Knee Arthritis Treatment Options
Osteoarthritis is a wear and tear disease. It typically occurs as we age and is the result of cartilage within the joint breaking down. This can cause pain and disability. Osteoarthritis (OA) and rheumatoid arthritis (RA) are different. RA is an autoimmune disease. This is an outline of treatment options available to patients with OA. If you have RA these options are available for you to try as well. Patients with RA typically will need to see a rheumatologist to discuss specific medications not outlined in this guide.
The first option is to live with the problem the way that it is. Arthritis is not life threatening but is life limiting. Osteoarthritis symptoms can result in decreased activity levels and potential weight gain. These factors can result in higher risk for cardiovascular events.
The second option is lifestyle modification including weight loss and activity changes. This includes diet change, exercise or physical and aqua therapy. Low impact exercise such as biking, walking and swimming can improve pain and function. Adhering to a low carbohydrate diet refraining from highly processed foods is the key to a healthier lifestyle. Ask us about referring you to a nutritionist. Many insurance companies cover this service.
- Did you know working with a therapist on the way you walk or utilizing shoe inserts or a specialized shoe could help you?
- Did you know that even 5 lbs of additional weight adds around 20 lbs of pressure to an arthritic knee?
The third option includes using oral or topical medications. This includes acetaminophen (Tylenol), anti-inflammatories (Ibuprofen, Advil, Aleve, Celebrex, Meloxicam) and supplements (Glucosamine, Chondroitin). Patients with history of stomach ulcers, kidney disease, gastric bypass or patients on a blood thinner should not use NSAIDs. Tylenol is a safer oral option for most patients. Topical medications and patches (Voltaren Gel, Mountain Ice, Salonpas) can also be helpful with lower side effects reported. There are several studies showing modest pain relief reported from using supplements. Supplements do not restore or slow degeneration of the cartilage. Using ice for 5-15 minutes several times a day may help improve symptoms short term. Ice acts as an anti-inflammatory. Narcotics are not effective in reducing pain and improving function in osteoarthritis. Some patients report success with using either oral or topical CBD.
The fourth option includes intra-articular injections such as Cortisone, Toradol and Viscosupplementation.
All injections have a very small risk of infection, well under 1%.
- Cortisone is a steroid meant to decrease inflammation within the joint and improve pain. This medication may affect blood sugar. Some insurance companies will authorize a steroid injection for our diabetic patients that will not increase blood sugar. Please ask us about it. Cortisone injections may provide pain relief for up to 90 days. This outcome depends on how severe your arthritis is. Patients with severe, bone on bone arthritis may only benefit a few weeks from this type of injection. You can have an injection once every 3 months if needed. There is some concern that these injections can cause further cartilage damage in the joint. However, these injections are still widely used and may help certain patients delay joint replacement. Symptoms may improve after 3 days of the injection. Some patients report delayed onset of relief.
- Unfortunately, 2% of patients who receive a cortisone injection can experience a flare up of pain related to the injection. This typically subsides within 72 hours and the injection can still help with the arthritis pain you were previously experiencing. Patients receiving cortisone injections may also experience facial flushing for up to 48 hours. Women more commonly experience this symptom. This is not an allergic reaction or medical emergency but can be uncomfortable.
- Toradol is an anti-inflammatory which can provide up to 3 months of pain relief, like Cortisone. However, this injection will not increase blood sugar. Pain flare is not typically associated with Toradol. Patients with severe arthritis may not experience long term, significant relief. This injection is used less frequently than cortisone or HA.
- Viscosupplementation also known as gel injections or Hyaluronic acid (HA). These injections are lubricating agents. HA is not currently recommended by The American Academy of Orthopedics. Studies show no significant improvement in function or long-term pain relief with HA especially in patients with severe OA. These injections are more likely to help in a patient with mild to moderate OA. The injections may not be covered by certain insurance companies. Many companies require preauthorization. The injections are usually a series of 3 (once a week for 3 weeks) and you can receive them every 6 months. Some patients report pain, stiffness and swelling after these injections. It may take up to 4 weeks after the last injection before symptoms improve.
The fifth option is considering biologic treatments such as PRP or stem cell injection. Unfortunately, these treatment options are not covered by insurance and can be costly. The success rate of these treatment options is somewhat unclear. Further research is still needed. Currently the Academy of Orthopedics encourages only those patients with mild to moderate arthritis to consider biologic treatments. This may be an option for a young patient needing to delay joint replacement. If you are interested in this treatment option, we have additional information for you.
The sixth option is cryotherapy. We offer a treatment called Iovera. This is a nerve freezing procedure. There are studies showing improved pain and function after Iovera treatment. This treatment is more likely to help someone with mild to moderate OA. Again, some insurance companies have resisted covering this treatment. Many people undergo this procedure prior to knee replacement to control postoperative pain. If you are interested in this treatment option, we have additional information for you.
The last option to consider would be knee replacement either a total knee or partial knee replacement. Talk to your provider to see which surgery you are a candidate for. Knee replacement requires commitment from both you and your family or friends. Recovery takes at least 8 weeks of restricting walking, performing hourly exercise, icing and elevating. We have a lot of information for you about knee replacement. Let us know if you are considering surgery.
Not sure if your knee is bad enough for surgery? You can take a quiz that may help you decide if you’re ready for knee replacement.
Open your phone’s camera and scan the QR code below to take you to the quiz website.
Once you finish the questionnaire you can ask one of our providers to help you review the results. A lower score indicates worse pain/disability. A score of 50 and under would indicate that you may benefit from this procedure.
American Academy of Orthopaedic Surgeons. AAOS. (2024). https://www.aaos.org/
American Association of Hip and Knee Surgeons. AAHKS. (2024). https://www.aahks.org/
Hip Arthritis Treatment Options
Osteoarthritis is a wear and tear disease. It typically occurs as we age and is the result of cartilage within the joint breaking down. This can cause pain and disability. Osteoarthritis (OA) and rheumatoid arthritis (RA) are different. RA is an autoimmune disease. This is an outline of treatment options available to patients with OA. If you have RA these options are available for you to try as well. Patients with RA typically will need to see a rheumatologist to discuss specific medications not outlined in this guide.
The first option is to live with the problem the way that it is. Arthritis is not life threatening but is life limiting. Osteoarthritis symptoms can result in decreased activity levels and potential weight gain. These factors can result in higher risk for cardiovascular events.
The second option is lifestyle modification including weight loss and activity changes. This includes diet change, exercise or physical and aqua therapy. Low impact exercise such as biking, walking and swimming can improve pain and function. Adhering to a low carbohydrate diet refraining from highly processed foods is the key to a healthier lifestyle. Ask us about referring you to a nutritionist. Many insurance companies cover this service.
- Did you know working with a therapist on the way you walk or utilizing shoe inserts or a specialized shoe could help you?
- Did you know losing 10 lbs can take almost 30 lbs of force off of your hip?
The third option includes using oral or topical medications. This includes acetaminophen (Tylenol), anti-inflammatories (Ibuprofen, Advil, Aleve, Celebrex, Meloxicam) and supplements (Glucosamine, Chondroitin). Patients with history of stomach ulcers, kidney disease, gastric bypass or patients on a blood thinner should not use NSAIDs. Tylenol is a safer oral option for most patients. There are several studies showing modest pain relief reported from using supplements. Supplements do not restore or slow degeneration of the cartilage. Narcotics are not effective in reducing pain and improving function in osteoarthritis. Some patients report success with using CBD.
The last option is to consider total hip replacement. Unfortunately, injections into the hip joint do not typically provide worthwhile, long term pain relief. Hip replacement requires commitment from both you and your family or friends. Recovery takes at least 8 weeks of restricting walking, performing hourly exercise, icing and elevating. We have a lot of information for you about hip replacement. Let us know if you are considering surgery.
Not sure if your hip is bad enough for surgery? You can take a quiz that may help you decide if you are ready for hip replacement.
Open your phone’s camera and scan the QR code below to take you to the quiz website.
Once you finish the questionnaire, you can ask one of our providers to help you review the results. A lower score indicates worse pain/disability.
