Ladder of Treatment for Osteoarthritis of the Knee
This leaflet will give you a short introduction to the
treatments used for knee osteoarthritis. Knee
osteoarthritis affects each person in different ways so
not all these treatments may be right for you. The
best treatment for you will depend on:

Anti-inflammatory tablets. These tablets are
usually recommended to help with pain if
paracetamol has not worked for you. This group
of tablets includes NSAIDs such as ibuprofen and
diclofenac and COX-2 agents such as celecoxib.
In a few people they may cause unwanted
effects, particularly ulcers and bleeding in the
stomach. If you are at risk of these side effects
your doctor may recommend other tablets to
prevent this(4).

Glucosamine tablets. Taking these tablets
regularly can help by reducing pain and allowing
you to be more mobile. X-rays of the knee also
show that in some people they stop osteoarthritis
getting worse(5).

Injections into the knee
Your knee
o
o
o


How much pain you get
How well your knee functions
The amount of damage in the knee
Your overall health
Your doctor can help you decide which treatments are
best for your knee.
Things you can do



Healthy eating to stay at a healthy weight. If
you are overweight losing weight can make a big
difference to your knee problems. Losing 5% of
your weight can reduce pain and improve
function(1).
Make changes to help you cope. It is important
that you learn the best ways to manage your knee
day to day. Most people find that they get less
pain after learning about osteoarthritis and ways
to cope. You can find out more from the list of
contacts at the end of this leaflet.
Exercise. Regular exercise can help to keep you
more mobile and make your knee less painful.
Exercise also makes people feel their overall
physical health is better. Many different types of
exercise can help, the most commonly
recommended
include;
walking,
cycling,
swimming and strength training for quadriceps
(thigh) muscles(2,3).

Physiotherapy can help you make the most of
the function in your knee – it involves much more
than just strengthening muscles. Flexibility,
muscle control and overall fitness and stability
can all be improved resulting in improvement in
pain, easier movement and better function in the
knee (6,7).
Knee braces. If your leg is slightly bowed or
knock knee’d then an ‘unloading’ type knee
support can help reduce pain and improve
stability.
Injections of steroids. Steroids have a short
lasting effect of about 1 month, reducing pain
and swelling. It is usually used to treat flareups of arthritis pain(4).
o
Viscosupplementation
Injections (e.g.
Synvisc). This liquid boosts the normal ‘oil’ in
the knee and may relieve pain and allow you
to be more active, lasting 6 months or more(8).
Surgery – Operations on your Knee

Keyhole knee washout (Arthroscopy). This is a
keyhole operation to wash out the knee joint.
Your surgeon may also remove some of the
damaged tissue in the knee. This can help to
reduce the pain in your knee but may not improve
the function(9).

Bone re-alignment operation (Osteotomy).
When the leg is bowed or knock knee’d more
weight is being taken on one side than the other,
wearing that side out. ‘Osteotomy’ corrects that
by cutting through the bone and correcting
alignment, taking some stress off the knee and
‘buying time’ (10).

Knee
replacement
(Arthroplasty).
Knee
replacement – top of the ladder - is indicated
when pain is severe limiting walking distance to
less than a mile, interrupting sleep and
substantially affecting quality of life. The benefit
needs to be considered against the risks of the
surgery(4).
Physiotherapy and Knee braces

o
Other sources of information about arthritis:
Treatments your doctor might prescribe
Arthritis Research Campaign

Arthritis Care
Painkillers. Most people find that taking
paracetamol helps reduce their pain and it is often
the first painkiller recommended. Painkiller gels
and creams – ibuprofen and capsaicin creams
both help by reducing pain in the knee. Both are
safe to use over long periods(4).
Linda Porteous Medical Student
for the Knee Team, UHCW NHS Trust
Version 2 March 2008
NHS Direct
www.arc.org.uk
0870 850 5000
www.arthritiscare.org.uk
0808 800 4050
www.nhsdirect.nhs.uk
0845 46 47 48
For references list see www.timspalding.com
Ladder of Treatment for Osteoarthritis of the Knee
(1) Christensen R, Marie-Bartels E, Astrup A, Bliddal H. Effect of
weight reduction in obese patients diagnosed with knee
osteoarthritis: a systematic review and meta-analysis. Ann. Rheum.
Dis. 2007 4 January 2007;66:433-439.
(2) Van Baar ME, Assendelft WJ, Dekker J., Oostendorp RA,
Bijlsma JW. Effectiveness of exercise therapy in patients with
osteoarthritis of the hip or knee: a systematic review of randomised
clinical trials. Arthritis and Rheumatism 1999;42(7):1361-1369.
(3) Devos-Comby L, Cronan T, Roesch SC. Do Exercise and SelfManagement Interventions Benefit Patients with Osteoarthritis of
the Knee? Journal of Rheumatology 2006;33(1):744-756.
(4) Jordan KM, Arden NK, Doherty M. Recommendations 2003: an
evidence based approach to the management of knee
osteoarthritis. Ann. Rheum. Dis. 2003;6:1145-1155.
(5) Richy F, Bruyere O, Ethgen O, Cucherat M. Structural and
symptomatic efficacy of glucosamine and chondroitin in knee
osteoarthritis: a comprehensive meta-analysis. Archives of Internal
Medicine 2003;163(13):1514-1522.
(6) Ottawa Panel Members , Ottawa Methods Group , Brosseau L,
Wells GA, Tugwell P, Egan M, et al. Ottawa Panel Evidence-Based
Clinical Practice Guidelines for Therapeutic Exercises and Manual
Therapy in the Management of Osteoarthritis. PHYS THER 2005
September 1;85(9):907-971.
(7) Bennell KL, Hinman RS, Metcalf BR, Buchbinder R, McConnell
J, McColl G, et al. Efficacy of physiotherapy management of knee
joint osteoarthritis: a randomised, double blind, placebo controlled
trial. Ann Rheum Dis 2005;64:906-912.
(8) Dagenais S. Intra-articular hyaluronic acid (viscosupplementation) for knee osteoarthritis. Issues in emerging health
technologies 2006 December;94(94).
(9) National Institute for Health and Clinical Excellence.
Arthroscopic knee washout, with or without debridement, for the
treatment of osteoarthritis (interventional procedures second
consultation). ;Consultation Document.
(10) Dowd GSE, Somayaji, H.S. and Uthukuri, M. High tibial
osteotomy for medial compartment osteoarthritis. Knee 2006 Mar
2006;13(2):87-92.