THE BEST CONSERVATIVE TREATMENTS FOR KNEE OA

A Convenient Rehabilitation Program

After the physical therapist teaches the patient how to do the exercises during the first visit in the Knee Rehabilitation Program for OA, patients do their exercises at home, 3–5 times a day. Most patients also use the IdealKnee, a stretching device for knee extension.

Patients complete most of their physical therapy at home, with guidance from their physical therapist and periodic visits at Shelbourne Knee Center. This maximizes results by enabling patients to continue therapy for longer.

CONSERVATIVE TREATMENTS for symptomatic knee osteoarthritis (OA), especially physical therapy (PT), are more effective than many physicians think in relieving pain and improving function. The American Academy of Orthopedic Surgeons (AAOS) strongly recommended the use of self-management, exercise and oral NSAIDs, when not contraindicated, in its 2021 update to the Clinical Practice Guideline for Management of Osteoarthritis of the Knee (Non-Arthroplasty).1 The AAOS also moderately recommended intraarticular corticosteroids to provide patients with short-term relief.1

Research-Backed PT

The Shelbourne Knee Center Knee Rehabilitation Program for OA exceeds the AAOS’s recommendations for selfmanagement and exercise by providing research-backed PT under the guidance of a physical therapist who specializes in knees.

“Many physicians tell patients that physical therapy won’t make the arthritis go away and shouldn’t help with symptoms. Our data shows that physical therapy does help arthritic knees get better,” says K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center.

Of 396 patients who participated in the Knee Rehabilitation Program for OA between 2013 and 2017, 76% avoided total knee arthroplasty. These patients maintained their improvements through the study’s one-year follow-up period.2

The Knee Rehabilitation Program for OA focuses on normalizing knee extension first, followed by improving flexion and then strength. Most other nonsurgical rehabilitation programs for knee OA focus on increasing strength, which is difficult to achieve in patients with even a few degrees of loss of extension and flexion.

Enabling PT with Corticosteroids

Despite the potential risk of accelerating osteoarthritis from intra-articular corticosteroids, the surgeons at Shelbourne Knee Center find them to be useful in some circumstances. “A corticosteroid injection is a way for us to provide a patient with short-term relief of significant symptoms, enabling us to then get to the root of the problem with physical therapy,” says Dr. Shelbourne. “We never recommend repeated injections every three months as the sole mode of treatment.” Patients who can’t tolerate an injection receive oral steroids.

Most patients are discharged from the Knee Rehabilitation Program for OA after 2–4 months. Then they self-manage their knee OA through the maintenance program.

NSAIDs are the best type of medication for relieving knee pain, says Dr. Shelbourne. While some data may show that a particular NSAID is most effective, what’s best in clinical practice varies among patients.

“Some people like naproxen because you only have to take it twice a day. Some people say naproxen doesn’t help but ibuprofen works,” says Dr. Shelbourne. Prescription NSAIDs are an option for patients who have GI problems from OTC NSAIDs or need longer relief.

References

1. American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). https:// www.aaos.org/oak3cpg. August 31, 2021.

Accessed July 13, 2022.

2. Benner RW, Shelbourne KD, Bauman SN, et al. Knee Osteoarthritis: Alternative Range of Motion Treatment. Orthop Clin North Am. 2019 Oct;50(4):425-432. doi: 10.1016/j. ocl.2019.05.001. Epub 2019 Aug 5.

Rare Knee Injuries: Research-Backed Treatment

TREATMENTS AT SHELBOURNE KNEE

CENTER are based on nearly 40 years of research and follow-up with more than 13,000 patients. The practice’s two surgeons, K. Donald Shelbourne, MD, and Rodney Benner, MD, have had their research published in more than 160 medical journals and over 100 book chapters. Because we specialize only in knees, we see more rare knee injuries than most orthopedic practices, and we welcome the opportunity to discuss these cases with our colleagues.

Through our Rare Knee Injury Research Program, we’ve begun to identify outcomes and factors related to those outcomes for the following injuries:

• Arthrofibrosis

• Chronic patellar tendinosis

• Failed ACL surgery

• Knee dislocations

• Patellar tendon rupture

• Patellofemoral instability

• Quadriceps tendon rupture.

Whether you would like to discuss a case or make a referral, patients will benefit from our research-backed treatment protocols. Referrals enable us to expand our research to further improve treatment for rare knee injuries.

To discuss a rare knee injury or other case with one of our orthopedic surgeons, email skckneecare@ecommunity.com or call 888-FIX-KNEE (317-924-8636)

ORTHOPEDIC SURGEONS n K. Donald Shelbourne, MD n Rodney Benner, MD

CLINICAL TEAM n Jean Fouts, RN, BSN n Lee Linenberg, CA n Emily Guy, PA

PHYSICAL THERAPISTS AND ATHLETIC TRAINERS n Bill Claussen, MPT n Emma Sterrett, LAT, ATC n Laura Bray-Prescott, PT/LATC n Darla Baker, PT, DPT ATC/L n Sarah Eaton, PT, DPT, ATC, LAT n Jennifer Christy, PT n Alana Gillenwater, PT, DPT n Bryanna McKinstry, PT

RESEARCH TEAM n Scot Bauman, PT, DPT n Adam Norris n Heather Garrison n Diane Davidson, BS, MBA, CCRC