While options for conservative treatment of knee osteoarthritis (OA) are limited, controversy continues to surround the safety and efficacy of commonly-used corticosteroid injections. Key research questions include how long clinically important benefits last and whether and how much corticosteroid injections damage the cartilage.
Calling the evidence inconclusive, the American Association of Orthopedic Surgeons (AAOS) neither recommended for nor against the use of corticosteroid injections in its 2013 clinical practice guidelines on treatment of knee OA. AAOS says the balance between benefits and potential harm is unclear due to lack of compelling evidence.
Short-Term Pain Relief Facilitates Physical Therapy
Despite the lack of compelling evidence, the surgeons at Shelbourne Knee Center find corticosteroid injections to be useful in some circumstances. “A corticosteroid injection is a way for us to provide a patient with short-term relief of significant symptoms, enabling us to then get to the root of the problem with physical therapy,” says Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center. “We never recommend repeated injections every three months as the sole mode of treatment.”
The Knee Rehabilitation Program for Osteoarthritis (OA) is designed to address the root cause of nearly all knee OA—stiffness and pain due to loss of range of motion (ROM). Led by Dr. Benner, the program is based on the practice’s long-term data on anterior cruciate ligament (ACL) reconstruction patients, which shows the importance of full ROM in good long-term outcomes1.
Rehab Program Exceeds Recommendation
The AAOS strongly recommended self-management, strengthening and physical activity as a conservative treatment for symptomatic knee OA. The Knee Rehabilitation Program for OA exceeds this recommendation by providing research-backed physical therapy under the guidance of a physical therapist who specializes in knees.
Patients focus on ROM first, to restore knee extension and then knee flexion equal to the normal knee. They then work on strengthening to provide good leg control and improve everyday function. Recommended low-impact activities to increase conditioning and improve exercise tolerance include using a stationary bike, elliptical machine, stair-master, or rowing machine, and swimming.
Patients complete most of their physical therapy at home, with guidance from their physical therapist and periodic visits to Shelbourne Knee Center. This maximizes recovery and function by enabling patients to continue therapy for longer.
Research Shows Improvements in Most Patients
Results on 396 knee OA patients in Shelbourne Knee Center’s OA Rehab Study2 show that most patients improved with physical therapy:
- Most patients have less pain and stiffness after 4–6 weeks of physical therapy and are able to return to their normal daily activities.
- Only 24%of patients went on to have a total knee arthroplasty (TKA).
For patients who don’t get enough relief through physical therapy and go on to TKA, the pre-op improvements made during the Knee Rehabilitation Program for OA facilitate a better surgical outcome and a faster, easier recovery.
The Mainstay of Treatment for Knee OA
The proven effectiveness of physical therapy and having on-site physical therapists and athletic trainers makes this a mainstay of treatment for knee OA at Shelbourne Knee Center. But physical therapy isn’t widely used for knee OA outside of our practice.
“Often, patients get a prescription from their orthopedic surgeon to go somewhere else for physical therapy and then decide they don’t want to do that,” says Dr. Benner. At Shelbourne Knee Center, a physical therapist sees patients with Dr. Benner, ensuring a smooth transition into the rehabilitation program. Close collaboration ensures that Dr. Benner is updated on each patient’s progress.
Use of Other Injections
As of now, platelet rich plasma injections and stem cell knee injections are unproven. “We don’t have good literature showing they reliably make people better,” says Dr. Benner. “Insurance companies usually don’t cover them and they can be very expensive.”
For more information about non-surgical treatments for knee OA at Shelbourne Knee Center, call 888-FIX-KNEE.
References
- Shelbourne DK. Thirty-five Years of ACL Reconstruction, presentation at Andrews University, February 2018.
- Shelbourne DK. Nonoperative Treatment of Knee Osteoarthritis, presentation at the Herodicus Society Meeting, June 2018.