Nonsurgical Treatment Options
Pain Reduction Without Surgery
Option 1: Unloader knee brace
Option 2: Custom shoe orthotic
Option 3: Hyalgan, synvisc or supartz injection
Option 4: Glucosamine/chondroitin
Option 5: Physical Therapy
Option 1: Unloader knee brace: A custom knee brace that reduces the stress on the medial compartment. Patients generally have less pain and greater function while using it. The brace may be worn as much or as little as desired. It is generally only effective while it is being worn. The brace is custom fitted by a representative from the company. If properly worn, there should be no significant risks associated with it. Any brace worn too tightly, however, has the potential to cause blood clots.
Option 2: Custom shoe orthotic: This custom heat-molded shoe insert is made in our physical therapy clinic. The orthotic features a small wedge in the outer aspect that reduces stress on the medial compartment of the knee by tilting the foot slightly outward. It provides effective relief of pain and pressure for most patients, but some patients find orthotics bothersome in their shoes. There is no significant risk associated with using orthotics.
Option 3: Hyalgan, synvisc or supartz injection: These are hyaluronic acid substitutes. This is the natural lubricant made by your body for joints. It is obtained for medical purposes from rooster combs. Although the substance only stays in the joints for a few days, its effects may be long lasting. It is not entirely clear why, but one theory is that the injections decrease inflammation. Patients must receive weekly injections for three to five weeks at their doctor’s office. The injections are quick and relatively painless. There have been no common side effects associated with the use of such injections. The success rate is somewhat variable and controversial. These injections appear to be effective less than 50% of the time.
Option 4: Glucosamine/chondroitin: These substances decrease pain in some patients. They may help cartilage nutrition or they may help by decreasing inflammation. They are sold over the counter. Chondroitin that is not derived from cows is recommended to avoid potential disease transmission.
Option 5: Physical Therapy: Arthritic and non-arthritic joints may develop “arthrofibrosis.” In this condition the knee fails to straighten fully. Persons with this condition walk with the knee bent to varying degrees. Physical therapy can usually diminish and often eliminate this “flexion contracture.” This improved motion decreases pain in the overwhelming majority of patients to some degree. At times it can allow a patient who needed surgery to function adequately without it. It takes hard work on the part of the patient and therapist but our expert physical therapist is quite experienced technique to achieve this goal.
Angelo Dizon,
M.P.T., C.S.C.S.