What treatments can be performed for hip and knee arthritis aside from joint replacement surgery, and current recommendations for each treatment
Andrew B. Harris, MD · Last reviewed September 2026
Most people with hip or knee arthritis are treated without surgery, and many patients can be treated that way for quite a while. Nonsurgical care is not necessarily just a “band-aid” while waiting for a joint replacement. For a large number of people, hip and knee arthritis can be treated without surgery for many years.
For arthritis, a joint replacement is usually an elective operation, and the timing is largely your choice. Some problems, such as certain fractures, collapse of the bone, or infection, are treated sooner; your surgeon will tell you if one applies. The right time for joint replacement surgery is generally when the joint limits daily life, when the other options are no longer providing relief, and when the patient decides they are ready. Until all three are true there is usually room to keep treating the joint without an operation.
Osteoarthritis is the most common reason a hip or knee wears out, but not the only one. Inflammatory arthritis, damage years after an injury or fracture, and loss of blood supply to the bone can lead to the same problem. The options below apply broadly across those causes.
None of these treatments, however, can reverse arthritis. Cartilage that has worn away does not grow back, and no medication, injection or supplement currently available regrows cartilage. Claims that a treatment regrows cartilage are not supported by current evidence.
What these treatments do is reduce pain, keep the joint moving, and keep a person doing what they want to do. That is a reasonable goal on its own, and for many people this approach can work well enough for a very long time.
They are also not a fixed sequence. There is no requirement to work through these nonoperative treatments in order before anything else can be considered. They are combined and tailored to the person, and most people stay on some version of this for an extended period of time before considering joint replacement surgery.
Exercise has some of the strongest evidence for treatment of arthritis symptoms, for both hip and knee arthritis,1,2,3 and it is the one thing people often expect to be told to avoid, or may have been told by family and friends to avoid.
Current research has not shown that reasonable exercise wears a joint out faster. Strengthening the muscles around a hip or knee generally reduces pain and improves function, and low-impact activity such as walking, cycling, swimming, a stationary bike and gentler structured movement such as tai chi is usually well tolerated even when the joint is beginning to wear out. If an activity causes sharp or lasting pain, check with your doctor or therapist.
A formal course of physical therapy is generally worthwhile, at least at the start, because the specific exercise techniques to help with arthritis pain are very important and a therapist can adjust the program as symptoms change. In the beginning, having a trained therapist coach you through specific movement patterns and strengthening exercises can be very helpful.
Losing weight reduces the load going through an arthritic hip or knee. It is one of the few things that changes the mechanics of the problem rather than only the symptoms, which is why it appears near the top of every guideline.
The effect is larger than most people expect. In an 18-month randomized trial of 142 adults with knee arthritis, each pound of weight lost was associated with roughly a fourfold reduction in the load going through the knee with every step.4 Across thousands of steps a day, a modest weight change is a substantial change in what the joint absorbs.
Weight loss may be the hardest thing on this list to do, and specific weight loss techniques and nutrition management are beyond the scope of this article but should be discussed with your healthcare provider if this is something that may benefit you and your hip or knee pain.
Anti-inflammatories. Non-steroidal anti-inflammatory medications (NSAIDs), taken as a pill or applied as a topical gel, are very useful for arthritis pain. Topical forms are also worth considering for people who cannot tolerate the pills. Taken regularly over long periods, NSAIDs carry some risk to the stomach, the kidneys and the heart, which is worth reviewing with the prescribing physician rather than assuming they are harmless because they are sold over the counter. Talk with your doctor before taking an NSAID regularly, especially if you have kidney, heart, or stomach problems or take a blood thinner.
Acetaminophen (Tylenol). Acetaminophen gives mild pain relief with few side effects at labeled doses. It can be taken on its own, alongside an anti-inflammatory medication, or when anti-inflammatory medications are not an option. Taking more than the maximum daily dose, including acetaminophen contained in other cold or pain medicines, can damage the liver, so ask your doctor or pharmacist what dose is right for you.
Opioids. Guidelines do not recommend opioids for long-term arthritis pain, and the evidence does not support them. If you already take one, do not stop or change it without talking to your prescriber.
Steroid injections. A steroid injection into the joint can settle down a flare and buy a period of relief. These injections are generally most useful for getting through a defined period, or when the diagnosis is uncertain and the response to the injection helps answer it. Relief from injections is usually temporary, and does not change the underlying arthritis. Repeated injections also tend to give less relief each time.
Injections are far more common in the knee than in the hip. The knee is a superficial joint that can usually be injected in an office without imaging, while the hip sits deep beneath muscle and generally needs ultrasound or fluoroscopy to inject accurately. There is also a long-standing concern that steroid injections into the hip may be associated with faster progression of arthritis in some patients. Pooling 27 studies and 5,831 patients, rapidly progressive osteoarthritis was reported in about 6% of hips after a steroid injection, although the authors of that analysis are careful to say the true incidence remains unknown because the condition is defined and followed so inconsistently across studies.5 A separate matched study comparing 93 injected hips against 93 similar hips that were not injected found no significant difference in progression at one year.6 The bottom line is that hip injections are generally used more selectively than knee injections.
Timing of the injection matters if surgery is possible in the near future. An injection within three months of a planned hip or knee replacement is associated with a higher risk of infection after surgery, so it is worth discussing this before considering a steroid injection.
Gel injections. Hyaluronic acid injections, often called “gel” shots, are worth understanding because the evidence behind them is mixed. The major guidelines do not recommend them, although some patients individually do find some benefit.1,2,3 In the hip they have not been shown to reduce pain or improve function, and the guide below places them among the treatments it does not recommend. In the knee the picture is less clear cut, and they sit with the treatments that have not shown a clear benefit but carry little risk. In practice they are still sometimes used, particularly for people who are determined to avoid surgery and have not had enough relief from anything else. The honest summary is that they are less reliable than a steroid injection and may or may not do anything for a given person.
PRP and stem cell injections. Platelet-rich plasma (PRP) and stem cell injections are the two patients ask about most. Whether either one helps is a complicated discussion, and the patients who are a reasonable fit for one or the other vary. Working that out takes a closer look at a particular patient’s symptoms and imaging than a general guide can offer. Both are usually paid out of pocket, and how the injection is prepared is not standardized between clinics so this should be discussed with your healthcare provider if you are interested in these options.
These treatments are not proven to help in current research and clinical guidelines, though some patients do find individual benefit. Most carry little risk, but check with your doctor or pharmacist before starting one.
Unproven usually does not mean harmful, and plenty of people try these anyway. It is worth knowing what the evidence does and does not show before spending money on these treatments.
The two guides below group these treatments by how well each one is supported by current research and clinical guidelines. Pick the joint you want to read about. Each guide can also be opened on its own page and saved or printed.
The guide is easier to read on its own page. Open the hip guide →Download PDF
The guide is easier to read on its own page. Open the knee guide →Download PDF
There is almost always no “hard deadline” to have a hip or knee replacement. Waiting does not generally ruin the result of a joint replacement done later, and there is generally no point at which the operation becomes “mandatory”. Exceptions include collapse of the ball of the hip, rapidly worsening arthritis, and bone loss, where waiting can make surgery and recovery harder; your surgeon can tell you if any of these apply to you.
X-rays alone are also usually not the deciding factor. The decision to pursue surgery is made by understanding how much the joint problem is limiting things a person actually wants to do, whether the treatments above are still providing relief, and whether the person feels that they are ready to undergo the surgery which involves making other compromises and potential risks.
There is a more complete discussion on the signs you may need a hip replacement and signs you may need a knee replacement pages.
Exercise and physical therapy, weight management, anti-inflammatory medication, self-management and low-impact movement such as walking, cycling, swimming or tai chi have the strongest evidence. Steroid injections, acupuncture, heat and cold, acetaminophen and a cane or brace help some people. None of these treatments, however, can reverse arthritis.
Broadly the same list. The main differences are that braces and wedge insoles are knee treatments, that gel injections have performed particularly poorly in hip studies, and that injections in general are used more selectively in the hip than in the knee.
Yes, and most people are. It does not reverse the arthritis, but it can reduce pain and keep a joint working, and for a large number of people it does that for many years.
There is no guaranteed way, but the options with real evidence behind them are exercise and physical therapy, weight management and anti-inflammatory medication. Many people are treated without surgery for years, and some never need an operation.
Current research has not shown that reasonable exercise wears a joint out faster. Strengthening the muscles around the joint and staying active with low-impact exercise usually reduces pain rather than accelerating the arthritis. If an activity causes sharp or lasting pain, check with your doctor or therapist.
It varies. Relief from injections is temporary, and does not change the underlying arthritis. Repeated injections also tend to give less relief each time.
Yes. Both names describe the same thing, a corticosteroid injected into the joint to settle inflammation and reduce pain for a period of time.
The major guidelines do not recommend them, though some patients individually do find some benefit. They are less reliable than a steroid injection, and they may or may not do anything for a given person. They are still sometimes used, particularly for people who are determined to avoid surgery and have not had enough relief from anything else.
They are not proven to help in current research and guidelines, though some patients do find individual benefit. Side effects are uncommon, but check with your doctor or pharmacist first, especially if you take a blood thinner. They are sold as supplements rather than regulated the way prescription medication is, so dose and purity vary by brand, and some interact with other medications including blood thinners.
The knee can usually be injected in an office without imaging, while the hip sits deep beneath muscle and generally needs ultrasound or fluoroscopy to inject accurately. There is also a long-standing concern that steroid injections into the hip may be associated with faster progression of arthritis in some patients. Across the published studies this has been reported in roughly 6% of injected hips, though the researchers who pooled that data say the true rate is not known because the condition is defined so differently from study to study.
Timing matters. An injection within three months of a planned joint replacement is associated with a higher risk of infection after surgery, so it is worth discussing before either is booked.
General information for patients and clinicians, not a substitute for advice from your own surgeon.
Dr. Harris reviews each case individually and goes through the nonsurgical options and the reasoning behind them before surgery is on the table. Send a message.
