How to help aging knees

The prognosis for people with knee osteoarthritis isn't as bleak as it might seem in the wake of a study finding that arthroscopic surgery, once hailed as promising, might not be the best option.

That study, in the Sept. 11 issue of the New England Journal of Medicine, suggested that people who undergo the surgery don't fare any better in the long run than those who receive physical therapy instead.

During the surgery, small incisions are made through which a camera and surgical instruments are inserted. Physicians can then repair or remove cartilage, flush the knee to remove debris or do both.

The trick is to find one or more treatments that can ease the pain of worn cartilage amid possibilities that include medication and physical therapy.

"When patients come into my office," says Ronald Grelsamer, a knee surgeon in the orthopedics department at Mount Sinai School of Medicine in New York, "I give them a list of 17 options to help them manage their condition. At the very bottom is arthroscopy. It works for a little while, but it's not going to cure it.

"What I've found is that nothing works for everybody, and everything works for somebody."

What are the options?

Oral nonsteroidal anti-inflammatories, such as Celebrex, can reduce inflammation and pain, as can cortisone injections. Hyaluronic acid injections can replace some of the viscous synovial fluids that lubricate the joints and that sometimes decrease with age. Acupuncture and massage also might alleviate pain. But as people get older and knees become more worn, the ultimate remedy could be a total knee replacement.

And although a New England Journal of Medicine study in 2006 found that glucosamine and chondroitin supplements did no better than a placebo among 1,583 people in reducing knee pain by 20 percent, some doctors still recommend it.

"The average effect is quite small," says John FitzGerald, assistant professor of rheumatology at the David Geffen School of Medicine at the University of California, Los Angeles, "and it can be slow-acting."

Exercise, lose weight

Much can be said for consistent exercise, which can also tamp down pain and improve mobility, according to health experts. One study published in the Annals of Internal Medicine compared a physical therapy program of manual therapy and exercise with a placebo program of subtherapeutic ultrasound. It found that exercise improved function, pain and stiffness scores more than the placebo.

A good first line of defense, health experts say, is shedding pounds.

"You can get some long-lasting effects," FitzGerald says. "Even with 5 to 10 pounds, which is a reasonable goal, people can expect a fairly significant improvement in knee pain."

But when knees hurt, the motivation to exercise goes south.

That's no excuse

Walking, swimming and water workouts are great for some people with arthritic knees, says Laura Bennett, a physical therapist at Good Samaritan Hospital in Los Angeles.

Walking time and intensity should progress gradually, she says. Many physical therapists will examine patients' muscle strength and flexibility, plus assess alignment and gait.

Because biomechanics vary from one person to the next, therapy programs need to be tailored.

Patients might be able to get referrals for licensed physical therapists from their doctors or hospitals. The American Physical Therapy Association also has lists of members on its Web site, www.apta.org.