Part III, Conservative treatments for knee arthritis

In conclusion, the conservative treatment of OA of the knee is important and should be exhausted prior to knee replacement. As a previously obese patient with knee OA once said to me who was the runner up on the “Biggest Loser” TV show approximately 10 years ago; “You can exercise to make yourself feel good, but you win the battle in the kitchen”. This statement was apparently written on the gym wall when she was participating in the biggest loser competition. She basically was told to get rid of all the processed foods in her kitchen and IF she did, she would lose at least 1 to 2 lbs./week. She did exactly that and lost about 6 lbs./ month which over the course of the first year was roughly 70 lbs. I recently attended a lecture for the faculty at the University of Minnesota when the “Blue Zone” author, Dan Buettner, discussed areas in the world where people live the longest. One of the main reasons why survivorship is so high in certain cultures is that they eat a “Mediterranean” type plant based diet and thus they keep their weight down as a result. Unfortunately, we are putting approximately 4.5 to 5 times our body weight on our knees when we ascend and descend stairs so think about what it would mean to lose 50 lbs. Sometime, grab a bag of salt for your water softener and carry it up and down stairs and think about how heavy it feels and what that amount of weight is doing to your knees especially if they are arthritic.      

            Although PRP and stem cell injections are not reimbursed by payers, many patients have noted improvement in their symptoms. However, the stem cell marketing that has been on TV and radio claiming “95% success rates” is simply NOT supported by any peer reviewed published literature.  High molecular weight or cross linked hyaluronic acid injectables (there are only 2 in the US) have been shown to be helpful, but lack of insurance coverage has resulted in decreased usage nationwide. In Minnesota, hyaluronic acid injections are covered by insurance companies if other conservative modalities such as NSAIDs and physical therapy have been attempted. The new long acting steroid injection (Zilretta) is encouraging but should be only used in patients with significant OA.

            Thus, a conservatively directed, logical approach should be used for every patient with knee OA prior to surgical intervention. Remember that knee replacement often does not fulfill patient expectations and only about 66% of patients feel that their knee is “normal” and that 1/3 still report residual symptoms. Do NOT be fearful of obtaining a second opinion IF your surgeon offers a surgical approach as the first line of treatment for your knee arthritis. The comments and statistics stated in these blogs are “evidenced based” and supported by the orthopedic literature. The opinions that I have offered are based upon 40 years of clinical experience as an orthopedic surgeon with a subspecialty interest in knee injuries and disease.