Q: I have arthritis in my knees. What proven treatments are out there besides knee replacement surgery?
A: With people living longer, the number of people affected by osteoarthritis is rising sharply. In 2005, 27 million people in the US were estimated to have OA, with the knees, hands and hips being the most common sites of involvement. OA is more prevalent in women than men. Obesity is a strong risk factor for developing OA.
There is some evidence that heavy activity may predispose someone for developing OA. Occupations that require repetitive overuse of the knee confers an increase risk of OA of the knee. Prior knee injury is also a strong predictor of OA, especially injuries to the meniscus. Finally, malalignment has a strong influence on load distribution across the knee joint and the subsequent development of OA.
The American Academy of Orthopaedic Surgeons recently published a set of guidelines of effective treatments for OA. The best available scientific evidence in the literature was synthesized by a group of medical providers including orthopaedists, rheumatologists, physical medicine and rehabilitation physicians, and physical therapists. Short of knee replacement surgery, the following treatments have shown to be helpful in treating painful osteoarthritis of the knee and helping patients maintain functional activities:
Self management programs including weight loss efforts, lower extremity and core strengthening and low-impact aerobic exercises.
Prescribed physical therapy, which may include range of motion exercises, strengthening, neuromuscular education and other useful modalities.
Hinged knee brace and/or unloading brace for those patients with excessive bow leggedness (varus) or excessive knock kneedness (valgus).
Nonsteroidal anti-inflammatory drugs (oral or topical).
Narcotic medications for refractory pain if needed on rare, intermittent occasions. (However, I don’t recommend these for numerous reasons.)
Knee steroid injections used periodically.
Arthroscopic knee surgery for those with associated meniscal tears or loose bodies.
Realignment osteotomy surgery for those young patients with excessive varus or valgus deformities.
There are several other treatments that I have found helpful for patients with OA such as smoking cessation, as smoking has a deleterious effects on cartilage. I also recommend eating a diet rich in natural antioxidants (i.e. fruits and veggies) and limiting foods that are highly processed. Many patients of mine have also had good relief with viscosupplementation injections for knee OA.
LACK OF EVIDENCE TO SUPPORT STEM CELL TREATMENT
Finally, numerous patients ask me if stem cell injections would help their arthritis pain in their knee. There is currently no good evidence out there for me to be able to recommend stem cell injections for arthritis.
Moreover, these injections are very costly to patients, as insurance companies will not cover them given this lack of evidence that they help. Furthermore, there is no good evidence in reputable journals that they build cartilage in arthritic knees.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team and chief of surgery at Vail Valley Medical Center. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit www.vsortho.com.