Q: I am a 60 years old male. I have suffered from osteoarthritis of both knees for some years now and it has progressively worsened. I take pain-killers on a need basis only. Now I find it very difficult to walk which is quite painful. I reduced my weight from 93 kg to 85 kg in about 3 months time by life-style modification. But the weight is stuck there. I am 5ft 7 inches tall. For the last 3 months I have started exercising which includes 20 minutes of stationery cycling, forward and side bends while standing, range of motion exercises (for knee) and raising of legs while lying down on the bed. But these exercises seem to have worsened my condition, both in respect of pain and stiffness. In the past I have tried physiotherapy, NSAIDs (but on a on/off basis), glucosamine sulphate in combination with chondrotin sulphate, Kerala Ayurveda message but with zero benefit. Is surgery the only answer to my problem? I have not gone in for surgery because some doctors (including a former Director General of the Armed Forces Medical Service) say I don't need surgery, while others, specially in private practice, say "Go in for total knee replacement." A doctor friend in UK (not an orthopaedic surgeon) says do this progressively: NSAIDs and physiotherapy, arthroscopy failing which unicompartmental surgery. What is your advice? I am mentally not prepared for TKR as yet, as I know of cases where it has not worked at all. My BP is very slightly elevated at times 120-130/80-85. My blood sugar is normal though once it showed PP 142 (normal range being 140). I do have prominent varicose veins behind the knee area going upto the groin. Will this cause complications in case I have to undergo TKR or unicompartmental surgery? Kindly advise.

A:I would not be quite enthusiastic for surgery at this point. I would encourage continuation of life style measures to help lose weight further. I would also like to have a look at your lipid profile even though it may be passed off as normal by usual laboratory standards. I would suggest doing a test for HbA1C to give an idea of your `average` blood sugar. You may use nutraceuticals like boswelia (Jointil 1 capsule twice daily), combination of glucosamine with chondroitin and MSM like conjoint tablets -twice a day. Local applications including Ayurvedic balms can be used. A useful exercise may be to lie down with a towel folded under your knees and attempt to squeeze it. You are welcome to discuss your reports further.