"An estimated  percent of people are at risk of developing knee osteoarthritis OA in their lifetime. According to a network metaanalysis research article published in the May   issue of the Journal of the American Academy of Orthopaedic Surgeons JAAOS the nonsteroidal antiinflammatory drug NSAID naproxen was ranked most effective in individual knee OA treatment for improving both pain and function and is considered a relatively safe and lowcost treatment method. Nonsurgical treatments for knee OA supported by previous research evidence include strength training lowimpact aerobic exercises NSAIDs and weight loss in individuals with a body mass index over . This new research analyzed data from multiple trials to determine the relative effectiveness of various nonsurgical treatments for knee OA. The treatments that were compared and ranked included acetaminophen ibuprofen intraarticular IA or joint injections of cortisone plateletrich plasma PRP hyaluronic acid HA several NSAIDs such as naproxen celecoxib and diclofenac and both oral and IA placebo.  This is the first comprehensive mixedcomparison analysis comparing bestevidence scientific research and excluding lower quality studies that can bias the outcomes said lead author and orthopaedic surgeon David Jevsevar MD MBA. Using a statistical ranking technique we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function and we attempted to fill in the gaps in evidence for more inconclusive treatments such as HA PRP and corticosteroids.  Authors analyzed  randomized controlled trials that examined knee OA treatments for at least  days and included a minimum of  participants per study group. Knee OA treatments were ranked on a scale of one to five with one being the most effective. They found the following   For pain reduction cortisone injections provided the greatest shortterm  to  weeks pain relief followed by ibuprofen PRP injections naproxen and celecoxib.   Naproxen ranked the highest for probability for improving function followed by diclofenac celecoxib ibuprofen and PRP injections.   Naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by cortisone injections PRP injections ibuprofen and celecoxib.   HA injections did not achieve a rank in the top five treatments for pain function or combined pain and function. An analysis of  articles also found that results with HA are not significantly different from those with IA placebo for treatment of knee OA. Because knee OA has both a high disease burden and high treatment costs additional prospective studies using similar outcomes timelines and measures of clinically important changes are needed explained Dr. Jevsevar. While the information in this analysis is helpful to physicians patients also can benefit from these findings and use it with their doctors to weigh all possible treatment options.  Although the use of NSAIDs for arthritic conditions such as knee OA has potential risks including heart attack and stroke existing evidence indicates that naproxen has less potential for adverse cardiovascular events.   More information about the AAOS and JAAOS Follow the AAOS on Facebook Twitter and Instagram  Follow the conversation about JAAOS on Twitter Disclosures From the Department of Orthopaedics DartmouthHitchcock Medical Center Lebanon NH Dr. Jevsevar American Academy of Orthopaedic Surgeons Rosemont IL Mr. Shores Mr. Mullen Ms. Schulte and Dr. Cummins and Franciscan Orthopedic Associates Tacoma WA Dr. Brown. J Am Acad Orthop Surg  . DOI .JAAOSD"