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Treating hip and knee arthritis without surgery is where I start with almost every patient I meet. Here is something you might not expect a joint replacement surgeon to say: surgery should be the last option, not the first.
I am a board-certified orthopaedic surgeon at the Bone and Joint Institute of Tennessee in Franklin. After more than twenty years and 700+ joint replacements a year, most people who sit across from me in clinic still leave with a plan that does not involve an operating room.
This guide covers what actually works, what is mostly marketing, and how much of it is in your control. It builds on my larger overview of nonsurgical joint pain treatment.
Can You Treat Hip and Knee Arthritis Without Surgery?
Yes. Most people with hip or knee arthritis can control their symptoms without an operation for years, using muscle strengthening, gentle motion, weight management, anti-inflammatory medicine, and well-chosen injections.
A quick picture of the problem helps. Arthritis is the wearing down of the cartilage, the smooth cushion inside your joint. I tell my patients to picture the tread on a tire wearing thinner and thinner until the joint is bone on bone.
A joint replacement trades out that worn surface, which is why it is the only true cure for arthritis. But cure does not mean first step. The goal of every nonsurgical treatment is simple: keep you comfortable, keep you active, and put surgery off as long as that makes sense.
What Can You Do on Your Own to Ease Arthritis Pain?
The three most powerful tools for managing arthritis without surgery are strength, motion, and weight. All three are in your control, and that is the best part: this is about what you can do for yourself, not what gets done to you.
How Does Muscle Strength Protect an Arthritic Joint?
Your muscles are the shock absorbers of your joints. Strong muscles around the hip and knee take load off the worn cartilage and soak up force that would otherwise pound the joint with every step.
You do not need to become a bodybuilder. You just need to keep the muscles that support the joint strong and working. In my experience, that alone can take the edge off arthritis pain.
Should You Keep Moving a Painful Arthritic Joint?
Yes. Gentle range of motion, a little bit every day, keeps good quality movement in the joint you have now. Pain does not always mean damage; moving an arthritic joint can be uncomfortable and still be good for you.
One honest caveat about formal physical therapy. For some problems, like arthritis behind the kneecap (patellofemoral arthritis), structured therapy is probably the best treatment we have. For an advanced arthritic hip, aggressive therapy can often make the pain worse.
So I tell my patients to guide their own activity. You know your body, and you know when to ease off. You can say no to any activity, but you have to say yes to something.
How Much Does Weight Loss Help Knee Arthritis?
Every pound you lose takes about 4 pounds of force off your knee with each step. That figure comes from published research on adults with knee osteoarthritis (Messier et al., 2005).
Lose just 5 pounds, and that is 20 pounds of force off your joint every time you take a step, multiplied across thousands of steps a day. You do not have to lose 50 pounds to feel the difference. I explain this connection in more detail in my article on weight and knee pain.
Which Over the Counter Medicines Work Best for Arthritis Pain?
Anti-inflammatory medicines like ibuprofen (Motrin, Advil) and naproxen (Aleve) usually work better for arthritis pain than Tylenol, because arthritis pain is driven largely by inflammation.
Tylenol is acetaminophen, a mild pain reliever. It may be the safest over the counter option we have, but it is not an anti-inflammatory, so it does not touch the actual driver of most arthritis pain.
If you have tried Tylenol and felt let down, you may simply not have tried the kind of medicine that targets the problem. I compare the two in Tylenol versus anti-inflammatories for arthritis pain.
One caution: anti-inflammatories are not right for everyone. They carry stomach, kidney, and heart risks in some people, so always check with your doctor about which option is safe for you.
What Injections Help Hip and Knee Arthritis Without Surgery?
When pills are not enough, three injection options have a real role in treating arthritis without surgery: cortisone, hyaluronic acid (gel shots), and PRP. Each works differently, and each has honest limits.
How Often Can You Get a Cortisone Shot?
My rule is no more than about 3 cortisone (steroid) shots per year in the same joint. A steroid shot calms inflammation and helps a lot of people, but too much steroid in a joint can speed up cartilage damage and weaken nearby tendons.
A careful randomized trial showed that repeated steroid injections every three months led to more cartilage loss than placebo injections, with no added pain relief (McAlindon et al., 2017). A cortisone shot can buy you time. A string of cortisone shots is not a treatment plan.
Do Gel Shots Relieve Knee Arthritis Without Surgery?
In my practice, about 80 percent of patients who get hyaluronic acid injections feel relief for six months, and some much longer. You might hear these called gel shots or lubrication shots; they are the same treatment.
I will be straight with you about the evidence. Guidelines from the American Academy of Orthopaedic Surgeons say the research support is not strong (Brophy and Fillingham, 2022). But I weigh the literature and the person sitting in front of me, and many of my patients come back asking for this injection by name. It can be repeated, just not more often than every six months.
Is a PRP Injection Worth the Cost?
PRP injections help roughly 70 to 80 percent of my patients get real relief for six months or longer, but it is usually an out of pocket expense, so you should weigh the cost going in.
PRP stands for platelet-rich plasma. We draw a small amount of your own blood, spin it down to concentrate the platelets and anti-inflammatory components, and inject that fluid back into your joint. The evidence is still evolving, and I review it honestly in the evidence on PRP for knee arthritis.
Do Stem Cell Injections Work for Hip and Knee Arthritis?
No. For an arthritic hip or knee, the best controlled studies show that most of the relief people feel after stem cell injections is a placebo effect, and the cells do not rebuild cartilage (Yin et al., 2025).
I understand the appeal; you hear stem cells and picture growing brand new cartilage. Who would not want that? But for advanced arthritis, the science is not there.
Here is what I tell my patients: if stem cell injections were free, I would still tell you not to do them for arthritis. And they are far from free. I have had patients spend ten, fifteen, even twenty thousand dollars on these injections and get no relief.
Two clarifications: some clinics market PRP as a stem cell treatment, and it is not. Stem cells do have a role for certain tendon problems, just not for an arthritic hip or knee. I go deeper in stem cell therapy for arthritis: hope or hype.
When Is It Time to Stop Treating Arthritis Without Surgery?
It is time to talk about surgery when the nonsurgical options stop working and your quality of life is paying the price. These treatments buy most people years of good living, but there is a point where they stop being enough.
Here is the question I ask in clinic: if your pain and your limitation were taken away tomorrow, how much would your life change? When that answer gets big enough, it is time to talk about a knee replacement or hip replacement.
The most common thing I hear after joint replacement is “why didn’t I do that sooner?” That does not mean rushing in. It means that when it is truly time, you will know, and we can figure it out together. My article on when it’s time for a knee replacement can help you think it through.
Where Can You Get Arthritis Care in Franklin and Middle Tennessee?
I see patients with hip and knee arthritis at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. Patients come from Franklin, Brentwood, Nashville, Columbia, Spring Hill, and across Middle Tennessee, and most start with a nonsurgical plan built around the options in this article.
If you would like to talk through your own arthritis journey, you can schedule a consultation online or call the office at (615) 791-2630.
Medical Disclaimer: This article reflects Dr. Calendine’s independent clinical perspective as a board-certified orthopaedic surgeon and is for educational purposes only. It is not a substitute for advice from your own physician. Medication information is general and does not include dosing; always confirm which treatments are safe for you with your own doctor. Individual results vary based on personal health circumstances.
References
- Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005;52(7):2026-2032. PMID 15986358
- McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975. PMID 28510679
- Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (nonarthroplasty), third edition. J Am Acad Orthop Surg. 2022;30(9):e721-e729. PMID 35383651
- Yin F, Wu H, Tong D, et al. Contextual effects of mesenchymal stem cell injections for knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2025;12:1636181. PMID 41041444
Watch: How to Treat Hip and Knee Arthritis Without Surgery
In this video, Dr. Cory Calendine, orthopaedic surgeon at the Bone and Joint Institute of Tennessee, walks through the nonsurgical treatment options for hip and knee arthritis, including strengthening, weight management, over-the-counter medicines, and an honest look at the evidence behind steroid, hyaluronic acid, PRP, and stem cell injections.
Ready to talk through your own arthritis journey? Schedule a consultation with Dr. Calendine at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067, or call (615) 791-2630. Serving Franklin, Brentwood, Nashville, Williamson County, and Middle Tennessee.
