Treatment of OA of the Knee: Best Non-Surgical Options for Pain Relief and Improved Mobility

Treatment of OA reduces swelling, stiffness, and pain.

OA of the knee is a very common condition. It is more common in eastern societies where squatting is common for various activities and may contribute to its development.

Despite the widespread incidence of this condition, there is no cure. Treatment is mainly geared towards pain control and functionality.

Symptoms of OA of the knee are quite characteristic and include pain in the knee with walking and morning stiffness lasting for about 30 minutes. Patients also occasionally experience swelling in the joint. On bending the joint, there is often crepitus palpable or audible to the patient or to surrounding observers. These symptoms vary with the severity of the disease. Very severe OA of the knee can cause disability.

What exactly is OA? OA is a degenerative disease of the knee joint. More specifically, it is a process involving various structures in the joint. As the process progresses, there is degeneration of the cartilage overlying the bones forming the joint. The semicircular rings of cartilage, known as the menisci, separating the two bones in the joint, also suffer degradation. The bone underlying the cartilage on the articular surface undergoes remodeling. Part of the remodeling involves new bone formation in the form of osteophytes. The synovium, or joint capsule, is not spared in this process and experiences inflammation.

We believe that OA results from repeated trauma or wear and tear on the joint caused by repeated or abnormal stresses placed on it. People involved in occupations requiring frequent squatting or lifting of heavy loads are most at risk, as are people who are overweight.

Over the years, OA therapy has evolved, and many treatment modalities have emerged. Some of these were later found to be useless, questionable in efficacy, or harmful to patients. Those that remain are a hodgepodge of treatments that have varying degrees of support from different authorities on the subject.

The diverse views and recommendations on which treatments are efficacious in the treatment of OA of the knee are a source of much confusion and bewilderment among patients.

OA care can be divided into two types: surgical and non-surgical. Here we will focus on the non-surgical modalities that exist for OA care.

Non-surgical modalities of OA care include meds for OA, physical therapy, exercise, weight management, application of various braces and supports, and cognitive-behavioral therapy for pain control.

Multiple medications for OA are recommended and have been tried over the years. Medications taken by mouth, such as NSAIDs (non-steroidal anti-inflammatory drugs) are the mainstay of therapy and are highly recommended for the treatment of OA of the knee joint.

NSAIDs, however, are not recommended for everyone, and you should consult your doctor before taking NSAIDs, as they can have serious side effects, such as GI bleeding and kidney disease.

 Other medications that have been found to be efficacious drugs for OA include various drugs used in the management of depression. One notable drug included in this group is duloxetine. Drugs such as these are used mainly for pain control. They work by modulating the transmission of pain signals.

Among medical treatments, there are medications applied to the skin, such as diclofenac topical gel and ibuprofen topical gel. These are NSAIDs and reduce inflammation and control pain. Other topical meds for OA like lidocaine and capsaicin cream numb the nerves, reducing pain in the joint.

Various intra-articular injections exist for osteoarthritis of the knee joint. Among the first drugs injected into the knee joint were corticosteroids. These reduce inflammation in the joints and improve functionality. The use of corticosteroids is not without its dangers, however, and further worsening of the degeneration of the cartilage is a serious concern.

Hyaluronic acid injections have recently fallen out of favor, although some physicians still prescribe this as an agent to increase the viscosity of the synovial fluid in the joint and to increase cushioning.

Platelet-rich plasma (PRP) injections have been shown to reduce pain and may stimulate the regeneration of joint cartilage, but this is still under investigation. Patients can try this OA therapy if more conservative treatments and drugs for OA fail.

Over-the-counter supplements may be tried with caution. Over-the-counter medications such as glucosamine, chondroitin sulfate, turmeric, ginger, and vitamin D are seen as more desirable by some patients. But while the risk of harm from either of these is relatively low, their efficacy is questionable.  

How effective are physical modalities for the treatment of OA? Simply put, very effective. Exercise and physical therapy can both improve functionality and reduce pain. Exercise can include strengthening exercises, range of motion exercises, or simple walking. Some patients may be better able to tolerate exercise if it is done in an aquatic environment.

The various braces and supports that exist to supplement drugs for OA are not to be forgotten. Patients can purchase knee braces or receive professional taping as effective treatments for their OA of the knee. These modalities vary in their effectiveness and degree of support and can be used as adjuncts to drugs for OA and exercise modalities. Patients can also use canes when this affords greater mobility and functionality.

There is not one single protocol for osteoarthritis of the knee joint. The choices are myriad, and the selection of the most appropriate modality should be a joint decision between the clinician and the patient. The decision is based on the severity of the OA, the availability of the treatment/drug, the patient’s comfort with the selection, and the expected efficacy of the OA therapy chosen.