KNEE OSTEOARTHRITIS CLINICAL CARE STANDARDS

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The  Australian Commission on Safety and Quality in Health Care’s, 2017, "Osteoarthritis of the Knee Clinical Care Standard" provides an evidence-based approach for patients with knee osteoarthritis, to enhance symptom control, joint function, psychological wellbeing, quality of life, participation in usual activities, and to lessen the disability of knee osteoarthritis.

The Standard relates to care that patients aged 45 years and over should receive when they present with knee pain and are suspected of having knee osteoarthritis.

The Standard was revised and updated in August 2024. The Clinical Care Standard has been endorsed by 22 organisations, including The Australian Physiotherapy Association.

The Clinical Care Standard considers new evidence and expanded priorities so that people with knee osteoarthritis receive consistent care.

The Clinical Care Standard comprises of eight quality statements focussed on comprehensive assessment and diagnosis, appropriate use of imaging, education and self-management, physical activity and exercise, weight management and nutrition, medicines used to manage pain and mobility, patient review, and surgery, in line with contemporary evidence and international guidelines.

1) COMPREHENSIVE ASSESSMENT AND DIAGNOSIS
A patient with suspected knee osteoarthritis receives a comprehensive assessment, including a detailed history, a physical examination, and evaluation of factors affecting quality of life and participation in activities. A diagnosis of knee osteoarthritis can be confidently made based on this assessment

2) APPROPRIATE USE OF IMAGING
Imaging is not routinely used to diagnose knee osteoarthritis and is not offered to a patient with suspected knee osteoarthritis as there is a poor correlation between radiological evidence of osteoarthritis and symptom severity.

3) EDUCATION AND SELF-MANAGEMENT
Information about knee osteoarthritis and treatment options is discussed with the patient, including:

• Strategies to support increased physical activity
• Strategies to improve comfort and mobility
• Weight management guidance
• Strategies to optimise overall health
• Discussion of non-pharmacological pain management
• Referral to other clinicians
• Adjusting the management plan as needed
• Involvement of the patient’s family / support team as appropriate

4) PHYSICAL ACTIVITY AND EXERCISE
A patient with knee osteoarthritis is advised that being active can help manage knee pain and improve function. Exercise will not cause damage and is not a risky activity.

5) WEIGHT MANAGEMENT AND NUTRITION
A patient with knee osteoarthritis is advised of the impact of body weight on symptoms. Loss of excess weight can reduce knee pain and improve function, reducing the need for medicines and surgery. A 5-10% weight loss over 20 weeks is associated with reduced pain and improved quality of life.

6) MEDICINES USED TO MANAGE PAIN AND MOBILITY
Patients should speak with their GP and pharmacist regarding the management of their medicines, any possible side effects, and any potential interactions. Patients are not offered opioid analgesics for knee osteoarthritis because the risk of harm outweighs the benefits.

7) PATIENT REVIEW
A patient with knee osteoarthritis receives planned clinical review at agreed intervals, and management is adjusted for any changing needs.

8) SURGERY
A patient with knee osteoarthritis who has severe functional impairment despite optimal non-surgical management is considered for timely joint replacement surgery or joint-conserving surgery. Arthroscopic procedures are not offered to treat uncomplicated knee osteoarthritis.

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​For more information and resources, see:
​www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard