Studies have shown that activities such as kneeling, squatting and stair climbing, particularly when a person is carrying heavy objects can worsen knee arthritis. Losing weight is very effective for improving arthritis symptoms.

There are several studies showing that these treatments are better than placebo (sham) treatments in people with mild to moderate disease. There have been no well-done studies comparing the creams to anti-inflammatory pills such as naproxen/Aleve.

Many of the studies are not of high quality; however there is reliable evidence that people with arthritis who exercise have better outcomes than those who don't. A physical therapist or athletic trainer can help with specific exercises that strengthen the muscles around the knee , as well as helping to avoid exercises that can make the knee worse, such as squats.

Studies have consistently shown that these drugs improve pain. There are concerns that the studies of anti-inflammatories are not of the highest quality. There are also concerns about the side effects of these drugs, particularly in people who have other medical problems as well. There are not adequate studies comparing these drugs to each other to recommend one over another. COX-2 type anti-inflammatories (Celebrex, others) can be used in individuals at higher risk for stomach problems, but have side effects of their own, including slightly increased risk of stroke and/or heart attack.

There is conflicting evidence on whether anti-inflammatories are better than acetaminophen for reducing knee arthritis pain. A recently published review of the medical literature suggests that anti-inflammatories offer better pain relief but do not result in better knee function for those with moderate to severe arthritis. Certain people may respond better to one type of drug or the other.

Studies have shown that those who completed arthritis education programs are better informed about their disease and need fewer doctor visits to manage their condition.

Knee replacement is major surgery. The surgeon cuts away the damaged bone and cartilage from the thighbone (femur), shinbone (tibia), and kneecap (patella), and replaces them with an artificial joint made of metal and plastic (the prosthesis).

The main risks associated with knee replacement are the risks of surgery (death, blood clots, heart attack, pneumonia, and wound infection) and the long term risks of the knee replacement wearing out (most last at least 15 years) or becoming infected. There are many different surgical techniques and prostheses. The decisions about which type of knee replacement to have depends in large part on the extent of arthritis in the knee, and the skill and experience of the orthopedic surgeon.

Some of the studies are of poor quality and questions remain about the effectiveness of these drugs, particularly chondroitin. Glucosamine cannot be taken by people with shellfish allergies and can also cause blood sugar problems in diabetics. Chondroitin can affect drug levels in those taking blood thinners. If you try them, be sure to tell your doctor.

Definitive studies are lacking. In certain small studies, people having acupuncture in addition to their regular treatment seemed to have less pain and better knee function. Additional studies are needed.

There are very few studies of knee bracing. Given that there is some evidence that bracing works and given the low associated cost and risk, it is reasonable to try bracing. The most effective braces are custom fit by your doctor.

Only certain types of knee problems can be treated with osteotomy. Not all knee surgeons perform osteotomies. Performing a knee replacement after the osteotomy has failed is more difficult than doing a knee replacement in a knee that did not have an osteotomy first.

These techniques attempt to repair the cartilage that lines the knee joint, either by making tiny cuts (microfracture) to stimulate new cartilage growth or transplantation of specially processed cartilage from cadavers (autologous transplantation), and appear to have good short term results for most people. More studies are needed to see how long-lasting the results are. More research is also needed to see which types of knee problems benefit from the various techniques.

Steroids (by decreasing inflammation inside the knee) and Hyaluron and Synvisc (by making the fluid in the knee more slippery) may improve pain in the short term (a few weeks), but the effects of hyaluronan may last longer.