Knee arthritis develops when a joint’s healthy cartilage wears away, leaving the surfaces of bone to rub directly together. That causes pain, clicking and a catching sensation.
Treatments include lifestyle changes, physical therapy and drugs to relieve arthritis pain and stiffness. Your doctor may also recommend surgery to relieve severe pain and disability.
A patient experiencing pain in the knee that doesn’t go away should seek medical attention from a doctor specializing in orthopedics as soon as possible. Depending on the severity of the symptoms, they can diagnose the condition and recommend treatment for it.
Symptoms of knee osteoarthritis include a pain that comes and goes over time, especially following activities that put pressure on the knee such as walking long distances, going up or down stairs, hiking, or sitting cross-legged for long periods. A patient might also hear a crackling sound in the knee when it is moved or feel a grating sensation when trying to straighten or bend the knee.
Some medications are effective in relieving the pain of knee osteoarthritis. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help relieve pain, though they should not be used by patients with certain health conditions such as coronary artery disease or congestive heart failure. Topical medications such as acetaminophen can also be used to reduce pain and are safe for most people.
Injections of hyaluronic acid, which occurs naturally in the knee and helps to lubricate the joint, might help relieve pain by adding some cushioning. Other injectable treatments include steroid injections and transcutaneous electrical nerve stimulation (TENS), which sends tiny electric shocks through pads placed on the skin to change how the nervous system senses pain and can reduce swelling.
Often the pain of knee arthritis can be relieved with conservative methods, but if it becomes disabling surgery may be recommended. Orthopaedic specialists can treat the knee with arthroscopic surgery, which involves inserting a thin tube with a camera on its end through an opening in the knee to remove damaged cartilage — the smooth covering that protects the bones in the joint. This can reduce pain and stiffness. It can also be used to clean the knee joint and remove loose bone fragments or cartilage. This is usually a minimally invasive procedure, and recovery is quick.
Inflammatory arthritis causes the knee to swell up and create extra fluid in the knee joint capsule, called effusion (water on the knee). This can increase pressure on the knee, further wearing away the cartilage. Surgery to drain the fluid can be performed under a local anesthetic.
There are several other surgical treatments for arthritic knees, such as knee osteotomy to realign the bone, or total or partial knee replacement to replace the damaged cartilage and bone. However, studies haven’t shown these options to be effective for knee pain from osteoarthritis. Other therapies that are sometimes promoted to decrease knee pain and disability include insoles or special medical shoes, glucosamine and chondroitin supplements; injections of hyaluronic acid to add lubrication to the knee joint; and stem-cell treatment that uses the patient’s own bone marrow cells to grow new cartilage and reduce inflammation.
Knee arthritis is a chronic condition, but some medications can help with pain and inflammation. A doctor can recommend over-the-counter or prescription painkillers. These include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin). Painkillers can cause side effects, so it’s best to take them as directed. Topical treatments such as capsaicin cream (Bengay) or methyl salicylate and menthol cream (Aspercreme) may also help.
Injections of hyaluronic acid, a gel-like fluid that’s normally found in the knee, may relieve pain. They provide extra lubrication and decrease friction or rubbing in the knee joint. Corticosteroid injections, which are powerful anti-inflammatory drugs, can also offer symptom relief for a short period of time. However, repeated use of these drugs can deteriorate articulate cartilage.
Other treatments include using a cane or a brace to help support the knee. Putting shock-absorbing inserts in your shoes can also reduce the amount of stress on your knees. You can also try heating or iceing your knee, applying topical creams, and doing exercises with a physical therapist to increase strength, motion, and flexibility.
Researchers are investigating the use of mesenchymal stem cells, which can grow into new cartilage and other tissues in the knee. These cells are extracted from bone marrow. Your NYU Langone doctor may discuss this experimental treatment with you if your knee is especially painful or stiff.
There are many different therapies to help with the pain, stiffness and other symptoms of knee arthritis. They won’t prevent or cure the condition, but they can improve your quality of life. Your doctor can advise you about these treatments.
Some people use heat or ice to relieve their pain and stiffness. You can buy gels, packs and hot water bottles at chemists or sports shops. A heat pack or a hot water bottle may ease your pain and stiffness, but be careful not to put direct heat on the skin as this can burn it.
Massage can help to strengthen the muscles around the knee and decrease pain. You can learn to do it yourself or visit a trained therapist.
Acupuncture can also help reduce pain and stiffness in some people with OA. However, the results of acupuncture studies have been mixed.
Other alternative treatments include a special diet that can help with weight loss (such as the Mediterranean diet), and taking herbal supplements, such as ginger extract or boswellia.
Another treatment that may ease the pain and stiffness of OA is called radiofrequency ablation, which works by killing the nerves that send pain signals to the brain. But this can only control the pain temporarily, as the nerves grow back over time. The other new treatment is autologous chondrocyte implantation, which involves taking cartilage cells from your knee and growing them in a lab to surgically replant them in your knee. This isn’t yet available for everyone with OA, but young people and athletes who have lost a lot of cartilage are potential candidates.