Treatment. Knee Osteoarthritis

Treatment of knee osteoarthritis

There is no cure for knee osteoarthritis, but there are ways to provide osteoarthritis pain relief and delay the progression of the disease.

Medications for knee osteoarthritis

Pain relievers: Also called analgesics, these medications can help relieve osteoarthritis pain and stiffness, but they don’t reduce inflammation, and they are not curative. One example of an analgesic that is available without a prescription is acetaminophen. 

Non-steroidal anti-inflammatory drugs: These are also known as NSAIDs. Examples of these include ibuprofen, naproxen, and aspirin. In addition to relieving pain, they also help to reduce inflammation caused by knee osteoarthritis. Factors to consider related to NSAIDs include: 

1. Side effects: NSAIDs can cause gastrointestinal problems, such as bleeding, in some patients. Your doctor will inform you of this and instruct you if using NSAIDs is the proper knee osteoarthritis treatment for you. Sometimes physicians prescribe other drugs to protect your stomach while taking NSAIDs 
2. Other side effects: NSAIDs can also increase the risk of stroke or heart attack in some individuals, so ask your doctor before self-medicating for knee osteoarthritis, especially if you have other health conditions such as diabetes, high blood pressure, problems with circulation, or high cholesterol.
3. If you cannot tolerate NSAIDs by mouth, creams, and gels which contain anti-inflammatory agents may work well for you. These are applied to the skin surfaces of your joints three or four times daily, and they absorb to provide relief. Very little of the medication is absorbed into the body. 

Capsaicin cream: This topical knee osteoarthritis medication is made from the chili pepper plant. It is also applied to the skin surface of the joint for knee osteoarthritis and is usually tolerated well. 

• Capsaicin cream is usually applied three times daily.
• It may cause a burning or warm sensation when first used, but this goes away quickly
• It may take a few days to become effective, so it is recommended to use it for several days before deciding whether it is helping knee osteoarthritis. 

Stronger pain relievers: narcotics or prescription NSAIDs 

These may be prescribed by your physician for knee osteoarthritis if other analgesics are not effective or if the pain is extremely severe.

• Stronger pain relievers come with a higher risk for side effects, including sedation, nausea, and constipation. 
• Narcotics carry the risk of addiction and are typically only prescribed for a short time. 
• Stronger pain relievers require a prescription from a doctor.
• Be sure to report any adverse side effects to your doctor right away.

Injections of corticosteroids 

Knee osteoarthritis is sometimes treated by injections of steroids given directly into the joint of the knee. 

• Steroid injections may take effect within a day and may help to relieve pain for many weeks or even a few months.
• Steroid injections are usually only used for severe knee osteoarthritis, to help provide relief for special important events, such as a wedding, or for sudden attacks of severe pain that are caused by the shedding of mineral crystals through the joint. 

Other treatment options

• Applications of heat or cold: This can often relieve stiffness and pain caused by knee osteoarthritis. Never apply an ice pack or heat directly to the skin. Wrap it in a thin towel or a t-shirt.
• Hyaluronic acid injections: If injections of steroids are ineffective, these injections may be considered. They help to provide lubrication to the knee. 
• Transcutaneous electrical nerve stimulation (TENS): Sometimes, this therapy is effective for knee osteoarthritis treatment, although it doesn’t work for all patients. It is a small device that sends mild electrical impulses to nerve endings and is thought to change the way the brain interprets pain. Physical therapy departments use large machines, but portable machines are available for home use. 
• Knee braces: These can help support the knee and provide relief in some cases of knee osteoarthritis, but patients need to consult their health care provider or physical therapist before using these to make sure they are the proper treatment. 
• Surgery: Surgery might be recommended for patients with severe knee osteoarthritis that causes extreme pain and immobility. Knee replacement surgery can provide pain relief, and replacements can last for an average of more than 15 years. 

Knee osteoarthritis surgery

In patients whose knee osteoarthritis surgery has been recommended, sometimes physical therapy is consulted prior to surgery for familiarization with assistive devices and the exercises that will begin after their operation. 

Arthroscopic procedures

These procedures can be used by doctors to remove any loose pieces of cartilage and clean the joint. This alone sometimes relieves the pain of knee osteoarthritis. If places on the cartilage are poorly worn, they can be roughened to promote the growth of new cartilage. This can provide pain relief for a few years. 

Proximal Tibial Osteotomy

In this operation, the bones of the lower leg are realigned to remove pressure from the cartilage. When the angle of the joint is repaired, pressure is taken off. The cartilage is then allowed to regrow. 

This operation can reduce the pain of knee osteoarthritis, but it does not completely eliminate it. However, if the procedure is successful, it typically provides relief for up to seven years.

Artificial Knee Replacement

Having a knee replaced is the recommended solution for knee osteoarthritis that is severe. However, most surgeons do not like to replace a knee joint in an individual who is less than 60 years old because younger, more active patients are likely to put too much pressure on the knee joint, causing it to crack or loosen. If the replacement has to be revised, the chances of complications are increased, and the chances of a successful outcome are usually less than an initial knee replacement.