The way medicine views treatment of knee osteoarthritis is slowly changing. Many people with this problem find themselves at a difficult crossroads. Recurrent steroid injections may offer mild relief but may not be safe long term. Traditional surgical options such as knee replacement surgery may be too early, and arthroscopic debridement has been shown to be no better than sham surgery. So what can we use that’s safe and effective? Here’s what I recommend:

1. If you have any excess weight, do everything you can to safely lose it and get to your ideal weight. Excessive pounds place tremendous strain on the knees. Reducing that excess is essential to any knee regimen.

2. Strengthening the muscles in your thighs and hips can help with knee pain as well. Physical therapy or a regular exercise regimen is useful, and will improve not only pain but also help with functional ability as well. Again, this is an integral part of any knee pain regimen.

3. Glucosamine chondroitin supplementation may help. The evidence is mixed, but approximately 50% of people who use these supplements will obtain some pain relief. Low risk, possible gain, makes sense to consider.

4. Hyaluronic acid knee injections. These work as lubricating fluid for the knees. Generally low risk, they have in some studies been shown to reduce pain longer than steroid injections. They do not have the risk of degrading cartilage like steroids do, so again another reasonable option.

5. Accupuncture can help with pain in arthritis patients.

6. Platelet rich plasma has been shown to reduce knee pain in osteoarthritis, possibly better than hyaluronic acid injections.

7. Mesenchymal stem cells: this is the next step that may be beneficial. Evidence shows it’s a safe treatment option. A number of early studies show they can help with pain significantly. A few smaller case reports show possible healing ability in some people as well.

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