A recent AAOS consensus meeting about the non operative treatment of knee arthritis has brought us some simple if discouraging news. This panel of surgeons reviewed the available high quality literature to assess the truly useful non operative treatments, in order to see what we as surgeons can do for folks who do not want or are not ready for joint replacement surgery.
Not surprisingly, the most effective non operative treatment is weight loss. Obese patients place an increased load on the knees and the load leads to increased arthritis, pain and disability (without even assessing the other effects of obesity. The data show that losing weight can increase function and decrease pain for a majority of patients with knee arthritis. It does not cure the condition but makes it more bearable.
Exercise can help as well , but not all exercise. Running , jogging and high impact aerobics condition the body but do not help the knee. Low impact exercise such as swimming, walking in water and walking can be helpful particularly when linked with exercise.
Non steroidal anti-inflammatories may help but there is no evidence that they can effect a long-term cure. They are worth trying, but there are no guarantees. Similarly, cortisone and hyaluronic acid injections can be helpful in the short term but rarely provide a long term cure. Again worth trying as they are low risk, but limited long term effectiveness.
Finally there is no convincing evidence that braces, glucosamine, therapy and acupuncture provide more than casual relief. These trials were controlled with placebos and seem to indicate that some people get relief from these modalities, but not enough to recommend them as treatment.
So, as I said not really surprising but sobering
