Knee osteoarthritis non-surgical options
With advanced knee osteoarthritis, a joint replacement operation may be recommended. However, there are other treatments that doctors may recommend to reduce pain and increase mobility before a surgical option is decided on.
Several medications may help reduce knee pain, and, in some cases, the inflammation that can cause joint swelling and discomfort. They include:
Paracetamol. This is usually the first painkiller used for knee osteoarthritis, although this does not help with inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs). These can help relieve pain and fight the inflammation that may be adding to pain. Some are available over-the-counter, for example ibuprofen. There are also prescription NSAIDs that your doctor can prescribe.
Stronger pain relief. When other pain relievers are not helping, your doctor may prescribe stronger painkillers. These may include opioid medications, for example codeine, often combined with paracetamol.
Joint pain may be helped with various over the counter and prescription creams, ointments and balms rubbed onto the skin over the affected joints.
Capsaicin. Found naturally in chillies, capsaicin in a cream is available as a prescription from your GP. Capsaicin works by blocking the transmission of a pain-relaying substance called substance P to the brain. It may also work as a counter-irritant.
Counter-irritants. These make the skin feel warm and are thought to work by irritating the same nerves as those responsible for sensing muscle or joint pain. By irritating these nerves the pain sensation felt from the muscles or joints is lessened. Examples of counter-irritants include salicylates and menthol.
NSAIDs. These work by inhibiting the cyclo-oxygenase enzymes that are responsible for triggering inflammation. Examples include ibuprofen and diclofenac.
If other approaches haven’t helped, or are not suitable, injections directly into a joint may help with osteoarthritis of the knee. Options include:
Corticosteroids (steroids). These injections can offer fast and effective relief from pain and inflammation lasting some weeks or several months.
Hyaluronic acid. This supplements the natural hyaluronic acid that lubricates the joints. However, the National Institute for Health and Care Excellence (NICE) does not recommend the use of hyaluronic acid injections for the treatment of osteoarthritis because of a lack of evidence of its effectiveness and cost-effectiveness. This treatment may be available privately.
Exercise and physiotherapy
In the past doctors recommended resting painful joints, but now keeping as active as possible is recommended. Walking and swimming are good exercises - swimming in particular is easier on the joints. Exercise helps strengthen joints as well as being good for general health. It also helps the release of pain-killing and feel-good chemicals, called endorphins.
Physiotherapy can help you regain range of movement and flexibility of your knees, and help to relieve pain. It may also strengthen the muscles that support your knee, thereby increasing your balance and stability. A physiotherapist can design a programme for you that may include stretching and range-of-movement exercises, strengthening exercises and cardiovascular exercises to help improve lung and heart fitness. A physiotherapist or occupational therapist can also recommend braces or splints to support and stabilise painful knees, or walking sticks to reduce the load on your knee.
Weight loss - when needed - may be one of the most effective things you can do on your own to improve the symptoms of knee osteoarthritis. Carrying excess weight puts extra pressure on the knees.
People who are a healthier weight also have fewer risks when undergoing joint replacement operations if that becomes necessary in future.