Updated recommendations for hip and knee osteoarthritis provide guidelines for warfighter ‘function and readiness’

Military healthcare personnel across the Defense Health Agency who treat patients with hip and knee osteoarthritis now have access to the 2026 Clinical Practice Guideline on the Non-Surgical Management of Hip & Knee Osteoarthritis.

Updated CPGs “allow us to provide current, evidence-based recommendations for managing osteoarthritis in service members and veterans, ensuring they receive the best care for this chronic and often difficult-to-treat condition,” said retired Army Col. (Dr.) Jess Edison, division director of rheumatology at the Uniformed Services University’s School of Medicine and one of the champions of the CPG work group.

The Department of Veterans Affairs and the Department of Defense prepared the guidelines, updating the 2020 version.

Condition impacts readiness, requires tailored treatments

Osteoarthritis can cause chronic pain, limit movement, and affect a service member’s ability to train, deploy, or complete mission tasks, and is a major cause of disability among veterans, said Edison. The updated guidelines help providers standardize care, improve outcomes, and reduce patient harm — ultimately delivering warfighter medical readiness, one of the DHA director’s Lines of Effort and a key goal of updated CPGs.

“Osteoarthritis is the second-leading cause of military separation after back pain,” noted Edison. “CPGs provide clinicians with a standardized, evidence-based approach to managing symptoms, meaning we can keep more service members healthy, functional, and deployable, while also giving clinicians the information for effective treatment they need and beneficiaries the patient-centered care they deserve.”

For service members with osteoarthritis, a personalized approach is recommended to work safely with the condition rather than expecting to reverse it. “From a readiness standpoint, it’s what can I do right to adapt and work through this arthritis because arthritis is an aging process,” said Army Lt. Col. Bryan Pickens, associate dean of the U.S. Army Medical Center of Excellence Department of Graduate Education. “You’re never going to reverse the process, but we can adapt, improve function, and decrease pain.”

Updated CPGs serve as a framework for treatment

The revised version provides 11 new recommendations, with key changes including weight loss in those with osteoarthritis of the knee, and emphasizes “against initiating opioids, given the harms that can occur,” Edison said.

Early identification, structured exercise-based therapy, physical therapy, weight management when appropriate, and shared decision-making are outlined to improve function and reduce unnecessary invasive interventions, the guidelines state. The CPGs also provide recommended treatment options, including pharmacological, nonpharmacological, and complementary and alternative medicine approaches, as well as referrals for surgical consultation — in an effort to deliver integrated capabilities to improve patient outcomes.

Guidelines make expert-led, evidence-based recommendations ‘digestible’ for providers

Pickens, a champion who led the work group, said regular updates matter because medical evidence continues to change. “The pace of advancements in medicine requires us to keep up from a literature standpoint,” Pickens said. “With CPGs, we try to distill that down for the provider as a good starting point for how to take care of our patients.”

CPGs “do not dictate what clinicians must do,” Edison said. “They help clinicians discuss options, risks, and benefits with their patients. This is especially important in osteoarthritis treatment, where the clinical path often depends on the patient's individual goals and functional priorities rather than disease severity alone.”

“We’re really trying to consolidate that best evidence into a place that makes it digestible,” Pickens said. The provider can then take the time to decide with the patient, “This is what I think we should do in this situation,” he added.

Time, Edison noted, is something medical providers do not have much of, with research and evidence changing rapidly. “CPGs are important because most clinicians are busy, and do not have the time to read every published study. A CPG is one of the tools used to simplify this appraisal, utilizing a panel of experts to deliver clear recommendations.”

Since 2024, the DHA’s Office of Evidence-Based Practice has overseen the joint VA-DOD CPG working groups, comprised of multifunctional, experienced healthcare professionals, and promote new and updated CPGs. Pickens highlighted that including representatives from all specialties involved in a patient's care are key to CPG recommendations. “The kind of breadth and depth of their specialties helps us get to a good product that makes solid recommendations.” Providing an all-encompassing view of osteoarthritis healthcare specialties also ensures military providers have the tools to maintain medical warrior currency and provide the best care for warfighters.

Edison noted CPGs focus on ensuring readiness and providing all patients with the healthcare they deserve. “For the patient, it means their care is grounded in the best evidence and tailored to them through shared decision-making. For the warfighter, it is about function and readiness.”