Non-Invasive Treatments For Knee Arthritis To Avoid Knee Replacement Surgery and Arthroscopy

Knee aches, pain and stiffness, together with knee weakness and instability are some of the main symptoms felt by people with knee arthritis.

Common Misconceptions About Knee Arthritis

• My pain is persistent. I’ve tried gels, painkillers, injections, and alternative treatments
  which did not work. There is no choice except for surgery.
• My pain is due to wear and tear, age related degeneration. Nothing much can be done, while it gets worse with time. I must just learn to live with it.
• My physical therapist and doctor both tell me to exercise more but I am not feeling any better. It maybe because I am just not trying hard enough.

How Does Knee Arthritis Affect Us?

The usual symptoms of knee arthritis include:

• Swelling in the knees
• Knee pain which increases with activity but gets better after resting
• Stiffening of the knees, especially in the morning or after a period of sitting
• Decreased mobility of the knee, making it particularly difficult for a person to use the stairs, get in and out of the car, and even walk
• Crackling sounds during knee movement

Standard Knee Arthritis Treatments and their Limitations
The traditional approach of knee osteoarthritis treatment in Singapore is to relieve the patient of knee pain and to improve the mobility of the knee joint while trying to delay knee replacement surgery where possible. Thanks to the advances of medical technology in recent years, the concept of disease modification and joint repair has become a realistic objective.

Commonly used approaches of knee arthritis treatment include:

• Exercise

Knee exercise is a commonly recommended treatment to help reduce joint stiffness, increase the muscular support around the knees, and to improve the function of damaged knees. The main limitation is the patience and determination needed, especially when the knee arthritis is severe.
However, when a patient is suffering from significant pain, it is often not practical to focus on exercise as the main solution.

• Weight loss

While it is commonly prescribed as a treatment to reduce pressures on the knees, this should be done with common sense. It clearly is not possible for someone suffering from severe pain to do marathons as a weight loss strategy. It is best to consult a physical therapist for the most effective exercises.

• Knee Braces

Patients are often recommended knee braces for knee pain. This especially works when they see friends with knee pain wearing a trendy looking knee brace. Unloader braces tend
to be firmer and push the knee back into better alignment, reducing the pressure on the affected parts of the knee joint.
While a knee brace can be useful, many patients find it uncomfortable having to wear it on a long term daily basis.

• Steroid Injections

A steroid injection is traditionally used by doctors trying to reduce pain in an inflamed knee joint. While the steroid component can be helpful in reducing inflammation, it has also the potential to damage the knee cartilage as a side effect. As a result, most doctors try to avoid repeating such injections.

• Visco-supplement Injections (Hyaluronic Acid)

Hyaluronic acid is naturally present as a lubricant in healthy knee joints. Joints with
osteoarthritis often suffer from the deficiency of hyaluronic acid. Visco-supplementation seeks to improve joint mobility and reduce pain by restoring hyaluronic acid content in the knee joint.
While this has become an increasingly popular treatment, results of the procedure have been unclear. Patients who respond positively tend to be those with mild osteoarthritis, and even in these cases, the results are often temporary.

Visco-supplementation can have side effects such as increased knee pain and swelling, as well as bleeding and infection which can be severe.

• Acupuncture

Acupuncture is an ancient form of treatment based on the concept that the body has specific channels, known as meridians, through which energy flows. By using tiny needles to stimulate the flow of energy at specific meridian points, acupuncture seeks to restore health and alleviate pain. While the clinical evidence for the effectiveness of acupuncture for knee osteoarthritis is not yet conclusive, acupuncture as a treatment is growing in popularity in many parts of the world.

• Transcutaneous Electrical Nerve Stimulation (TENS)

A TENS machine is now a very common alternative to pain medications used by both physical therapists and patients. By using small electrical impulses to stimulate the nerves, TENS can help reduce the pain.

While a TENS machine is generally considered very safe, it should not be used by someone with any of the following conditions:
-Pregnancy
-Implanted electrical devices: Pacemakers, Cochlear implants, etc.
TENS electrodes should also never be placed over the front of the neck (where there is the
carotid sinus) and over areas with damaged skin. There are currently many models of TENS devices available for use by professionals as well as for home use by patients. These are usually easily available at a pharmacy, medical supply store, as well as through a quick Amazon or Google search.

Other traditional treatment strategies for knee pain include:

• oral painkiller medications
• analgesic gels and patches
• ultrasounds and heat packs
• traditional massages
• glucosamine joint supplements
• knee arthroscopy procedures
• knee surgery

However, for a large group of patients, these solutions are not ideal. The less invasive approaches may not work, have side effects, or simply be impractical.

The more aggressive options may carry even more risk, and be quite expensive.

In the United States where there is a reliance on prescription painkillers, there is now a recognized opioid epidemic.

According to the US Department of Health & Human Services (HHS), more than 130 people died every day from opioid-related drug overdoses in 2016 and 2017.

Over the past few years, there have been many positive developments in the treatment of knee arthritis.

The key strength of newer treatment methods include:

A) They address the underlying cause of the knee condition specifically targeting:

-arresting the underlying and any ongoing knee damage
-promoting actual tissue repair
-supporting the body’s natural healing response

B) The treatments have an extremely good safety profile and are very practical to use. While we naturally carry the treatments in our clinic, they can even be bought online for convenient use in the home.

C) Compared to many treatments that patients are likely to have tried with minimal results, the treatments are very affordable.

What are the some of the interesting treatment technologies patients should know about?

1: Protective Nano Gels

2: Anti-inflammatory and Natural Supplements for Joint Repair

3: Portable Pulsed Electromagnetic Field Technology

A very important concept is to understand is that there is no single miracle cure for knee problems. It is a combination of different proven treatment strategies, each working through different complementary mechanisms, that work together to give amazing results.

Let us go through each of the following strategies we use for patients on a daily basis:

1: Protective Nano Gel

The basic principle is to start by preventing further damage to the knee joint by lubricating the knee with a protective gel.

FLEXISEQ is a specially formulated gel, which does not contain pharmaceutically active ingredients.

It uses Sequessome Technology™, a new advanced technology developed in Germany.

It contains nanostructures that are able to cross through the skin barrier through topical application, and target the knee joint.

They act as a physical bio-lubricant to lubricate the joint and improve physical function and significantly reduce pain.

Flexiseq: Interview with Dr Rother

Flexiseq is used not only for degenerative knee arthritis but also for knee injuries from sports

2: Anti-inflammatory and Natural Supplements for Joint Repair

While it is important to protect the knee joint from further damage, it is even more important to promote knee recovery by reducing inflammatory damage and supporting the body’s natural healing ability.

This is best achieved with supplements such as collagen hydrolysate, hyaluronic acid, and natural anti-inflammatory herbs.

Collagen Hydrolysate

Made from the hydrolysis of collagen molecules, collagen hydrolysate is now widely used as for joint health.

Listed below are some of the many published clinical data on the benefits of collagen hydrolysate:

-Collagen hydrolysate is of interest as a therapeutic agent of potential utility in the treatment of osteoarthritis and osteoporosis. Its high level of safety makes it attractive as an agent for long-term use in these chronic disorders. Semin Arthritis Rheum. 2000 Oct;30(2):87-99. [https://www.ncbi.nlm.nih.gov/pubmed/11071580]

-Bioactive Collagen Peptides Stimulate the Regeneration of Cartilage Tissue. [www.nutraingredients-usa.com/Research/Modified-collagen-may-stimulate-cartilage-re-growth-Study]

-Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. [https://www.tandfonline.com/doi/abs/10.1185/030079906X148373]

-24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. [https://www.tandfonline.com/doi/abs/10.1185/030079908X291967]

-Collagen Hydrolysate Improves Joint Function in Adults with Mild Symptoms of Osteoarthritis of the Knee. [https://journals.lww.com/acsm-msse/Fulltext/2004/05001/Collagen_Hydrolysate_Improves_Joint_Function_in.730.aspx]

Hyaluronic Acid

As a substance naturally found in the human body, hyaluronic acid is found in high concentrations in the synovial fluid of the knee joint. It works by acting as a lubricant and cushion in the knee.

Hyaluronic acid is well known as the active ingredient for viscosupplmentation ( joint lubricating gel injection) injection performed by doctors for patients with knee problems.

Taken orally even as as a single supplement, it is a very popular joint supplement.

Avocado and Soy Unsaponifiables

Another less well known supplement taken for osteoarthritis is ASU, or the extract from avocado and soya bean oils. There is currently moderately good evidence that taking ASU supplements can help improve the symptoms of hip and knee osteoarthritis.

ASU is quite commonly used in parts of Europe to treat osteoarthritis at a dose of 300mg a day. While it is not as clearly useful for neck osteoarthritis, ASU can be a very safe option to consider when other options are not suitable, such as for vegans.

Before we cover the remaining treatment strategies, let us explore what being free from knee pain can mean for you.

Does it mean being able to walk more confidently again? Or not suffering with every single step, even when going to the toilet?

To some people, it may mean no longer being stuck to a wheelchair and not being dependent on someone else to help you move around.

For people with less severe knee problems, it can mean regaining your lifestyle by being able to enjoy exercise and your hobbies or perform at a higher level in sports.

It can also mean rejoining your friends in activities to regain your social network and not looking “older than your age”.

You will also want to prevent your knee condition from worsening to a point where risky and expensive surgery is necessary.

Bearing these in mind, let us get to the important remaining treatments for knee arthritis.

Are The Above Strategies Sufficient For Every Patient With Knee Arthritis?

The treatments discussed are usually effective for people with mild to moderate knee arthritis.

However for people who have been recommended knee surgery, had tried knee surgery unsuccessfully, or are not eligible to do knee surgery, you will need stronger clinical treatments.

If your condition is extremely severe, or if you need fast relief due to daily suffering with every single step you take, consult us for our Knee Arthritis Program.

It is a non-invasive treatment program that uses non-invasive radio-frequency energy to help activate cell metabolism.

The result is an acceleration of the natural healing processes in the knee joint, reducing pain and inflammation from the first session.

Developed with international medical expertise, it is a clinic based, non-invasive therapy.