Knee Arthritis: Treatment Options Before Knee Replacement

What knee osteoarthritis is, and why surgery is rarely the first step

Osteoarthritis is gradual wear of the smooth cartilage that covers the ends of the bones in the knee. It often causes pain on walking or climbing stairs, stiffness after sitting, swelling and a feeling that the knee is less reliable than it used to be.

X-ray changes and symptoms do not always match. Some people with marked changes on an X-ray manage well, while others with milder changes have a lot of pain. For this reason, treatment is guided by how the knee affects your life, not by the image alone. In many patients, a well-structured non-surgical plan keeps them active for years.

Weight, exercise and activity: the foundation

These measures are recommended by international guidelines for almost everyone with knee osteoarthritis, at any stage.

• Weight management: every kilogram of body weight is multiplied across the knee with each step, so even modest weight loss often reduces pain.
• Physiotherapy and strengthening: stronger quadriceps and hip muscles help to unload the joint. A physiotherapist can build a programme you can continue at home or in the gym.
• Low-impact activity: cycling, swimming, aqua exercise and walking on even ground are usually well tolerated. In Doha, an air-conditioned gym, a pool or an early-morning walk in the cooler months makes it easier to stay consistent.
• Activity modification: you do not have to stop being active, but reducing repeated deep squatting, kneeling or high-impact jumping can help a painful knee settle.

Pain relief, bracing and injections

Simple pain relief, such as paracetamol or anti-inflammatory gels and tablets, can help during flare-ups. Anti-inflammatory tablets are not suitable for everyone, particularly people with stomach, kidney or heart problems, so check with your doctor before taking them regularly.

An unloader brace or a walking stick in the opposite hand can reduce load on the worn side of the knee for some patients.

Injections are another option:

• Corticosteroid injections can reduce pain and swelling for a period of weeks to a few months. They are usually not repeated too often.
• Hyaluronic acid (gel) injections help some patients, but research results are mixed and not all guidelines recommend them.
• Platelet-rich plasma (PRP) is being studied widely. Some studies report benefit, others do not, and the evidence is still evolving. It is reasonable to discuss it, with realistic expectations.

Osteotomy: realigning the knee in selected younger patients

When arthritis mainly affects one side of the knee, often the inner side in bow-legged knees, and the patient is younger and active, a realignment osteotomy may be an option. The surgeon cuts and repositions the shin bone or thigh bone to shift weight towards the healthier side of the joint.

Osteotomy preserves your own knee and can delay the need for replacement. It suits a specific group of patients, so careful assessment with standing X-rays and examination is essential.

Partial or total knee replacement

If the wear is limited to one compartment and the ligaments are intact, a partial (unicompartmental) knee replacement may be possible. It replaces only the damaged part, and many patients find the knee feels more natural and recovery is quicker.

When arthritis affects several parts of the knee, a total knee replacement is usually the more suitable choice. Both are well-established operations. The right option depends on your X-rays, examination, age, activity level and goals, which Dr. Gelber discusses with each patient at Aman Hospital in Doha.

Signs it may be time to consider surgery

There is no fixed point at which surgery becomes necessary. It may be worth discussing it when:

• Pain wakes you at night or is present at rest.
• Walking distance is shrinking and daily tasks, such as prayer, stairs or getting out of a car, are becoming difficult.
• You have given non-surgical treatment a fair trial for several months without enough improvement.
• The knee is becoming visibly more bowed or knock-kneed.

The decision is yours, made together with your surgeon after an individual examination.