Emerging Treatments for Knee Osteoarthritis: Choosing the Right Option for Your Condition

Knee osteoarthritis (OA) is a chronic condition marked by pain, stiffness, and ambulatory difficulty. In recent years, several biological and interventional therapies have emerged as alternatives to traditional treatments.

In this article, rheumatologist Dr Eugene Lim will delve deeper into the condition, explaining what it is, the signs and symptoms to watch for, and available treatment approaches.

Knee Osteoarthritis

Osteoarthritis is a degenerative joint disease that happens when the cartilage cushioning the ends of your bones in the joints gradually wear away, resulting in bone-on-bone friction, which causes pain, stiffness and swelling.

Your knees are commonly used through day-to-day motion, carrying you from one place to another and bearing your weight during standing and movement. As such, it is one of the most common joints affected by osteoarthritis.

Knee osteoarthritis is a chronic condition with no known cure but there are treatment options available to slow its progress, relieve pain and restore function in the knees.

If left untreated, knee osteoarthritis may lead to debilitating pain and permanent disability.

Do You Have It?

One of the most common symptoms of knee osteoarthritis is pain in your knees. It might hurt when you apply pressure to it, when you move, or even when you are standing still. Other symptoms to look out for include:

• Stiff knees, especially in the morning or after you’ve been sitting for a long time
• Swollen or puffy knees
• Hearing a cracking or grinding noise when you move your knees
• Wobbly and unstable knees that feel like they might buckle or give way
• Your knees locking up or feeling stuck when you try to move

Treatment Approaches

In medical terms, the suffix ‘-itis’ is used to signify an inflammation of a specific body part or tissue, such as with ‘arthritis’ which is an inflammation of the joints’ and ‘gastritis’ which refers to the inflammation of the stomach.

Treatment methods for such conditions will involve the suppression of inflammation. However, classical features of inflammation like redness (rubor), warmth (calor) and swelling (tumor) are not commonly seen in osteoarthritis, and treatments geared towards reducing inflammation have yet to demonstrate much efficacy.

Hence, the practical treatment targets for osteoarthritis is to relieve pain (dolor) and restore function (functio laesa) in patients. Here are some emerging treatment options:

1. Orthobiologics: Using Natural Materials to Treat Joint Disease

Orthobiologics are treatments drived from natural biological material. They help patients delay the need for total knee replacement, and enhance the body’s ability to heal from injuries.

Examples of orthobiologics include:

• Hyaluronic Acid Injections: Gel-like substances that are injected into the knee to lubricate and cushion the joint, and to restore a non-inflammatory micro-environment.
• Platelet-Rich Plasma (PRP): A concentration of a patient's own platelets to promote healing and reduce inflammation. The higher the platelet numbers and concentration, the better the efficacy.
• Mesenchymal Stem Cells (MSCs): Derived from bone marrow, fat, or other tissue, these cells are believed to reduce inflammation and support tissue repair.
• Autologous Cartilage Implants: Chondrocytes (cartilage cells) are grown in a lab and re-implanted to help repair damaged cartilage.

2. Prolotherapy: Sugar Injections That May Help

Prolotherapy involves injecting a concentrated sugar solution into the joint. A 2016 review found that prolotherapy led to significant improvements in pain and function compared to exercise alone. While further studies are needed, it shows potential as a safe and affordable option.

3. TissueGene-C (TG-C): A Cell-Mediated Gene Therapy Approach

TG-C is a cell-based gene therapy that uses modified chondrocytes (cartilage cells) to deliver a therapeutic gene that releases anti-inflammatory signals and promote tissue repair. It aims to break the cycle of inflammation in OA.

4. Interventional Procedures: Non-Surgical Pain Relief

There are two minimally invasive procedures to help reduce knee pain:

• Arterial Embolisation: Blocks abnormal blood flow in the inflamed areas of the knee, reducing pain and inflammation. Small studies show good early results and this procedure is recommended for patients who have not found sufficient relief through conservative treatments and are ineligible for a knee replacement surgery.
• Joint Denervation: Another treatment option for those suffering from chronic knee pain caused by osteoarthritis, particularly when other treatments such as medication or physiotherapy have been ineffective. It targets specific nerves around the knee and blocks pain signals. This can be done as an office procedure, under ultrasound guidance of radiofrequency neuroablation (burning) or cryoneuroablation (freezing). A 2025 study involving 90 patients demonstrated reduced pain and improved quality of life for up to 9 months following nerve cryotherapy.

While traditional treatments for knee osteoarthritis remain important, new biological and interventional approaches offer additional options for patients when traditional options fail to deliver adequate pain relief or functional restoration. However, many are still being studied, and results can vary depending on how treatments are prepared and delivered. Always consult a medical professional to discuss which treatment approach is most suitable for your condition.