Osteoarthritis of the Knee - Treatment Options

Treatment for osteoarthritis of the knee can take a variety of forms, from exercise and bracing, to pharmacological and surgical options.

When the disease process is in its early stages and symptoms are mild, treatment usually consists of analgesia and a conservative program of weight loss and physical therapy. As the symptoms grow in severity, the treatment also becomes more serious with a variety of surgical interventions considered. The decision to escalate treatment is dependent on the individual and their pain levels, their knowledge of the condition, and the advice of medical professionals.

In order to provide informed consent, one must first possess sufficient knowledge of the procedure in question, including the intended benefits and potential risks.

The following summarizes the different treatment options:

Pharmacological

Once the pain becomes unmanageable with non-prescription medication, a medical practitioner needs to be consulted as each persons' personal medical history affects which of the higher classes of drugs are suitable and safe to use. Typical medications include non-steroidal anti-inflammatories and low doses of opioids such as codeine.

Exercise

The quadriceps and hamstring muscles cross over the knee joint and provide support. Due to the pain of osteoarthritis, it is typical for sufferers to be less active than previously, and muscle strength decreases. The result is a reduction in support of the knee joint and a vicious cycle is established when more pain occurs. Exercise to increase the strength of these key muscles can stop this cycle and slow the progression of degenerative joint disease. This usually occurs with the help of a physical therapist. Weight loss is also a significant goal of this type of treatment.

Bracing

If only one half of the knee (inside or outside) is affected, orthopaedic bracing can help by offloading the affected side and redistributing the weight. It does not treat the affected area but can provide symptomatic relief and delay the need for more serious options.

Surgery

Surgical management can include relatively minor procedures like arthroscopy (key-hole surgery) and continue to total knee arthroplasty or joint replacement.

An arthroscopy can be both a diagnostic tool and a treatment. Through small incisions, a camera and implements are placed into the joint and the extent of the degeneration observed. Rough surfaces can be made less so, and meniscal tears trimmed. The surfaces remain worn and the benefits vary significantly between patients. Arthroscopy rarely provides long term relief but has a low complication rate.

For unicompartmental arthritis - where only either the inside or outside of the knee are affected - an operation called a High Tibial Osteotomy may be performed. This involves either adding or removing a wedge of bone to offload the affected side and return weight to the underutilized surface. This operation is usually done on patients too young to have a total knee replacement with the aim being to provide some relief from pain while the patient moves closer to a suitable age.

As the majority of the pain in arthritic knees comes from the worn joint surfaces, replacing these joints is an effective treatment. It is also a significant surgical procedure that involves the insertion of a prosthesis. With the increased benefits comes increased risks. There is also a limited life expectancy of the operation itself with the possibility of future revision surgery.

Potential complications include infection, DVT, nerve damage, ongoing pain / failure to improve pain, loosening of the prosthesis and complications from the anaesthetic.

Although these complications are thankfully rare, they should discourage people with mild pain from considering surgical intervention until their pain is having a significantly negative effect on their quality of life.

A sensible approach to the osteoarthritic knee would be to act early on the risk factors you can change such as weight and muscle strength. This can help decrease pain and delay the need for more drastic measures.

When pain no longer responds to analgesia, mobility is significantly decreased, and everyday activities become difficult, it is time to discuss your options with an experienced Orthopaedic Specialist. Even if surgery is required, previous work done in the areas of weight loss and strengthening will make the recovery easier and quicker.