Treatment Options for Knee Osteoarthritis

Seeing as osteoarthritis is degenerative and progressive in nature treatment is focused on controlling symptoms, improving joint function, and maintaining quality of life. The typical treatment plan for knee osteoarthritis includes exercise, weight management, and education in addition to other at home therapies such as heat and cold application. Topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) may also be used. Corticosteroid injections into the joint as well as duloxtetine may also provide short-term relief. In some cases, surgical intervention may be necessary to provide symptom relief.

Exercise

Leading a sedentary life is hazardous to the health of the knee joint as the absence of simulation promotes quicker degeneration of the knee cartilage. Light to moderate low impact physical activity is encouraged for individuals with knee osteoarthritis to help maintain knee joint function. Further, physical activity has numerous other benefits including a decreased risk of diabetes, heart disease, falls, and disability, and also helps to improve mental health.

Exercise plans should take into account the severity of their osteoarthritis, limitations, and preferences to enhance long-term adherence to the plan. A 2021 study from the Journal of American Medicine further supports the use of online clinically-based exercise plans as effective for treatment of pain and mobility. It’s important that high-impact activity be avoided to decrease the risk of further damage to the joint. Each plan should include cardiovascular activities such as walking, cycling or swimming to help decrease pain and improve joint function as well as cardiovascular fitness; strengthening exercises for the hamstrings, quadriceps, hip abductors, and calves to improve strength and function, provide joint stability, and decrease pain; balance training to help reduce the risk of falls; and stretching exercises to improve joint range of motion.

Weight Management

Maintaining a healthy weight is a crucial component of managing knee osteoarthritis symptoms, as obesity predisposes individuals to suffer from knee osteoarthritis and associated symptoms. When walking, the knee joint supports 3 to 5 times the body weight so small drops in weight can make a huge difference on the forces being applied to the joint, which helps to control pain and improve function of the joint. 

Hot and Cold Therapy

Hot and cold therapy can help to relieve pain associated with knee osteoarthritis. Applying ice to the affected knee for 10 to 15 minutes at a time can help to decrease inflammation and reduce pain. While applying moist heat to the affected knee for 15 to 20 minutes at a time can help to improve blood flow and soothe stiff and achy joints and muscles. Often it will take a little trial and error to find out whether ice or heat, or a combination of both, helps to relieve symptoms.

Medications

Over-the-counter NSAIDS including ibuprofen and naproxen can help to relieve inflammation and pain associated with knee osteoarthritis. COX-2 inhibitors including celecoxib and meloxicam, may also be recommended. They are special types of NSAIDs that have been associated with fewer gastrointestinal side effects. However, oral NSAIDs are associated with gastrointestinal, cardiac, renal, and hematological side effects so their long-term use should be limited. Topical NSAIDs have been shown to be a safer option, with only slightly inferior efficacy compared to oral NSAIDs.

Duloxetine is an antidepressant that has been approved by the US Food and Drug Administration (FDA) for the treatment of fibromyalgia and diabetic peripheral neuropathy. However, recent studies have shown that this medication, when used for longer than 10 weeks, helps to control pain and improve function in patients with knee osteoarthritis.

Joint Injections

Injection of corticosteroids into the affected joint can help to decrease inflammation and pain, however, the effects are short-term. Joint injections are often limited to 3 or 4 per year due to potential side effects. In addition to steroid injections, other options have come into popularity. Research suggests that hyaluronic acid injections may may reduce inflammation and friction, slowing the degeneration of cartilage and bone. Platelet rich plasma, or PRP, is another type of injection used in osteoarthritis. It uses a concentration of a patients own blood platelets to promote healing in a specific location.

Surgical Options

In some cases of knee osteoarthritis, surgical intervention may be necessary. In younger, healthy patients with small areas of cartilage damage, cartilage grafting may be used. This procedure takes cartilage from another part of the knee to fill a hole in the damaged cartilage. In patients with early-stage knee osteoarthritis, where only one side of the knee joint is damaged, an osteotomy may be used. This procedure involves cutting and reshaping either the shinbone or thighbone to relieve pressure on the knee joint, helping to decrease pain and improve function of the joint. In advanced cases of knee osteoarthritis partial or total knee replacement may be necessary. This procedure involves removing the damaged cartilage or bone and replacing it with new plastic or metal joint surfaces to decrease pain and restore function of the joint.