5 Questions To Ask Your Doctor About Knee Arthritis
David Frankel, MD

1. Do I need a knee replacement if I have knee arthritis?
   A diagnosis of knee arthritis does not mean that you are going to need a knee replacement. Doctors should treat a patient’s symptoms and not the severity of knee arthritis on x-ray images. While some patients may go on to have a knee replacement, surgery should be reserved for those knee arthritis patients who have failed conservative management due to pain that is not controlled and that interferes with activities of daily living.
    
2. What are some basic things that I can do to help my knees?
   Weight loss is very important. Any weight that you lose can make a difference, as you will be putting less pressure on your knee joints. With weight loss, your pain related to knee arthritis can be decreased, you can delay the progression of your knee arthritis, and knee replacement surgery may be prevented. Exercise is good for patients with knee arthritis, often leading to decreased symptoms. When considering exercise activities, focus on those that are not painful. Lower impact activities will put less stress on your knees. If walking bothers your knees, you may consider aquatic exercise such as water aerobics or deep-water running or riding an exercise bicycle. Resistance training can improve knee arthritis symptoms, as well as your strength and physical function. Although it may take some trial and error to determine which works best for you, heat and cold therapy can be beneficial in treating your knee arthritis symptoms by decreasing pain, swelling, inflammation and stiffness.
    
3. Is Physical Therapy helpful for knee arthritis?
   Supervised rehabilitation in physical therapy can be very effective in treating the symptoms of knee arthritis.Physical Therapy may include muscle strengthening, joint mobility, flexibility training and manual therapy techniques. Your physical therapist should provide a home exercise program that you can perform on the days that you are not having supervised rehabilitation and you can incorporate this program into your regular exercise activities once you are released from therapy for ongoing benefit.
    
4. Are there any oral or topical medications that I can use to help my symptoms?
   Acetaminophen is a pain reliever, but it does not affect inflammation. Regular use of acetaminophen can provide pain relief caused by mild to moderate knee arthritis. Because it is relatively safe and has less serious side effects, acetaminophen should be considered first when it comes to oral pain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) treat pain and inflammation related to knee arthritis. Although oral NSAIDs may be more effective than acetaminophen, they have higher risks and their use should be limited in duration. Stronger oral medications such as opioids or narcotics may be considered for breakthrough pain due to knee arthritis; however, their use should be limited. Topical NSAIDs may be effective in treating the symptoms of knee arthritis. Topical capsaicin cream is also effective, although local irritation can occur at the site of application. Glucosamine and chondroitin supplements may provide relief for patients with moderate to severe pain related to knee arthritis. For patients with mild pain, glucosamine and chondroitin together or alone may not be beneficial for pain relief.
    
5. Are cortisone injections or viscosupplementation injections helpful?
   Cortisone injections may help the inflammation related to the arthritis in your knee joint and thereby reduce the pain. Cortisone injections usually include a corticosteroid medication and a local anesthetic medication. The injections may provide immediate benefit due to the local anesthetic medication, while the effect of the corticosteroid medication may take several days before onset. On average, the pain relief may last for weeks to months. Due to potential side effects, the number of injections per year per joint is typically limited to no more than three injections per year. Viscosupplementation, also known as ‘rooster comb’ injections, can be helpful for patients with mild to moderate knee arthritis. Hyaluronic acid is a naturally occurring substance found in knee joint fluid, acting as a lubricant and shock absorber. People with knee arthritis may have lower levels of hyaluronic acid in their knee joint. With viscosupplementation, a gel-like substance containing hyaluronic acid is injected into the knee joint. The injections may be performed weekly for three to five weeks. Viscosupplementation does not have an immediate pain-relieving effect, but the benefit can last for several months. If effective, viscosupplementation may be repeated after six months.