(i) Novel treatments for early osteoarthritis of the knee

While partial/total knee replacement remains the cornerstone of treatment of end stage osteoarthritis (OA), there is a large population of patients with painful knees and early arthritis for whom arthroplasty is inappropriate. Weight loss, anti-inflammatory analgesics, physiotherapy, use of sticks, and activity modification remain the basis of treatment in this group. In this article we review the evidence for a number of popular treatment options and review possible future therapeutic strategies. Once considered a safer alternative, COX-2 inhibitors have become the subject of intense scrutiny with recent evidence suggesting cardiac and CNS side effects. Current evidence supports the use of intra-articular visco-supplementation and corticosteroids but the role of oral glucosamine and chondroitin sulphate remains debatable. Arthroscopic debridement and micro-fracture techniques are shown to be effective in selected patients.