Dear Dr. Garner,
I am 55 years old and am in pretty good shape, although a little overweight.
I have been having pain in my right knee. My doctor thinks it is arthritis, and that I might need surgery. I really would like to avoid the knife. Is there anything you think I could do short of surgery.
Limping in Little Neck

Dear Limping,
I was just talking to my brother, Dr. Bruce Garner, who is a rheumatologist, about this condition. There are many different types of arthritis of the knee. The most common is known as osteoarthritis. This basically means that the knee joint has been injured, from the constant pounding of running and walking during the past 55 years.
It doesn’t happen overnight, and the pain can come on gradually.
It is the most common type of knee arthritis. There are some risk factors which increase one’s chance of having knee problems including:
• Excess weight – Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up stairs. Losing just five pounds can relieve your pain by at least 50%.
• Overuse – Any repetitive activity, such as bicycling a few miles every morning to gardening all weekend, can fatigue the muscles around your joints and lead to excessive stress.
• High-risk sports and activities – Some sports can put greater stress on your knees than others. Alpine skiing with its sharp twists and turns and falls, basketball’s jumps and pivots and the repeated pounding your knees take when you run or jog, all increase your risk of arthritis.
• Previous injury – Old fractures or tears of the meniscus lead to increased risk of osteoarthritis.
• Age – As one gets older, there is a greater likelihood of osteoarthritis. It typically affects patients over age 50.
• Genetic predisposition – Knee arthritis tends to run in families.
Knee arthritis symptoms tend to progress as the condition worsens. It also seems to be worse on days depending upon the weather and humidity.
It is important to understand this because the symptoms may change from day to day, and may not be a sign of progression of the disease.
The most common symptoms of knee arthritis are: pain with activity; limited range of motion; stiffness of the knee; swelling of the joint; tenderness along the joint; a feeling that the knee may “give out”; deformity of the joint such as “knock-knees” or “bow-legs.”
The medical evolution of a patient with knee arthritis should begin with a physical exam and X-rays.
Treatment of knee arthritis should begin with the most basic steps, progressing to the more involved, with surgery being a last option.
The following are some of the treatment options available:
• Weight loss – The most important thing you can do, and yet tends to be the least commonly performed treatment.
• Limiting activities that stress the knee.
• Relieve the stress — Use a cane or crutch in the hand opposite the affected knee to decrease the demand placed on the joint.
• Physical therapy – By strengthening the muscles around the knee joint, it may help decrease the burden on the knee.
• Anti-inflammatory medications such as Motrin.
• Cortisone injections may help decrease inflammation and reduce pain.
• Synvisc – In this procedure, a gel is injected into the knee joint to serve as an extra shock absorber. This may help against pain in some patients and delay the need for surgery.
• Glucosamine – This is a supplement that can be purchased in a drug store, or health food store. Some people swear by this treatment, while scientific studies have not been that encouraging.
• Knee arthroscopy – Your doctor will put a “scope” into the joint to clean up torn cartilage.
• Knee surgery – Can be anything from a partial replacement to a total replacement. This is something that should be reserved for last, and carefully reviewed with your physician.

* Reprinted with permission of The Tablet