Arthritis Treatment: What Are the Options For Treating Osteoarthritis of the Knee?

Osteoarthritis of the knee (OAK) is one of the most common maladies seen in a rheumatologist's office.

According to the Centers for Disease Control and Prevention, based on figures from 2007 to 2009, there are more than 50 million Americans with arthritis. Of these, more than half are limited in their activity because of their condition. (Hall MJ, DeFrances CJ. 2001 National Hospital Discharge Survey. Adv Data. 2003; 332: 1-18. Published April 9, 2003; Hall MJ, DeFrances CJ, et al. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Report. 2010; 29: 1-20, 24).

One striking finding in these surveys is the increasing frequency of knee replacement surgery, also known as total knee arthroplasty. In 2007, 543,000 knee replacements were performed. The demand for this procedure is increasing most in the 45 to 64 year age group (Bozic KJ, Masselli J, et al. JBJS Am. 2010; 92: 2643-2652; Jain R. Am J Ortho. 2011; 40 (suppl): 1-4).

It has been predicted that the demand for knee replacement surgery will increase by 673% between 2005 and 2030. And, revisions- meaning replacements of the replacements are also expected to soar by 601% by the year 2030.

Orthopedic surgeons are licking their chops and already planning for this deluge by planning to train more joint replacement surgeons, button-holing politicians to increase reimbursement for the procedure, increase access to operating rooms, and even starting high volume efficient centers just devoted to joint replacement.

In all fairness to orthopedic surgeons, they are dealing with the problem of osteoarthritis of the knee in the only way they know how... and that is to replace the joint.

However, there are other methods of dealing with OAK. Early on, the judicious use of anti-inflammatory medicines, both oral as well as topical may help. Weight control, physical therapy and injections of either glucocorticoid or viscosupplements (lubricants) can also be of benefit. Knee bracing is another option as is the injection of platelet-rich plasma (PRP). The latter has been shown to help with symptoms. There may also be a disease modifying effect.

Biotech and pharmaceuticasl companies are looking into the possibility of developing disease modifying osteoarthritis drugs (DMOADS). However, the course to FDA approval is arduous.

Finally, progress in the use of autologous stem cells has proven to be a real boon for many osteoarthritis of the knee sufferers. At our center, we are seeing very promising results. As techniques for this procedure improve, the need for total knee arthroplasty, hopefully, will decline.