Non-operative treatment options for knee osteoarthritis

Michael DeRogatis, Hiba K. Anis, Nipun Sodhi, Joseph O. Ehiorobo, Morad Chughtai, Anil Bhave, Michael A. Mont


Background: Knee osteoarthritis (OA) is a prevalent and debilitating condition for which a wide range of non-surgical treatment options are available. Although there is plethora of literature investigating their safety and efficacy, for many treatment modalities, a consensus has not yet been reached concerning efficacy. Therefore, it is essential for practitioners to understand the risks and benefits of the available treatments for the successful management of knee OA. This study explored the efficacy of non-surgical treatment options for knee OA including: (I) non-steroidal anti-inflammatory drugs (NSAIDs); (II) weight loss; (III) intra-articular injections; (IV) physical therapy; and (V) bracing.
Methods: A comprehensive literature review of studies between 1995 and 2018 was conducted using the electronic databases PubMed and EBSCO Host. Searches were performed using the following terms: total knee arthroplasty (TKA); cyclooxygenase-2 inhibitors; bracing; physical therapy; weight loss; knee; treatment; therapeutics; OA; intra-articular injection; hyaluronic acid; corticosteroid; and alternatives. The initial search yielded 7,882 reports from which 545 relevant studies were identified. After full-text analysis, 43 studies were included for this analysis.
Results: NSAIDs are most effective when used continuously and may be used in conjunction with other forms of treatment for knee OA as they have been shown to provide some pain relief as well as functional improvements. Weight loss is a safe and effective way to improve knee pain, function, and stiffness without adverse effects. However, it can be very challenging for obese patients with knee OA due to their limited mobility and lack of adherence to a low-calorie diet. Intra-articular injections have had mixed results, with findings from recent studies indicating long-term outcomes to be equivocal. Physical therapy leads to significant improvements in pain and function. Decreased compliance with physical therapy is thought to be due to high copayments, pain with activities, lacks of transportation, and high time commitments. Brace modalities have demonstrated significant pain and functional improvements and prolongations of the time to TKA. Additionally, they limit the need for other treatment modalities which are associated with greater risks.
Conclusions: NSAIDs, weight loss, intraarticular injections, and physical therapy have all been shown to be effective non-surgical treatment options for knee OA. However, these options have some limitations, and are best when used in conjunction. Bracing for knee OA is a noninvasive, non-pharmacologic option which can significantly reduce pain and improve function with minimal adverse effects. Therefore, a combination of knee braces along with other non-operative modalities should be one mainstay of treatment in conjunction with other treatment modalities to reduce pain, improve function, stiffness, and mobility in knee OA.