Discover a world of educational opportunities to support your lifelong learning
Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship
RACGP offer courses and events to further develop the knowledge you need to develop your GP career
2022 RACGP curriculum and syllabus
for Australian general practice
The Abuse and violence: working with our patients in general practice provides the best-available current evidence for GPs
Stay up-to-date with the latest information and resources on the COVID-19 vaccine rollout.
Download the Standards for general practice (5th edition) - a benchmark for quality care and risk management in Australian general practices
Coronavirus (COVID-19) resources for general practitioners
Advice and guidelines for GPs and practice teams to help protect general practice information systems
Video consultations can provide convenient and accessible healthcare delivery
Read all of the RACGP reports and submissions on various healthcare topics
Read all of the RACGP position statements on various healthcare topics
Join our RACGP Facebook groups
Guideline for the management of knee and hip osteoarthritis
We are unable to recommend either for or against the use of MSM for people with knee and/or hip OA.
Conditional (neutral) recommendation
MSM is an organosulfur molecule that can be synthesised commercially from dimethylsulfoxide (DMSO). DMSO is a pungent solvent that has been used as an application for pain relief over arthritic joints. MSM has the advantage of being odourless, and can be easily taken orally in the form of a pill or a powder. The optimal dosing of MSM is not known, but 1–2 g twice a day is often offered in clinical practice.
There are three trials with short study durations (12–13 weeks), and pooled data found statistically and clinically significant benefits in pain. Even larger effects were found in function, but with very serious inconsistent results and high heterogeneity across studies. One trial had a high risk of bias because of inappropriate randomisation technique; while the other had potential reporting bias (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). The doses in the trials ranged from 1.5–6 g/day for 12 weeks. All of the studies were conducted in knee OA, so extrapolation to hip or other OA sites requires additional caution.
The working group discussed the concerns in the literature of publication bias, effects being mostly driven by industrysponsored trials, and the overall poor quality of the positive trials.
The use of MSM for OA is relatively safe. Minor side effects were recorded, including gastrointestinal adverse events, fatigue and headaches; however, these were not statistically significant compared with placebo.
We do not recommend offering arthroscopic, lavage and debridement, meniscectomy and cartilage repair for people with knee osteoarthritis (OA) unless the person also has mechanical symptoms of a clinically locked knee as per Australian Knee Society’s ‘Arthroscopy position statement’.
Strong against recommendation
Very low (lavage and debridement)
Very low (cartilage repair)
Arthroscopic surgery in people with knee OA is widely available and commonly occurs. It allows the surgeon to visualise the interior joint space. Arthroscopic joint lavage uses saline irrigation to remove particulate material, (eg cartilage fragments, calcium crystals). In arthroscopic debridement, whereby surgical instruments are used to smooth any rough articular surfaces. The goals of arthroscopic lavage and debridement are to decrease synovitis and improve joint motion. Arthroscopic meniscectomy is an outpatient, minimally invasive surgical procedure used to treat a torn meniscus cartilage in the knee.
There is very low-quality evidence that there is no apparent benefit in terms of pain, function or quality of life (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document) for joint lavage, debridement and meniscectomy in the setting of knee OA. Arthroscopy occurs more commonly in the private hospital setting than public hospitals. It is important to note that arthroscopy rates in knee OA have been declining in the past few years.
In the context of an intervention where there is a debatable benefit, measurable costs and potentially serious harms, the working group strongly recommends against the use of arthroscopy for lavage and debridement in the setting of knee OA. The Australian Orthopaedic Association and the Knee Society position statement strongly states that arthroscopy is not indicated for the treatment of knee OA. In the infrequent instance where exercise fails to release the locked knee, arthroscopy could be indicated.
Side effects from arthroscopic surgeries can include local pain and swelling, infection, prolonged drainage from the surgical site, bleeding into the joint, and thrombophlebitis. It is also associated with a number of potential harms, including deep venous thrombosis, premature joint replacement, and rarely, pulmonary embolism and death.
Did you know you can now log your CPD with a click of a button?
Administrative-report.pdf (PDF 2.76 MB)
Algorithm-Holistic-assessment-diagnosis-and-management-of-knee-and-hip-osteoarthritis.pdf (PDF 0.05 MB)
Guideline-for-the-management-of-knee-and-hip-osteoarthritis-2nd-ed-Appendix-1.pdf (PDF 0.04 MB)
Guideline-for-the-management-of-knee-and-hip-osteoarthritis-2nd-ed-Appendix-2.pdf (PDF 0.05 MB)
Implementation-plan.pdf (PDF 1.79 MB)
Public-consultation-summary.pdf (PDF 0.29 MB)
Technical-document.pdf (PDF 5.79 MB)