Knee Osteoarthritis Treatment

Physio Penrith Recommended Treatments

Treatment of Knee Osteoarthritis at Sydney Muscle & Joint Physio Penrith

What is knee osteoarthritis?

Osteoarthritis is a chronic insidious disease that affects many joints in the adult body, most commonly the knees, hips and hands. We cannot reverse osteoarthritis, but there are many guideline-based treatments and approaches to managing the impairments associated with knee osteoarthritis. Osteoarthritis was once considered to be a disease of articular cartilage, but recent research has indicated that the condition involves the entire joint. The loss of articular cartilage is often the primary change, but a combination of cellular changes and biomechanical stresses causes several secondary changes, including subchondral bone remodeling, the formation of osteophytes, the development of bone marrow lesions, change in the synovium, joint capsule, ligaments and periarticular muscles, and meniscal tears and extrusions. You can read more on "How to thrive with knee osteoarthritis".

What are the symptoms of knee osteoarthritis?

Most commonly the signs and symptoms of knee osteoarthritis is the individual is aged 50 years or older, has activity-related joint pain, has morning stiffness that lasts <30 minutes, has crepitus on active motion, has restricted movement (will often have flexion contracture) and bony enlargement and has no detectable warmth. Muscle tightness and discomfort will often be felt in the back of the leg and knee in muscles like the hamstrings and calves. Further, the quadricep muscles or thigh muscles at the front of the leg will show atrophy (loss of size) and have weakness.

Diagnosis of knee osteoarthritis

A clinical diagnosis of knee osteoarthritis can be made with the following: the individual is aged 50 years or older, has activity-related joint pain, has morning stiffness that lasts <30 minutes, has crepitus on active motion, has restricted movement and bony enlargement and has no detectable warmth. A typical knee osteoarthritis diagnosis can be made without requiring further investigations and most often plain radiograph (x-ray) or MRI is not needed. You can assess whether you have knee osteoarthritis by answering these questions, which have been compiled from diagnostic criteria of knee osteoarthritis and is based on history, physical examination, radiographic findings and laboratory findings- Do you have knee osteoarthritis?

Treatment of knee osteoarthritis

Strategies for relieving pain, minimising disability and slowing disease progression around knee osteoarthritis are key treatment goals of conservative, non-surgical management. Implementing conservative management strategies at a population level for people with osteoarthritis could result in substantial cost savings for the Australian healthcare system. Below is a summary of the key recommendations from the RACGP Guideline for the Management of Knee and Hip Osteoarthritis, and also those supported by the physiotherapists and exercise physiologists at Sydney Muscle & Joint Clinic Penrith.

  • Land-based exercise- regular exercise is important for relieving pain and improving function in people with knee osteoarthritis. Land based exercise is your first line of treatment and can include muscle strengthening exercises, walking and Tai Chi, stationary cycling and Hatha yoga. This is what Sydney Muscle & Joint Physio Penrith prides itself on, research supported exercise in the management of knee osteoarthritis. Our physiotherapists use different strengthening exercises targeting gluts, quadriceps, hamstrings and calf muscles to reduce pain, increase strength and improve balance and walking ability.

  • Aquatic exercise- may be considered for some people with knee osteoarthritis.

  • Weight management- weight loss of only 10% of body weight is strongly recommended for people with knee osteoarthritis who are overweight or obese.

  • Cognitive behavioural therapy- can be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.

  • Heat therapy- heat packs or hot water bottles may be applied as a self-management strategy. Our physiotherapists also utilise heat to encourage analgesia to assist in exercise interventions.

  • Assistive walking devices- using a cane or other devices (eg walker, crutches) may be appropriate for some people with knee osteoarthritis to help improve pain, mobility and balance.

  • Manual therapy- a short course of manual therapy or massage could be considered for some people with knee osteoarthritis as an adjunct to lifestyle management. At Sydney Muscle & Joint Physio Penrith manual therapy techniques include joint mobilisations and soft tissue work especially on calves, hamstrings and quadriceps.

  • TENS machine- transcutaneous electrical nerve stimulation (TENS) that can be used at home may be appropriate for some people with knee osteoarthritis.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs; eg ibuprofen)- taken orally at low doses for short periods are recommended for some people with knee osteoarthritis. Monitoring for possible adverse effects of the drugs is necessary. Although there is no recommendation either for or against NSAIDs applied locally to the skin, it may be reasonable to trial topical NSAIDs for a short period, with monitoring of possible adverse effects, then discontinue use if not effective.

  • Paracetamol- although there is no recommendation either for or against paracetamol, it may be reasonable to trial paracetamol for a short period in some people with knee osteoarthritis, with monitoring of possible adverse effects, then discontinue use if not effective.

  • Corticosteroid injections- could be offered for short-term symptom relief (4-12 weeks) for some people with knee osteoarthritis, but care should be taken with repeated injections because of potential harm. At Sydney Muscle & Joint Physio Penrith our physiotherapists would encourage a corticosteriod injection to help getting the patient exercising and moving, also if the knee was highly irritable and there was impending travel or an event.

  • Duloxetine- could be considered for some people with knee osteoarthritis when other forms of pain relief are inadequate.

  • Opioids -there is a strong recommendation against the use of oral and transdermal opioids.