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Treatment Options

 
  Watch the video to see how knee pain can affect your daily life and ways you can treat your pain

If you have arthritis in one or both of your knees, you have many options to control your pain and stiffness. Treatments can include exercise, weight control, physical therapy, medications, injections, and surgery, among others. Most treatments will involve a combination of the methods described below. Before beginning any treatment, discuss your options with your doctor.

  1. Exercise, Rest, and Joint Care
    Research shows that exercise is one of the best treatments for osteoarthritis.1 Exercise improves mood and outlook, decreases pain, increases flexibility, improves blood flow, helps maintain weight, and promotes general physical fitness. Exercise is inexpensive and, if done correctly, has few negative side effects. Low or non-impact exercise such as biking, elliptical runner and swimming is recommended to minimize increased trauma to the joint. At the same time, your treatment must include rest. You need to recognize the body's signals and know when to stop or slow down, to prevent pain caused by overdoing it.

  2. Weight Control and Knee Pain
    For overweight people with knee pain, losing weight is powerful medicine. Your knee works like a scale, and a lighter load reduces pressure on your knees. Good nutrition can help you maintain your body weight or lose weight. Unfortunately, the effects of osteoarthritis often lead to decreased activity, making weight loss difficult.

  3. Non-Rx Treatments
    Some pain treatments don’t involve drugs. Warm towels, hot packs, or a warm bath or shower apply moist heat to the joint, which can help relieve pain and stiffness. In some cases, cold packs can relieve pain or numb the affected area. Water therapy in a heated pool or whirlpool also may offer relief. Some knee patients wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

  4. Medications and Supplements for Knee Pain
    Medicines used to treat osteoarthritis include over-the-counter drugs like acetaminophen, aspirin, and ibuprofen. In addition to pills, some people use pain-relieving creams, rubs, and sprays which are applied directly to the skin. Prescription medicines include a class of pills called NSAIDs (nonsteroidal anti-inflammatory drugs), mild narcotic painkillers, and corticosteroids (orally and/or injected into the joint) such as prednisone.
    In addition to medicines and injections, some patients use nutritional supplements. Examples include glucosamine and chondroitin. These products are treated by the Food and Drug Administration as food items and are not controlled by the FDA in the way that medicines are. It’s important to talk with your doctor before using any supplement, because they may have side effects and can interact with other medicines.

  5. Hyaluronic Acid Injections
    Another option is injections with a natural chemical found in the joint fluid in your body, called hyaluronic acid. The body produces this fluid naturally to serve as a lubricant and shock absorber in the joint. It is needed for the joint to work properly. Injections are used for patients who do not get relief from conservative treatments, but who may not yet be ready for surgery. For more on this option, visit www.orthovisc.com.

  6. Knee Surgery
    When treatments like exercise, weight control, and medicines fail to provide relief, surgery may be needed. Options include:
  • Arthroscopy. When osteoarthritis occurs, small pieces of cartilage may wear away from the joint surfaces and float around the inside of the joint. This joint debris may cause inflammation and pain. Your doctor may suggest arthroscopy to remove the debris, clean up the joint, and provide pain relief. Recent data suggests that arthroscopy may be helpful to relieve mechanical symptoms associated with arthritis such as locking or catching, but may not give substantial long-term relief of the pain associated with arthritis.2
  • Osteotomy. This is a procedure in which the bone is cut, either above or below the affected joint, and re-aligned to a better position. It is often used when the cartilage wear is confined to one part of the joint. Unfortunately, the success of this operation decreases as the degree of arthritis and deformity increases.
  • Knee replacement. Partial or total knee replacement can relieve pain and increase mobility. This operation resurfaces the damaged joint with metal and plastic implants. Knee replacement can help people get back to everyday life, such as climbing stairs, tying shoes, and getting up from a chair with less pain. It can also allow them to resume work.

Talk with your doctor about how knee pain affects your life. Only a surgeon can determine if knee replacement is an appropriate option. Let your doctor know when non-surgical treatments are no longer effective. Your doctor may recommend knee replacement to reduce pain and restore mobility.  

Reference:
1. Handout on Health: Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases, July 2002.

2. Wray et al, A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine 347:81-88, 2002.

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