What to try before joint surgery

What to try before deciding on surgery

Regular movement keeps the muscles around a sore joint working, and stronger muscles can support more of your weight during each step. Walking, gentle stretching, and simple strength work may all help. Add a little at a time because more work isn't always better.

A cane, brace, or change in chores may reduce strain. An anti-inflammatory gel is medicine rubbed on the skin over a sore knee. Compared with a pill, less of that medicine travels beyond your knee. Still, ask your doctor or pharmacist whether the gel suits your health.

What to bring to the next visit

Write down the chores and movements that have become hard. Include sleep, stairs, walking, dressing, and standing up from a chair. Take along your medicines and any older X-ray report. Tell the doctor which exercises or aids helped and which didn't.

Pain near your knee can begin in the hip, so the doctor may move both areas to find where the soreness starts. An X-ray can show worn joint surfaces, but it can't show your daily limits. Describe those limits so the doctor can judge what comes next.

What to ask when basic care has not helped

You don't have to repeat care that hasn't helped without a reason. Ask what another try may change and when you'll review it. A surgery visit may make sense when ordinary tasks keep getting harder. Severe joint wear can make more waiting less useful.

When soreness doesn't ease, QC Kinetix provides regenerative treatment options made by preparing some blood drawn from your arm; a clinic medical provider then guides the prepared portion inside your joint through a needle. Ask whether that person is a doctor, nurse practitioner, or physician assistant. Also ask how this choice compares with more home care or surgery.

Sources

1. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA, and education plus structured land-based exercise as core for hip and polyarticular OA. Topical NSAIDs are strongly recommended for knee OA (Level 1A). Intra-articular corticosteroids and hyaluronic acid are Level 1B/2 for knee OA depending on comorbidity and are NOT recommended for hip or polyarticular OA. Oral NSAIDs are not recommended for people with cardiovascular comorbidity or frailty, and oral and transdermal opioids are strongly not recommended (Level 5).

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

2. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing for tibiofemoral knee OA, topical NSAIDs for knee OA, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA. Radiofrequency ablation for knee OA, acupuncture, thermal modalities, acetaminophen, duloxetine and tramadol are only CONDITIONAL recommendations.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

3. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 randomised trials, assessing pain, physical function and quality of life immediately after treatment and the sustained effect at 2-6 months and beyond 6 months. Only 19 of the included studies (20%) met all three low-risk-of-bias criteria the authors applied.

   Fransen M, McConnell S, Harmer AR, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2015. DOI: 10.1002/14651858.CD004376.pub3.

4. In 156 patients with knee osteoarthritis randomised in the US Military Health System, physical therapy produced a mean WOMAC total score of 37.0 at one year versus 55.8 for a single intra-articular glucocorticoid injection (mean between-group difference 18.8 points favouring physical therapy, 95% CI 5.0 to 32.6, on a 0-240 scale where higher is worse). Secondary outcomes moved in the same direction.

   Deyle GD, Allen CS, Allison SC, et al. — Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.. New England Journal of Medicine, 2020. DOI: 10.1056/NEJMoa1905877.

5. In the IDEA trial, 454 overweight and obese adults aged 55+ with pain and radiographic knee OA were randomised to intensive diet plus exercise, diet alone, or exercise alone for 18 months. Mean weight loss was 10.6kg (11.4%) with diet plus exercise, 8.9kg (9.5%) with diet alone and 1.8kg (2.0%) with exercise alone; knee compressive force and IL-6 were lower in the diet groups than the exercise-only group.

   Messier SP, Mihalko SL, Legault C, et al. — Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial.. JAMA, 2013. DOI: 10.1001/jama.2013.277669.

6. FDA states directly that regenerative medicine therapies - including stem cells, stromal vascular fraction, umbilical cord blood, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes - have NOT been approved for the treatment of any orthopedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain. FDA further states that being charged for these products, or being offered them outside an FDA-overseen clinical trial, means a patient is likely being deceived and offered a product illegally, and that a product's presence on clinicaltrials.gov or a firm's FDA registration does not mean the product is legally marketed. Reported harms include blindness, tumor formation, neurological events and life-threatening bacterial infections.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA.gov, 2021.

7. A 2025 Bayesian network and dose-response meta-analysis of 92 randomised trials in 6,079 people with knee or hip osteoarthritis found aerobic training most likely to rank first for pain relief (SUCRA 84.7%; SMD -1.00, 95% CrI -1.50 to -0.62), ahead of strength plus flexibility (SUCRA 73.0%), yoga (63.7%), strength alone (55.9%) and flexibility alone (39.8%) - but with NO statistically significant difference between exercise types. Pooled across modalities, the dose-response relationship was U-shaped, meaning more exercise is not linearly better.

   Liang Z, Wang C, Zhang X, et al. — Optimal modality and dose of exercise for relieving pain in patients with knee or hip osteoarthritis: Bayesian pairwise, network, and dose-response meta-analyses.. Seminars in Arthritis and Rheumatism, 2025. DOI: 10.1016/j.semarthrit.2025.152855.