How to Save Your Knees From Arthroscopic Surgery

If you have osteoarthritis of the knees, with all of the pain and loss of flexibility that entails, chances are your doctor has recommended arthroscopic surgery. This is a procedure in which the surgeon inserts a scope into the knee and cleans out bits of loose bone and smoothes rough cartilage. But there are ways to avoid this invasive, expensive surgery and actually alleviate the arthritis.

"Most people accept osteoarthritis as a part of aging and have this misperception that there's nothing you can do," says Patience White, chief public health officer for the Arthritis Foundation and a rheumatologist in Washington, D.C. "There is no quick fix, but there are things you can do." For example: Lose weight. Every pound you gain means about four extra pounds the knees must bear. So every pound you lose means less stress on the knees.

Exercise. "Most people who begin to have joint pain assume they cannot exercise," White says. "Actually, physical activity makes it better." Go to www.arthritis.org for details on safe and effective exercise programs. Use certain medications. These can include ibuprofen, acetaminophen and injections of steroids and lubricating agents. The best results come when medications are combined with increased activity in one's lifestyle.

According to American Academy of Orthopaedic Surgeons board member Michael Schafer, a Chicago orthopedic surgeon, "The more you can be proactive and work on this yourself, the better you'll do." Use supplements. Even though scientific studies are inconsistent on glucosamine and chondroitin sulfate, "a number of my patients tell me it helps them, and I believe them," one orthopedist says.

Get physical therapy. Patients who keep all their appointments and do the home exercises they're assigned get better, and "it's incredibly less expensive" than surgery, says Lynn Snyder Mackler, a certified sports physical therapist at the University of Delaware in Newark. In the past, osteoarthritis, the most common form of arthritis, was thought to result entirely from wear and tear on joints - unlike rheumatoid arthritis, a disorder in which the immune system attacks joints.

Today, osteoarthritis is understood to be a more complex inflammatory disorder. Doctors don't yet know all the details, but they do know that the cartilage surrounding joints breaks down over time. That allows bones to rub together and causes stiffness, pain and loss of movement. They also know some people are at greater risk than others. But people can change their risk and can help themselves once symptoms develop, White says.

Health professionals also have tools beyond the surgery proven ineffective in the New England Journal of Medicine study. (The surgery involves inserting a scope in the knee, then flushing away loose bone chips and smoothing rough cartilage.) "We have a lot to offer," says Tony Rankin, an orthopedic surgeon in Washington, D.C., and president of the (AAOS).

Here's how to save your knees: The more you weigh, the higher your risk. Each pound you gain adds 4 pounds of stress to your knees when you walk, White says. If you have pain and stiffness already, losing weight will help. Arthroscopic surgeries such as those in the recent study can still help patients who have certain injuries in addition to arthritis, Rankin and Schafer say. Other surgeries, including bone realignments, are sometimes appropriate. And knee replacement surgery remains an effective option when all else fails.