Knee Osteoarthritis Treatment Without Surgery

“Doctors perform approximately 1 million surgical knee replacements each year,” he said. “Of course, a proportion of these people need surgery. However, I’ve always felt that a lot of patients with OA are getting knee replacements much sooner in life than needed.”

Dr. Jayabalan is the physician-scientist director of the Nancy W. Knowles Strength + Endurance Lab at Shirley Ryan AbilityLab and assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine. 

Staying active is the best way for a patient to keep OA from getting worse. Yet, one of the biggest challenges of current knee OA treatment practices is that diagnosis typically happens only after a patient is in such severe pain that activity is difficult.

“Right now, I can diagnose patients with knee OA using an X-ray and send them for physical therapy, pain management and maybe injections,” Dr. Jayabalan said. “However, by that point, the OA is already far down the line. I don’t have anything to prescribe that will prevent its progression.”

To help doctors diagnose knee OA much earlier, Dr. Jayabalan and his lab team are developing a new protocol that he describes as a “cartilage stress test.”

“We have the patient exercise to put stress on the joints, and then we measure the body’s responses to that stress by looking at blood- or synovial-based biomarkers,” he said.

For patients with joint pain caused by advanced knee OA, an exercise prescription consisting of even the simplest tasks, such as walking for 30 minutes, can present an overwhelming challenge. Dr. Jayabalan’s lab is pursuing a hopeful alternative — use of an anti-gravity treadmill that allows knee OA patients to walk longer without increasing joint pain, while still reaping the full cardiac benefits.

Anti-gravity treadmills are increasingly more common in physical therapy regimens for patients recovering from ACL and other knee injuries. These devices enclose the patient’s lower body in a vacuum, and allow the therapist to vary the body-weight load that patients feel as they walk or run on the treadmill.

In a pilot study, Dr. Jayabalan’s team observed 30 patients with knee OA over the course of two 30-minute sessions. In one session, research subjects attempted to walk for 30 minutes on a treadmill at their full body weight. In the second, they attempted the same goal on an anti-gravity treadmill, set to reduce their body weight by 50 percent. Study results were overwhelmingly positive.