Preventing Knee Arthritis

There is unfortunately no magic way to reverse arthritis, though there may be some utility in anti-inflammatory diets. This is true especially if patients have underlying conditions such as gout which we know is exacerbated by the intake of foods such as fish, red meat, and alcohol products.

The use of glucosamine chondroitin and turmeric and other supplements do not have the highest quality level 1 evidence in the literature to support their use. However, as these are relatively low risk modalities that patients often ask about, as long as the risk profile is low and the potential benefit is reasonable, I don’t think there’s any issue in trying these as they do help some patients control the inflammation in the knee.

What is most important is trying to have a healthy weight where your fitness is appropriate. This is a conversation I have with patients several times a day in terms of having an optimal weight and it can be a source of anxiety or frustration because they feel that their knee joint is preventing them from walking and being able to do the things they want to do. But having a healthy weight is very important because for every one additional pound of weight, this actually can add four pounds of more stress to the knee joint. The other thing to consider is if we ever have a conversation about proceeding with a knee replacement, we need to really focus on getting the weight off because that will significantly help with reducing the risk of complications after a knee replacement. Our goal with taking the weight off, though we know it’s a sensitive topic, is just because we want our patients to be successful and we will work together accomplish that.

A great way to protect the knee and ensure its longevity is to keep the muscles around the knee working properly. Physical therapy is an option for knee arthritis as well. While in some patients, therapy can irritate the underlying cartilage, in many patients it can actually help by stretching out the hamstrings, strengthening the quadriceps, improving kneecap tracking, the consideration of foam rolling or dry needling, and overall improving the dynamics and load distribution around the knee joint. So talking with a professional about how to best optimize the dynamics of the knee can really accelerate the benefits of non-operative management.

Keeping motion in the knee is also important. We have all heard the saying, “motion is lotion” and the rationale for this is by keeping the knee moving, this promotes turnover of the synovial fluid which is the fluid that bathes the knee joint. This fluid provides nutrients and by keeping the knee moving, we keep that nutrient inflow turning over. The best ways to keep the knee moving are high motion but low impact activities. So swimming, cycling, elliptical use, and gentle walking are all examples of excellent low impact but high benefit/high motion exercises that keep the joint lubricated and healthy.\

Additionally, when you have knee problems, modifying activity can be very important to preventing undue stress on the knee. Obviously, we want patients to remain active but we do want to avoid steep hills, skiing, or other activities that require repetitively going up and down large inclines.

Furthermore, bracing the knee can be very helpful. A simple knee compression sleeve can help provide some support especially when patients are performing higher intensity activities such as prolonged walking or hiking. Sometimes a well-fitting hinged knee brace can also give good support with these higher activities. In certain types of arthritis where there is some deformity and compression of one of the knee compartments, a specific type of brace called an unloader brace can help reduce the load through that compartment.

When we talk about medications, the most routinely used medications for treating arthritis belong to a class of medications known as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). These medications can be taken orally of which there are several formulations. Of the many oral options available, my choice often would be either a 7.5mg or 15mg dose of Meloxicam. The reason I prefer this medication is it is a once-a-day anti-inflammatory that provides not only pain control but sustained anti-inflammatory effects to calm down the knee. There are also topical anti-inflammatories such as Voltaren cream which can provide some local anti-inflammatory benefit for the knee. Our perspective regarding NSAIDs is they should be used judiciously for a well-defined and reasonable amout of time and that a patient’s primary care physician has cleared them to take these medications. But as long as used in a healthy and judicious manner, NSAIDs can be very helpful in a patient’s non-operative healing pathway with knee arthritis.