An up front disclosure is needed here. I currently work with surgeons who perform the total knee (and shoulder and hip) arthroplasty aka joint replacements. I have a parent who has had a hip replaced and is enjoying the benefits of improved pain and mobility. That being said, holding off joint replacement is the goal of many individuals.
Whether you wish to put off surgery for a later time, are medically unable to pursue surgery, or do not feel the risk is worth the potential benefit, the feeling that TJA (total joint arthroplasty, where arthroplasty means joint replacement) is unsuitable is quite common. In general, the advice for those who wish to keep away the knife, so to speak, is to keep weight low, keep your muscles strong around your knee, and to minimize the pain associated with your arthritis.
Keep weight low
Your joints are just like any other moving mechanical part. Think of your car or truck tires. If you keep the car or truck loaded down with lots of extra weight, the friction between your tires and the road increases as the weight increases, thus the tires wear down more quickly. Much like the tread on your tires, joint cartilage wears down in the same mechanical fashion. Study after study has shown the close correlation with obesity and arthritis. Not only does being obese worsen the rate at which individuals develop arthritis but also decreases the age of onset.
Keep Your Muscles Strong
I liken the muscles around the knee to the shock absorbers in a car. Seem like lots of car analogies today, but it's because both are mechanical systems that rely on basic physics for much of how they function. If the muscles around your knee are stronger, your gait and mechanics improve. Think of your gait and walking mechanics. Do you step heavily or do you walk smoothly? If you step heavily, you're placing lots of extra (and unneeded) stress on your articular cartilage. People with a fluid heel strike, rolling motion through the foot, and strong push-off minimize the up and down motion of walking - which is borne by your joints - and instead translates that force into forward motion. Also, strong muscles increase joint stability and decrease micromotion, decreasing wear on articular cartilage!
Minimize the Pain
In regards to minimizing pain in arthritis, there are multiple medications you can take, braces you can wear, exercises you can perform, injections you can receive, and supplements you can take. As far as medications, injections, and braces, I would ask your personal physician for their recommendations as you and your medical needs are individual (and I don't want to take on the responsibility of giving medical advice to someone I've not even met). Pain perception, however, is one of the cornerstones of arthritis treatment, and, as osteoarthritis is not deadly or contagious, it's main mechanism of disability is the debility caused by pain itself. In the future, I'll devote more comprehensive blog posts to some of the above topics, but I'll have to refrain for now.
News in the scientific space!
There has been some debate as to whether there is an intensity at which exercise is beneficial or perhaps even detrimental in arthritis. If you've been following this blog, you know I recommend exercise in most of its forms to prevent and ameliorate the effects of osteoarthritis and its more inflammatory cousins: rheumatoid, psoriatic, lupus associated, etc. To wit, there is some exciting news recently in the literature that says that "brisk" walking can decrease risk for total knee replacement in patients with arthritis! In the study, "brisk" walking was defined as having a step rate at 100 per minute. That's rather hard to qualify, so I did a little research and found that this song has a step rate of approximately 100 beats (steps) per minute. See the attached video below for the interview with the researcher, Ms. Hiral Master, below!