What is the first-line nonoperative management for symptomatic knee osteoarthritis?

• A. Weight loss, physical therapy, activity modification, and NSAIDs as appropriate
• B. Surgical arthroplasty
• C. Rest with no activity
• D. Corticosteroid injections only

Answer: (A)

Managing symptomatic knee osteoarthritis starts with conservative measures that reduce joint load, improve support, and control pain, without jumping to surgery. The best first-line approach combines nonpharmacologic and pharmacologic strategies: weight reduction if overweight to lessen mechanical stress on the knee, a structured exercise or physical therapy program to strengthen the quadriceps and surrounding muscles and to maintain range of motion, and activity modification to avoid activities that aggravate symptoms. Alongside these, NSAIDs or other analgesics can be used as appropriate to help manage pain.

Surgical arthroplasty is considered only after conservative measures have failed or if there is advanced joint damage, so it isn’t a first-line option. Rest with no activity isn’t beneficial for knee OA because it leads to weakness and stiffness without addressing the underlying mechanics. Corticosteroid injections can relieve pain but are not used as the sole, initial management; they’re typically considered as an adjunct to a broader plan.