Treatments for Osteoarthritis of the Knee

18 Alternative to Knee Replacement Surgery

Man holding injured knee, cropped
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Osteoarthritis of the knee can trip you up, literally and figuratively. Not only can pain and stiffness make it hard to walk smoothly, but deciding on a treatment for knee osteoarthritis can be puzzling. There are many approaches to dealing with this condition. Some are considered safe and effective by the American Academy of Orthopaedic Surgeons (AAOS), and some are not, so it can be helpful to have a sense of which treatments are recommended and which aren't as you and your doctor sort through the possibilities.

Here's what the American Academy of Orthopaedic Surgeons (AAOS) says about 18 noninvasive treatments for knee osteoarthritis, based on different levels of evidence. They stop short of including knee replacement but keep in mind that may be the best treatment option for you. Before you read on, note that the AAOS guidelines pertain to people who have symptoms of knee osteoarthritis, such as joint pain and stiffness. They aren't meant as recommendations for those who've had knee X-rays that show evidence of joint degeneration but who aren't experiencing any symptoms.

Recommended Treatments for Knee Osteoarthritis

1. Rehabilitation, education, and wellness activities. This includes participation in self-management programs and making changes in activity when possible to protect your joints (for example, walking or swimming rather than running for cardio exercise).

2. Pain relief medication. Oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) are highly recommended for relieving pain and inflammation.

The prescription opioid narcotic tramadol also gets high ratings from the AAOS for treating pain from knee osteoarthritis. 

3. Weight loss. If you're overweight, defined by having a body mass index (BMI) greater than 25, you will greatly benefit losing 5 percent of your body weight and maintaining the lower weight through diet and exercise.

4. Lateral heel wedges. These are insoles that elevate the outer edge of the foot in order to change the way the knee joint works. The AAOS stresses that it does not recommend lateral heel wedges for people with medial compartment knee osteoarthritis.

5. Needle lavage. This is the practice of washing out the joint. The AAOS doesn't advise against it but says doctors should be on the lookout for new research. The one high-quality study found no measurable benefit.

6. Tibial osteotomy. Although the studies supporting this procedure, in which a piece of the tibia (one of the two bones of the lower leg that forms the bottom of the knee joint) is removed, are of low quality, the AAOS does not recommend against it.

Treatments With Inconclusive Evidence

7. Physical agents, including electrotherapeutic modalities. These include transcutaneous electrical nerve stimulation (TENS); shortwave diathermy; inferential current; therapeutic application of a musically modulated electromagnetic field (TAMMEF); and ultrasound. Of these, ultrasound has the most evidence showing it can be effective, but overall there's too little conclusive research to fully judge any of these treatments, according to the AAOS guidelines.

8. Manual therapy. This includes chiropractic therapy, myofascial release, and Swedish massage. The AAOS is neither for nor against these therapies.

9. Knee brace. An example of a knee brace is a medial compartment unloader, which is designed to take stress off of the inner knee in someone whose osteoarthritis is focused there. Studies of the effectiveness of knee braces do not show whether they're helpful or not.

10. Acetaminophen, opioids, and pain patches. Although there's evidence that NSAIDs are effective for treating knee osteoarthritis, the jury is still out on non-NSAIDs (with the exception of tramadol).

11. Injected corticosteroids. Intra-articular corticosteroids are injected into an affected joint. It's unclear how helpful this treatment can be for osteoarthritis of the knee.

12. Biologic injections: Neither for nor against injections with growth factor or platelet-rich plasma.

13. Arthroscopic partial meniscectomy: If you have signs and symptoms of a torn meniscus or loose body, they can't recommend for or against this procedure. 

Treatments That Are Not Recommended

14. Glucosamine and chondroitin. Although glucosamine and chondroitin are both substances the occur naturally in joints, the AAOS strongly advises against taking them in the form of dietary supplements for treating osteoarthritis of the knee. 

15. Viscosupplementation. This treatment involves injecting hyaluronic acid, which is an important component of the synovial fluid that cushions and lubricates joints, into the area where the bones of the joints meet. The AAOS does not recommend intra-articular hyaluronic acid injections knee osteoarthritis.

16. Acupuncture: There's strong evidence acupuncture does not relieve pain related to knee osteoarthritis.

17. Arthroscopy with debridement or lavage. This is a procedure in which damaged tissue is removed from between joints noninvasively.

18. Unispacer. This is a free-floating device that compensates for lost cartilage, which the AAOS says should not be implanted in someone with symptomatic unicompartmental knee osteoarthritis.

Sources:

American Academy of Orthopedic Surgeons. "Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition." May 18, 2013.

Battisti E, et al. "Efficacy and Safety of a Musically Modulated Electromagnetic Field (TAMMEF) in Patients Affected by Knee Osteoarthritis."  Clin Exp Rheumatol. 2004 Sep-Oct;22(5):568-72. 

Duivenvoorden T, et al. "Braces and Orthoses For Treating Osteoarthritis of the Knee." Cochrane Database Syst Rev. 2015 Mar 16;(3):CD004020. doi: 10.1002/14651858.CD004020.pub3.

MedLine Plus. "Drugs, Herbs, and Supplements: Tramadol." Apr 2017.

National Institutes of Health. "Glucosamine and Chondroitin for Osteoarthritis." Nov 2014.

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