People’s University of Medical & Health Sciences for Women, Nawabshah

Abstract

Importance: Knee osteoarthritis (OA) is a leading cause of pain and disability worldwide, with disproportionate impact in low- and middle-income countries (LMICs) where resource limitations constrain evidence-based care.

Objective: To synthesize current evidence on the management of knee OA and evaluate the challenges of translating global guidelines into resource-limited health systems, with a focus on Pakistan and comparable LMICs.

Evidence Review: A narrative review was conducted using PubMed, Scopus, Web of Science, and Cochrane Library (2000–2025). Randomized controlled trials, systematic reviews, meta-analyses, and clinical guidelines were included. Data were extracted on non-pharmacologic, pharmacologic, injection-based, and surgical interventions, with emphasis on feasibility in LMICs.

Findings: A total of 146 sources met inclusion criteria. Non-pharmacologic interventions (exercise therapy, weight reduction, and patient education) demonstrated consistent benefit and are strongly recommended by international guidelines. Oral and topical NSAIDs provide effective pain relief, though safety and affordability differ across settings. Acetaminophen shows limited efficacy. Corticosteroid injections offer short-term relief, while hyaluronic acid is no longer broadly supported. Platelet-rich plasma demonstrates promise but remains experimental and costly. Total knee arthroplasty is highly effective but inaccessible to most LMIC patients due to financial and infrastructural constraints. Cultural factors, gender inequities, and insufficient rehabilitation services further exacerbate care gaps.

Conclusions and Relevance: Management of knee OA in LMICs requires adaptation of evidence-based strategies to local constraints. Policy priorities should include integrating OA care into primary healthcare, task-shifting rehabilitation services, subsidizing surgical interventions, and expanding patient education. Strengthening musculoskeletal health systems will be essential to reduce disability and improve quality of life in resource-limited settings.