Initial treatment is directed at eliminating inciting activities if possible, in conjunction with icing, Tylenol, and non-steroidal anti-inflammatory medications (NSAIDs). Knee braces and assistive devices for ambulation (cane, crutches, walker) can also be employed. An exercise program incorporating stretching, muscle strengthening, and low-to-no impact cardiovascular exercise often proves effective in alleviating symptoms. Biking, swimming, and other exercise classes can be helpful. Controlling weight by limiting caloric intake, aided by dietary counselling, in conjunction with an appropriate exercise program is a key aspect of the treatment plan.
Subsequent options in the treatment algorithm include formal physical therapy, injections, and surgery. Injections of corticosteroid medications aid in decreasing acute inflammation and pain but do not alter the degenerative process. Viscosupplementation injections are a means of replenishing the hyaluronic acid material which is a key component of the normal lubricating joint fluid; the joint fluid in an arthritic knee is felt to thin out with the OA process.
Arthroscopic surgery is utilized infrequently with osteoarthritis, except in cases of associated symptomatic meniscal tears, loose bodies, or with appropriate mechanical symptoms such locking (i.e. “my knee gets stuck”); the natural history and progression of OA is unchanged by knee arthroscopy. Similarly many of the types of meniscal tears noted on MRI and at arthroscopy – radial posterior horn or medial meniscal root tears – have an associated poor prognosis when treated surgically.
Ultimately total knee, or in select cases partial, replacement is the definitive treatment for end-stage osteoarthritis of the knee, when the patient can no longer function as desired and all conservative treatment options have been exhausted.
Dr. B. Rodney Comisar is a board certified, fellowship-trained orthopedic surgeon who specializes in sports medicine related injuries. He has a sub-specialty certification in Sports Medicine. Dr. Comisar offers a full spectrum of sports medicine surgery, including arthroscopy and minimally invasive procedures. Dr. Comisar’s special areas of interest include: multi-ligamentous knee injuries/dislocations; ACL injuries/reconstruction; rotator cuff injuries/tears; patellar instability/dislocation; proximal hamstring ruptures; shoulder instability; and shoulder arthritis including total shoulder replacement and reverse total shoulder replacement.
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