Early in the disease process when damage to the joint surface cartilage is not severe, arthritis will often respond well to non-surgical measures. All patients should take simple measures to minimise the symptoms they experience from knee arthritis.
- Activity modification. Symptoms can be reduced by reducing impact or jarring activities, by improving the shock absorption of shoes and the surfaces walked or played on, by weight reduction if overweight. Using a walking stick/pole will also reduce stresses across the knee and subsequent pain.
- Physiotherapy. The main aim of a physiotherapy exercise programme is to improve the quality of muscles around the knee so that they can act as external shock absorbers to compensate for worn out internal shock absorbers.
- Painkillers/Anti-inflammatory medications. Use of simple painkillers (analgesics) such as paracetamol, anti-inflammatory medication and other analgesics. If different types of analgesics are used then the pain-killing effects can add up to provide greater pain control. For example, paracetamol and ibuprofen (an anti-inflammatory analgesic) will usually provide better pain relief than either analgesic taken by itself. Taking analgesics before and/or after performing activities that exacerbate symptoms, e.g. walking or playing tennis, can often allow patients to perform these activities more easily.
- Injections of cortisone. These can be useful particularly for exacerbations of arthritis.
- Injections of visco-supplements. Lubricants such as hyaluronic acid (e.g. ostenil or duralane) can also provide benefit although this tends to be temporary.
If these measures fail to control symptoms and restore activities then surgical treatments, including arthroscopy, osteotomy and knee replacement can be considered.
Arthroscopy has a limited role but might be helpful in patients who have marked mechanical symptoms due to a cartilage tear or loose body.
Osteotomy (leg realignment surgery) can be an alternative to joint replacement for patients who have developed a deformity as a result of their arthritis.
Ultimately, for many patients, the only long-term solution might be a partial or total knee replacement.