What Are the Non-surgical Options for Managing Knee Osteoarthritis?
The best treatment a surgeon can offer patients with knee pain from osteoarthritis is helping them lose weight, according to William J. Long, MD, FRCSC, of the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine in New York, New York.
Speaking at ICJR’s annual Winter Hip & Knee Course, Dr. Long told attendees that many of the treatments used in these patients, such as glucosamine, acetaminophen, long-term NSAID treatment, cortisone injections, viscosupplementation, and plasma-rich protein, have issues. Some put the patient as risk for serious complications, while others are not proven to provide clinically significant benefits.
He believes diet and exercise for weight loss should be the cornerstone of non-operative treatment. Research has shown, he said, that a 5% decrease in weight over a 20-week period – a very reasonable goal – can have significant benefits, such as reducing disability and pain.
In his practice, he advocates a non-impact conditioning program that increases strength and weight loss for patients with symptomatic mild to moderate knee osteoarthritis. He will give cortisone injections or prescribe a short course of NSAIDs for acute flares, keeping in mind the risk for complications. He will occasionally use viscosupplementation, although he admits he is not sure if it works – he has seen some improvement in patients with inflamed knees, but not in those with pain not caused by inflammation.
Click the image above to watch Dr. Long’s presentation.