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Twenty-five (25) Treatments for Osteoarthritis of the Knee

1. Drug and non-drug treatments.

Medical experts agree that the most effective treatment programs for osteoarthritis of the knee (OA of the knee) include both medications and non-drug treatments. In fact, the results of clinical studies conclusively show that the best way to manage your pain is a combined approach that includes taking analgesic or non-steroidal anti-inflammatory drugs, educating yourself on the causes and symptoms of OA of the knee, and participating in such therapeutic activities as regular exercise and physical therapy.

Non-Drug Treatment

2. Education and self-management.

The initial focus of any treatment program for OA of the knee pain relief should be to take a proactive approach to learning as much as you can about the disease, instead of relying on passive therapies delivered by your health professional. This approach to your treatment can lead to dramatic improvements in your agility and relief from pain.

Health care professionals can prescribe medicines and recommend treatments to help you manage your OA of the knee pain, but the real key to living well and enjoying activities despite the disease is an everyday commitment to managing the discomfort. Research shows that people with OA of the knee who take part in their own care report less pain and make fewer doctor visits.

By learning as much as you can about the disease, you'll be able to identify and learn about the latest pain management techniques. You can:

  • develop your own individualized exercise program
  • manage fatigue and stress more effectively
  • learn more about the purposes and effective use of medications
  • find solutions to problems caused by your arthritis
  • identify ways to deal with anger, fear, frustration and depression
  • discuss with others the role of nutrition in arthritis management
  • learn new ways to communicate with family and friends and
  • form a partnership with your health-care team.

3. Regular telephone contact.

For many people dealing with OA of the knee, a monthly phone call with a trained professional can lead to profound improvements in joint pain relief and physical function for up to a year. During these conversations, you can discuss and learn more about your condition, and effective ways to manage your condition proactively. So don't forget to put a reminder on your calendar – and make the call!

4. Physical therapy.

Studies consistently support the usefulness of an evaluation by a physical therapist and instruction in appropriate exercise that can help you reduce pain and improve function. Once you've come up with a program that works for you, be sure to make the time to complete these workouts on a regular basis to increase your chances of experiencing positive results as soon as possible. Physical therapists can also provide helpful support devices to make your daily tasks like climbing stairs or walking from your car to your office much easier and less stressful on your knees.

5. Aerobic, muscle-strengthening and water-based exercises.

A rounded exercise program can promote muscle strength, improve range of motion, increase mobility and ease pain. It can also be fun and motivating, especially when you start seeing and feeling results from your efforts. Regular exercise will also help you sleep better at night. Here's a tip - ask a friend or family member to join you as a workout partner. Making exercise a social activity will help you stick with it, and your workout partner can also serve as a coach to keep you motivated.

6. Weight loss.

Maintaining your recommended weight or losing weight if you are overweight can lessen your pain by reducing stress on your knees. Weight loss specifically helps ease pressure on your knees. Talk to your doctor about a weight-loss plan that includes a healthy diet with flavorful foods, and an appropriate exercise plan that starts off slow and gradually increases in intensity. You can increase your chances of sticking with a weight loss programs by avoiding extreme measures.

7. Walking aids.

Using a cane or crutches when you walk can reduce pain from OA of the knee. If both of your knees are affected, a wheeled walker may be preferable. Your doctor or physical therapist can help you decide which of these aids will most help you get around without pain.

8. Footwear and insoles.

Special footwear and insoles – not to mention shoes or sneakers that fit properly - can reduce your pain from OA of the knee and improve walking. Talk to your doctor or physical therapist and ask for their help in making the right choices for you.

9. Knee braces.

A knee brace can reduce pain, improve stability and reduce your risk of falling as you go about your daily routine.

10. Heat and cold.

Many people find the heat of a warm bath, heat pack or paraffin bath eases OA of the knee pain by increasing blood flow and easing pain and stiffness. Others find relief in cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation and can relieve pain or numb the sore area. Still others prefer alternating the two. Talk to your doctor or physical therapist to find out if heat or cold – or a combination of the two - is the best treatment for you.

11. Transcutaneous electrical nerve stimulation (TENS).

TENS is a technique in which a weak electric current is administered through electrodes placed on the skin. It is believed to stop messages from pain receptors from reaching the brain, and has been shown to help with short-term pain control in some patients with OA of the knee.

12. Acupuncture.

A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been touted as a treatment for OA of the knee pain. A recent trial of 352 patients with OA of the knee showed small but statistically significant improvement in pain intensity at two and four weeks following a course of acupuncture. Scientists believe the needles stimulate the release of natural, pain relieving chemicals produced by the nervous system.

13. Acetaminophen.

A dosage of up to four (4) grams per day of acetaminophen can be an effective initial treatment for OA of the knee pain. It is often the first medication doctors recommend for OA of the knee because of its safety relative to some other drugs and its effectiveness against pain.

14. Nonsteroidal anti-inflammatory drugs (NSAIDs).

Despite cardiovascular and gastrointestinal concerns about this class of drugs, NSAIDs can be useful for OA of the knee pain, but be sure to use the lowest effective dosages and avoid long-term use if possible. If you're at high risk of gastrointestinal side effects, a COX-2 inhibitor or a traditional NSAID along with proton pump inhibitor or other stomach-protective drug may be a better choice. Because of the risk of side effects, your doctor should monitor your intake of NSAIDs on a regular basis.

15. Topical pain-relieving creams, rubs and sprays.

These products, which should be applied directly to the skin over the knee(s), contain ingredients that work in one of three different ways: by stimulating the nerve endings to distract the brain's attention from the joint pain; by depleting the amount of a neurotransmitter called substance P that sends pain messages to the brain; or by blocking chemicals called prostaglandins that cause pain and inflammation.

16. Corticosteroid injections.

Corticosteroids are powerful anti-inflammatory hormones made naturally in the body or man-made for use as medicine. Injecting corticosteroid compounds directly into the knee(s) can be useful when there is localized inflammation and/or moderate to severe pain that doesn’t respond to oral pain relievers. This is typically a short-term measure, and generally not recommended for more than two to four treatments per year.

17. Hyalruonic acid injections.

Sometimes called viscosupplements, hyalruounic acid substitutes are designed to replace a normal component of the joint involved in joint lubrication and nutrition. A series of injections of hyaluronic acid may be useful in treating OA of the knee pain, according to the experts. (In the U.S., the injections are approved only for OA of the knee.) 

18. Glucosamine and/or chondroitin for symptom relief.

Treatment with one or both of these supplements may provide symptomatic benefit for some people with OA of the knee. However, experts advise that you stop using them if you don’t notice any relief within six months.

19. Glucosamine sulfate and/or chondroitin for possible structure-modifying effects.

There is some evidence that glucosamine or chondroitin may not only ease symptoms but also may slow or halt cartilage breakdown in OA of the knee.

20. Opioid and narcotic analgesics.

Using weak opioids and narcotic analgesics can be considered if you can't tolerate other medications or if other medications are not effective. Stronger opioids should be used only for the management of severe pain in “exceptional circumstances.”

21. Knee replacement surgery.

When symptoms of OA of the knee are not controlled with drug and non-drug treatments, replacing the knee joint with prosthesis is often effective.

People reach the decision to have knee replacement surgery at different times and for different reasons. For some, it's when the pain becomes unbearable and is no longer relieved by exercise, medication or other conservative methods. For others, stiffness or immobility affects their ability to do their job, care for their home and family or enjoy their favorite activities.

Waiting a month – or even a year or two – to pursue surgery probably won’t have lifelong effects (although many people who have waited much longer say they wish they had had it sooner). And waiting for even a short time can enable you to learn all you can about the procedure and then prepare for it – mentally, physically and financially.

22. Unicompartmental knee replacement.

Approximately 30 percent of people with OA of the knee have disease that is largely restricted to one area of the joint. In these cases, unicompartmental knee replacement (also called partial knee replacement) may offer the same improvement and function as total knee replacement but with less trauma and better range of motion.

23. Osteotomy and joint-preserving surgery.

For young, active people with OA of the knee, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement by years.

24. Joint lavage and arthroscopic debridement.

The roles of joint lavage (flushing the joint with a sterile saline solution) and arthroscopic debridement (the surgical removal of tissue fragments from the joint) are controversial. Some studies have shown short-term relief; others suggest improvement in symptoms could be attributable to a placebo effect.

25. Joint fusion when replacement has failed.

When knee replacement fails, joint fusion (a procedure in which the bones that form the joint are surgically prepared and then held in place with screws, pins or plates until they fuse into a single rigid unit) can be considered a salvage procedure.

EUFLEXXA (1% sodium hyaluronate) is used to relieve knee pain due to osteoarthritis. It is used in people who do not get enough relief from simple pain medications such as acetaminophen or from exercise and physical therapy.

Important Safety Information
You should not receive this product if you have had any previous allergic reaction to EUFLEXXA or hyaluronan products. You should not have an injection into the knee if you have a knee joint infection or if you have skin disease or infection around the injection site.

EUFLEXXA is only for injection into the knee performed by a qualified doctor. After you receive this injection you may need to avoid activities such as jogging, tennis, heavy lifting, or standing on your feet for a long time (more than one hour). The safety and effectiveness of repeat treatment cycles of EUFLEXXA have not been established. The safety and effectiveness of EUFLEXXA have not been shown in people under 18 years of age.

Side effects sometimes seen when EUFLEXXA is injected into the knee joint were pain, swelling, skin irritation, and tenderness and these were generally mild and did not last long.

Please see Full Prescribing Information.

Please see Important Information for Patients.

Patient Treatment Information

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Euflexxa® is a registered trademark of Ferring Pharmaceuticals Inc.