What to try before knee surgery

What to try at home first

Keep the knee moving, but don't force it through sharp soreness. Brief walks and steady exercises may build strength around the joint. If you're carrying extra weight, losing some may take strain off the knee. A cane or fitted brace can also make daily movement easier.

What to ask about medicines

Creams rubbed on the knee can ease arthritis soreness for some people. Pills may help too, but each one has risks. Kidney disease, heart trouble, stomach bleeding, and your other medicines may change what's safe, so show the full list to your doctor or pharmacist. Ask when to stop a medicine if it isn't helping or causes trouble.

What to know before choosing PRP

PRP means platelet-rich plasma: plasma is the liquid part of blood, and platelets are tiny pieces carried in it. Clinic staff take a blood sample, then use a spinning machine to gather more platelets before putting the prepared portion into your knee. Concentrated PRP has more of those platelets, but clinics don't all prepare it alike. Results are mixed, so ask what you'll receive, what it may change, and whether you'll pay cash.

When to talk about surgery

Talk about surgery if other care leaves you with strong soreness and less movement. A partial operation may suit you when only one part of the knee is badly worn. Total replacement is used when the wear spreads across more of the joint. Your surgeon can explain what the hands-on check and X-ray show.

How to choose what to try

Give simple care a fair try, but don't repeat it forever. Choose one result to watch, such as sleep or walking, and set a day to review it. Replacement can improve movement, yet it brings recovery time and real risks. You and your doctor can weigh cost, likely relief, and risk together.

Sources

1. 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.

2. 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.

3. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.

4. The Cochrane review of topical NSAIDs for chronic musculoskeletal pain in adults evaluated randomised, double-blind, placebo- or active-controlled trials meeting stringent quality criteria, searched to February 2016, and is the evidence base underlying the guideline preference for topical over oral NSAIDs in knee osteoarthritis.

   Derry S, Conaghan P, Da Silva JA, et al. — Topical NSAIDs for chronic musculoskeletal pain in adults.. Cochrane Database of Systematic Reviews, 2016. DOI: 10.1002/14651858.CD007400.pub3.

5. A Bayesian network meta-analysis of 137 randomised trials (33,243 participants) comparing acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular corticosteroids, intra-articular hyaluronic acid and oral and intra-articular placebo for knee OA found all interventions significantly better than oral placebo for pain, with effect sizes ranging from 0.63 (95% CrI 0.39 to 0.88) for hyaluronic acid down to 0.18 (0.04 to 0.33) for acetaminophen at 3-month follow-up. For function, all interventions except intra-articular corticosteroids beat oral placebo.

   Bannuru RR, Schmid CH, Kent DM, et al. — Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis.. Annals of Internal Medicine, 2015. DOI: 10.7326/M14-1231.

6. 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.

7. A 2026 network meta-analysis of 21 RCTs (2,254 patients) found both leukocyte-poor and leukocyte-rich PRP significantly improved 6-12 month WOMAC function versus placebo (MD -10.54 and -13.20 respectively) and both were superior to hyaluronic acid, with leukocyte-poor PRP ranked first (P-score 0.96) — a materially more favourable read of PRP than the RESTORE trial, which is why this corpus presents both.

   Journal of Orthopaedic Surgery and Research authors — Leukocyte-rich versus leukocyte-poor platelet-rich plasma and hyaluronic acid for knee osteoarthritis: a systematic review and network meta-analysis.. Journal of Orthopaedic Surgery and Research, 2026. DOI: 10.1186/s13018-026-06689-4.

8. A meta-analysis of 28 RCTs (3,246 knee OA patients) reported PRP gave pain relief comparable to hyaluronic acid with better functional improvement, no significant difference versus corticosteroid as monotherapy, and better pain and function than physical or exercise therapy; the authors also reported better outcomes in KL grade I-II knees, i.e. earlier disease.

   European Journal of Medical Research authors — Efficacy and safety of platelet-rich plasma injections for the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.. European Journal of Medical Research, 2025. DOI: 10.1186/s40001-025-03253-4.