Before these appropriate use criteria are consulted, it is assumed that:

  1. The physician has an informed discussion with the patient about the treatment options and that the optimum treatment options may change over time for the patient. Before operative intervention is recommended, the appropriateness and potential efficacy of non-operative intervention has been considered.
  2. The clinician knows the contraindications to the utilization of certain medications and anesthetics or important surgical contraindications to operative interventions.
  3. Prescription of narcotic medicine for refractory pain (oral or transcutaneous opioids) should be monitored, intermittent or low dose in conjunction with other therapies
  4. The patient has a diagnosis of osteoarthritis of the knee.
  5. The patient is symptomatic including pain, instability, stiffness, quadriceps weakness and/or atrophy, and/or deformity that leads to loss of function.
  6. The patient’s symptoms are consistent with the history, physical exam, and imaging findings.
  7. The imaging findings are consistent with early, mild, moderate, or severe osteoarthritis.
  8. AP and/or PA Flexion weight-bearing (Either AP or PA flexion), lateral, and/or patellar view radiographs are obtained.
  9. If a patient has a BMI ≥ 30, discussion of and/or referral for weight loss and nutritional counseling is strongly recommended.
  10. The physical examination, history, and imaging studies have excluded the following potential causes of knee pain:
    • Referred pain from the spine
    • Ipsilateral hip arthritis
    • Ankle/foot deformity
    • Vascular disease (arterial or venous)
    • Non-articular causes of knee pain including soft-tissue disorders
    • Neoplasm
    • Neuropathy
    • Stress fractures, insufficiency fracture, osteonecrosis, or symptomatic metabolic bone disease
    • Confirmed inflammatory disorders
  11. At the time of the development of these appropriate use criteria, serotonin inhibition therapies were not part of the guideline and were not part of the data analyzed. Therefore, they were not considered as a treatment
  12. There will be patients for whom arthroplasty may be the most appropriate treatment, but the use of arthroplasty was not considered in these appropriate use criteria.




Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment.

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