Options in Knee Arthritis

The following is a summary of various treatment modalities available for patients with osteoarthritis of the knee.  I’m happy to discuss any of these with you and answer questions.  Not all are appropriate in all patients.

1.    Activity modification –       Certain changes in lifestyle may be necessary to accommodate degenerative changes in the knee.  Sometimes if more stressful impact activities stop, then other types of activities are possible without symptoms.  Typically, activities like jogging, tennis, basketball, etc. are not a good idea, and these limitations may be permanent.  Think of substituting biking, stationary bike, elliptical machine, and swimming instead.

2.    Non-steroidal anti-inflammatory medicines  (Naprosyn, Mobic, Celebrex) –       These medicines can decrease pain and inflammation in the knee.  They work best if taken in blocks of time; that is, 10 days, 2 or 3 weeks at a time.  Once symptoms have improved they can be stopped.  Reuse again if symptoms of inflammation recur.

3.    Non-narcotic pain medicine –       Good for long term relief of pain due to chronic degenerative changes in the knee.  Something that could be taken at the

4.    Visco-supplementation  (Supartz, Synvisc) –       Series of injections lasting 3 to 5 weeks given into the knee.  These colloid substances can coat the end of the arthritic knee and relieve symptoms.  Usually helps in about 50% of patients.  Variable length of improvement.

5.    Steroid shots –       Intra-articular steroid shots can be used for acute flare-ups of knee inflammation and swelling.

6.    Arthroscopy –              Unresponsive knee swelling and / or mechanical symptoms such as locking and catching may be amenable to operative arthroscopy.  The scope doesn’t replace articular surface that has been lost, but can address loose bodies, and meniscal tears.

7.    Cartilage restoration procedures –               Newer procedures to replace lost articular cartilage.  Usually for strictly focal lesions.  I’ll let you know if you are a candidate for one of these new procedures.

8.    Partial knee replacement (Oxford Knee) –      Good procedure for arthritis limited to the medial compartment of the knee.  Ligaments have to be intact too.  For patients who are candidates and have significant pain despite appropriate conservative management.   There is a smaller incision and shorter recovery time compared to a total knee.

9.    Total knee replacement ( Otis Med / Biomet knee) –       For patients with worsening arthritis who have failed conservative treatment.  Today, we are using a new Custom Fit technique where custom cutting jigs are designed by a computer based on patient anatomy.   This requires a preoperative MRI.

10. Glucosamine / Chondroitin sulfate – These supplements are heavily marketed for use in knee arthritis.  Unfortunately, there are no good studies to prove their effectivemess.  Probably won’t do any harm.