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Unfortunately, knee osteoarthritis, a condition characterized by a slow, steady loss of the knee’s cushioning cartilage, is progressive and, at the moment, incurable, says Dr. Michael Parks, an orthopedic surgeon at the Hospital for Special Surgery in New York City, who specializes in knee replacements.

But there are ways to slow the progression. “The most important,” he says, “is activity modification.” While long-distance running, for instance, doesn’t seem to directly cause arthritis in most people’s knees, it may speed the condition once it starts, Dr. Parks says. “It’s best, once you have a diagnosis of knee arthritis, to limit repetitive impacts on the joint,” he says. So switch from running to cycling or low-impact elliptical training. Swimming is also good, he says, although the breaststroke, with its whippy frog kick, may stress the knee and should be avoided. “Water aerobics are also very good, especially for people who are older or overweight,” Dr. Parks says. “The buoyancy of the water unloads the knee.”


Activity of some kind is essential, though. Multiple studies have found that movement bolsters the health of the knee’s remaining cartilage. It also can help people to maintain their weight, which is another key to slowing arthritis, says Dr. Sabrina Strickland, an orthopedic surgeon and sports medicine specialist at the Hospital for Special Surgery. “I tell patients” with knee arthritis, “try to be as skinny as you can be.” Being svelte won’t cure the condition, she adds, but it’s “likely to make the symptoms better. Carrying less weight usually means feeling less pain.”

As for the supposedly cartilage-building supplements, such as glucosamine and chondroitin or shark cartilage, “there is very little if any science” showing that they work as promised, Dr. Parks says. “I tell people, if they want to spend their money on them, that’s up to them. There don’t seem to be side effects, and some people do say it makes them feel better. But most people don’t get benefits.”

In his experience, relatively severe knee arthritis pain often does lessen for a while after injections of a lubricating fluid, known as hyaluronic acid, that works like WD-40 in the joint, allowing the bones to slide against one another with less friction. But the pain-relieving effects wear off after a few months.

Meanwhile, scientists are working on a variety of ways of growing cartilage in the lab and inserting it into the knee. But those experiments, while promising in limited human studies, have not yet been shown to cure arthritis; only to slow its onslaught.

Most people with arthritis will, at some point, probably need a knee replacement, Dr. Parks said. “When the pain is so severe that it impinges on your ability to be active and to live your life as you’d want,” it may be time to look into a new joint, he said. “But, even though I’m a surgeon, I tell people, try everything else first.”

by Gretchen Reynolds for the New York Times

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