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Knee Osteoarthritis: When to Consider Surgery

Knee osteoarthritis (OA) can affect your every move: walking, climbing stairs, even sitting or lying down. Surgery can help bring relief, but doctors almost always advise trying other treatment options first. These include:

Medications you take by mouth. Over-the-counter options include Tylenol (acetaminophen) as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) or Aleve (naproxen sodium). Stronger NSAIDs are available by prescription.

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Creams or ointments you rub onto the skin. Different forms are sold over-the-counter. Stronger versions are available with a prescription.

Medications injected into the joint. Corticosteroid injections fight inflammation and can offer fast pain relief that may last up to several months. Injections of hyaluronic acid boost the natural joint fluid that keeps knees moving smoothly.

Exercise and physical therapy. Exercise strengthens the muscles that support your knee. Physical therapy also helps. A physical therapist can design the program for you and see if you need supportive braces, splints, or canes. If you're overweight, exercise can help you lose weight and take some of the pressure off your knees.

Weight loss. Every pound you gain puts an extra 3 pounds of pressure on your knees. If you eventually need knee replacement surgery, your chances of success are much greater if you first lose extra weight.

Nutritional supplements. Some people take glucosamine and chondroitin for OA. Studies on how well they work have had mixed results. Another substance, called SAMe, has been shown to work as well as non-prescription pain relievers and may have fewer side effects. It works more slowly, though. Before you start taking any supplements, even if they're natural, tell your doctor so they can check on side effects.

These treatment options may provide enough relief to keep you moving comfortably. If they don't relieve your pain well enough, they become less effective, or you can't tolerate them, your doctor may suggest surgery. The two types of surgery most often recommended for knee OA are arthroscopic surgery and knee replacement surgery.

Arthroscopic Surgery

In this type of surgery, the surgeon inserts a thin tube with a tiny camera on the end through a small opening in your skin to view the inside of your knee. The surgeon can then remove damaged cartilage -- the smooth covering that protects the bones in the joint. The knee can be cleaned or flushed to remove loose bone or cartilage pieces that may be causing pain.

Most people can get back to their usual activities a few days later. The recovery usually isn't painful.

Arthroscopic surgery may provide short-term relief from pain. It can also delay the need for more complex surgery.

Knee Replacement Surgery

If you have tried all other osteoarthritis treatment options and still have knee pain, your doctor may suggest knee replacement. It can help reduce your pain and improve your ability to move.

Knee replacement surgery involves removing all or part of the knee joint and replacing the damaged parts with an artificial joint. These are made of metals and plastics.

It may take months to recover fully, but the relief can last many years or even a lifetime.

It may be time to have knee replacement surgery if you have:

  • Severe knee pain that limits your everyday activities
  • Moderate or severe knee pain while resting, day or night
  • Chronic knee inflammation and swelling that doesn’t improve with rest or medications
  • Knee deformity: a bowing in or out of your leg
  • Knee stiffness: inability to bend and straighten your knee
  • No pain relief from NSAIDs (or can't tolerate them) or other conservative measures

WebMD Medical Reference

Reviewed by David Zelman, MD on April 08, 2013

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