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Ask an orthopedist: What are the most effective alternatives to knee replacement surgery?


by Steve Greer, MD, primary care sports medicine 

Nagging knee pain has become an unwelcome part of your life.

You’ve tried all the usual home treatments – gels, creams, heat and ice, over-the-counter pain relief medications, and the list goes on. But you’re still turning down invitations for a friendly tennis match or a pickup game of basketball, or avoiding hobbies like gardening. You want to say goodbye to stubborn knee pain, but you’re just not ready for a knee replacement.

You’re not alone. One of the most common questions my patients ask is: “What are all my non-surgical treatment options for knee pain?”

Knee surgery can be extremely effective when it’s done at the right time and for the right reasons. But there are several non-surgical alternatives that can successfully relieve pain and restore mobility – pushing your need for surgery out or possibly taking it off the table all together.

As an orthopedist at TRIA, I’ve helped treat knee pain in hundreds of patients. I know first-hand that surgery isn’t always the best fit. Many of my patients don’t know that non-surgical options can heal their knee pain. Here are some of the non-surgical treatments I commonly recommend.

Commit to regular exercise to keep your joints moving

When your knees hurt and feel stiff, exercise is usually the last thing on your mind. But moving more can actually help manage your knee pain in many ways, including:

  • Building muscle strength to help support your knees
  • Improving your knee flexibility and reducing stiffness
  • Stimulating the flow of fluid around the knee to reduce buildup

While almost any exercise will help, low-impact exercises that focus on strengthening the legs, hips and core are recommended, such as:

  • Swimming
  • Strength training
  • Cycling
  • Yoga
  • Walking

How often do you need to exercise? For starters, just get moving. Eventually, you’ll be able to work your way up to exercising three to five times a week. The key is finding and sticking with a regular exercise routine.

Keep in mind that just because it hurts, doesn’t mean it’s harming you. Feeling some discomfort while you adjust to your workout is normal. However, if you feel intense pain, you should stop doing that particular exercise.

It usually takes about four to six weeks to improve your fitness level and strengthen your knees, so don’t give up. Consistency can help with long-lasting pain relief.

Work to shed a little weight to reduce pressure on your knees

Our knees support us whenever we walk, sit or stand. They take a lot of wear and tear throughout our lives. If you’re overweight, losing weight can help make your knees’ work easier.

Even losing 10% of your body weight can help alleviate knee pain. One pound lost can eliminate four pounds of pressure on your knees.

Excess weight can also add to inflammation throughout your body, which can make the inflammation in your knee more painful. So, losing weight may help reduce that inflammation.

If you have struggled with weight loss in the past, help is available. Dietitians, nutritionists and other specialty doctors can provide medical weight management and guidance to help you reach your goals.

Try physical therapy for targeted knee pain relief

Knee pain can affect your strength, balance and mobility. If knee pain has stopped you from doing something you enjoy, physical therapy may be able to help you get back to it.

Physical therapy, sometimes called rehabilitation, is a type of treatment that combines exercise, education and hands-on care to strengthen and loosen muscles and joints.

During physical therapy, a physical therapist will guide you through a treatment plan that fits your specific needs. You’ll work together to come up with a treatment goal, such as improving your knee mobility, reducing swelling or improving your balance.  

Treatment plans often include guided exercise with a physical therapist a few times a week, a personalized exercise plan to do at home and hands-on care like massage.

A physical therapist will also teach you about the causes of your knee pain and show you how to perform regular activities to avoid pain or further injury.

You’ll likely finish your physical therapy plan in about three months. However, for lasting results, you should continue physical therapy exercises at home. By strengthening your knees and learning how to move, physical therapy can provide long-term pain management.

Look into regenerative supplements that could help your body make new cartilage

Some people with knee pain take nutritional supplements called glucosamine and chondroitin. These are substances found in cartilage, and they help to maintain cartilage structure and slow cartilage deterioration in joints.

Supplements in higher doses have been shown to reduce pain for about 60% of the people who take them. While this isn’t significantly high, for some it is worth a try as an alternative to surgery. Because they are used by your body to make cartilage, it may take up to 6 weeks to notice a difference.

Talk to your doctor to find out if supplements might be a good option for you and your knee pain. And don’t forget to your labels carefully, as many of these supplements are made from shellfish, but there are some vegan versions as well.

Ask a doctor about injections that can relieve pain and prevent further wear and tear

Injections are another common method used to reduce inflammation and knee pain quickly. There are several types of injections, and your doctor can help to determine the best type for you.

Steroid injections that can reduce inflammation in knees  

Steroid injections for knee pain are typically corticosteroids (sometimes called cortisone) shots. Cortisone mimics the effects of a substance called cortisol that is naturally produced by the adrenal glands.

Steroids help reduce the inflammation and offer pain relief, because knee pain is often caused by inflamed tissue.

It usually takes about three to seven days for steroid injections to work to their full effect. But it’s possible to feel relief as soon as 24 hours.

Though they offer significant pain relief, the effects of steroid injections are temporary. On average, steroid shots relieve pain for three months, though you may feel relief for up to six months.

Steroid injections may cause side effects. It’s common to experience minor pain and swelling in the knees for a couple days after the shot. Your doctor will be able to answer any questions you have about side effects.

Hyaluronic acid injections that can help lubricate your joints

Your body makes hyaluronic acid naturally. It’s a fluid that helps lubricate your joints in order to protect them wear and tear. Think of it as a shock absorber for your knees.

Injecting more hyaluronic acid into your knees can help boost your body’s natural supply. More hyaluronic acid may help better protect your knees and reduce knee pain.

Though these injections can offer significant pain relief, they may require several injections over a few weeks before you feel any relief.

Orthobiologics

Orthobiologics, which some refer to as regenerative medicine, is an emerging field, and TRIA is at the forefront. Orthobiologic treatments are minimally invasive treatment options that use natural, tissue derived product to help restore function and help the body heal more quickly.

Orthobiologics are usually used alongside other knee pain treatments like physical therapy. And depending on your type of pain, medical history and personal preferences, your doctor can recommend which orthobiologic approach is best for you. Some options include:

  • Platelet rich plasma (PRP)
  • Bone marrow aspirate concentrate (BMAC)
  • Placental tissue matrix therapy (PTMT)

Are any of these non-surgical knee treatment options right for you? Talk with a doctor.

You might be tempted to grit your teeth and continue to tough out your knee pain. But before you resign yourself to missing out on your favorite sport, jogs around the neighborhood or dancing at your grandkid’s wedding, ask an orthopedist how they can help.

I have the pleasure of working with experienced orthopedists and orthopedic surgeons who are among the best in the Midwest. At TRIA, non-surgical treatments are always the starting point.

We’ll work with you to create a tailored treatment plan to help reduce and heal knee pain. If or when the time comes to consider knee replacement surgery, we’ll talk you through the process.

Ready to talk with an orthopedist? We’re here for you.

Schedule an orthopedic appointment

 

About Steve Greer, MD

Steve Greer, MD is an experienced orthopedist who specializes in both family and sports medicine. He completed is residency in family medicine and fellowship in primary sports medicine at Moses Cone Memorial Hospital, which is located in Greensboro, N.C. He’s held several positions with schools, colleges, and sports organizations, and currently works with patients at two TRIA clinics on the east side of the Twin Cities.

 

 

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