Conservative treatments for symptomatic knee osteoarthritis (OA), especially physical therapy, are more effective than many physicians think they are in relieving pain and improving function. The American Academy of Orthopedic Surgeons (AAOS) strongly recommended the use of self-management, exercise and oral NSAIDs, when not contraindicated, in its 2021 update to the Clinical Practice Guideline for Management of Osteoarthritis of the Knee (Non-Arthroplasty).(1) The AAOS also moderately recommended intra-articular corticosteroids to provide patients with short-term relief.(1)
Research-Backed PT
The Shelbourne Knee Center Knee Rehabilitation Program for OA exceeds the AAOS’s recommendations for self-management and exercise by providing research-backed physical therapy under the guidance of a physical therapist who specializes in knees.
“Many physicians tell patients that physical therapy won’t make the arthritis go away and shouldn’t help with symptoms. Our data shows that physical therapy does help arthritic knees get better,” says K. Donald Shelbourne, MD, an orthopedic surgeon and head of the OA Knee Rehabilitation Program at Shelbourne Knee Center.
Of 396 patients who participated in the Knee Rehabilitation Program for OA between 2013 and 2017, 76% avoided total knee arthroplasty (TKA). These patients maintained their improvements through the study’s one-year follow up period.(2)
The research-backed OA Knee Rehabilitation Program focuses on normalizing knee extension first, followed by improving flexion and then strength. Most other non-surgical rehabilitation programs for knee OA focus on increasing strength, which is difficult to achieve in patients with even a few degrees of loss of extension and flexion.
Enabling PT with Corticosteroids
Despite the potential risk of accelerating osteoarthritis from intra-articular corticosteroids, the surgeons at Shelbourne Knee Center find them 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 Dr. Shelbourne. “We never recommend repeated injections every three months as the sole mode of treatment.” Patients who can’t tolerate an injection receive oral steroids.
NSAIDs are the best type of medication for relieving knee pain, says Dr. Shelbourne. While some data may show that a particular NSAID is most effective, what’s best in clinical practice varies among patients. “Some people like naproxen because you only have to take it twice a day. Some people say naproxen doesn’t help but ibuprofen works,” says Dr. Shelbourne. Prescription NSAIDs are an option for patients who have GI problems from OTC NSAIDs or need longer relief.
References
- American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). https://www.aaos.org/oak3cpg. August 31, 2021. Accessed July 13, 2022.
- Benner RW, Shelbourne KD, Bauman SN, et al. Knee Osteoarthritis: Alternative Range of Motion Treatment. Orthop Clin North Am. 2019 Oct;50(4):425-432. doi: 10.1016/j.ocl.2019.05.001. Epub 2019 Aug 5.