Non-Surgical Treatments for Osteoarthritis of the Knee

Man holding injured knee, cropped

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Osteoarthritis of the knee can trip you up, literally and figuratively, and so can deciding on a treatment for it. You've got a lot of approaches to consider for dealing with knee osteoarthritis.

Some available treatments are considered safe and effective by the American Academy of Orthopaedic Surgeons (AAOS), and some are not. It can be helpful to have a sense of which treatments are or aren't recommended as you and your doctor sort through the possibilities.

Below, you'll find the American Academy of Orthopaedic Surgeons' (AAOS) opinion on 18 noninvasive treatments for knee osteoarthritis, based on different levels of evidence. Because these are noninvasive options, they stop short of knee replacement. Keep in mind that replacement may be the best treatment option for you.

The AAOS guidelines pertain to people who have symptoms of knee osteoarthritis, such as joint pain and stiffness. They aren't meant for cases in which knee X-rays show evidence of joint degeneration but there aren't any symptoms.

Recommended Treatments

These recommended treatments all have enough evidence backing them for the AAOS to consider them safe and effective for knee osteoarthritis.

Rehabilitation, Education, and Wellness Activities 

This includes participation in self-management programs and making changes in activity when possible to protect your joints (for example, walking or swimming rather than running for cardio exercise).

Pain-Relief Medication

Oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) are highly recommended for relieving pain and inflammation. The prescription opioid Ultram (tramadol) also gets high ratings from the AAOS for treating pain from knee osteoarthritis.

Weight Loss

If you're overweight, which is defined by a body mass index (BMI) greater than 25, the AAOS says you may greatly benefit from losing even 5% of your body weight and maintaining the lower weight through diet and exercise.

Lateral Heel Wedges

These are insoles that elevate the outer edge of the foot in order to change the way the knee joint works. The AAOS stresses that it does not recommend lateral heel wedges for people with medial compartment knee osteoarthritis.

Needle Lavage

This is the practice of washing out the joint. The AAOS doesn't advise against it but says doctors should be on the lookout for new research. The single high-quality study cited in the guidelines found no measurable benefit.

Tibial Osteotomy

In this procedure, a piece of the tibia (one of the two lower-leg bones that form the bottom of the knee joint) is removed. Although some studies support this procedure, the AAOS considers them of low quality. Even so, the guidelines don't recommend against it.

Treatments With Inconclusive Evidence

Many treatments, including some in common use, aren't backed by strong evidence or any evidence at all. The AAOS considers evidence about the following treatments inconclusive, meaning it's too early to say whether they're safe and effective.

Physical Agents, Including Electrotherapeutic Modalities

These include transcutaneous electrical nerve stimulation (TENS); shortwave diathermy; inferential current; therapeutic application of a musically modulated electromagnetic field (TAMMEF); and ultrasound. Of these, ultrasound has the most evidence showing it can be effective, but overall there's too little conclusive research to fully judge any of these treatments, according to the AAOS guidelines.

Manual Therapy

This includes chiropractic therapy, myofascial release, and Swedish massage. The AAOS is neither for nor against these therapies.

Knee Brace

An example of a knee brace is a medial compartment unloader, which is designed to take stress off of the inner knee in someone whose osteoarthritis is focused there. Studies of the effectiveness of knee braces do not show whether they're helpful or not.

Acetaminophen, Opioids, and Pain Patches

Although there's evidence that NSAIDs are effective for treating knee osteoarthritis, the jury is still out on non-NSAIDs (with the exception of tramadol). These include Tylenol (acetaminophen) and opioids such as Vicodin (hydrocodone-acetaminophen).

Injected Corticosteroids

Intra-articular corticosteroids are injected into an affected joint with the goal of relieving inflammation. It's unclear how helpful this treatment can be for osteoarthritis of the knee.

Biologic Injections

The AAOC is neither for nor against injections with growth factor or platelet-rich plasma.

Arthroscopic Partial Meniscectomy

The treatment is sometimes used for a torn meniscus or loose body, but the AAOC doesn't recommend for or against this procedure.

Treatments That Are Not Recommended

The following treatments are believed to be ineffective for symptoms associated with osteoarthritis of the knee. (Some, though, may be effective for other conditions.)

Glucosamine and Chondroitin

Although glucosamine and chondroitin are both substances the occur naturally in joints, the AAOS strongly advises against taking them in the form of dietary supplements for treating osteoarthritis of the knee. 

Viscosupplementation

This treatment involves injecting hyaluronic acid, which is an important component of the synovial fluid that cushions and lubricates joints, into the area where the bones of the joints meet. The AAOS does not recommend intra-articular hyaluronic acid injections for knee osteoarthritis.

Acupuncture

There's strong evidence acupuncture does not relieve pain related to knee osteoarthritis.

Arthroscopy with Debridement or Lavage

This is a procedure in which damaged tissue is removed from between joints noninvasively. The AAOS believes it to be ineffective against knee osteoarthritis symptoms.

Unispacer

This is a free-floating device that compensates for lost cartilage, which the AAOS says should not be implanted in someone with symptomatic unicompartmental knee osteoarthritis.

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  2. Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the kneeCochrane Database Syst Rev. 2015;(3):CD004020. Published 2015 Mar 16. doi:10.1002/14651858.CD004020.pub3

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