I recently presented at London Bridge Hospital as part of a multidisciplinary evening with surgeons, physiotherapists and a specialist knee brace company. My role was to talk about the conservative management of knee osteoarthritis and also talked about the injection therapy.
I started with basic definitions of knee osteoarthritis which I tell patients. This concentrates on pain in the joint, function limitation and reduced quality of life. I then talked about the various pathological changes that can occur within the knee and referenced the NICE guidelines which advise a holistic approach, not only concentrating on the actual pathology within the knee but also talking about mood, sleep and exercise. The core treatments for osteoarthritis are those of weight loss and physical therapy, strengthening muscle and flexibility. Additional adjuncts can be used.
I went on to detail various other treatments which are non-pharmacological, including the need for braces and sensible footwear. I also talked about exercising and the avoidance of impact twisting turning activity and to do non-impact exercise such as cycling and swimming.
Injection therapy is not solely related to steroid. I use steroid for very swollen knees, which are very painful and synovitic and steroid is a good option to reduce swelling and give a quick fix. This will allow reduction of pain and increased function and also allow physical therapy supervised strengthening. Other modalities are viscosupplement injections which act as a lubricant and stabilise cartilage by stiffening it.
Lastly I talked about ortho-biologics, including platelet-rich plasma injections, as well as stem cell injections. The research for these two is slightly limited and mixed but I believe that with time this will be the future.
On the whole, it was a great evening and we had talks from Technique Physiotherapy, as well as Ossur, talking about knee braces. Also, Mr Ian McDermott, Knee Surgeon, talked about the role of surgery for arthritis of the knee.
Dr Kal Parmar, Consultant in Sports & Exercise Medicine
26th June 2019