Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflict of interest. 3. Pain Pract. 2025 Jan;25(1):e13408. doi: 10.1111/papr.13408. Epub 2024 Sep 1. 9. Chronic knee pain. Vanneste T(1)(2)(3), Belba A(1)(2)(4), Oei GTML(5)(6), Emans P(7), Fonkoue L(8)(9), Kallewaard JW(6)(10), Kapural L(11), Peng P(12), Sommer M(2)(3), Vanneste B(13), Cohen SP(14)(15), Van Zundert J(1)(2)(3). Author information: (1)Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Genk, Belgium. (2)Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. (3)MHeNs, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands. (4)Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. (5)Department of Anesthesiology and Pain Medicine, Dijklander Ziekenhuis, Hoorn, The Netherlands. (6)Department of Anesthesiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands. (7)Department of Orthopaedic Surgery, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, The Netherlands. (8)Department of Morphology, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium. (9)Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium. (10)Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands. (11)Carolinas Pain Institute, Winston Salem, North Carolina, USA. (12)Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. (13)Department of Anesthesia and Pain Medicine, AZ Groeninge, Kortrijk, Belgium. (14)Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. (15)Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. INTRODUCTION: Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. METHODS: The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. RESULTS: Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. CONCLUSIONS: When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery. © 2024 The Author(s). Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain. DOI: 10.1111/papr.13408 PMCID: PMC11680467