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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.
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. “
HOW TO STRENGTHEN YOUR ARTHRITIC KNEES
To strengthen the muscles supporting your knee, closed kinetic chain exercises, such as leg squats and lunges, which are friendlier to arthritic knees are recommended. Ask your doctor or exercise professional if these exercises are appropriate for you. Try to do 12 to 15 repetitions (or as many as you can) on at least two or three days a week.
With your body straight, and your shoulders even with your hips, step forward with one leg and lower your hips until both of your knees are bent at about a 90-degree angle, with your rear knee parallel to the ground. If you can’t bend to a 90-degree angle, go as low as you can. (Also, to ease the impact on your knee, you can do this exercise by stepping backward instead of forward.) Engage your abdominal muscles, and keep your chin parallel to the ground and the knee of your front leg aligned with your ankle, not extended over your toes. The heel of your rear leg should be lifted off the floor, and your back should remain in a neutral position, not hunched over or arched. Hold for a second or two, and then return to the starting position and repeat with your other leg.
Stand with your toes pointing straight ahead and your feet spread a little more than shoulder-width apart. Slowly lower yourself while bending your hips, knees and ankles until you reach a 90-degree angle. If you can’t bend that far, just go as low as you can. Use your arms to help steady yourself. Keep your back in a neutral position (not hunched over or arched), your chest lifted, your buttocks above knee level, and your knees pointing straight ahead and not extending beyond your toes. Return to the starting position.