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Knee Osteoarthritis: What treatments work and what doesn't
- By Sarah Frost
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Chances are you or someone you know has knee pain. But, with so many options out there, what treatments are actually beneficial? We look at what the research says and what will give you bang for your buck when treating knee arthritis in 2024.
Knee Arthritis: A pandemic of pain
Across human history achy knees are nothing new. However, modern history has seen a sharp rise in rates of arthritis. The Lancet found that 16% of adults experience knee arthritis, making it the most commonly affected joint followed by the hip and the hand. This rate has increased over 70% since 1990 and is expected to keep rising.
The history of knee osteoarthritis is a long one and there are many ancient remedies for the disease. The Ancient Egyptians treated joint pain with oils and ointments. Hippocrates, the father of modern medicine, prescribed physical activity to treat rheumatism of the joints.
In more recent times, physiotherapy acts as a frontline treatment with surgery recommended for end-stage osteoarthritis. However, physiotherapy itself encompasses a lot of treatment modalities and it’s important to know what works and what doesn’t.
Figure 1: Knee arthritis is often treated with a combination of therapies including physiotherapy, exercise, bracing and medication.
manual therapy
Does it help? Yes, in the short term.
Manual therapy involves all ‘hands-on’ treatment techniques used by physiotherapists. This may involve massage, joint mobilisation and stretching. A recent study on this topic found that manual therapy improved pain and movement in knee osteoarthritis. These findings were short term, so it is best used when combined with other long term treatment options such as exercise therapy.
Exercise Therapy
Does it help? Yes, it’s probably your best bet.
Exercise is a go-to treatment option for knee osteoarthritis for a reason. Scientific research consistently shows that exercise helps to improve pain, movement and function in arthritic knees. Not only that, but exercise helps to manage risk factors that contribute to osteoarthritis such as obesity. When comparing different types of exercise, studies have found that hydrotherapy is best for pain management, while resistant training, yoga and cycling can improve strength and function.
New programs have emerged over the last decade, such as the GLA:D protocol, which has been shown to reduce the need for surgery in those with knee osteoarthritis. Generally, the principles of exercise should be to strengthen the knee, improve fitness and increase confidence in the affected leg through graded exercises.
Medications
Does it help? Yes, in the short term.
Medication can help to manage pain and swelling in knee arthritis. The most effective medications are non-steroidal anti-inflammatory medications such as ibuprofen. Topical anti-inflammatories such as voltaren gel are recommended due to low risk of side effects.
Opioid medications show similar effects as anti-inflammatories but greater side effects long term. Over the counter analgesics, like paracetamol, show a small effect on pain. Medications are a great option when paired with exercise which can sometimes be painful.
Lifestyle modification
Does it help? Yes, and it’ll improve more than your knees.
There are many risk factors for knee osteoarthritis including diet, alcohol consumption, smoking and a sedentary lifestyle. Some risk factors are unavoidable such as age and genetics, but many can be addressed by living a healthy lifestyle. A common misconception is that those who exercise are more prone to arthritis – in fact, the opposite is true. Regular exercise, a balanced diet and minimising alcohol intake are some steps that will reduce your risk of knee arthritis.
Osteoarthritis has many of the same risk factors as heart disease, cancer and type 2 diabetes, so a lifestyle change to treat your joints carries a lot of benefits.
Injections
Does it help? No, it should not be recommended.
Cortisone, Plasma-Rich-Protein (PRP) and Hyaluronic Acid (HA) injections have become increasingly popular in recent times. Often prescribed by orthopaedic surgeons and sports physicians, these injections are used to treat a range of physical ailments. However, there is no evidence that supports their use for knee osteoarthritis.
A study in 2023 compared these injections to a placebo injection. They found there was no benefit of these injections over a placebo, in fact they carry a number of risks including infection and high-cost. For those reasons, they should not be recommended for knee arthritis.
Supplements
Does it help? Probably not.
There are such an array of supplements, herbs and alternative medicines that we could write an entire blog post on them alone. Due to this, there isn’t a lot of good scientific research on these products, especially with so many brands, formulations and dosages on the market.
High quality studies have shown no benefit in glucosamine, vitamin D, fish oil or krill oil supplementation for knee arthritis. However, these supplements seem to improve other types of arthritis such as rheumatoid arthritis and juvenile arthritis. Herbal treatments seem to improve knee arthritis in scientific studies but are not recommended in international guidelines for treatment. In summary, it looks like supplements aren’t that effective but if you find a combination that works for you, keep it up, we still have a lot to learn about this topic.
Bracing
Does it help? Maybe, more research is needed.
Much like supplements, the medical bracing market is flooded with a multitude of brands, styles and materials of varied effectiveness and cost. A knee guard from the pharmacy can cost $30 while an arthritis unloader brace can set you back over $2,000.
Studies on bracing demonstrate varied results, from positive to negative. A low cost brace is a great idea for many, especially those engaging exercise. However, with so little evidence supporting the use of more expensive braces, we recommend waiting until more scientific studies are completed before investing in a high cost item.
Surgery
Does it help? Yes, knee replacement surgery is safe and effective.
Knee replacement surgery is recommended when all other treatments have failed or when a joint has advanced osteoarthritis. Studies on knee replacements show full recovery in 12-24 months with a success rate of 90%, making it one of the most successful surgical procedures in Australia.
The total cost of a knee replacement is about $23,000, in 2023 the average ‘out-of-pocket’ cost was $2,000 for public patients. It is important to note that less invasive procedures such as knee arthroscopy to ‘clean out’ the knee have been found to be ineffective for knee arthritis. In fact, these surgeries usually accelerate knee osteoarthritis and should only be recommended under specific circumstances.
so, how should i treat my knee?
Unfortunately, there is no ‘one size fits all’ solution to knee osteoarthritis. It’s best to analyse your individual circumstances and decide the best course of action.
For mild and moderate osteoarthritis, a combined approach of manual therapy, exercise and medication is effective for most people. When coupled with positive lifestyle changes long term, most people can slow the progression of the disease and avoid a knee replacement.
In advanced knee osteoarthritis, it is best to trial a gentle exercise program, such as hydrotherapy, alongside a good medication protocol to manage pain. If this approach is not effective, then a surgical opinion may be the best route. As mentioned above, knee replacement surgery is very safe and effective in Australia.
Based on the current evidence, we do not recommend injections or knee arthroscopes for knee arthritis – these approaches have been proven to be ineffective. Use caution when supplements, braces or alternative therapies promise relief – research shows that this might not be helpful.
At the end of the day, use your best judgement alongside a good physiotherapist and a trusted orthopedic surgeon.
ABOUT THE AUTHOR
Sarah Frost founded Homemade Physiotherapy in 2021 with the vision that high quality physiotherapy doesn't have to be provided in a clinic.
With over a decade of experience, Sarah combines her expertise from private practice and community based care to provide personalised and goal-orientated treatment to her patients.
Sarah values holistic and collaborative approaches to rehabilitation, working alongside universities and healthcare industry leaders to provide a physiotherapy experience that you can trust.
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ABOUT US
We are a small team of dedicated physiotherapists experienced in NDIS & Aged Care services.
Founded in January 2021, we provide personalised treatment so that you can feel better, move more and achieve your life goals.
