The Short Version
Non-surgical treatment does not make established arthritis disappear or regrow missing cartilage. The goal is to control symptoms, maintain strength and motion, and help you continue doing the things that matter to you.
There is no single treatment that every patient has to try. Exercise, physical therapy, medications, injections, weight management, braces, and walking aids are tools. We choose the ones that make sense for your symptoms, health, and goals.
The Big Picture
What are we trying to accomplish?
When patients hear that they have arthritis, one of the first questions is often: "How do we fix it?"
That depends on what we mean by fix.
We currently do not have a nonsurgical treatment that reliably restores an arthritic hip or knee to normal cartilage. But that does not mean there is nothing we can do.
Many patients can manage arthritis successfully for months or years without joint replacement.
The goals of nonsurgical treatment are to:
- Reduce pain
- Maintain or improve motion
- Build strength around the joint
- Make walking and everyday activity easier
- Help you remain active
- Maintain an acceptable quality of life
If your X-ray still shows arthritis but you are comfortable, active, and doing what you want to do, treatment is working.
Do I need to try everything?
No.
I do not think arthritis treatment should become an obstacle course where every patient has to complete the same checklist.
Some treatments may not be medically safe for you. Others may not make sense for the type or severity of arthritis you have. And a treatment that helped someone else may do very little for you.
The goal is to use reasonable treatments that have a realistic chance of helping you.
Movement & Strength
Exercise and physical therapy
One of the most common reactions to a painful joint is to stop using it.
Some activity modification is sensible, but complete rest is usually not the answer. Over time, inactivity can lead to weakness, stiffness, loss of endurance, and even more difficulty moving.
Exercise
Regular exercise can improve pain and function in patients with arthritis, particularly when the activity is matched to what the joint can tolerate.
Good options may include:
- Walking
- Stationary or outdoor cycling
- Swimming
- Water exercise
- Strength training
- Low-impact fitness programs
You do not necessarily need to avoid an activity simply because you have arthritis. The better question is how your joint responds to it.
Physical therapy
Physical therapy can help improve strength, mobility, balance, and movement patterns.
For hip arthritis, therapy often focuses on hip and core strength, motion, and walking mechanics.
For knee arthritis, strengthening the quadriceps, hamstrings, hip muscles, and the rest of the leg can improve how the knee functions.
Therapy cannot regrow missing cartilage. Its purpose is to help you function better with the joint you have.
How I Think About It
Movement is medicine — but the dose matters.
I generally want patients moving and strengthening rather than becoming afraid of their joint.
That does not mean pushing through severe pain every day. The goal is to find an amount and type of activity your joint can tolerate consistently.
Pain Control
What medications can help?
Medication can reduce arthritis symptoms, but it does not reverse the underlying cartilage loss.
Anti-inflammatory medications
Nonsteroidal anti-inflammatory drugs, or NSAIDs, can reduce pain and inflammation from symptomatic hip and knee arthritis.
Common examples include medications such as ibuprofen and naproxen, as well as prescription anti-inflammatory medications.
Topical anti-inflammatory medications can also be useful, particularly for the knee because the joint is relatively close to the skin.
NSAIDs are not appropriate for everyone. Kidney disease, stomach ulcers, bleeding risk, certain heart conditions, blood-thinning medications, and other medical issues can affect whether they are safe for you.
Acetaminophen
Acetaminophen may provide some pain relief for certain patients, although it does not have the same anti-inflammatory effect as an NSAID.
It also has dosing limits and may not be appropriate for patients with certain liver conditions or other medical concerns.
What about opioid pain medication?
Chronic opioid medication is generally not a good long-term treatment for osteoarthritis.
These medications have significant potential side effects and risks and do not correct the underlying joint problem.
If you take pain medication regularly, especially an anti-inflammatory medication, make sure your physicians know what you are taking and how often you use it.
Injections
Do injections help arthritis?
Injections can be useful for selected patients, but it is important to understand what they can and cannot accomplish.
An injection may decrease symptoms. It does not rebuild the damaged joint surface or permanently eliminate arthritis.
Corticosteroid injections
Corticosteroid, or cortisone, injections can provide short-term relief for some patients with hip or knee arthritis.
Some patients get substantial relief. Others get only modest improvement or no meaningful benefit. The duration of relief also varies.
For the hip, the joint is deep beneath the surrounding soft tissues, so injections are commonly performed with imaging guidance to make sure the medication reaches the joint.
What about gel injections?
Hyaluronic acid injections are often called gel injections or viscosupplementation.
They are sometimes used in the knee, but current orthopedic guidelines do not recommend hyaluronic acid injections for routine treatment of knee osteoarthritis because the average clinical benefit has been inconsistent.
For hip arthritis, hyaluronic acid injections are not recommended because studies have not shown them to provide meaningful benefit compared with placebo.
What about PRP?
Platelet-rich plasma, or PRP, is made from a patient's own blood and contains a concentrated mixture of platelets and other biologic factors.
There is ongoing research into PRP for osteoarthritis. Some studies suggest that selected patients with knee arthritis may experience symptom improvement, but results vary and the evidence is not as established as it is for several standard treatments.
PRP does not reliably regrow normal joint cartilage, and insurance coverage can also be limited.
What about stem cells?
Treatments marketed as "stem cell" or regenerative injections are frequently advertised as a way to rebuild an arthritic joint.
At this time, patients should be cautious about claims that an injection can reliably regrow normal cartilage or reverse advanced hip or knee arthritis. Those claims go beyond what current clinical evidence has established.
A Useful Perspective
An injection is a tool, not a requirement.
If an injection gives you meaningful relief and helps you remain active, that can be useful.
If injections have stopped helping, repeatedly performing them simply to delay a larger decision may not accomplish much.
Reducing Joint Stress
Braces, canes, weight management, and activity changes
Weight management
If you are carrying excess weight, weight reduction can be particularly helpful for knee arthritis because the knee experiences substantial forces with every step.
Weight management can also improve general health and may reduce surgical risk if joint replacement becomes necessary later.
This is not about blaming someone for developing arthritis. Arthritis is influenced by age, genetics, previous injury, anatomy, and many other factors. Weight is simply one factor we may be able to modify.
Using a cane
A cane can reduce the amount of force going through a painful hip or knee and may improve balance and walking tolerance.
When using a cane for one painful hip or knee, it is generally held in the hand opposite the affected side.
Knee braces
Bracing may help selected patients with knee arthritis, particularly when symptoms and arthritis are concentrated in one part of the knee.
Bracing has a much smaller role in typical hip osteoarthritis because of the anatomy and location of the hip joint.
Activity modification
Sometimes small changes make a meaningful difference.
You might replace running with cycling, break a long walk into shorter sessions, use a handrail on stairs, or alternate higher-impact activities with lower-impact exercise.
The goal is not to gradually remove everything you enjoy from your life. It is to find ways to remain active without repeatedly overwhelming a painful joint.
When Symptoms Progress
What if non-surgical treatment stops working?
Arthritis often changes gradually. A treatment that worked very well two years ago may no longer provide the same relief.
That does not necessarily mean the treatment failed. It may simply mean that the arthritis or its effect on your life has changed.
I start thinking more seriously about joint replacement when several things line up:
- The hip or knee is clearly the source of the symptoms
- Imaging shows arthritis significant enough to explain them
- Pain or stiffness is meaningfully limiting quality of life
- Reasonable nonsurgical treatment is no longer giving acceptable relief
- The patient understands the benefits and risks of surgery
- The patient feels ready to proceed
You do not have to wait until nothing works at all.
One of the most common misconceptions is that you have to exhaust every possible injection, medication, brace, and therapy program before you are allowed to discuss joint replacement.
That is not how I think about the decision.
The question is whether the treatments that reasonably make sense for you are still allowing you to live an acceptable life.
A Useful Question
Are we still treating your arthritis — or are you reorganizing your life around it?
If you have stopped traveling, exercising, walking with your spouse, playing with your grandchildren, shopping normally, or doing other things that matter to you, that deserves to be part of the conversation.
If you are reaching that point, the next step is not automatically surgery. The next step is a conversation about whether joint replacement now makes sense for you.
Common Questions
Frequently asked questions
Can exercise make my arthritis worse?
Appropriate exercise is generally an important part of arthritis treatment. Some activities may aggravate symptoms, so the type and amount of exercise may need to be adjusted. Pain does not automatically mean that normal exercise is destroying the joint.
Can physical therapy rebuild cartilage?
No. Physical therapy does not regrow cartilage lost to established osteoarthritis. It can improve strength, motion, balance, and function and may reduce pain.
How many cortisone injections can I have?
There is not one injection schedule that is appropriate for every patient. How much relief you receive, how long it lasts, your medical history, the condition of the joint, and whether surgery is being considered all matter.
Are gel injections better than cortisone?
Not necessarily. Corticosteroid injections have evidence for short-term symptom relief. Hyaluronic acid injections are not recommended for hip arthritis and are not recommended for routine treatment of knee arthritis in current AAOS guidelines.
Can supplements rebuild my joint?
No supplement has been shown to reliably regrow normal cartilage in an arthritic hip or knee. Supplements are often marketed aggressively, so it is worth discussing what you are taking with your physician.
Should I stop walking because my joint is bone-on-bone?
Usually no. The goal is generally to remain active within what your symptoms allow. If walking has become difficult, we can modify the activity, use a walking aid, or choose other forms of exercise rather than simply becoming inactive.
Does trying non-surgical treatment mean I am just delaying the inevitable?
Not necessarily. Some patients manage arthritis successfully for years without surgery. If nonsurgical treatment is giving you an acceptable quality of life, there is no prize for having a joint replacement sooner.
Likewise, there is no prize for delaying surgery indefinitely when arthritis is significantly limiting your life and the treatments you are using are no longer helping enough.
Key Takeaways
What I want you to remember
- Having hip or knee arthritis does not automatically mean you need joint replacement.
- Exercise and strengthening are important foundations of nonsurgical arthritis treatment.
- Medications can reduce symptoms but need to be chosen with your overall health in mind.
- Corticosteroid injections can provide short-term relief for selected patients.
- Hyaluronic acid injections are not recommended for hip arthritis and are not recommended for routine treatment of knee arthritis.
- Braces, walking aids, weight management, and activity modification can be useful tools in the right patient.
- Nonsurgical treatment is successful when it helps you maintain an acceptable quality of life — not when it changes what the X-ray looks like.