the new guidelines to assist in planning the highest quality care to comply with the new rules, according to Dr. Jevsevar.

    The CPG, “Surgical Management of Osteoarthritis of the Knee,” provides guidelines for surgeons and patients to consider when making decisions about knee replacement. Among the key CPG recommendations in the report that received a “strong” rating are:

    • Reduction of risk factors such as weight and smoking
    • Administration of multimodal anesthesia, including local anesthetic and nerve blockade around the knee joint to decrease pain and opioid use following TKA
    • Treatment with tranexamic acid to decrease postoperative blood loss and transfusions following TKA
    • Starting rehabilitation the same day as TKA is performed to reduce length of hospital stay

    The Society of Military Orthopaedic Surgeons, Arthroscopy Association of North America, American Geriatrics Society, American College of Radiology, The Knee Society, and American Association of Hip and Knee Surgeons endorsed the CPG.