Physiotherapy Q&A: can I improve my knee pain without having knee replacement surgery?

I am 52 years old and have right knee pain, my X-ray shows some moderate arthritis but I don’t relish the thought of surgery, and think I am too young. I would rather try and improve things myself if possible as I worry that an operation would require me to take lots of time off work to recover. Can I improve my pain or do I need to start considering a knee replacement?”

Toby Lambourne, Horder Healthcare Advanced Practitioner answers the question:

Managing knee osteoarthritis (OA) is a very personal experience where there are several options if basic advice and medication via your GP hasn’t helped. Replacement surgery is certainly one of those options but the younger and more active people are, the keener they are to avoid or delay a total knee replacement (TKR). This is predominately because it means they are more likely to one day to need a revision of the replacement and this is an even more complicated procedure. TKR is generally successful with 81% of people reporting improvements in their symptoms.

In most cases, an operation only requires an individual to spend 2-3 nights in hospital. With regards to driving it is 6 weeks until you can drive and returning to work varies on how manual your job is and how well your recovery progresses. Some people return on lighter duties initially.

Although many people do well, national research suggests that almost 20% say they are no better after an operation and a small percentage of patients say they are worse off. It is therefore not a decision to be taken lightly especially as there are the usual risks associated with surgery to be considered as well.

The National Institute for Health and Care Excellence Guidelines (NICE, 2015) advocate that those being referred for surgery should have been offered at least the core treatment options prior to referral for a knee replacement. Core treatments include provision of appropriate OA management information, help to lose weight if relevant, and activity/exercise guidance. Often referral to a physiotherapist ensures that you will receive all of this advice and outcomes have shown that people can then delay, or even negate the need for a knee replacement if they are able to care for their knee pain themselves. This is known as ‘self-management’.

Locally, via an NHS referral to Sussex MSK Partnership East, various sites offer classes which include a group education session and exercise class all targeted at individuals with either OA knee or hip pain and the research outcomes are excellent. One to one physiotherapy sessions can also be arranged if you have specific individual needs or are not able to attend a class around your work hours.

Additionally, knee injections are sometimes helpful for pain relief. The NICE guidelines state that ‘Intra-articular corticosteroid injections should be considered as an adjunct to core treatments for the relief of moderate to severe pain in people with osteoarthritis’. By improving your pain, an injection may help you self-manage as you should then feel more able to exercise and strengthen the knee.

Ultimately there are lots of options available to people with OA knee pain and surgery can be delayed/avoided with good self-management. The goal is to improve your symptoms with the most conservative option possible. In the first instance though, your GP is a good starting point for further assessment and to seek a referral.

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