What to ask before you choose joint care

What to ask about a treatment claim

Ask whether the treatment was tested for the same joint and cause. Then ask what doctors compared it with and how long relief lasted. A group result doesn't promise that you will get the same result. It can still show whether the claim has sound support.

Knee results don't always apply to a hip or shoulder. Brief relief isn't the same as easier walking months later. Ask whether people slept, moved, or worked better after treatment. Possible harm and recovery time belong in that answer too.

How to compare continued care with surgery

Exercise and strength work can make movement easier before surgery is needed. Replacement may help more when joint wear and daily limits are severe. An operation also carries risk and requires time to recover. You and the surgeon need to weigh both sides.

Waiting can cost strength when walking and sleep keep getting worse. Yet one failed home remedy doesn't make surgery necessary. Ask whether a full course of planned exercise improved specific daily tasks. If it didn't, ask what another try is expected to change.

What to ask when soreness remains

If soreness remains, QC Kinetix can explain regenerative treatment choices that use blood taken from you, which a clinic medical provider prepares and returns inside the joint through a needle after an exam. One choice is platelet-rich plasma, made by spinning blood from your arm and keeping a liquid layer with extra platelets. Platelets are tiny parts of blood that help seal a cut. The prepared liquid is the part returned to your joint.

Animal results can show how an idea might work, but they don't prove it helps people. Human results may differ because clinics can prepare platelet-rich plasma in different ways. Ask what happened in people with the same joint problem who received the same care. Also ask whether a doctor, nurse practitioner, or physician assistant performs it.

Sources

1. In 100 adults with mostly moderate-to-severe knee OA who were judged NOT eligible for knee replacement, a 12-week individualised non-surgical programme (neuromuscular exercise, education, insoles, dietary advice, pain medication if indicated) beat usual care at 12 months by 9.6 KOOS4 points (95% CI 4.4 to 14.8), with a number needed to treat of 7.2 for a 15% improvement and no serious treatment-related adverse events.

   Skou ST, Rasmussen S, Laursen MB, et al. — The efficacy of 12 weeks non-surgical treatment for patients not eligible for total knee replacement: a randomized controlled trial with 1-year follow-up.. Osteoarthritis and Cartilage, 2015. DOI: 10.1016/j.joca.2015.04.021.

2. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

3. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.

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. A systematic review and meta-analysis of 89,996 patients (60.6% female, mean age 67.4) awaiting primary elective total hip or knee replacement found a significant deterioration in joint function (mean difference 0.0575% per additional day of waiting, 95% CI 0.0064 to 0.1086, p=0.028) and in health-related quality of life per additional day of waiting. Meta-analysis could not detect a relationship with post-operative outcomes, and patient responses to delayed surgery were unanimously negative.

   Cooper GM, Bayram JM, Clement ND. — The functional and psychological impact of delayed hip and knee arthroplasty: a systematic review and meta-analysis of 89,996 patients.. Scientific Reports, 2024. DOI: 10.1038/s41598-024-58050-6.

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.