Knee Osteoarthritis

Knee osteoarthritis is characterized by pain, stiffness and swelling of the knee that worsens with weight bearing activities and movements that load the knee joint such as walking, stairs, hills and transitions from sitting and standing. It tends to be worse in the mornings and after prolonged inactivity due to the stiffness. X-rays typically show bony spurs/ osteophytes and a loss of joint space between the thigh and shin bones. While knee OA may eventually lead to the need for a total knee replacement, there are many conservative treatment options to delay this as long as possible.

The most evidence-based recommendations include physical therapy/guided exercise, weight loss and the use of NSAIDs. Each pound of weight loss may decrease knee joint forces by up to 3-4x that amount. Biking may be used to work on fitness with less load on the knee joint. Physical therapy should include exercises to improve the strength of the entire lower extremity but especially the quadriceps, mobility and range of the knee and kneecap, and flexibility of the quad, hamstring and calf.

Manual therapy may be used to improve flexibility of muscles and mobility of the kneecap with passive stretching to address range of motion. Shoewear/ insoles may provide more cushion to decrease joint forces with walking and standing. Supplements such as fish oil, vit D and glucosamine may be trialed.

Orthopedic doctors may recommend glucocorticoid, hyaluronic acid and/or platelet-rich plasma (PRP) injections in severe cases to delay the need for surgery.