The Australian Commission on Safety and Quality in Health Care has produced the Osteoarthritis of the knee clinical care standard indicators to assist with local implementation of the Osteoarthritis of the knee clinical care standard to support the delivery of high quality care (ACSQHC 2017).

The Osteoarthritis of the knee clinical care standard relates to the care patients aged 45 years and over should receive when they have knee pain and are suspected of having knee osteoarthritis. It covers the initial clinical assessment, ongoing conservative management over the course of the condition and referral to surgery if required. The clinical care standard applies to all healthcare settings where care is provided to patients with knee osteoarthritis, including primary care, specialist care, hospital and community settings.

A clinical care standard is a small number of quality statements that describe the clinical care that a patient should be offered for a specific clinical condition. The quality statements that are included in the Osteoarthritis of the knee clinical care standard are as follows:

1. Comprehensive assessment. A patient with knee pain and other symptoms suggestive of osteoarthritis receives a comprehensive assessment that includes a detailed history of the presenting symptoms and other health conditions, a physical examination, and a psychosocial evaluation that identifies factors that may affect their quality of life and participation in their usual activities.
2. Diagnosis. A patient with knee pain and other symptoms suggestive of osteoarthritis is diagnosed as having knee osteoarthritis based on clinical assessment alone. X-rays are considered only if an alternative diagnosis is suspected (for example, insufficiency fracture, malignancy). Magnetic resonance imaging (MRI) is considered only if there is suspicion of serious pathology not detected by X-ray.
3. Education and self-management. A patient with knee osteoarthritis receives education about their condition and treatments for it, and participates in the development of an individualised self-management plan that addresses both their physical and psychosocial health needs.
4. Weight loss and exercise. A patient with knee osteoarthritis is offered support to lose weight, if they are overweight or obese, and advice on exercise, tailored to their needs and preferences. The patient is encouraged to set weight and exercise goals, and is referred to services to help them achieve these, as required.
5. Medicines used to manage symptoms. A patient with knee osteoarthritis is offered medicines to manage their symptoms according to the current version of Therapeutic Guidelines: Rheumatology (or concordant local guidelines). This includes consideration of the patient’s clinical condition and their preferences.
6. Patient review. A patient with knee osteoarthritis receives planned clinical reviews at agreed intervals and management of the condition is adjusted for any changing needs. If the patient has worsening symptoms with severe functional impairment that persist despite the best conservative management, they are referred for specialist assessment.
7. Surgery. A patient with knee osteoarthritis who is not responding to conservative management is offered timely joint-conserving (e.g. high tibial osteotomy) (Zhang et al. 2008; American Academy of Orthopaedic Surgeons 2013), or joint replacement surgery, depending on their fitness for surgery and preferences. The patient receives information about the procedure to inform their treatment decision. Arthroscopic procedures are not effective treatments for knee osteoarthritis, and therefore should only be offered if the patient has true mechanical locking or another appropriate indication for these procedures (examples of appropriate indications for arthroscopic procedures are true mechanical locking, septic arthritis, or investigations when MRI is not possible) (Australian Knee Society 2016).