Knee Arthritis Treatment Options

Nonoperative treatment is the first line of approach for knee arthritis. This is suitable for most patients, particularly in the early stages of arthritis or for those who aren’t surgical candidates due to other health conditions.

Nonoperative approaches include lifestyle modifications, physical therapy, over-the-counter pain relievers, and other medication options such as corticosteroid or hyaluronic acid injections. The aim is to manage pain, reduce inflammation, and improve function.

Lifestyle Modification

Lifestyle modifications for managing knee arthritis often include weight loss, as reduced body weight decreases the load on the knee joint. Switching to low-impact exercises like swimming or cycling can also help by keeping joints active without too much strain. Additionally, assistive devices like a cane or walker can help to offload the affected knee and improve stability.

Physical Therapy

Physical therapy is a crucial component of managing knee arthritis nonoperatively. It focuses on exercises to strengthen the muscles around the knee to provide better support and stability to the joint, and stretching exercises to improve flexibility and range of motion.

Injections

Corticosteroid injections can provide temporary relief from arthritis pain by reducing inflammation. Hyaluronic acid injections, also known as viscosupplementation, can help lubricate the joint, potentially improving function and easing pain. However, these treatments do not alter the disease progression and their efficacy can vary between individuals. Platelet-rich-plasma (PRP) injections are newer that have started to be used in knee arthritis. The evidence is limited, but some patients feel that it helps there symptoms better than the other injections, and may slow down the progression some.

Bracing

Bracing can provide some patients with relief from knee arthritis. Certain braces can offload the portion of the knee affected by arthritis, thereby reducing pain. Soft knee supports or compression sleeves can also provide some relief by providing warmth and support.

When nonoperative treatments do not provide sufficient relief, surgical options can be considered. The choice of surgery depends on the patient’s age, overall health, activity level, and the severity and location of the arthritis.

Arthroscopy

This minimally invasive procedure can be used to remove loose bodies or trim damaged cartilage. However, its efficacy for treating knee arthritis is limited and it is not typically the primary treatment choice. It can help reduce some mechanical symptoms such as clicking and catching due to loose pieces in the knee or meniscus tears from arthritis, but will not fix the worn out cartilage. In some instances, it may actually progress the rate of arthritis.

Cartilage Preservation

If the area of knee arthritis is small, it may be possible to preserve or replace the damaged cartilage. There are multiple options for this depending on the size and severity.

Osteotomy

This involves reshaping the bones to relieve pressure on the arthritic area. Osteotomy can be effective for younger patients with arthritis limited to one area of the knee. It can be performed by cutting either the tibia (High Tibial Osteotomy), or femur (Distal Femoral Osteotomy) to realign the knee to remove pressure from the arthritic area.

Partial Knee Replacement (PKR)

PKR, also known as a unicompartmental knee replacement, is considered when arthritis affects only one part of the knee. It involves replacing the damaged part of the knee with artificial components. The recovery time is usually shorter compared to total knee replacement, and it preserves more of the patient’s natural knee.

Total Knee Replacement (TKR)

TKR involves the replacement of the damaged knee joint surfaces with artificial components. It is highly effective for relieving pain and improving function, and is typically considered for patients with severe arthritis.

Joint Fusion (Arthrodesis)

This is considered a last-resort option when other treatments have failed or aren’t suitable. Arthrodesis involves fusing the bones of the knee into one solid bone, which can relieve pain but at the cost of knee flexibility. It is very rare that someone needs this.