Knee Osteoarthritis
Knee osteoarthritis. Click to enlarge

While knee osteoarthritis is often a progressive and irreversible degenerative process, functional improvement and pain control are reasonable treatment goals.

Earlier treatment intervention may improve the odds of preserving joint integrity and function for years - or even a lifetime - which can stave off debilitating pain and possible need for joint replacement surgery.

Non-Surgical Treatments for Knee Osteoarthritis

Physical therapy and exercise
A graduated and targeted knee strengthening and stretching exercise program is an integral component of the treatment of knee osteoarthritis. Most often, an appropriately trained physical therapist or doctor will evaluate the biomechanical issues that may contribute to the individual's knee arthritis pain. Then, they will teach the patient specific exercises to stretch inflexible soft tissues, and others that build the muscles around the knee, thereby supporting the knee joint and making it less prone to further cartilage loss.

Article continues below
Advertisement

Activity modification
While exercise is important to treating knee osteoarthritis, some types of activities and exercise will aggravate the knee joint. Certain high impact activities should be avoided and alternatives may be identified. For example, jogging may be replaced with cycling or swimming, both of which exert less force on the knee joint. While painful knee osteoarthritis may cause someone to be less active in general, less physical activity is not advisable. In fact, inactivity is harmful, and often leads to other health problems. The health care provider will work with the individual patient to find alternatives or adaptive strategies to perform daily activities that trigger pain.

Periodic rest
A little discomfort is to be expected as stiff joints loosen up in the morning or at the beginning of exercise. However, when people feel terrible pain that limits their ability to function normally, they should generally not try to "work through the pain." Moderate to severe knee pain is a signal that the joint needs a rest. If there is no pain relief within 2 to 4 days of rest, then the individual should seek medical attention.

Warm or cold compress
Using a warming pad or whirlpool for a few minutes can loosen a stiff knee joint making activity easier. Icing the knee joint for 15 or 20 minutes after activity can decrease swelling and provide some immediate pain relief. Heating or icing a joint is focused on improving symptoms temporarily: it does not alleviate the underlying causes of knee pain and will not improve long-term joint function by itself.

Weight loss
A diet to maintain healthy weight can pay big dividends for those suffering from knee osteoarthritis. For every extra pound on the body an extra three pounds of pressure is exerted on the weight-bearing knee joint. Gaining 10 pounds can mean 30 pounds more pressure on the knee with each step, as well as a significantly greater chance of developing osteoarthritis.5 For people who are overweight or obese, losing weight will significantly reduce pressure and strain on the knee joint, thereby alleviating symptoms and perhaps slowing progression of knee osteoarthritis.

Medications and Injections for Knee Osteoarthritis

The medications listed below can be used to alleviate the symptoms of knee osteoarthritis. Doctor and patient should discuss medication in the context of the patient's lifestyle, severity of pain and medical history. Potential side effects and interaction with other drugs and vitamins/supplements should also be considered.

  • Analgesics. Pain relievers, such as acetaminophen (Tylenol) have relatively few side effects and relieve pain but do not reduce swelling.
  • Non-steroidal anti-inflammatory drugs (NSAIDs). Patients with moderate to severe pain may benefit from anti-inflammatory medications, such as aspirin, ibuprofen (Advil), naproxen (Aleve) or COX-2 inhibitors (Celebrex) to reduce the swelling and inflammation that are a common cause of pain. These drugs carry significant side effects and should be used with caution in elderly persons, in particular in those with high blood pressure and heart problems.
  • Topical analgesics. These creams can be applied directly onto the knee. Some involve topical preparations of NSAIDs that are touted to carry less risk of side effects. Some of these creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot, and Zostrix. Most can be used in combination with oral pain medications.

Glucosamine and chondroitin sulfate
Glucosamine sulfate and chondroitin sulfate occur naturally in the body's cartilage. In clinical trials conducted by the American College of Rheumatology, some patients with knee osteoarthritis reported benefits from taking supplements containing glucosamine sulfate or a combination glucosamine sulfate with chondroitin sulfate. Experts agree more study is needed to fully understand how these alternative supplements affect the symptoms of knee osteoarthritis.6

Injections
Two types of injections are commonly used for treatment of severe pain from knee osteoarthritis: steroid injections and hyaluronic acid injections.

  • The goal of steroid injections is to reduce swelling and thereby alleviate knee stiffness and pain.
  • The goal of hyaluronic acid injections, also known as viscosupplementation, is to provide lubrication for the knee joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates the knee joint.

The degree of pain relief from injections is variable. If effective, the results from the injections are temporary, sometimes lasting up to 6 to12 months.

Steroid and/or hyaluronic acid injections are usually used with the goal of providing enough pain relief to enable the patient to get started with a physical therapy program to strengthen muscles and rehabilitate the knee. Injections may also be an option for individuals who are sensitive to oral or topical medications.

Supportive devices and orthotics
Certain orthopedic products may be used to help stabilize or take pressure off the knee. Some examples include:

  • Cushioning shoe inserts can lessen the pressure put on the knee joint when walking
  • Elastic knee braces can support the knee joint
  • Using a cane on the opposite side of the affected knee can provide extra stability and reduce pressure on the knee

Coping techniques
To manage the pain, patients may employ techniques such as relaxation (e.g. relaxation tapes, meditation), visual imagery, biofeedback or hypnosis. For many, these techniques, along with a positive attitude that focuses on what activities are possible, can have a significant impact in moderating the knee pain.

Knee surgery
The majority of people with knee osteoarthritis will never need surgery. However, if osteoarthritis symptoms are severe and other treatments don't succeed, knee replacement surgery may be a treatment option.

Surgeries to relieve osteoarthritis of the knee include:

  • Knee arthroscopy to remove loose pieces of cartilage
  • Knee osteotomy to align bones and reduce friction
  • Knee arthroplasty to replace the knee joint with an artificial one.

A total knee replacement surgery is a relatively involved procedure and may require a long recovery and rehabilitation period. For most patients, commitment to an extensive and rigorous non-surgical treatment program, which typically includes rehabilitative physical therapy and exercise, will help them avoid the need for knee surgery.

References

  1. Felson DT, "Weight and osteoarthritis," The Journal of Rheumatology: Supplement, vol 43 (Feb 1995):7-9.
  2. Loes M, "Natural Medicine and Pain Relievers: A Review," Natural Medicine Online
Pages:
More Resources in the Osteoarthritis Center