By Scott Bradley, MD
Too often, patients with knee pain give up hope of relief if they can’t or prefer not to have a surgical procedure.
However, a wide range of conservative therapies can significantly improve joint pain and range of motion in osteoarthritis patients. The most commonly known treatments are medications, physical therapies and steroid injections, but the list of options is growing.
Patients may not be good candidates for knee replacement surgery due to multiple factors, including age, obesity, certain chronic diseases, and/or other medically limiting co-morbidities. Non-invasive therapies aim to reduce pain to manageable levels, allowing patients to handle tasks of daily living and enjoy as active a lifestyle as possible.
All of the following treatments are performed in-office, involve minimal recovery time, and are covered by most insurance plans:
• Non-opioid medications such as anti-inflammatories and topical creams are good starting points for many patients, along with ice and rest as needed.
• Physical therapy can yield very positive results in patients who commit themselves to the process. In cases of more severe pain or balance issues, aquatic physical therapy is a safe, gentle and effective alternative to land-based programs, removing the pressure of gravity and risk of falls while still working all the important muscle groups.
• Steroid injections typically provide three to six months of relief.
• Hyaluronic acid joint injections – also known as HA or gel injections – are another path forward, particularly for patients with diabetes or osteoporosis that may need to limit steroid use. HA is a joint lubricant naturally produced by the body that can decrease with age. Gel injections frequently are given as a three-part series, one per week, and take effect after four to six weeks. The goal is to gain at least six months of improvement on pain and/or stiffness. For patients who qualify for steroid injections, physicians also can alternate between the two.
• Genicular nerve blocks can disrupt pain signals from a group of three sensory nerves that supply the knee. The treatment, performed under live X-ray guidance, uses radiofrequency ablation to target the superior medial, superior lateral and inferior medial nerves at the base of the femur and top of the tibia. While the nerves do grow back, that takes about a year on average. Before deciding on these blocks, physicians inject a long-acting numbing medication around the nerves to test if it can “turn off” usual pain during a day of normal activity, by a minimum of 50 percent. As the procedure does not impact interior joint space, most patients who have had a previous surgery or joint replacement are still candidates.
While patients with knee pain tend to feel isolated and discouraged, this problem is, in fact, common and should not bring their lives to a screeching halt. As specialists, our job is to supply multiple treatment alternatives and find the right recipe for a better quality of life.
Dr. Bradley is a Board certified and fellowship trained physical medicine and rehabilitation specialist with Hampton Roads Orthopaedics Spine & Sports Medicine, based in Williamsburg. hrosm.com
