Abstract
Nonoperative treatment for osteoarthritis of the knee includes weight loss, low-impact quadriceps-strengthening exercises, oral medications, and intra-articular injections. Runhaar et al. showed that a reduction of >5 kg or >5% of body weight over a 30-month period reduced the risk of radiographic osteoarthritis in middle-aged obese women1. Similarly, Kim et al. observed that obesity negatively correlated with the percentage of muscle mass index and knee extensor strength. The authors concluded that weight loss may be a better approach than increasing muscle mass strength to improve musculoskeletal conditions2. Finally, delayed progression of cartilage degeneration on magnetic resonance imaging (MRI) and clinical symptoms positively correlated with a >10% body mass index (BMI) reduction over 48 months3. Knee extensor strength is a proxy for overall knee health and function. Resistance exercise training has been shown to be effective in relieving pain, stiffness, and improving function in patients with knee osteoarthritis4. Culvenor et al. determined, via systematic review and meta-analysis, that lower knee extensor strength was associated with an increased risk of both symptomatic and functional deterioration of knee function but was not correlated with tibiofemoral joint-space narrowing5. Even in patients with cardiopulmonary medical comorbidities, a tailored exercise therapy program has also been shown to be safe and efficacious6. Additionally, combination therapies such as periosteal stimulation, manual therapies, and transcutaneous electrical nerve stimulation (TENS) with a home exercise program can be beneficial in relieving pain and improving function in older patients with advanced osteoarthritis of the knee joint7,8. Oral pain relievers play an important role in the nonoperative treatment of knee osteoarthritis. Da Costa et al. found through network meta-analysis that all preparations of nonsteroidal anti-inflammatory medications, irrespective of dosing, improved pain symptoms compared with placebo but also …
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