Knee osteoarthritis is a common condition in today’s population, made even more prevalent by the increasing amount of aging Baby Boomers and the obesity epidemic. In this article, I’ll review what knee osteoarthritis is as well as provide you with non-surgical treatment options to consider.
What is knee osteoarthritis?
First, let’s discuss some anatomy. The knee joint is made up of the following 3 bones:
- Thigh bone on top (i.e. the femur)
- Shinbone on the bottom (i.e. the tibia)
- Kneecap (i.e. the patella)
As you can imagine, bone is a rough, hard material. To cushion the knee joint, the surfaces of all 3 of these bones are lined with a soft tissue called cartilage.
Knee osteoarthritis refers to the wearing away of this cartilage, usually occurring slowly over a long period of time. This wearing away can cause friction, inflammation, stiffness, and pain in the knee joint – especially with deep bending and stairs.
Non-surgical knee osteoarthritis treatments
I have seen many patients who ask me if they just need to deal with the symptoms until they decide that they want a knee replacement. On the other hand, I have had patients who will tell me that another physician recommended that they go for a knee replacement as their first treatment option! As a non-surgical orthopedic doctor, I am happy to inform my patients that there are several options for treating knee arthritis that can postpone surgery or even make it unnecessary. I will go through each of these options below.
1) Weight loss
For those who are overweight, knee wear and tear is more likely. In fact, for every one pound overweight, there is an additional 4-5 pounds of force on the knee. Therefore, for overweight individuals, even a weight loss of 5 pounds can take 20-25 pounds of pressure off of the knees. This can greatly improve knee pain from osteoarthritis.
An effective way to lose weight is through a proper diet and exercise program. The best exercises for someone with knee osteoarthritis are low impact ones. For example, consider swimming, elliptical, and cycling instead of running and jumping.
2) Physical therapy
Another good treatment is physical therapy. Manual treatment can loosen the knee joint to reduce stiffness and can also keep the muscles relaxed that often tighten around the joint. Modalities such as heat, ice, ultrasound, and electric stimulation can work to reduce inflammation and therefore, pain.
Stretching and strengthening exercises can assist in better support for the knee joint. These work on the thigh muscles including the hamstrings in the back and quadriceps in the front of the thigh. Stronger muscles around the knee joint can prevent the joint from collapsing on itself reducing friction and pain.
3) Pain medication
Anti-inflammatory medication can provide temporary relief of joint pain and inflammation. These come in over-the-counter and prescription doses and include popular brands such as Advil and Motrin (both contain the active ingredient ibuprofen) and Aleve (i.e. naproxen) amongst others. Anti-inflammatory medication is not appropriate for every patient and can raise the risk of heart and stomach issues, especially when taken chronically.
Topical anti-inflammatory creams are available by prescription (Voltaren gel and Pennsaid cream) and can reduce but not eliminate these risks. Tylenol may also be effective in controlling the pain from arthritis but does not act as an anti-inflammatory.
In terms of supplements, there is conflicting evidence of whether glucosamine and chondroitin provide any relief of knee osteoarthritis pain. Personally, I have had patients anecdotally tell me that they have seen improvements taking these supplements. As a result, they may be worth looking into.
5) Knee brace
Using a knee brace (i.e. bracing) can also be helpful for select people. A brace can provide more support to the knee and help with better alignment. This is especially the case in those who are knock-kneed or bow-legged.
However, keep in mind, bracing should always be coupled with strengthening exercises. This way the knee does not become weak from becoming too reliant on the brace.
6) Steroid injection
When it comes to injections, there are a couple of commonly administered therapies available to treat osteoarthritis. One of these is the cortisone injection.
A cortisone injection is usually composed of two medications – a numbing medication called lidocaine and a steroid which acts as a strong anti-inflammatory medication. The numbing medication works for a few hours while the steroid kicks in a couple of days later and usually works for a few weeks. Sometimes, it will break the pain cycle and the pain will take longer to return. Other times, the good results are fleeting.
Personally, I’ve found patients like steroid injections because they work quickly to eliminate pain and inflammation. However, a few downsides are their duration of action, that they can be slowly destructive to tissue, and that they can raise blood sugar in diabetics. On the tissue destruction point, one injection into the knees every 3-6 months is fine, but more than 3 per year is too much.
7) Hyaluronic acid injection
The other type of injection is a hyaluronic acid injection. Hyaluronic acid is a chemical that is naturally found in the knee. It helps to lubricate the joint and can become deficient in osteoarthritis. A derivative of this substance can be injected into the knee to supplement the dwindling natural supply.
Sometimes, this medication can be derived from a rooster’s comb, which is why many patients refer to it as the chicken shot. What I like about hyaluronic acid is that it is healthy and nourishing to the knee joint. It does not work as quickly as cortisone but its effects last much longer (six months to even a year in some patients). This injection is available in several brands and comes in a series of injections. Some brands are a single injection while others are two, three, or five injections that are administered weekly.
All of the above treatments are administered with the goal of controlling the symptoms of osteoarthritis. They may even slow the progression of the wear and tear. This is especially the case for weight loss, physical therapy, and strengthening.
A lot of patients ask if these treatments will regrow their knee cartilage. Unfortunately, the answer is no. These treatments do not cure arthritis.
Knee osteoarthritis treatments aimed to regrow cartilage
Platelet-rich plasma and stem cells are two newer therapies that do aim to regrow cartilage. I’ll dive into both of these therapies below.
8) Platelet-rich plasma
Platelet-rich plasma is a solution made from a patient’s own blood. The blood is spun down into the platelets – a component of blood that contains a lot of healing growth factors. This is then reinjected into the knee to attempt to stimulate cartilage healing.
9) Stem cells
Stem cells are taken from the bone marrow (or fat) and work similarly to platelet-rich plasma. These are a special type of infant cells that can change into cartilage cells when injected into the knee.
Both of these treatments have shown promising results as options to treat knee arthritis. With this in mind, they are newer so more data is always coming out. Furthermore, platelet-rich plasma and stem cells are not usually covered by insurance and can run from hundreds to thousands of dollars out of pocket.
If you are still in pain, despite trying the treatments listed above, surgery may then be the answer. From a simple clean out procedure that removes loose cartilage bits to a total knee replacement, there are multiple surgical options available.
Prior to beginning any of the above therapies, you should discuss your individual health situation with your physician to see which treatment options are better for you. During your visit, they can answer any questions you have as well as evaluate any contraindications to the above treatments listed.
What has your experience been like with non-surgical treatments options for knee osteoarthritis? Let us know in the comments below!