Review examines surgical and non-surgical treatments available for patients with knee arthritis

American Academy of Orthopaedic SurgeonsJul 8 2010

Tailoring treatment programs to individual goals and activities is the key to success

Middle-aged men and women with osteoarthritis of the knee now have more options than ever before for treatments that may allow them to remain active in the sports they love, according to a review published in the July 2010 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).  

"The number of patients between the ages of 40 and 60 who are experiencing knee arthritis is growing, and unlike most older patients, this patient population presents a unique set of treatment challenges," noted lead author Brian Feeley, M.D., assistant professor of orthopaedic surgery, University of California, San Francisco. "Understanding available options and tailoring treatments to each patient's needs and desires is the key to successful outcomes."

The review examined both surgical and non-surgical treatments available for younger patients with knee arthritis to determine the best course of action for patients who want to continue to participate in demanding sports. Unlike elderly patients, where pain reduction and basic mobility are the two primary goals, Dr. Feeley noted younger, more active patients require more flexible treatment programs to allow them to remain as active as they would like.

"There is an increasing trend in the United States of people who want to stay active in sports and recreational activities after the age of 40.  These patients are not content with being told to stop what they love doing," added Dr. Feeley. "As a result, orthopaedic surgeons and other physicians need to come up with different treatment strategies, including non-operative treatments or even cartilage restoration procedures, to address pain and functionality and to help keep patients as active as possible."

While some patients may eventually require surgery, Dr. Feeley said in most cases, non-operative management such as bracing, viscosupplementation (injection of hyaluronic acid), activity modification or anti-inflammatory medication might be used initially, to see if the symptoms resolve or if there is enough improvement to make surgery unnecessary.  

"In a vast majority of cases, the onset of arthritis is a slow, degenerative process and therefore there is rarely a need to rush to surgery," he added. "Depending on the symptoms and activity level, many patients can be managed well with non-operative treatment strategies, whereas others truly benefit from surgical procedures. For each patient, it is important to tailor treatment to their symptoms and activity level, and to look for a healthcare provider who is willing to work with them over time to keep their knee as healthy as possible."

Although alternative treatments like acupuncture, glucosamine and chondroitin may be incorporated into an overall treatment plan, Dr. Feeley noted that currently there is no strong clinical evidence supporting the efficacy of these alternative-types of treatment.  

For patients suffering with arthritis of the knee, Dr. Feeley recommends the following approach to help patients remain active:

1. Take control of your situation — understand the disease process and learn about different treatment options.
2. Work with your physician to come up with both short-term and long-term courses of treatment to help manage your symptoms early while maintaining the health of your knee and body for as long as possible.
3. Be flexible with your activities and do not put the exact same stresses on the knee everyday.  In some cases, mild activity modification such as switching to more biking or swimming and less running may make a huge difference in the number and severity of symptoms. Trying new activities also can help keep morale high.
4. Don't be afraid to ask questions of your physician. Look for a doctor who can help you understand the advantages and disadvantages of each treatment option, and who is willing to work with you to tailor a treatment strategy to your individual needs.

"Even when surgery is necessary, proper follow-up treatment and physical therapy tailored to the patient's needs can go a long way toward keeping that patient active and satisfied in the long-term," stated Dr. Feeley.