How Knee Osteoarthritis Is Treated

Osteoarthritis (OA) of the knee), a condition in which the cartilage that cushions the joint wears away, can hobble you with pain, stiffness, and limited range of motion. Treating these symptoms is key to managing knee OA and involves a variety of measures, ranging from home remedies to over-the-counter (OTC) or prescription pain medications to injections. These treatments are meant to alleviate discomfort and restore movement as well as to prevent the need for knee replacement surgery.

In 2019, the American College of Rheumatology (ACR) and the Arthritis Foundation (AF) updated their recommendations for managing osteoarthritis of the hip, knee, and hand. Based on a thorough review of clinical research, the organizations reported which treatments for knee OA they strongly recommend and those they conditionally recommend. The ACR/AF recommendations also identify treatments that they strongly or conditionally recommend against.

Senior man having his knee examined

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Home Remedies and Lifestyle

Of all the strategies you can use to relieve knee osteoarthritis and prevent further damage, weight loss and exercise may well be the most effective.

Besides those two measures, there are others you can take that require no medication or the involvement of a doctor or other medical professional—although you should always check with your caregiver before trying anything new on your own.

  • Exercise: Strengthening the muscles that support the joint is essential to treating knee OA. In fact, the ACR/AF guidelines state "all patients should be encouraged to consider some form of exercise as a central part of their treatment plan." Although they do not suggest specific regimens, they do suggest physical activity is more likely to be effective in a class setting or with the guidance of a physical therapist.
  • Weight loss: If you have a body mass index (BMI) of over 25 (the definition of overweight), taking off 5% or more of your body weight may help relieve symptoms of knee (and hip) arthritis and make it easier to move. Losing even more weight may increase these benefits.
  • Self-efficacy and self-management programs: Group classes or other educational programs can help patients learn about arthritis and ways to deal with pain and limitations it causes. Typically such classes take place two to six times a week.
  • Heat and cold: Applying an ice pack or other source of cold helps to divert blood from inflamed areas around a joint, which reduces swelling. Heat, from a heating pad, for example, can ease pain.
  • Balance training: Exercises that teach how to control and stabilize the body can help prevent falls. A good source for information about the importance of balance training is the American Physical Therapy Association.

Over-the-Counter (OTC) Therapies

The local drugstore or supermarket may be a source of effective remedies for pain and swelling brought on by osteoarthritis of the knee.

  • Oral non-steroidal anti-inflammatory drugs (NSAIDs): The most common of these are Advil (ibuprofen) and Aleve (naproxen).
  • Topical NSAIDs: Creams, ointments, gels, and medicated patches can provide symptom relief directly the affected joints, such as Voltaren Gel (diclofenac, 1%).
  • Topical capsaicin, the ingredient in chili peppers that make them hot, may be helpful for relieving OA of the knee, as the joint is close enough to the surface of the skin it can be easily absorbed in painful areas.
  • Cane: It may be advisable to use a cane to help you walk if more than one joint is affected by OA and it is difficult for you to get around on foot.
  • Acetaminophen: The active ingredient in Tylenol may provide pain relief (but will not bring down swelling or reduce inflammation).
  • Kinesiotaping: Kinesiotape is a stretchy adhesive that can be applied much like a brace to support inflamed or injured joints. Because it's stretchy, the tape allows the joint to move, which isn't the case with knee braces.

Prescriptions

When over-the-counter remedies aren't enough to manage your OA pain, your doctor may write you a prescription. Here are two medications recommended in the guidelines:

  • Tramadol, an opioid that's sold as ConZip or Qdolo
  • Cymbalta (duloxetine), a type of antidepressant known as a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that has been found to help relieve joint and muscle pain

Surgeries and Specialist-Driven Procedures

  • Intra-articular corticosteroid injection: This procedure involves injecting a steroid medication between the bones of the affected joint to relieve inflammation. The injection is sometimes referred to as cortisone shots.
  • Tibiofemoral knee brace: For people who can tolerate wearing the device, this type of brace is strongly recommended when OA is interfering with the ability to walk.
  • Patellofemoral knee brace: The ACR/AF guidelines conditionally recommend this type of brace, emphasizing the importance of proper fitting and input from a person's doctor.
  • Radiofrequency ablation (RFA): This is a non-invasive procedure in which radio waves are sent through special needles to nerves that send pain signals to the brain. This temporarily blocks those signals. Radiofrequency ablation often is performed with the guidance of X-ray imaging to make sure the right nerves are being targeted.
  • Knee replacement: The medical term for this procedure is knee arthroscopy. It involves removing part or all of the knee joint and replacing it with a man-made implant constructed from metal and plastic.

Complementary and Alternative Medicine (CAM)

  • Tai chi: This ancient Chinese martial art is strongly recommended for knee surgery. It involves slow, gentle, flowing movements with meditation and deep breathing.
  • Yoga: Research has found yoga to be effective for relieving knee OA symptoms. In one study of people between age 30 and 75, for example, those who practiced yoga felt stronger, more flexible, and more mobile after just a week of daily practice.
  • Acupuncture: This ancient Chinese medicine technique, in which slender needles are inserted into specific sites on the body to relieve pain, is conditionally recommended for treating knee OA.
  • Cognitive behavioral therapy (CBT): In studies, CBT has been found to help people with osteoarthritis to deal with fatigue, disability, low mood, and pain, and to improve overall quality of life.

A Word From Verywell

Knee osteoarthritis can be debilitating, so it's important to fine-tune treatment to the degree of damage to the joint and the amount of pain and loss of function you have. This means working with your doctor to determine the best strategies for you and then following through on them. Doing so may mean the difference between improving your ability to walk and move and eventually needing knee surgery.

Note there are several treatments the ACR/AF strongly recommends against for knee osteoarthritis: glucosamine, chondroitin, bisphosphonates, hydroxychloroquine, biologic medications, stem cell injections, hyaluronic acid injections, platelet-rich plasma, and transcutaneous electrical stimulation (TENS).

The guidelines also conditionally recommend against a number of other treatments. Ultimately, you and your doctor will consider the pros and cons of all options to determine which may be safe and effective for you.

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