Your joints undergo a normal cycle of wear-and-tear and repair throughout life. With aging, the body’s ability to repair the joints leads to changes in the structure and shape of the joints. These changes can lead to joint problems such as osteoarthritis.

Knee osteoarthritis is one of the most frequent and debilitating conditions that can have an exhausting effect on everyday activities and enjoying life. While osteoarthritis of the knee cannot be cured, there are many treatment options that can slow down the damage and improve the quality of life.

This article discusses effective non-surgical treatment options to learn about addressing and relieving the painful symptoms of knee osteoarthritis.

What is knee osteoarthritis and how common is it?

Knee osteoarthritis (OA), commonly termed degenerative joint disease, is a form of arthritis that occurs due to the progressive loss and wear-and-tear of articular cartilage. During knee osteoarthritis, the cartilage buffer in the knee joint breaks down over time.

This breakdown of cartilage causes it to become rough and frayed, decreasing the protective space between the bones. When this happens, bones rub together, and joints become inflamed [1].

Knee osteoarthritis is more likely to occur in people aged 50 years and older and worsens over time. According to the Australian Institute of Health and Welfare (AIHW), knee osteoarthritis affects 1 in every 5 Australians over 45 years old.

What are the symptoms of knee osteoarthritis?

The following are some common symptoms associated with knee osteoarthritis:

Pain in the knee joint that gradually develops over time and worsens with activity.
Difficulty walking
Knee pain at nighttime
Pain after prolonged resting and sitting
Knee swelling and stiffness
Stiffness within the joint resulting in the inability to straighten or bend the knee
Clicking, grinding, or cracking sounds with joint movement
Joint pain that becomes worse with changing weather [2].

What are the risk factors for knee osteoarthritis?

The exact cause of osteoarthritis remains unknown, but there are various factors that may contribute to its development:

Age

Your likelihood of developing knee osteoarthritis increases as you age.

Genetics

If you have a family history of knee osteoarthritis, you are more likely to develop knee osteoarthritis with increasing age.

Weight

Carrying additional weight can put extra stress on weight-bearing joints like the knees and hips. This extra stress can increase your symptoms of knee osteoarthritis [3].

Previous trauma

Certain injuries conditions such as an ACL rupture or a meniscal can increase the risk of osteoarthritis in later life.

Gender

Women over 50 are more at increased risk of knee osteoarthritis than men.

Non-surgical treatment options for knee osteoarthritis

The following is an overview of effective non-surgical treatment options for knee osteoarthritis:

1. Weight loss

Carrying additional weight increases the pain from knee osteoarthritis due to extra pressure it puts on the knees. It is highly beneficial to lose weight to reduce the severity of knee osteoarthritis. Each extra kilogram of weight can effectively increase the force passed through the knee by 6 kilograms.

Losing weight decreases not only the extent of strain on the knee joint but also eases the symptoms of osteoarthritis. Weight loss also decreases your risk of developing other health complications such as heart disease, type 2 diabetes, and hypertension.

Losing only 5% of your body weight can help maintain a healthy weight through exercise and diet [4].

2. Medications

Over-the-counter (OTC) medications are usually the first line of treatment for knee OA because they help relieve pain and discomfort. For severe pain, prescription medications are recommended.

a. Over-the-counter options

Acetaminophen (Paracetamol) is a common OTC pain reliever that helps ease pain associated with knee OA.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen, are also used for relieving pain and discomfort. COX-2 inhibitors, including Mobic and Celebrex, are a type of anti-inflammatory that has less side effects on the gastrointestinal tract. [5].

b. Prescription medication

If OTC medications cannot effectively ease pain associated symptoms of knee osteoarthritis, then your doctor may consider prescribing stronger medications like:

Tramadol
Palexia or Endone

These should only be used on a short-term basis while you are awaiting a review by a specialist.

3. Exercise and physiotherapy

Physiotherapy and supervised exercise have been proved to be effective in reducing stiffness, pain, and swelling and improving knee joint function. Your physiotherapist may recommend some strength and flexibility exercises, which can:

Reduce extra stress on the knees
Improve range of motion and flexibility of the knee joint
Strengthen muscles in the legs and knees
Restore normal knee joint function [6].

Some suitable exercises include stretching, walking, cycling, yoga, tai chi, and water aerobics, such as swimming.

Since knee osteoarthritis is affecting a significant elderly population in Australia, certain treatment programs are very useful for managing symptoms of osteoarthritis. Among these programs, GLA:D is the most common one.

GLA:D Program

Good Life With Arthritis: Denmark is a well-known and evidence-based program developed for patients with knee osteoarthritis. This exercise and education program includes 12 x exercise sessions and 2 x education sessions for a duration of 6 weeks with the aim of self-management of osteoarthritis. It has been shown to improve pain and function while decreasing the need for strong painkillers.

With GLA:D program, you can perform strengthening exercises and correct daily movement patterns to develop the capacity to prevent pain and progression of other symptoms [7]. To read about the GLA:D program and find a local provider, click here.

4. Lifestyle modifications

Lifestyle modifications, including physical activity and dietary changes, can also be helpful in managing symptoms of knee osteoarthritis. Moderate physical activity may reduce inflammation and pain.

If you participate in sports and activities like tennis, running, and gymnastics, you may need to switch to low-impact activities like swimming or biking. You may also need to slow down the duration and intensity of such activities.

5. Intra-articular injections

Intra-articular injections are another treatment option for relieving pain that has not been eased with NSAIDs or physiotherapy. The intra-articular injection is administered directly into the knee joint capsule affected by osteoarthritis. Hyaluronic acid and corticosteroids (steroids) are the most common injections used for knee osteoarthritis:

a. Steroids

Corticosteroid injections are direct-acting anti-inflammatory medications to provide long-term management of symptom flare-ups. When injected, corticosteroids work by preventing inflammatory cells from producing as a result of a chronic condition like knee osteoarthritis, thereby alleviating pain and stiffness in the affected area [8]. Unlike oral steroids, a steroid injection has limited systemic side effects.

b. Hyaluronic acid (SynVisc, Durolane)

The knee joint’s synovial fluid naturally contains hyaluronic acid for lubricating the joint. With knee osteoarthritis, the breakdown of hyaluronic acid means there is more friction within the joint. An injection of hyaluronic acid into the knee joint can reduce pain and increase the joint’s range of motion[9]. Hyaluronic acid injected into the knee is akin to putting oil into a car. The effects can often last for 4-6 months.

c. PRP

PRP stands for platelet-rich plasma. It involves taking blood from the patient and passing it through a centrifuge to separate the growth and healing factors from the rest of the blood. The platelet-rich component of blood is then re-injected into the knee and helps decrease the inflammation. The anti-inflammatory component of PRP can help with the pain of knee osteoarthritis.

A recent randomized control trial in Melbourne suggests that patients with mild to moderate knee osteoarthritis did not have a significant improvement in symptoms or improvement in joint structure with an injection of PRP. Read more about this study here.

6. Hydrotherapy

Hydrotherapy is a common passive treatment for reducing the symptoms of knee osteoarthritis. The properties of water, in particular buoyancy, allow it to reduce loading within the joint. Gentle exercises in warm water will provide the best therapeutic environment without aggravating your joints [10].

7. Braces

If you have medial compartment osteoarthritis (osteoarthritis on the inside of the knee joint), your doctor may recommend an unloader knee brace. These braces are designed to relieve pressure off the inner knee [11].

8. Alternative treatments

Alternative treatments usually target stiffness, pain, and swelling associated with knee osteoarthritis. Below are some alternative things to do at home that may be helpful in knee joint pain and joint mobility:

a. Curcumin

Studies have reported that curcumin, an anti-inflammatory component present in turmeric, helps ease pain and inflammation due to knee osteoarthritis [12]. You can take supplements that contain significant levels of curcumin for preventing joint inflammation.

b. Glucosamine and chondroitin

Taking glucosamine and chondroitin supplements in a typical dose of 500-1500 milligrams a day is an option for alleviating symptoms of knee osteoarthritis. These supplements prevent chondrocytes from damaged because they play a vital role in maintaining cartilage structure [13].

Recent large-scale studies have shown that the benefits of glucosamine and chondroitin in knee osteoarthritis are not as much as we have previously thought.

What if non-surgical options fail to treat knee osteoarthritis?

The natural history of osteoarthritis is that it gradually worsens with time. When non-surgical therapies do not help in treating the symptoms of knee osteoarthritis or the pain becomes worse, surgical treatment is often recommended. There are different surgical options available:

a. Knee osteotomy - in which the bone is reshaped or cut to remove extra pressure from the arthritic part of the knee. To learn more about knee osteotomy, click here.

b. Partial knee replacement – the arthritic side of the knee is replaced with an artificial prosthesis but the rest of the knee and the internal ligaments are left alone. To learn more about partial knee replacement, click here.

c. Total knee replacement involves removing the damaged bone and tissue and replacing the knee joint with an artificial joint. To learn more about partial knee replacement.

Summary

Knee osteoarthritis can have a challenging effect on your life by interfering with your daily life activities. This chronic condition is most common in older adults aged over 50 years. Women are more likely to develop knee osteoarthritis than men. Non-surgical treatments options are the best way to manage symptoms of knee osteoarthritis better. But if symptoms become more severe, there are effective surgical options.

Mr Pai is a knee specialist that regularly consults on patients with knee osteoarthritis. He will provide a well-balanced opinion on what options will be effective in reducing your knee pain.

Book a consultation

References

1. Felson DT. Osteoarthritis of the Knee. N Engl J Med 2006;354:841–8. https://doi.org/10.1056/NEJMcp051726.

2. Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J 2017;21:16–183. https://doi.org/10.7812/TPP/16-183.

3. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. Int J Obes 2001;25:622–7. https://doi.org/10.1038/sj.ijo.0801585.

4. Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum 2005;52:2026–32. https://doi.org/10.1002/art.21139.

5. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 2014;22:363–88. https://doi.org/10.1016/j.joca.2014.01.003.

6. Bennell MFMRHV der ESL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015. https://doi.org/10.1002/14651858.CD004376.pub3.

7. Barton CJ, Kemp JL, Roos EM, Skou ST, Dundules K, Pazzinatto MF, et al. Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis. Osteoarthr Cartil Open 2021;3:100175. https://doi.org/10.1016/j.ocarto.2021.100175.

8. Law TY, Nguyen C, Frank RM, Rosas S, McCormick F. Current concepts on the use of corticosteroid injections for knee osteoarthritis. Phys Sportsmed 2015;43:269–73. https://doi.org/10.1080/00913847.2015.1017440.

9. Aggarwal A, Sempowski IP. Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature. Can Fam Physician 2004;50:249 LP – 256.

10. Dias JM, Cisneros L, Dias R, Fritsch C, Gomes W, Pereira L, et al. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Brazilian J Phys Ther 2017;21:449–56. https://doi.org/10.1016/j.bjpt.2017.06.012.

11. [11] Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JAN, Bierma-Zeinstra SMA. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2015;2015. https://doi.org/10.1002/14651858.CD004020.pub3.

12. [12] Nakagawa Y, Mukai S, Yamada S, Matsuoka M, Tarumi E, Hashimoto T, et al. Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci 2014;19:933–9. https://doi.org/10.1007/s00776-014-0633-0.

13. [13] Glucosamine and Chondroitin for Osteoarthritis | NCCIH n.d. https://www.nccih.nih.gov/health/glucosamine-and-chondroitin-for-osteoarthritis

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Non-surgical options for knee osteoarthritis