Expert Q&A: Treatments for Osteoarthritis of the Knee
Answers to common questions from a top orthopedic surgeon.
Published July 26, 2012
Healthline interviewed orthopedic surgeon Dr. Henry A. Finn, M.D., F.A.C.S., Medical Director of the University of Chicago Bone and Joint Replacement Center at Weiss Hospital for the answers to the most common questions surrounding treatments, medications, and surgery for osteoarthritis of the knee. Dr. Finn, who specializes in total joint replacement and complex limb salvage surgeries, has led more than 10,000 surgical procedures.
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I've been diagnosed with OA of the knee. What can I do to delay surgery? What kinds of non-surgical methods work?
I'd recommend trying an arthritic off-loader brace to support the knee and/or a heel wedge that directs the force to the least arthritic side of the joint. NSAIDs such as Motrin or Advil can help if your stomach can tolerate them.
Are cortisone injections effective, and how often can I get them?
Cortisone with a long- and short-acting steroid can buy two to three months' relief. It's a myth that you can only have one a year or once in a lifetime. Once a knee is highly arthritic there's no downside to cortisone. These injections have only a minimal effect on the body.
Are exercise and physical therapy effective in dealing with OA of the knee?
Mild exercise that isn't painful over time improves endorphins and can improve functioning. Physical therapy has no benefit before surgery. Swimming is the best exercise. If you're going to work out at the gym, use an elliptical machine. But keep in mind that osteoarthritis is a degenerative disease, so you are likely to need a replacement eventually.
When should I start considering some form of knee replacement surgery?
The general rule is when the pain becomes continuous, is unresponsive to other conservative measures, and is interfering significantly with daily living and your quality of life. If you have pain at rest or pain at night, that's one strong indication that it's time for a replacement. You can't go just by an X-ray, though. Some people's X-rays look terrible, but their pain level and functioning is adequate.
Is age a factor when it comes to knee replacements?
Paradoxically, the younger and more active you are, the less likely you are to be satisfied with a knee replacement. Younger patients have higher expectations. In general, the elderly aren't concerned about playing tennis; they just want pain relief and to be able to get around. It's easier for the elderly in other ways as well. Elderly people don't feel as much pain in recovery. Also, the older you are, the more likely your knee will last for your lifetime. An active 40-year-old will probably need another one eventually.
What kinds of activities will I be able to do after a knee replacement? Will I still have pain after getting back to normal activity levels?
You can walk all you want, golf, play sports like non-aggressive doubles tennis—but no diving for balls or running all over the court. I discourage high-impact sports that involve twisting or turning, like skiing or basketball. An avid gardener will have a difficult time because it's hard to kneel with a knee replacement. Keep in mind that the less stress you put on your knee, the longer it will last.
How do you select a surgeon?
Ask the surgeon how many knees he does per year. He should do a couple of hundred. His infection rate should be under one percent. Ask about his general outcomes, and whether or not he tracks outcomes, including range of motion and loosening rate. Statements like “our patients do great,” aren't good enough.
I've heard about minimally invasive knee surgery. Am I a candidate for that?
Minimally invasive is a misnomer. No matter how small the incision, you still have to drill and cut the bone. There's no advantage to a smaller incision, but there are disadvantages, such as it takes longer, and there's an increased risk to bone or arteries. The durability of the device is decreased because you can't put it in as well, and you can't use devices with longer components. Also, it can only be done with thin people. There's no difference in the amount of bleeding or recovery time. Even the incision is only an inch shorter. It's simply not worth it.
How about arthroscopic knee surgery, where they clean out the joint. Should I try that first?
The Journal of the American Medical Association recently published an article stating there is zero benefit to it. It's no better than cortisone injections, and it's a lot more invasive.
- H, Finn, MD. (2012, June). Interview by E Manfred [Audio Tape Recording]
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