Osteoarthritis of the Knee

Non-operative treatment

There are many treatments proven to be effective that can be tried for osteoarthritis (OA) before progressing to surgical treatment:

• Weight loss has been shown to slow progression of disease and to relieve symptoms in obese patients with OA of the knee.
• Regular simple analgesia such as paracetamol (2 tablets, 2 – 3 times per day).
• Topical heat (such as a wheat bag) can decrease night-time discomfort.
• Soft sole shoes or shoe inserts to decrease heel strike forces transmitted through the knee.
• Stretching the tendons and muscles around the knee to maintain range of motion.
• Strengthening the supporting muscles (quadriceps, hamstrings and calves) with isometric and low-impact exercises (e.g. hydrotherapy).
• Using a walking stick (usually in the opposite hand) decreases load through the knee.

• Braces or supportive strapping improve proprioception and keep the knee warm in winter. More complex (and expensive) braces may unload the affected compartment.
• In medial compartment OA, a 6mm lateral heel build-up or in-shoe orthotic leads to transfer of more weight through the unaffected lateral compartment during the stance phase of gait.
• Short term oral anti-inflammatory medications (NSAIDs) are useful for exacerbations. Check with your local doctor on what he would recommend for you.
• Several clinical trials in patients with OA have demonstrated good results with oral glucosamine or chondroitin sulfate (e.g. Arthro-eeze). Their efficacy appears to be comparable to that obtained with commonly used NSAIDs.
• Intra-articular injection of anti-inflammatory medication (cortisone) is more successful in the acutely inflamed knee. More than three injections in any one joint per year should be performed with caution.
• Intra-articular injection of hyaluronic acid (e.g. Synvisc) seems to be as effective as commonly used NSAIDs in relieving pain and improving function in patients with OA of the knee, with a reduced incidence of side effects.