Knee osteoarthritis – what is the answer?

Recently, during one of my regular Melbourne radio segments, I received a call from a 47-year-old tradesman asking advice about his severe, knee osteoarthritis. After years of working on building sites, both his knees have severely degenerated to the point where he is now in considerable pain, but, like all of us – he has to earn a quid.

Image source: Unsplash, Eagle Media Pro

Because he is far too young, as it is suggested that knee replacements have around a 15 to 20 year use by date and also the fact that the recovery time for him to be able to get back to normal activity could be months, he basically cannot afford to go down this path.

So, what are his options? Unfortunately, although there are some therapies that may ease some of his discomfort, the only definitive answer when you are experiencing bone on bone arthritis, is a total replacement.

Many of my long-term readers will know that I had my knee replaced in May 2020 with a very good result. I am no longer in pain and can walk freely but I’m still impeded if I try to run at a moderate pace and still find kneeling quite difficult. But, prior to the operation, I needed a walking stick purely to get up and down stairs and after a few hundred metres on the flat had to stop because of pain. Thankfully, this is no longer the case.

For people who are either too young, or those who are too old with many other comorbidities to make an operation feasible, what are your alternatives? During the 12 years that I was in progressive pain from my arthritis I tried all of these with limited success, some better than others.

There are a few injectables on the market which include Synvisc, PRP therapy and stem cell therapy. I had Synvisc and PRP on multiple occasions with some benefit and pain relief. I had stem cell therapy twice, the first time making my pain worse and the second bout giving me some minor relief.

Synvisc is inexpensive; PRP has a modest cost and stem cell therapy is quite expensive.

There are a number of natural therapies available over the counter which have not been trialled in major studies but there are a number of small studies, published in a variety of journals, showing benefit.

Arborvitae – this is concentrated pine bark extract and other natural substances which is taken in a daily drink. I have had a number of patients and calls into my various radio segments suggesting that they have had enormous benefit from using this product. I must add that this company does advertise on the Nine radio network where I am a regular presenter. A variety of studies have shown significant reductions in pain & inflammation with Arborvitae.

Curcumin – there are a number of high-quality curcumin based products on the market. I found that the use of a particular curcumin product which is enhanced with a modified polyphenol technique also gave me very good relief.

PEA (Palmitoylethanolamide) – I’ve had a number of patients and friends tell me that they have had enormous relief from the pain with this product. The dose is 600mg daily.

High dose Omega3 – There are three main products on the market which include krill, high strength fish oil and New Zealand green lipped mussels, all of which have shown varying benefits.

Glucosamine products – I believe the best combination is glucosamine, chondroitin and MSM. There are also some observational trials suggesting people who take glucosamine on a regular basis have lower rates of death and cardiovascular disease.

Arthritis causes a combination of pain, limitation of movement, stiffness and swelling of the joint. This makes normal functioning very difficult and thus relieving the symptoms is important. There are a variety of painkillers available on the market. These include high-dose paracetamol which may have long-term effects on liver function and also the vast array of non-steroidal anti-inflammatory drugs. The non-steroidal anti-inflammatory drugs have been studied extensively and certainly relieve pain but there are significant problems with gastrointestinal irritation and bleeding along with an effect on kidney function and high blood pressure. From a variety of trials, the safest of all of these drugs is no doubt celecoxib and I suggest that taking this drug in a dose of 200 mg daily, especially on the days that you are performing heavier activity, will certainly give you relief. This must be done under the supervision of your doctor with regular monitoring of your kidneys, BP and gastrointestinal system.

The holy grail for the management of knee osteoarthritis is to rebuild healthy cartilage within a damaged joint. There are numerous research facilities around the world working on this very issue with promising trials of a variety of different substances, typically injected, but as yet, none are clinically available. Hopefully over the next few years there will be some effective therapies available.

I certainly was hanging out for a number of years for this but, unfortunately, my knee pain and the immobility caught up with me and I certainly do not regret my decision.

As I say about many conditions, you should never suffer in silence because there is always some relief that can be offered.