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About Treatment

Osteoarthritis of the knee is a disease which involves cartilage destruction and pain. Once destroyed, cartilage seldom returns to normal. So, early detection and countermeasures are essential. It is important that this disease not be left untreated and that you attempt to cure it, working in cooperation with your doctor, instead of assigning the entire task to the doctor. First, you should exercise (physical therapy), including improvement in your daily living habits, and visit a medical facility without delay to receive drug therapy, etc. as needed (conservative therapy). If the disease advances, an operation may become necessary (surgical treatment).

- Table: Methods of treating osteoarthritis of the knee

Conservative therapy Improvement in habits Lose weight to reduce the load on the knee(s)
Exercise therapy Strengthen the muscles around the knee which protect the knee
Drug therapy Suppress pain and inflammation with medication
Splint therapy Use a plantar splint or knee supporter
Physical therapy Apply warming or cooling of the knee
Surgical treatment Arthroscopic surgery  
High level tibial osteotomy  
Knee replacement surgery  

Alleviation of symptoms by exercise (physical therapy)

Physical techniques for treatment include habit improvement, exercise therapy, splint therapy and physical therapy.

- Habit improvement

This includes attempts to alleviative obesity (responsible for osteoarthritis of the knee), avoiding motions causing loads on the knee during daily life, thermotherapy by bathing, and so on. Depending on the knee condition, some approaches to habit improvement are recommended while others are not. It is advisable for you to initiate habit improvement upon consultation with your doctor.
If you have pain, it will be beneficial to use a cane, hand rails and so on.

- Exercise therapy

Exercise therapyKnee pain renders individuals unwilling to move. This leads to decreased exercise during daily life, resulting in weakening of the muscles (quadriceps muscle of the thigh, hamstrings, triceps surae muscle, etc.) around the knee. As these muscles protect the knee, a vicious cycle is triggered. It is very important that individuals practice muscle training, articular motions, stretching, etc., regularly. Strengthening of the muscles around the knee joint can support the knee and reduce pain, accompanied by delayed progression of osteoarthritis of the knee. You should receive advice from your doctor as to the optimal exercise therapy for your knee condition.

- Splint therapy

Splint therapyIn bow-legged and baker-legged individuals, the medial side and lateral side of the knee respectively, are loaded with a high percentage of body weight. For this reason, the knee cartilage of the heavier load bearing side is likely to be injured. To avoid this, the location of body weight loading can be changed with the use of a foot/shoe splint (shoe sole cover).
However, you should use it upon consultation with your doctor specializing in the care of osteoarthritis of the knee.

- Physical therapy

Physical therapy is designed to suppress knee pain and inflammation by means of stimulation with light, heat or electricity. It can be divided into thermotherapy and cooling therapy.
Thermotherapy aims to improve blood flow and reduce knee pain through warming of the knee. At hospitals, the knee is warmed with infrared rays, low-frequency waves, lasers, hot packs, etc. At home, you can warm the knee by bathing or using a hot compress or warmed towel. To prevent knee pain, it is important to protect the knee from cooling by using a supporter, etc.
Cooling therapy is aimed at reducing the pain by applying a cold compress, cold towel, etc., to the knee.

Treatment with medication (drug therapy)

Drug therapies include intra-articular injection (nourishing the cartilage to reduce pain and improve knee motility) and oral or topical administration of pain relief drugs.

- Intra-articular injection

Intra-articular injectionHyaluronic acid is injected into the joint. Hyaluronic acid is abundant in articular fluid (synovial fluid). It enables smooth motions of the joint and affects the cartilage which serves as a cushion. Hyaluronic acid is deficient in patients with osteoarthritis of the knee.
Direct injection of hyaluronic acid into the knee joint facilitates smooth motions of the joint, protects the cartilage and suppresses knee pain and inflammation. As a rule, patients receive one injection weekly for 5 weeks. If responses to the injections are seen, another dose is injected once 2-4 weeks thereafter, depending on symptoms. If this therapy is combined with exercise therapy, etc., progression of the disease may be delayed, and patient QOL (quality of life) can thus be improved. Upon relapse of symptoms, hyaluronic acid injection may be repeated.

- Steroid injection

In cases where knee inflammation, etc., with severe fluid pooling and intense pain, steroid preparations are injected into the joint. This therapy is expected to manifest efficacy (suppression of inflammation and alleviation of pain) rapidly, but repeated steroid injections have been reported to adversely affect the joint cartilage. So, steroid administration is used with caution, based on the physician's judgment.

- Oral drugs

Drugs suppressing pain and inflammation (non-steroidal anti-inflammatory drugs) are orally administered. These drugs are useful for managing pain in patients unable to move because of intense pain. However, prolonged use of these drugs can induce adverse reactions such as gastrointestinal disorders.

- Topical drugs

Drugs suppressing pain and inflammation can be administered in the forms of a compress, ointments, gels, etc. Drug preparations of various forms, compositions and formulations are available by prescription from physicians. If over-the-counter (OTC) drugs are minimally effective or difficult to use, seek advice from an orthopedic surgeon.

Surgical treatment

Surgery may be performed in cases with advanced knee joint inflammation, causing deformation of the joint. Several surgical techniques are available.

- Arthroscopic surgery

A small camera (arthroscope) is inserted into the knee to observe inside the joint. As needed, the shredded portion of the cartilage is removed with the arthroscope. It is sometimes used for suturing, resection, etc., if the patient has pain of the meniscus, etc. This operation requires only several small holes in the knee and can be performed with less stress on the patient. Also, the hospital stay is shorter.

Arthroscopic surgery

- High level tibial osteotomy

In bow-legged cases with high loads on the medial aspect of the knee joint, the bone is partially resected obliquely so that weight can be shifted to the lateral aspect of the knee joint and the load on the medial aspect may thereby be reduced. This operation is suitable for relatively young patients (age less than 65).

High level tibial osteotomy

- Total knee replacement surgery

In osteoarthritis of the knee cases whose knee cartilage has worn out, the destroyed knee joint is replaced with a prosthetic joint (made of metal or plastic).

Prosthetic joint