Non-Operative Knee Treatment

When you have knee arthritis, there are times when you may not feel like exercising, or you might worry that exercising may do more harm than good to your joints. However, research has shown that physical activity is the single most effective non-drug treatment for improving pain and function.

While it is important to maintain as much activity and joint motion as possible, you should be aware of and avoid activities that could worsen your condition. For example, impact activities such as running and jumping will often accelerate cartilage loss within the joint. If you are an active person, you may need to modify your workout to avoid putting stress on your joints.

The key is to focus on low impact activities that do not require significant weight bearing on the knee joints. If you have arthritis, the following exercises are especially effective at helping you maintain knee range of motion, strength, and function:

• Walking
• Swimming
• Water aerobics
• Stationary or recumbent cycling
• Yoga and tai chi
• Strength training with weights and resistance bands

Be sure to consult your doctor about exercising with osteoarthritis and the specific exercises that are best for you. You may also want to visit a physical therapist to help you begin an appropriate and effective exercise regimen or modify your existing activities.

Physical and/or occupational therapy is an excellent way to start or modify an exercise program tailored specifically for your knee arthritis and needs (e.g., any co-existing medical conditions or physical limitations). The main goals of therapy are to relieve pain and improve function in your affected joint(s).

A physical or occupational therapist will develop an exercise plan designed to:

• Improve your mobility and flexibility
• Increase stability of your knee joint by strengthening the surrounding muscles
• Improve your coordination and balance
• Maintain fitness and the ability to perform daily activities

Aquatic therapy in a heated pool can be especially soothing and effective. The buoyancy of the water takes stress off the knees while exercising, and the resistance of the water can help strengthen your muscles and stabilize joints.

In addition to creating an individualized exercise program, your therapist may also:

• Apply heat to treat stiffness and ice to decrease pain
• Recommend the use of assistive devices such as walkers, canes, braces, splints, or shoe inserts to help support your joints and relieve stress
• Instruct you on how to do your daily activities, such as getting dressed, doing housework, and preparing meals, using proper posture and body mechanics. This puts less stress on your joints and relieves pain.
• Suggest modifications to your home and work environments such as ergonomic chairs, cushioned floor mats, grab bars/rails, chairlift for stairs, etc. Making these changes can help relieve pain, improve posture, and add stability.

Weight loss is probably the single most effective intervention you can take on your own. For the average patient who is somewhat overweight, losing 20 pounds or more can often decrease your discomfort and delay the need for surgery.

Weight loss is also important for increasing the life span of a joint replacement. In addition, surgery is less risky for patients who are not severely overweight.

Injection therapies do not cure the underlying problems of arthritis but can be useful for short-term relief and for diagnostic purposes. Injection of the knee joint typically is quick and only takes a few minutes in the office.

Steroid injections into the knee joint and/or bursa are usually effective and may be all that is required in combination with physical therapy and anti-inflammatory medications for resolution of a patient’s symptoms. The injection is usually administered over the side of the knee or from the front.

Occasionally, some patients may develop fluid around the knee joint that needs to be drained (aspirated). Many physicians will also inject the knee with corticosteroids after aspirating it.

Knee joint injections are useful in determining where a patient’s primary source of pain is originating from. They are also helpful in providing a few months of relief prior to knee replacement surgery.

Long-term use or overuse of steroid injections can weaken bones and tissues, but most orthopedic surgeons typically consider injections a few times a year to be acceptable.

Viscosupplementation therapy is an appropriate treatment for people with moderate to moderately severe knee osteoarthritis that has failed to respond to conservative treatments such as anti-inflammatory medications, steroid injections, and physical therapy.

Viscosupplementation was approved by the FDA in 1997. It uses a gel-like fluid called hyaluronic acid (HA) to supplement the synovial fluid in the knee joint. Hyaluronic acid is a substance that occurs naturally in the joint. HA injections reduce knee arthritis pain by lubricating the joint so that bones glide smoothly and by decreasing inflammation.

Other benefits include a low risk of side effects. Unlike steroid injections, which can cause osteoporosis if administered too often, viscosupplementation has not been shown to have such an effect.

While viscosupplementation may help relieve the symptoms of osteoarthritis, it does not reverse the arthritic process or re-grow cartilage.

At Orthopaedics New England, we administer hundreds of hyaluronic acid injections each year, and generally about two-thirds of patients report that they feel better after the injections.