I am a 45 year old ex-jock who badly injured my knee playing high school football. I have had it scoped several times for cartilage tears and “cleanouts” but I am now told that my x-rays show moderate arthritis. I’ve tried cortisone shots. I’ve been avoiding activities and sports and have gained considerable weight. They say I am too young for a knee replacement. What can I do? Are there any other options?

You, like many active individuals in your age group are in that middle ground in terms of treatment options for your arthritic knee. You have been through several surgeries already and unless there is something very specific such as a new torn cartilage or loose body more arthroscopic surgery is not the answer. There comes a point where repeat, relatively minor arthroscopic surgery procedures really don’t offer much. You are young for knee replacement surgery and hopefully your arthritis is not yet at that point.

There are some treatment options for you and usually it is a combination of things that can help keep you active and comfortable in terms of your knee. Hopefully you can also avoid or prevent the knee from knee replacement down the line. Keeping your weight down is essential. Every extra pound you carry puts significant weight on your knee, in fact, with certain activities your knee senses 4 or 5 pounds for every 1 extra pound that you carry. Keeping your legs strong is also very important especially your quadriceps muscle on the front of your thigh. Weight training and stationery cycling are excellent in that regard.

Occasional cortisone or steroid injections could be helpful especially around times of significant flare-ups. Certain supplements are very effective in helping to control osteoarthritis symptoms and I would recommend Glucosamine and Chondroitin Sulfate. My preference is Cosamin DS because in the supplement world brand does matter and you want to be sure you are getting the best of ingredients. Tumeric is another supplement that has also been shown to help osteoarthritis.

There are also other newer non-surgical alternatives such as Viscosupplementation (VS). VS agents are a gel that can be injected into your joint and act as a “lubricant” for your creaky knee. It may help control inflammation and even possible protect the joint, although more research is needed in that regard. If patients respond, pain is often reduced and function improved for up to six months. I have had some patients actually get one year or more remarkable improvement of their symptoms. More recently, injections like PRP (Platelet-Rich Plasma, where your blood is drawn and spun down in a centrifuge, and the growth factors from the blood are injected in your knee) have shown even better clinical results than viscosupplementation. Here’s the latest research regarding PRP for arthritis. In the relatively new field of regenerative medicine, even newer options like stem cell injections are being used to manage arthritis. All of these novel options may help younger athletes and other patients postpone, or maybe even someday completely avoid, a knee replacement!

Depending on the pattern of wear in your knee, you may be a candidate for other non-arthroscopic surgical procedures (i.e. osteotomy or partial joint replacement). There are also many newer regenerative surgical technologies that might prevent you from ever having to actually have a knee replacement. The future is very bright in this area!

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