1. Lifestyle measures: weight loss, exercise & strength rehab
Sometimes basic measures can be taken to improve the health of your own body and knee joint resulting in a significant improvement of symptoms. We would always recommend starting with these measures whether you require any other form of treatment or not.
The outcome of any injections or surgery is much improved if the patient is motivated to improve the strength and muscle function around the knee joint as well as reduce the forces transmitted through the knee joint by reducing body weight.
2. Injections: Steroid, Hyaluronic Acid & PRP
Steroid Injections
The orthopaedic community has been using steroid injections for decades, and this still has a role to play when PRP can’t be used. However, steroids have been shown to upregulate MMPs and their action, causing them to work harder and break down the cartilage even faster. This then in fact accelerates OA and results in joint replacement surgery much earlier than necessary.
We try to avoid the use of steroid injections.
However, steroids can be effective for pain relief in severe OA and inflammatory conditions when joint replacement surgery may be too high risk.
Hyaluronic acid
Hyaluronic acid / Hyaluronan injections have been used for many decades to help treat joint and musculoskeletal problems.
Hyaluronic acid injections are an effective method of treating knee joint pain and OA. These work by providing a lubricant and cushioning effect in the knee joint as well nourishing the cartilage.
Types available:
- Ostenil
- Ostenil Plus
- Durolane
- Synvisc / Synvisc one
PRP
PRP has emerged as a leading joint preservation treatment for OA. There is now lots of evidence to support the use of PRP in OA.
Platelets are isolated from patient’s own blood and injected into the affected area. This helps the healing process and reduces pain whilst improving function. This can help stop the progression of OA and delay or prevent the need for major surgery.
PRP is highly effective in reducing inflammation and furthermore, helps to slow down and stop the progression of osteoarthritis by downregulating the effect of the MMPs (enzymes that break down cartilage). PRP helps to improve the function of the chondrocytes (cartilage cells) and the production of healthy matrix leading to better cartilage and joint health.
PRP injections can be used in the early, mild and moderate stages where evidence supports benefit, however, is not appropriate to have PRP treatment when the joint has severe changes.
PRP injections have been found to be more effective that hyaluronic acid and steroid injections.
PRP works best in grade I-III. It is not effective in grade IV.