Non-surgical treatments
Much knee and hip pain can be managed without an operation. On this page you can read about the usual options, such as exercise, weight loss, walking aids and injections, and when it is time to think about surgery.
What does non-surgical treatment mean?
It means controlling pain and improving joint movement without an operation. For most patients with knee and hip osteoarthritis (osteoarthritis means the gradual wearing away of the cartilage that covers the joint surface), this route is the first step, and sometimes it is all that is needed.
Non-surgical treatment does not return worn cartilage to its original state. But in many people it reduces pain, improves movement, and delays the need for an operation or avoids it altogether.
Who is it for?
- People who have recently developed knee or hip pain
- Patients who have pain but whose limitation is not yet severe
- People who, for any reason, are not suitable for surgery or do not want it
- People with injuries for which the doctor has judged that non-surgical treatment is enough
After examining you and reviewing the imaging, the doctor tells you which combination suits you. Every patient is different.
What are the treatments?
Usual options in medical sources:
- Exercise and physiotherapy. Low-impact exercise such as walking, swimming and cycling, along with strengthening the muscles around the joint. Strong muscles take some of the load off the joint. The physiotherapist writes a programme that suits you.
- Losing weight. If you are overweight, every kilogram less means less strain on the knee and hip.
- Walking aids. A stick or walker to reduce load, suitable shoes or a medical insole. Some people also use a knee brace. The benefit of a knee brace is not clear for everyone.
- Heat and cold. A hot or cold pack can reduce pain for a while. Do not put ice directly on the skin.
- Pain-relief medicines. Painkillers taken by mouth, or applied as gels or creams. Only the doctor decides the type, dose and duration, because each medicine has its own side effects and limits for each patient. Do not take them for long without your doctor’s advice.
- Joint injections. Injecting certain medicines into the joint can reduce pain for weeks to months. This is usually considered when other methods have not been enough.
- Changing activity. Avoiding things that irritate the joint more, such as running on hard surfaces, a lot of sitting down and standing up, or heavy loads.
There are also some smaller surgical options (such as arthroscopy or realigning the bone) that are alternatives to joint replacement and are not suitable for everyone. The doctor explains them if needed.
Follow-up
These treatments usually show results over a few weeks to a few months, not overnight. You need to keep exercising, keep a note of your pain and movement, and see the doctor for follow-up as booked. If you have not improved after a reasonable period, review the plan with your doctor.
Risks and limits
- Too much exercise or activity. It may increase pain and swelling. If you get severe pain or swelling after exercise, reduce the intensity and talk to your physiotherapist or doctor.
- Medicines. Every medicine has its own side effects (for example, some affect the stomach or kidneys). For this reason they should be taken only on your doctor’s advice.
- Injections. They may reduce pain only for a time, and very rarely may cause an infection.
Sources say that surgery is needed in only a small number of patients with osteoarthritis and may not relieve all symptoms.
When to call
See a doctor if:
- The pain suddenly becomes very severe, or began after a fall or blow
- You cannot put weight on the leg, or the joint has locked
- The joint suddenly becomes hot, red and swollen, especially with a fever
- Pain at night or at rest has increased and is disturbing your sleep
- The leg has become weak or goes numb
- Swelling and pain in one calf, with redness (a possible sign of a clot)
If leg pain or swelling comes with sudden shortness of breath or chest pain, call 115 (the emergency number in Iran) at once or go to the emergency department.
Every patient’s treatment plan is different; ask your doctor about your own situation.
Frequently asked questions
Does non-surgical treatment cure osteoarthritis?
Osteoarthritis has no definite cure, but sources say it does not necessarily get worse over time. The aim of these treatments is to reduce pain and swelling and keep movement, not to bring back worn cartilage.
Which is better: exercise or rest?
Suitable exercise is one of the most important treatments for osteoarthritis. But the wrong kind of exercise, or too much, can put strain on the joint. It is best for the doctor or physiotherapist to set the type and amount.
Are joint injections safe?
Injections have both benefits and limits. Some injections reduce pain for weeks to months, but they are not suitable for everyone, and the number of times they can be given is limited. Only a doctor decides the type and timing of an injection.
What should I do if I am overweight?
Extra weight puts a lot of strain on the knee and hip, and losing it can reduce pain. It is best to work out a safe plan that suits you with your doctor and a nutrition specialist.
When is non-surgical treatment no longer enough?
Surgery can be considered when severe pain continues despite non-surgical treatment, you have pain at night or at rest, and walking and daily tasks have become hard. You and your doctor make this decision together.