Knee osteoarthritis is an incredibly common cause of pain. Risk factors range from mechanical problems like excessive weight and prior trauma, to more functional etiologies such as weakened ligament or tendons. In addition cartilage specific micro-environment issues that may have a genetic component may be important. And even possibly inflammatory cytokines that may exacerbate existing damage or directly contribute to pain. With all of these potential issues, it’s amazing that our non-surgical treatment algorithm is perceived as limited.
So what can work? If you have functional weakness, that should be corrected with focused physical therapy and prp/prolotherapy when appropriate. Hyaluronic acid treatments have anti-inflammatory properties that can help if you have mild to moderate arthritis. A number of articles in the last 2 years have shown that prp can work even better than hyaluronic acid treatments in controlling pain. Some of this may be due to improving the cartilage micro environment with needed growth factors, but the science there is still being worked out. Other cell based therapies are emerging as well- just ask the long line of athletes going to Germany for IRAP treatment. And of course there is the great potential of stem cells helping to repair existing damaged cartilage- more on that in the future.
You should notice that I didn’t even mention steroid injections. Yes they do work in treating pain. They certainly can help if you have significant inflammatory synovitis as well. But they don’t fix any of the problems I listed earlier. A more nuanced and personalized approach seems like the best way to deal with knee arthritis. That’s what you should be asking for as well.