What are the AAOS guidelines for total knee arthroplasty in the treatment of osteoarthritis (OA)?

Updated: Jun 10, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print
Answer

A 2016 guideline on surgical management of knee osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) includes the following recommendations regarding total knee arthroplasty (TKA) [154] :

  • Obese patients have less improvement in outcomes (strong supporting evidence)
  • Patients with diabetes are at higher risk for complications (moderate evidence)
  • Patients with select chronic pain conditions have less improvement in patient-reported outcomes (moderate)
  • Patients with depression and/or anxiety symptoms have less improvement in patient-reported outcomes (limited)
  • Patients with cirrhosis or hepatitis C are at higher risk for complications (limited)
  • An 8-month delay to TKA does not worsen outcomes (moderate)
  • Supervised exercise before TKA might improve pain and physical function after surgery (limited)
  • Compared with placebo, peri-articular local anesthetic infiltration in TKA decreases pain and opioid use (strong)
  • Compared with general anesthesia, neuraxial anesthesia can improve select perioperative outcomes and complication rates (moderate)
  • Use of a tourniquet in TKA decreases intraoperative blood loss (moderate) but increases short-term postoperative pain (strong) and decreases short- term postoperative function (limited)
  • In patients with no known contraindications, treatment with tranexamic acid decreases postoperative blood loss and reduces the necessity of postoperative transfusions (strong)
  • Routine use of antibiotics in the cement for primary TKA is not recommended (limited)
  • Outcomes and complications are no different with posterior-stabilized versus posterior cruciate–retaining arthroplasty designs
  • Outcomes are no different with either all-polyethylene or modular tibial components (strong)
  • Use of patellar resurfacing makes no difference in pain or function (strong), but could decrease cumulative reoperations after 5 years (moderate)
  • Cemented or cementless tibial component fixation provides similar functional outcomes and rates of complications and reoperations (strong)
  • Use of either cemented or cementless femoral and tibial components results in similar rates of complications and reoperations (moderate)
  • Either cementing all components or using hybrid fixation (cementless femur) results in similar functional outcomes and rates of complications and reoperations. (moderate)
  • Use of either all cementless components or hybrid fixation (cementless femur) results in similar rates of complications and reoperations (limited)
  • Simultaneous bilateral TKA can be performed in patients aged 70 or younger or with American Society of Anesthesiologists (ASA) status 1-2, because there are no increased complications (limited)
  • In patients with medial compartment osteoarthritis, revision surgery risk could be lower with TKA than with (moderate); however, risk of deep venous thrombosis and manipulation under anesthesia may be higher with TKA) than with unicompartmental knee arthroplasty (limited)
  • In patients with medial compartment knee osteoarthritis, there is no difference in outcome and complications with unicompartmental knee arthroplasty versus valgus-producing proximal tibial osteotomy (moderate)
  • Using intraoperative navigation makes no difference in outcomes or complications (strong)
  • Compared with conventional instrumentation, use of patient-specific instrumentation for TKA makes no difference in pain or functional outcomes (strong) or in transfusions or complications (moderate)
  • Use of a drain with TKA makes no difference in complications or outcomes (strong)
  • Use of cryotherapy devices after TKA does not improve outcomes (moderate)
  • Postoperative continuous passive motion (CPM) does not improve outcomes (strong)
  • Rehabilitation started on the day of surgery reduces length of hospital stay (strong), and reduces pain and improves function compared with rehabilitation started on postoperative day 1 (moderate)
  • A supervised exercise program during the first 2 months after TKA improves physical function (moderate) and may decrease pain (limited)
  • Selected patients might be referred to an intensive supervised exercise program during late-stage post-TKA to improve physical function (limited)

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!