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Treatments for Osteoarthritis of the Knee: What Works?

What’s in a typical treatment plan?

Osteoarthritis (OA) is the most common chronic disorder that affects the joints. OA of the knee happens when the cartilage, or cushion, between the knee joints breaks down. This can cause pain, stiffness, and swelling.

Your doctor will recommend treatment options that can help with your joint pain and swelling. This can improve your quality of life and help you maintain your day-to-day activities. There isn’t a cure for OA, so effective management is crucial.

Your treatment options will depend on a number of factors unique to you and your health needs. These include your medical history, level of pain, and the impact of OA on your daily life.

In most cases, treatment includes a combination of therapies, as well as healthy lifestyle changes. Here’s what you should know about each treatment option. Be sure to talk to your doctor before making any changes, big or small, to your prescribed treatment plan.

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Lifestyle changes

Healthy habits

Healthy lifestyle habits can be especially helpful to people with OA of the knee. Your doctor may suggest incorporating the following changes into your treatment plan.

Get regular exercise

Exercise is the single most important action you take to help with your OA. Research has consistently shown that people with OA of the knee can greatly benefit from regular, moderate exercise.

Regular exercise can help:

  • with weight loss, which can ease the strain put on your joins
  • preserve range of motions in the joints
  • improve muscle strength
  • reduce joint pain and swelling

Most experts recommend low-impact aerobic exercise, such as biking, walking, or swimming. Water aerobics is another good option. This type of exercise alleviates pressure on the joints while allowing for all the benefits of aerobic exercise.

Riding a stationary bike is another good choice, because it takes pressure off the knee joints. It also helps to maintain strength in the quadriceps and hamstring muscle groups. These groups are used when going from sitting to standing position, and help to stabilize the knee.

If your OA is severe, you may want to avoid high-impact exercises such as running or step aerobics. Be sure to talk to your doctor about the best workout regimen for you.

Maintain a healthy weight

If you’re overweight, losing even a small amount of weight can be beneficial for your OA. Losing weight can reduce the strain on your joints, and in turn alleviate your symptoms.

To maintain a healthy weight, practice a regular exercise routine in addition to eating healthy. Here are a few tips for a balanced diet:

  • Make sure your diet consists of fruits, vegetables, protein, carbohydrates, and fats.
  • Limit your intake of sugars, saturated fats, and salt.
  • Try to get two servings of fish per week.
  • Avoid fried foods.
  • Eat red meat no more than twice a week.

Stretch

There are small things that you do every day to help manage your OA. For example, you may find it helpful to start your day with stretching exercises or yoga. This can help loosen up your joints and may reduce or prevent symptoms during the day.

Medications

Over-the-counter (OTC) and prescription medications for pain relief

Many people with OA take medications to relieve pain and reduce their symptoms.

Some OTC options may relieve mild pain, such as:

  • Acetaminophen (Tylenol). This is often a first-line treatment for those with mild-to-moderate OA pain. Common side effects include nausea and upper stomach pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). If acetaminophen isn’t providing relief, you may consider an NSAID such as naproxen (Aleve) or ibuprofen (Motrin). These OTC medicines can sometimes cause stomach problems.

If your symptoms are severe, your doctor may prescribe:

  • COX-2 inhibitors. These inhibitors are prescription-strength NSAIDs. Celecoxib (Celebrex) is common option. COX-2 inhibitors have less risk for stomach problems, but may cause serious heart problems.
  • Hyaluronic acid: This acid is used as a type of joint-replacement fluid. It acts as a shock absorber and lubricant. Your doctor will inject the acid at the doctor's office. There’s a slight chance the acid may break down inside your joints, so it should be used with caution. Be sure to discuss the potential benefits and risks of this injection with your doctor.
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Therapy

Physical and alternative therapies for relief and rehabilitation

There are different therapy options for OA, including physical, occupational, and alternative therapies. Physical therapy uses exercises to condition muscles and improve flexibility and joint mobility. Occupational therapy focuses on helping you better manage your normal activities, such as walking, bathing, and dressing. You may only need these therapies for a short time as you learn to live with your OA or as your symptoms flare up.

Alternative therapies for OA can include massage, hydrotherapy, and relaxation therapies. Acupuncture may also be beneficial. Evidence suggests that acupuncture may be effective in reducing OA symptoms when used with other medicines, or, in some cases, in place of pain medication altogether.

Injectable steroids

Injectable steroids to reduce inflammation

Injectable glucocorticoids or corticosteroids are steroids that can be injected directly into the joint. Steroid injections are used to temporarily relieve pain and reduce inflammation. There may be a risk of damage to your cartilage, so most doctors limit steroid injections to three or four times a year per joint.

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Viscosupplementation

Viscosupplements to cushion joints

In people with OA, the fluid inside the knee joint that provides lubrication and cushioning for your joints can become degraded. Viscosupplements are injected directly into the knee. They replace diseased knee fluid with a gel-like substance similar to the fluid found in healthy joints. This can provide cushioning and lubrication for the joint, and may relieve pain.

Learn more: Comparing viscosupplement options »

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Surgery

Surgeries to repair joints

If you have severe joint pain and haven’t found relief with other therapies, surgery may be your next option. Your doctor will help you decide if you’re a candidate for surgery, especially after you’ve exhausted all other methods for managing your OA.

The most common surgical options for treating OA of the knee are:

  • Arthroscopic surgery: This is a minimally-invasive procedure used to repair injury in or clean debris from a joint. People under the age of 40 are generally the best candidates for arthroscopy. In most cases, it will relieve painful symptoms almost immediately after the procedure. The drawback, however, is that studies haven’t shown whether the surgery will prevent any further joint damage.
  • Osteotomy: This procedure involves cutting the bone to take pressure off the injured part of the joint and correct the alignment of the bones. This treatment is usually reserved for more active people under the age of 40 whose bones aren’t at the correct angles. This type of surgery is typically effective in stopping joint damage.
  • Joint replacement: This is a complex procedure that involves replacing injured or damaged parts of the knee with artificial parts. Joint replacements have been studied extensively and are proven to reduce pain and improve mobility and daily function. However, these joints will wear out because they’re artificial. Depending on your age, another joint replacement surgery may be necessary down the line. Artificial parts made of newer materials usually last several decades before another replacement is needed. Total joint replacements generally aren’t recommended if you are severely overweight or have weak bones.

Read more: Maintaining fitness with osteoarthritis of the knee »

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Outlook

What happens next?

The most important thing you can do is talk to your doctor about the different ways you can manage your OA. Whether your case is mild, moderate, or severe, OA of the knee can progress and your pain may worsen over time. Starting treatment at the first signs of OA may help slow or reduce worsened pain over time.

With your doctor’s permission, you should start by incorporating regular, moderate exercise and stretching practices. With the right treatment, you can get the pain relief needed to lead a more active life. Only your doctor can tell you what treatment is right for you.

Keep reading: Expert Q&A on treatments for osteoarthritis of the knee »

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