Surgery is the last item on this page deliberately. For most people with hip or knee arthritis, the treatments below — used properly and given time — control symptoms well. They also make surgery safer and recovery faster if an operation is needed later. Nothing here is wasted effort.
Exercise and physiotherapy
Exercise is the single best-supported treatment for arthritis of the hip and knee. That surprises many people — a worn joint feels like something to protect, not to work. But strengthening the muscles around a joint reduces the load going through it, and moving the joint keeps it supple. Australian and international guidelines put exercise first for good reason.
A physiotherapist can build you a program suited to your joint and your fitness, and progress it as you get stronger. It takes weeks to feel the benefit, not days. Expect some muscle soreness at the start; that is different from harm.
Weight management
Each kilogram of body weight puts several kilograms of force through the knee with every step. Losing even a modest amount of weight measurably reduces pain in weight-bearing joints. If you are carrying extra weight, this is likely to be the most powerful thing you can do for your joint — and if surgery is needed later, it also lowers the risk of complications from both the anaesthetic and the operation.
This is easy to say and hard to do. Your GP can help, and there are structured programs that work. It is raised not as a judgement, but because the evidence is strong.
Medicines
- Paracetamol helps some people with milder pain and is safe for most when taken as directed.
- Anti-inflammatory tablets (NSAIDs) such as ibuprofen are often more effective for arthritis pain. They are not suitable for everyone — they can affect the stomach, kidneys and blood pressure — so check with your GP or pharmacist, especially if you take other medicines.
- Anti-inflammatory creams and gels are worth trying for the knee, where the joint is close to the skin.
- Stronger pain medicines (opioids) have a poor record in arthritis: modest benefit, significant harms, and real dependence risk. They are not a long-term treatment for joint pain.
Walking aids and simple measures
A walking stick used in the opposite hand takes meaningful load off a painful hip or knee. Firm, supportive shoes help. So does pacing — planning the day so the joint is not asked to do everything at once. None of this is giving in; it is managing a mechanical problem mechanically.
Injections
- Corticosteroid injections can settle a painful flare of knee arthritis for weeks to a few months. Relief is temporary and repeated injections give diminishing returns, so they are best used sparingly and with a purpose — settling a flare, or getting you through an event.
- Hyaluronic acid (“gel”) injections and platelet-rich plasma (PRP) are heavily marketed. The evidence for lasting benefit is weak, and Australian guidelines do not recommend them for routine use. This practice does not offer treatments that cannot be justified from the evidence.
Arthroscopy — a note
Keyhole surgery to “clean out” an arthritic knee was common for decades. Good trials have since shown it does not help osteoarthritis, and it is one of the procedures Choosing Wisely Australia — the profession’s own campaign against low-value care — specifically advises against for arthritis. If someone offers to arthroscope your arthritic knee, it is reasonable to ask why.
When is it reasonable to consider a replacement?
There is no X-ray finding, score or age that makes the decision for you. A joint replacement becomes worth discussing when three things line up:
- The arthritis is advanced on examination and X-ray.
- The non-surgical options above have been genuinely tried and are no longer holding the line.
- The joint is taking things from your life you are not willing to give up — sleep, work, independence, the walk you have always done.
If that describes you, the next chapters explain what preparing for surgery involves, and what the operation actually is. Reading them commits you to nothing.