Knee deep in treatments. But which ones work?
Nearly half of adults over the age of 50 report knee pain in a one-year period with osteoarthritis (OA) being the most common cause. OA happens when the cushioning (cartilage-lining of joints) breaks down faster than your body can build it back up. Outside of knee replacement, medical treatment has focused on methods to relieve pain and stimulate the cushioning that the body’s cartilage naturally provides.
How well do these approaches work?
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“A Shot to the Knee,” the April 2024 AARP Bulletin, investigated the research on four common injection approaches: corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), and stem cell therapy. Although sharing your questions with your healthcare provider is recommended, the AARP article can help with general questions and provides detailed explanations of each injection and is accessible online: (www.aarp.org/health/conditions-treatments/info-2024/knee-injections-for-pain.html.
While each treatment described is promising and may offer temporary relief, the article concluded that “Studies in recent years have found that most of these injections actually do very little to improve osteoarthritis in the knees and are only slightly more effective that a placebo.”
Guidelines of the American Association of Orthopedic Surgeons (AAOS) reflects that conclusion, only conditionally recommending the use of one type of injection-corticosteroids for short term pain relief. AAOS advises against hyaluronic acid injections and at this point does not recommend either PRP and stem cell injections which are not fully approved by the FDA and are regarded as experimental by insurance companies. Research shows that corticosteroids can provide short term pain relief, although some patients report having success with injections every three months for several years.
So what else is available other than knee replacement?
You may have seen the May 2024 headline, “Orthopedic surgeon among first to place new shock absorber implant for knee.” Although this treatment is not yet available widely and may not be appropriate for those with severe knee osteoarthritis, shock absorber implants are a promising new development. (To learn more just type in the above headline into a Google search.)
Other approaches which are not new but have proven successful are physical therapy and weight loss for those who are carrying extra weight. These approaches are recommended as front-line therapy, even if other treatments are anticipated.
In one study (“Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial”) obese osteoarthritis patients who lost weight improved their knee function as much as those going through surgery – within just eight weeks. The researchers concluded that losing 20 pounds of fat “might be regarded as an alternative to knee replacement.”
An anti-inflammatory diet focusing on whole foods with emphasis on fruits, vegetables, legumes, seeds, nuts, and whole grains has also been shown to decrease inflammation and arthritis pain.
One study (pubmed.ncbi.nlm.nih.gov/25871017/)zeroed in on a particular food that has shown to be especially beneficial in terms of blocking inflammation: sesame seeds. Although the study was small, involving with only 50 patients with osteoarthritic knees, the results after 2 months of taking ¼ cup of sesame seeds per day resulted in significant improved total blood antioxidant measurements. The study concluded “Sesame seed is a natural and safe substance that may have beneficial effects in patients with knee OA, and it may provide new complementary and adjunctive treatment in these patients.”
Bottom Line: While at this point research has not yet shown successful ways of regenerating cartilage that work as well as the cartilage we were born with, there are successful approaches beyond joint replacement that provide pain relief and lessen inflammation -from physical therapy, diet, weight loss and corticosteroids injections — and perhaps even sesame seeds!
