Joint care choices make sense after the cause is clear

Home care, medicine and braces may ease a steady ache

Shorter activity, better rest and gentle strength work may calm familiar soreness. A cane can take pressure off a sore knee or hip when fitted well. An unloader knee brace is a fitted brace that shifts pressure away from the worn side of a knee. Comfort still matters.

Each choice needs a clear reason and a day to check results.

Medicine may help, but kidney, stomach and heart trouble can change what is safe. Ask a doctor or pharmacist before adding a pain reliever. If the joint stays sore, the doctor may check the cause again. A different brace, guided exercise or another kind of care may fit better.

Shots differ in what they contain and how well they work

Cortisone is a steroid shot that may give short relief for some people. Gel is a shot of slippery liquid made to act like joint fluid. PRP means platelet-rich plasma, a shot prepared by spinning some of your blood and keeping the part rich in platelets, which help clotting.

Gel and PRP don't give the same result to everyone.

Biologic therapies are clinic shots made from a person's blood, fat, marrow or donated tissue. Some clinics call these natural pain treatments. Ask exactly what the shot contains, what relief is likely, how long it may last and what it costs. A doctor needs to examine the joint before saying whether a shot is safe and likely to help.

Surgery becomes reasonable when daily life keeps getting harder

Knee or hip surgery alternatives may be useful while walking, sleep and chores stay steady. At QC Kinetix, medical providers—the health staff who examine joints and perform care—explain regenerative treatments, procedures made from body material, for soreness after the exam.

Non-surgical care shouldn't delay surgery that has become necessary.

Replacement may be reasonable when other care hasn't helped and the worn joint keeps limiting daily life. Ask the surgeon what the operation may improve, what recovery takes and which risks apply. Then compare that answer with what more non-surgical care can reasonably offer. Your joint and overall health guide the choice.

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. 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.

4. The RESTORE trial randomised 288 community-based participants aged 50+ with symptomatic medial knee OA (Kellgren-Lawrence grade 2 or 3) to three weekly intra-articular injections of leukocyte-poor PRP or saline placebo, with participants, injectors and assessors all blinded. 93% completed the 12-month follow-up. PRP did not produce a clinically meaningful improvement in knee pain over placebo, and did not slow medial tibial cartilage volume loss on MRI.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

5. A systematic review and meta-analysis of 169 randomised trials (21,163 participants) of viscosupplementation for knee OA found clear evidence of small-study effects and publication bias. The prespecified main analysis, restricted to 24 large placebo-controlled trials with at least 100 participants per group (8,997 randomised), found a pain reduction of SMD -0.08 (95% CI -0.15 to -0.02) - the confidence interval excluding the prespecified minimal clinically important difference of -0.37.

   Pereira TV, Jüni P, Saadat P, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

6. A meta-analysis of 16 randomised trials (807 participants) of intra-articular mesenchymal stem cells for chronic knee pain from osteoarthritis found that at 3-6 months MSC therapy probably produces little to no difference in pain (WMD -0.74cm on a 10cm VAS, 95% CI -1.16 to -0.33, against a minimally important difference of 1.5cm) or physical function, both moderate certainty; at 12 months, probably little to no difference in pain. MSC therapy may increase the risk of any adverse event (RR 2.67, 95% CI 1.19 to 5.99) and of knee pain and swelling (RR 1.58, 95% CI 1.04 to 2.38).

   Sadeghirad B, Rehman Y, Khosravirad A, et al. — Mesenchymal stem cells for chronic knee pain secondary to osteoarthritis: A systematic review and meta-analysis of randomized trials.. Osteoarthritis and Cartilage, 2024. DOI: 10.1016/j.joca.2024.04.021.

7. 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.