Osteoarthritis (OA) is a progressive "wear and tear” disease of the joint. In the United States, the prevalence of knee arthritis has doubled since 1940. Genetics, high body mass, certain occupations or heredity can also increase the risk of developing this disease. OA of the knee may not be completely preventable, but there are nonsurgical treatment options for those who have been diagnosed with OA.
In 2013, the American Academy of Orthopaedic Surgeons published the second edition of evidence based guidelines for treatment of osteoarthritis of the knee. The first recommendation encouraged patients to participate in self-management programs which include strengthening and low impact aerobic exercises. Keeping muscles around the joint strong help decrease the symptoms of OA.
Another recommendation is weight loss to achieve a body mass index (BMI) of less than 25. Every pound of weight can feel like 5 pounds of weight to the knee. A 20-pound weight loss can feel like a 100-pound weight loss to the knee, significantly decreasing the load on the joint and improving pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs), both oral and topical, have been shown to decrease the symptoms of OA. Medications include ibuprofen and naproxen sodium, both of which can be purchased without a prescription. Other NSAIDs such as diclofenac, celecoxib, and meloxicam are available with a prescription. The anti-inflammatory properties in the medication have been shown to decrease both pain and stiffness in multiple studies. These medications do have side effects and can interact with other medications, so you should discuss their use with your medical provider. Tylenol has not been found to be as effective for OA.
Studies have shown that patients with symptomatic knee OA who receive a cortisone injection into the knee have improvement in pain and stiffness, with an improvement in function for up to six months. This type of injection can help patients who are not ready or are unable to undergo surgical treatment. Hyaluronic acid injections provide a “lubrication” effect to the knee, but their routine use is not currently recommended due to a lack of support in studies. Other types of biologic injections including bone marrow aspirate, platelet rich plasma, and stem cells are currently being studied but do not have any long term studies to support their routine use at this time. Currently, these experimental biologic treatments may lack the demonstrated safety and efficacy of many other traditional orthopedic therapeutics.
If you are experiencing knee problems, work closely with your physician or orthopedic surgeon to develop the best course of treatment for you.
Dr. Roxanne Keene is an orthopedic surgeon at CHI St. Alexius Health’s Williston Specialty Clinic.