Researchers have found, in the synovial fluid of knee joints, clear differences in the messages cells are sending and receiving via tiny pieces of RNA (called microRNA) in males and females with osteoarthritis.

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Knee osteoarthritis (OA) is a bumpy road, so to speak. There’s the joint stiffness that you struggle to overcome each morning. Then, throughout the day, every step and every ounce of force you place on your arthritic knee can trigger pain that limits your activities. If you’re one of the 14 million Americans with knee OA, that bumpy road seems to lead to a knee replacement. But it doesn’t have to. Take advantage of an array of knee replacement alternatives to relieve your pain and help you function with knee OA.

Most important, combining these treatments with knee-strengthening exercises may help you postpone, and potentially avoid, a knee replacement.

Oral and Topical Medications as Knee Replacement Alternatives

Many people first turn to over-the-counter pain relievers like acetaminophen (Tylenol^®) and the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil^®, Motrin^®) and naproxen (Aleve^®) to ease knee OA pain. Some may need higher-strength prescription versions of these or other NSAIDs. Opioid painkillers, such as hydrocodone (Vicodin^®), are typically reserved for patients with severe pain from end-stage arthritis.

Although effective, all oral pain relievers may cause side effects. High doses of acetaminophen (more than 4,000 mg, or about eight extra-strength capsules, a day) can cause liver damage. NSAIDs may cause gastrointestinal and renal side effects and also carry warnings about increased cardiovascular risks. So, experts generally advise patients using NSAIDs to take the lowest dose for the shortest duration. To minimize the side effects of oral NSAIDs, your doctor may prescribe a topical NSAID containing diclofenac (found in Voltaren Gel^® and the Flector^® patch) to provide rub-on relief.

Another topical treatment that doctors might reccommend is capsaicin cream, which relieves pain by depleting a chemical messenger (substance P) that transmits pain signals to the brain. This option offers some people pain relief without the side effects of other treatments.

Injecting Pain Relief

If oral or topical pain relievers aren’t enough to manage your knee OA, ask your physician about corticosteroid injections. They provide rapid pain relief that lasts, on average, about two to three months, and they’re covered by most insurance providers. However, because overuse of these injections may weaken tendons and other tissues in the joint, some experts limit their use.

In viscosupplementation, hyaluronic acid is injected into the knee to help improve its synovial fluid. The treatment—administered as one, three or five injections each given a week apart—is best for people with mild-to-moderate knee OA. The injections may take eight to 12 weeks to produce results, but their effects can last six to nine months or more. “About 70 percent of people respond very well to them.

Among the latest injectable treatments for knee OA is platelet-rich-plasma (PRP), in which healing substances from your blood are removed and injected into the arthritic joint. Some studies suggest that PRP is effective for knee OA in the short term. But, on the downside, PRP is costly and typically isn’t covered by insurance.

Other Knee Replacement Alternatives

Knee braces are among the most basic tools to help you function with knee OA. A simple synthetic rubber pull-on knee sleeve may ease pain and improve function, while a more complex, custom-fitted unloader brace can provide more stability to an arthritic knee.

Some people have found relief from knee OA by taking supplements of glucosamine and chondroitin, compounds found in healthy joint cartilage. It may take two to three months of daily use before you see results—recommended daily doses are 1,500 mg of glucosamine and 1,200 mg of chondroitin.

Studies examining the use of another knee replacement alternative, acupuncture, to treat knee OA also have produced conflicting results. And, keep in mind that acupuncture can be expensive—ranging anywhere from $75 to $200 or more per session—and may not be covered by insurance.

Stay Active

The goal of all knee OA treatments is to allow you to stay physically active. Consider a referral to a physical therapist, who can help you develop an exercise regimen as a knee replacement alternative that is tailored to your fitness level and capabilities.

Cycling and aquatic exercises are appropriate aerobic activities for most people with knee OA, and, most importantly, they can help you optimize your weight and thus reduce knee strain. Conversely, sports like running, basketball, and singles tennis can tax an arthritic knee and might be avoided.

Strength training to target the quadriceps, hamstrings and gluteal muscles that support the knee also is vital for people with knee. However, he recommends exercises such as leg squats and lunges (see chart) rather than leg raises (done on an exercise machine), which can place undue stress on the knee. The stronger your muscles that support and protect your knees are, the less pain you’ll have.

Similarly, exercises that work on your balance and proprioception (the sense of knowing from moment to moment where your joints are) can help your arthritic knees. Simply stand on one leg for 30 seconds, holding on to a countertop or sink if necessary, and then switch legs. “