The earlier knee arthritis is treated, the more likely knee pain can be relieved and the less likely it will get worse. Knee arthritis treatment may include nonsurgical treatments, injections, and surgery. Typically, nonsurgical treatments are tried first. Surgery is not usually necessary and recommended only when other treatments have been tried and have not adequately relieved symptoms.
Most physical therapy programs combine strengthening, stretching, and aerobic conditioning. The goals of physical therapy for knee arthritis include:
- Strengthening the muscles surrounding the knee as well as the buttocks and hip
- Stretching tight and inflexible muscles, such as hamstrings
- Encouraging the exchange of fluids and nutrients in the body with light aerobic exercises, such as walking, swimming, or pool therapy
Strong, pliable muscles can better support the knee joint, resulting in less pressure on the damaged cartilage and bone.
Gait and posture training
A physical therapist or doctor can also evaluate a person’s walking stride and/or other motions to identify biomechanical issues that may contribute to the individual's knee arthritis. Retraining and introducing new habits can limit future knee problems. Appropriately designed shoe inserts can help unload the part of the knee that is painful and may reduce overall discomfort.
Pain medications can be used to temporarily relieve knee arthritis pain.
- Over-the-counter oral pain medication. Analgesics, such as acetaminophen (Tylenol), can reduce pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as such as aspirin, ibuprofen (Advil), naproxen (Aleve), can reduce pain as well as the inflammation that contributes to pain.
- Prescription oral medication. When pain does not respond to over-the-counter medications, doctors may recommend prescription-level doses of medications such as naproxen and ibuprofen. They may also prescribe other types of medications, such as COX-2 inhibitors (Celebrex).
- Topical medications. Topical pain relievers come in both prescription and over-the-counter formulas. These creams can be applied directly onto the skin over the knee. In general, topical analgesics are less likely than oral medications to carry risks and cause side effects, such as stomach upset.
New medications to treat knee osteoarthritis are being explored and developed. Most pharmaceuticals, whether taken via pills or injections, are designed to treat the symptoms of arthritis and not reverse the process. In addition, some people use CBD and medical marijuana products (where they are legal), though more research is needed in this area.
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For people who are overweight or obese, losing weight will significantly reduce pressure on the knee joint. Reducing this pressure can help reduce or eliminate symptoms and slow down the progression of knee osteoarthritis.
Injections for Knee Osteoarthritis
When first-line treatments such as losing weight and physical therapy do not adequately relieve knee arthritis pain, a doctor may suggest therapeutic injections.
Several types of injections are available to help alleviate knee osteoarthritis pain.
- Hyaluronic acid injections, also known as viscosupplementation, provide lubricating fluid to the knee joint and can reduce pain.
- Platelet rich therapy (PRP) injections use elements of a patient’s own blood to reduce pain, improve function, and theoretically encourage tissue repair and healing.
- Stem cell injections use cells derived from bone marrow or fat (adipose) to harvest growth factors and some stem cells directly from the patient, and inject them back into the patient that same day. As with PRP, the goal of this treatment is to encourage new tissue growth.
- Prolotherapy is a therapy that involves several injections of an irritant (typically dextrose based “sugar water”) into the damaged tissue. Proponents believe the irritant spurs inflammation and re-starts the body’s natural healing process.
- Cortisone (steroid) injections are the most common type of joint injection used but have limited applicability as they may contribute to cartilage loss in an arthritic knee. 1 McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017 May 16;317(19):1967-1975. doi: 10.1001/jama.2017.5283. PubMed PMID: 28510679; PubMed Central PMCID: PMC5815012. Some doctors who treat knee arthritis will offer a steroid injection only once, while many arthritis experts have entirely stopped using steroid injections for knee arthritis. The goal of these injections is to reduce inflammation and thereby alleviate knee stiffness, swelling, and pain.
PRP injections, stem cell injections, and prolotherapy are regenerative medicine treatments that aim to reduce pain, improve function, and provide an environment to support tissue repair. They are considered experimental by insurance companies and are typically not an insurance-covered treatment.
Injections can be a great source of pain relief for some people, but they do not always work. The effect may be dramatic for some, and less so for others. The duration of action varies by individual.
The majority of people with knee osteoarthritis will never need surgery. However, if symptoms are severe and other treatments do not succeed, surgery may be a treatment option.
The most common surgery for knee arthritis is a total knee replacement. Other, less common surgeries include partial knee replacement and knee osteotomy surgery.
Arthroscopic knee surgery with debridement is a minimally invasive surgery that is no longer considered an effective treatment for knee osteoarthritis. Arthroscopic knee surgery is still an effective treatment approach for other knee problems, such as certain types of meniscus tears.