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If you are suffering with osteoarthritis there are several treatment options that are available for you to try in order to relieve your symptoms. There are two types of treatments: non-surgical treatments and surgical treatments.
It is often the case that a combination of treatments is required in order to prevent the condition and symptoms from worsening and to allow you to live a life as near as possible to before your osteoarthritis diagnosis.
The exact course and combination of treatments you will receive for your osteoarthritis will be determined by several factors, including the affected joints in the body, the specific symptoms you are experiencing and the severity of the symptoms. Your GP will decide which treatments are suitable by also considering your individual circumstances, such as your weight, physical activity, occupation and your leisure activities.
The long term aim of treatment is to protect the joint cartilage from further damage to postpone the need for surgery for as long as possible. In some cases, it may be necessary for a patient to have surgery to strengthen, repair or replace the affected joints. It may be that surgery is the most suitable treatment but this course of action will only be taken if your GP has tried other treatments and they have not been successful.
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Non-surgical osteoarthritis treatment options
Traditionally knee braces could be quite uncomfortable to wear as they were very big and bulky, however over recent years there have been huge advances in design and efficient and comfortable models have been developed. Knee braces are not all the same so it is vital to have an accurate diagnosis of the condition before attempting to use a knee brace. It is necessary to ascertain if the condition is unicompartmental, i.e. just one side of the knee is affected, if the condition affects both sides of the knee, or if it is the patella (knee cap) which is affected.
For patients with unicompartmental knee osteoarthritis, that is valgus or varus knee conditions, it may be beneficial to wear an unloading brace. An unloading knee brace works by taking the pressure off of the areas worst affected by the osteoarthritis and the braces are able to apply corrective forces to the area. Both improve knee stability and proprioception, which is the sense of body position and self-movement.
If the patella (knee cap) is affected by osteoarthritis it causes pain in the very front of the knee, making it difficult and painful for sufferers to kneel down or climb stairs. In this situation, the root cause is where the patella sits, in the trochlear groove, the articular cartilage underside starts to wear down, causing inflammation. If the wear and tear becomes severe, the bone can even become exposed, causing severe pain as the bones move across the rough surface of the trochlear groove. In this situation, patellofemoral osteoarthritis bracing can be used to attempt to realign the patella over the femur bone.
Whichever type of brace you require, it is also important to consider the style and fit so it is vital to try out various braces to get one that fits perfectly. We would always recommend working with a clinical professional to select the appropriate brace. This means you can have the brace fitted professionally, and it will provide you with the opportunity to try out the brace in a controlled environment before wearing it out and about.
Many people find their symptoms can be helped greatly by wearing a brace but with osteoarthritis treatments, options should not be looked at in isolation. It is important to consider the use of a brace alongside other osteoarthritis knee treatment, such as following a nutrition plan or exercise regime.
Suitable footwear for helping osteoarthritis
Osteoarthritis in the foot can affect any of the joints in the foot, but it is the big toes that are most commonly affected, as these are more susceptible to the pressure and wear and tear from walking. Toes can become stiff and rigid over time from this pressure and walking may become difficult. Choosing the most suitable footwear can help those with osteoarthritis in the foot and those with osteoarthritis in the knee or hips. It is advisable to choose footwear that has good shock absorbency, provides the body with support and minimises pressure on the joints. The correct type of shoe can help reduce inflammation and pain in the whole body, especially when used alongside other treatment plans.
Osteoarthritis can be a debilitating and painful condition and many people experience stiffness, so they try to limit their activity. However, mild to moderate exercise can be one of the most effective and important treatments for osteoarthritis, whatever a person’s age or fitness level. It may seem challenging at first but by combining exercises designed to increase general fitness levels with specific muscle strengthening training, many people see an improvement in their symptoms as their fitness and strength increases. It is essential to exercise gently and only take activities at your own pace. Any exercise regime should be undertaken on the advice of your GP, physiotherapist or a specialist.
Muscle strengthening exercises are very important as stronger muscles are required to support damaged joints. If the muscles surrounding the affected joints are strong it means there is less pressure and less demand on the joint itself. When a joint is inflamed, swollen or painful, it can seem like a difficult task but a medical professional can help devise a suitable regime.
Gentle stretching exercises, or range of motion exercises, move the joint affected with osteoarthritis through a full range of motion in order to improve movement. The flexibility of the knee is predominantly seen to be bending and stretching of the knee but it is important to also consider the connection of the knee to the hip and to the ankle, so exercises which focus on moving both the ankles and the hips smoothly in circular motions can have a real positive impact, especially when carried out every day.
Undertaking aerobic exercise when you are suffering from symptoms of osteoarthritis can be especially daunting but aerobic exercise is valuable for several reasons. Aerobic or endurance exercises are beneficial for the heart and lungs, build stamina and can reduce fatigue. Increasing the calories the body burns, aerobic exercises can be effective in helping lose weight or maintain a healthy weight. This can be helpful for those suffering with osteoarthritis as carrying excess weight can exacerbate inflammation and pain in the knees. Releasing hormones, such as endorphins, which are known to be ‘happy hormones’, aerobic exercises can improve your mood and aid a better night’s sleep, which will make you feel better overall.
Walking is a great exercise as it’s relatively easy on the joints and it’s free. As well as lowering blood pressure, improving circulation and reducing the risk of heart disease by strengthening the heart, walking can also tone the muscles that support joints and can lower the risk of bone fractures by slowing bone mass loss.
Aquatic exercises can be an ideal starting point for those who are just beginning an exercise regime and those who are overweight or trying to lose weight may also find exercising in water beneficial. Aquatic exercises do not require any swimming. They are simply performed in water as the buoyancy can help reduce the pressure on joints from the weight of the body and the water provides resistance for the muscles as they are moving so they become stronger.
Patients should really see the benefits from sticking to an exercise regime that has been planned by a medical professional, especially if used in conjunction with other forms of treatment such as a knee brace or nutrition plan.
Nutrition plays an important role in osteoarthritis treatment in several ways. Firstly, if a person is carrying excess weight, it puts pressure on the joints, exacerbating osteoarthritis and causing discomfort. Secondly, as well as a balanced diet for general health and wellbeing, a nutrition plan for osteoarthritis treatment will focus on eating well to reduce inflammation.
Anti-inflammatory foods such as fish, olive oil and berries are increased in the diet and pro-inflammatory foods such as sugar, most forms of dairy and red meat, are excluded or limited. Vitamins are also important as vitamins C and D have been shown to improve the development and maintenance of cartilage.
A good nutrition plan can be extremely effective especially when used in combination with other treatment plans such as exercise, or the use of a knee brace.
If you are suffering with great discomfort and pain from osteoarthritis, your GP or specialist may prescribe painkillers to reduce the symptoms. Paracetamol may be suggested initially for pain relief and this is easily available over the counter at pharmacies and must be taken according to the instructions on the packaging.
Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed if paracetamol is not effective in reducing pain levels. Traditional NSAIDs include medications such as ibuprofen, diclofenac or naproxen and COX-2 inhibitors such as etoricoxib. The two types of NSAID act in slightly different ways and as well as oral medication, NSAID creams are available which can be very helpful for reducing swelling and easing pain.
Less effective than oral pain killing medication, gels and salves may still be helpful in reducing pain and inflammation for some patients, and they are less likely to cause any side effects. Some creams work by blocking nerves in the affected area from sending pain signals to the brain, but it can be some time before the full benefits are felt.
Opioids such as codeine are sometimes used as an alternative to NSAIDs or paracetamol, but these can have some side effects, including nausea, drowsiness and constipation.
When inflammation is particularly severe, doctors may prescribe intra-articular injections as an alternative to oral or topical painkillers. After relieving pressure from the joint, medicine (usually corticosteroid) is injected into the affected area. There are fewer side effects with injections and they can be administered up to four times a year.
Viscosupplementation may be prescribed before surgery if other forms of painkillers and treatments have not been effective. Up to five injections of hyaluronic acid are administered in this procedure, which acts as a shock absorber and lubricant and can be found in synovial fluid in joints.
Many people find that painkillers used in conjunction with an exercise program and/or the use of a knee brace, for example, can alleviate symptoms and delay the need for surgery.
Keyhole surgery such as arthroscopy can be used to efficiently correct a joint deformity or preserve the joint function. An arthroscope, a thin tube containing a camera, is inserted and the surgeon can view images in order to determine and implement the best course of action.
If the affected area is contained within one compartment of the knee, a partial knee replacement or unicompartmental procedure, may be an option and the damaged bone is replaced with plastic or metal components.
Total knee replacement surgery, or total knee arthroplasty, is an operation to replace the whole knee with an artificial one and is a common operation in the UK. Commonly carried out on 60-80-year-olds, a total knee replacement can last over 20 years in the most successful cases, providing long-term relief but will only be advised if other forms of treatments have not been successful.
You may find the following information useful which relate to the treatment options available for osteoarthritis of the knee:
- OATechNetwork public patient portal
- Arthritis Research UK: Osteoarthritis in General Practice, Data & Perspectives
- The Global Economic Cost of Osteoarthritis: How the UK Compares - Chen et al, 2012 Economic costs, UK
- NICE Pathway: Osteoarthritis: Care and Management
- NHS: Osteoarthritis Decision Aid Process Explained
- OARSI guidelines for the non-surgical management of knee osteoarthritis, January 2014