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One of the most effective means of treatment is physical therapy. The most effective therapy is called closed-chain quadriceps strengthening. With this therapy, the foot is planted on the floor to strengthen the large thigh muscles. This often improves the way the kneecap moves through the knee joint, decreasing pain and increasing ability to function.
Weight loss is also a very effective means of dealing with knee arthritis. When we speak about weight, we usually speak about the body mass index (BMI), which is a ratio of weight to height that can be calculated using online calculators such as the one you can access at this link: https://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. People with a body mass index above 30 should consider weight loss to see whether that improves symptoms before embarking on any kind of joint replacement.
Based on the way body mechanics work, if you lose 1 pound of overall body weight, it takes 3 pounds of stress off your knee. I had several patients who were too heavy to undergo joint replacement, and I asked them to lose weight before undergoing the surgery. When they lost the weight, they came back and decided that they no longer needed the joint replacement because their pain had improved so dramatically. Certainly, this does not apply to everyone, but it has convinced me that attempting weight loss before considering knee replacement is a sound strategy if your body mass index is higher than 30.
Steroid injections into the knee are commonly used for knee arthritis treatment. Although a very small risk of infection is associated with the injections, they are remarkably effective in relieving pain. Unlike steroid pills, they rarely have any major effects on the whole body other than a temporary rise in blood sugar in diabetic patients.
Steroid injections can be administered into the knee every 3 months in the clinic (we have to wait 3 months between shots). I have had patients who have had delayed joint replacement for years with routine steroid injections.
Anti-inflammatory medications, such as acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil), are also very effective at relieving pain. For acetaminophen to be effective, patients should take it three times a day. For example, patients without liver problems can take two Extra-Strength Tylenol (1000 mg acetaminophen) three times a day to maximize the results. Ibuprofen and naproxen can also be used for pain relief as long as patients do not experience stomach problems, such as ulcers or bleeding. Excessive use of ibuprofen or naproxen can cause kidney damage, so follow the instructions on the bottle.
Other Nonoperative Treatments
Other treatments, such as knee unloader braces, heel wedges placed in the shoe, and injections of hyaluronic acid (a gel that is injected into the knee) have been used in the past for conservative treatment of knee arthritis. The American Academy of Orthopaedic Surgeons has not found them to be of substantial benefit. However, if the patient wants to try heel wedges, unloader braces, or injections of the hyaluronic acid gel, I am more than happy to accommodate them.
Surgical Treatment for Knee Arthritis
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