Suffering from knee pain due to osteoarthritis? You may not need surgery. Here’s what you can try instead
Most people with knee osteoarthritis can control their pain and improve mobility without surgery, according to updated treatment guidelines from the Australian Commission for Safety and Quality in Healthcare.
So what is knee osteoarthritis and what are the best ways to manage it?
More than 2 million Australians suffer from osteoarthritis
Osteoarthritis is the most common joint disease, affecting 2.1 million Australians. It costs the economy A$4.3 billion each year.
Osteoarthritis usually affects the knees, but can also affect the hips, spine, hands, and feet. It affects the entire joint, including bones, cartilage, ligaments, and muscles.
Most people with osteoarthritis experience persistent pain and have difficulty performing simple daily tasks, such as walking and climbing stairs.
Is it due to “wear and tear”?
Knee osteoarthritis primarily affects older adults, people who are overweight or obese, and those who have had previous knee injuries. But contrary to popular belief, knee osteoarthritis is not caused by “wear and tear.”
Research shows that the amount of structural wear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and very severe symptoms, while others have a high degree of structural wear and minimal symptoms. Therefore, X-rays are not necessary to diagnose knee osteoarthritis or guide treatment decisions.
Telling people they are suffering from wear and tear can make them anxious and worried about damaging their joints. It can also encourage them to try invasive and potentially unnecessary treatments, such as surgery. We have demonstrated this in people with osteoarthritis and other common pain conditions, such as back and shoulder pain.
This has sparked a global call for a change in the way we think and communicate about osteoarthritis.
Learn more: How long does back pain last? And how can knowing more about pain increase your chances of recovery?
What is the best way to manage osteoarthritis?
Nonsurgical treatments are effective for most people with osteoarthritis, regardless of their age or severity of symptoms. These include education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medications.
Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.
Health professionals who use positive, reassuring language can improve people’s knowledge and beliefs about osteoarthritis and its management.
Many people think that exercise and physical activity can cause further damage to their joints. But it is safe and can reduce pain and disability. Exercise has fewer side effects than commonly used painkillers, such as paracetamol and anti-inflammatories, and can prevent or delay the need for joint replacement surgery in the future.
Many types of exercise are effective for knee osteoarthritis, including strength training, aerobic exercise like walking or cycling, yoga, and tai chi. So you can do the type of exercise that works best for you.
It is also important to increase general physical activity, for example by taking more steps throughout the day and reducing sedentary time.
Weight management is important for people who are overweight or obese. Weight loss can reduce knee pain and disability, especially when combined with exercise. Losing just 5 to 10 percent of your body weight can be beneficial.
Painkillers should not replace treatments such as exercise and weight management, but can be used alongside these treatments to help manage pain. Recommended medications include paracetamol and non-steroidal anti-inflammatory drugs.
Opioids are not recommended. The risk of harm outweighs the potential benefits.
What about surgery?
People with knee osteoarthritis typically have two types of surgery: knee arthroscopy and knee replacement.
Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to be causing pain.
However, quality research has shown that arthroscopy is not effective. Therefore, arthroscopy should not be used in the management of knee osteoarthritis.
Joint replacement involves replacing the joint surfaces with artificial parts. In 2021-22, 53,500 Australians underwent knee replacement surgery to treat osteoarthritis.
Joint replacement is often considered inevitable and “necessary.” However, most people can effectively manage their symptoms through exercise, physical activity, and weight management.
The new guidelines (known as “standards of care”) recommend that joint replacement surgery be considered only for people with severe symptoms and who have already tried nonsurgical treatments.
I have knee osteoarthritis. What should I do?
The standard of care refers to free, evidence-based resources to help people with osteoarthritis. These include:
If you have osteoarthritis, you can use the standard of care to inform discussions with your healthcare provider and to make informed decisions about your care.
