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Knee Pain Treatments: Injections or Surgery? (video)

A Scripps knee pain specialist explains your options

A Scripps knee pain specialist explains your options

Does your knee hurt when you run, climb stairs, walk or even just stand up? You’re not alone. About one in four Americans lives with chronic knee pain that interferes with their ability to move comfortably and limits their quality of life. Knee pain is common, but a variety of treatments can help relieve it.


In this video, San Diego Health host Susan Taylor talks with Jeffrey Wilde, MD, an orthopedic surgeon at Scripps Clinic Torrey Pines and Scripps Clinic Mission Valley, who specializes in treating knee pain. They discuss why knee pain happens and how to treat it.

What causes knee pain?

Knee pain is often due to injury, such as falls, accidents or sports injuries. Overusing the knee joint also can lead to knee pain, especially if you don’t allow yourself proper rest between activities.


One of the most common causes of knee pain is osteoarthritis, a progressive form of arthritis that causes the cartilage that cushions the ends of the bones in the knee joint to wear away over time. Early-stage osteoarthritis may simply irritate the knee, but as the disease advances, the damage to the cartilage becomes increasingly more severe — as does the pain.


“Any number of things can cause knee pain and often a simple X-ray and examination can help sort out what’s going on,” says Dr. Wilde. “Once we know why you’re having pain, whether it is an injury or arthritis or something else, we can create a plan to treat it.”

Non-surgical treatments for knee pain

The best treatment for knee pain depends in large part on its cause. Treating mild pain and swelling due to overuse or minor injury may be as simple as taking an over-the-counter anti-inflammatory medicine like ibuprofen, icing the knee for 20 minutes a few times a day, and resting. Once you’re feeling better, return to activity slowly. Start with low-impact activities like cycling or swimming, avoiding anything that causes discomfort.


If you’re not feeling relief after a week of at-home treatment and rest, make an appointment with your doctor. You may be a good candidate for a cortisone injection; your doctor will inject cortisone, a strong anti-inflammatory, into the affected area of your knee joint. Also known as corticosteroid injections, cortisone shots are usually covered by insurance. About 95% of people get good results from a cortisone injection, says Dr. Wilde.


Hyaluronic acid (HA) injections may be another option. Hyaluronic acid is a gel-like substance found in the synovial fluid that lubricates your joints and helps them move smoothly. Osteoarthritis tends to decrease synovial fluid production, so these injections can help replace it. Results usually last about six months. Hyaluronic acid knee injections are also called gel injections or viscosupplementation and are usually covered by insurance.


Your doctor may use numbing medicine before doing a cortisone or gel injection. Both types of shots may cause discomfort for the first day or two; ice can help. It usually takes a few days for the shots to take effect and significantly relieve knee pain. Treatment can be repeated several times a year.


“Pain relief typically lasts three to four months with cortisone shots, and you can get them up to four times a year,” says Dr. Wilde. “Gel shots last about five to six months, and those can be done twice a year. You can use both of them on a staggered schedule, so often times we’re getting quite a bit of relief for many months.”

When should you consider knee replacement surgery?

If knee osteoarthritis is severe, knee replacement surgery may be the best option.


“Bone-on-bone arthritis happens when the cushion between the bones is completely gone, and when folks have that and their symptoms get pretty significant, it’s time to consider a joint replacement,” says Dr. Wilde. “Depending on the damage, we may recommend a total knee replacement, or a partial one.”


During total knee replacement surgery, the surgeon removes the damaged parts of the thigh and shin bones that make up the knee joint and replaces them with metal or plastic implants. If only part of the knee is damaged, replacing just those parts may be enough.


Both procedures can be done using minimally invasive surgical techniques that require fewer and smaller incisions than conventional “open” surgery. Most people are up and walking the day of surgery and are fully functional within three to four months.


“If you’re struggling with knee pain, make an appointment to talk about your options,” says Dr. Wilde. “Our goal is to restore quality of life and get people back to the activities they enjoy.”