The updated knee osteoarthritis standard, and the care that adds little value
In August 2024, the Australian Commission on Safety and Quality in Health Care released an updated Osteoarthritis of the Knee Clinical Care Standard, revising the original 2017 version (ACSQHC, 2024). Its eight quality statements describe what good care looks like, from diagnosis through to referral for surgery.
What's new in 2024
The Commission highlights several changes:
Stronger statements on imaging, reinforcing that most people don't need scans to diagnose knee osteoarthritis.
Expanded guidance on weight management, nutrition, physical activity and exercise as the foundation of care.
More focus on psychosocial wellbeing, cultural safety and equity.
Better communication to support self management, so patients understand their condition and their options.
Arthroscopy: still not recommended
The case against arthroscopy for degenerative knee disease is well established. A 2017 BMJ guideline made a strong recommendation against it for nearly all adults with degenerative knee pain, with or without meniscal tears or mechanical symptoms. It found surgery gave only small, short term gains that were outweighed by its burdens and risks, and that further research was unlikely to change the recommendation (APTA summary of the BMJ guideline, 2017).
Why low value care is a rehab issue
Every unnecessary scan or procedure uses time, money and patient goodwill that could go towards what works: exercise, education, weight management and, when needed, well timed joint replacement with good rehab.
Putting the standard into practice
Lead with conservative care, and document it clearly before surgical referral.
Make exercise specific. Give patients a structured program, not just advice to stay active.
Follow up. Regular review keeps patients engaged and helps identify who genuinely needs surgery.
Digital programs can help clinicians deliver the standard consistently, giving every patient a structured plan and giving the clinician a clear view of how it's going.
This article is general information for health professionals and is not clinical advice.
