Hip & Knee Pain and Osteoarthritis

Patient Guide to Evidence Based Joint Preservation & Non-Surgical Treatment Options

Summary

Hip and knee osteoarthritis (OA) are common causes of joint pain, stiffness, and reduced mobility. Non-surgical treatments—especially exercise, weight management, physical therapy, medications, and selected injections—are the foundation of symptom relief and joint preservation.

Some newer or heavily advertised treatments may not be covered by insurance because strong medical evidence is limited or inconsistent. This guide explains what helps, what may help some people, and what has not been proven, using the best available medical research.

Understanding Osteoarthritis Severity

Mild Osteoarthritis

• Early cartilage wear
• Mild pain or stiffness, often after activity
• X rays may show small bone spurs and minimal joint space narrowing

Moderate Osteoarthritis

• More cartilage loss
• Pain and stiffness affect daily activities
• X rays show clear joint space narrowing and bone spurs

Severe Osteoarthritis (“Bone on Bone”)

• Near complete cartilage loss
• Constant pain, stiffness, and limited motion
• X rays show little to no space between bones

What does “bone on bone” mean?

It means the joint cartilage is largely gone. While joint replacement is often recommended, many patients still get meaningful symptom relief from non-surgical treatments, depending on goals and overall health.

Non-Surgical Treatments: What Helps Most Patients

Exercise & Weight Management (Strongly Recommended)
Regular exercise improves pain, strength, balance, and daily function.
What it is: A planned program of movement (walking, cycling, swimming, strength training, or low impact classes) plus activity habits throughout the week.
How it is thought to help: Exercise strengthens muscles that support the joint, improves joint mechanics and balance, and can reduce pain sensitivity over time.
How to do it: Start low and go slow. Choose low impact options, build consistency, and increase gradually. Exercise does not damage arthritic joints when done appropriately.
When applicable, weight loss reduces stress on the joint. For the knee, each pound of body weight lost reduces joint load by about four pounds with each step.
Where to get help: A physical therapist, athletic trainer, or clinician can help design a safe plan, especially if pain or fear of movement is limiting activity.

Strengthening (Especially Thigh & Hip Muscles)

Strengthening muscles around the knee and hip improves joint stability and reduces pain for many people.

What it is: Resistance exercises (using body weight, bands, machines, or free weights) to build strength and endurance.

How it is thought to help: Stronger muscles absorb more force and reduce stress on painful joint surfaces during daily activities like stairs, standing, and walking.

Both lighter and heavier strengthening programs can help—consistency matters more than intensity.
Most important muscle groups to prioritize (common focus areas in therapy programs):

• Knee: Quadriceps (front of thigh), hamstrings (back of thigh), calf muscles
• Hip: gluteus medius (hip “side” muscle/abductors), gluteus maximus (hip extensors), deep hip rotators

Physical Therapy

Supervised physical therapy improves pain, walking ability, and confidence with movement.

What it is: Guided evaluation and treatment by a licensed physical therapist, often including strengthening, mobility work, balance training, and education.

How it is thought to help: Targets strength and movement patterns that commonly worsen hip/knee pain (such as weakness, stiffness, poor balance, or altered gait).

How it is delivered: Usually a short series of visits plus a home exercise program.

Best results occur when clinic visits are combined with a home exercise program.

Medications

Anti Inflammatory Medications (NSAIDs)

Examples: ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), meloxicam (Mobic), celecoxib (Celebrex)

What they are: Medicines that reduce inflammation and pain.

How they are thought to help: Decrease inflammatory pain signaling in and around the joint.

How they are taken: By mouth, usually short term or intermittently as needed. Some people may use them on a scheduled basis with clinician guidance.

Important note: NSAIDs can have side effects (stomach irritation/bleeding risk, kidney strain, blood pressure effects). Discuss safe use with your clinician, especially if you have kidney disease, ulcers, take blood thinners, or have heart disease.

Topical Anti Inflammatories

Example: Diclofenac gel (Voltaren Gel)

• What it is: An anti-inflammatory applied to the skin over the painful joint.
• How it is thought to help: Delivers medication locally with lower whole-body exposure than pills.
• How it is used: Rubbed on the painful area, typically daily for a period of time.
• Often effective with fewer whole body side effects.

Acetaminophen

Example: acetaminophen (Tylenol)

• What it is: A pain reliever that does not reduce inflammation.
• How it is thought to help: Works on pain signaling pathways.
• How it is taken: By mouth, often for mild pain or when NSAIDs are not safe.
• May help mild pain but is often less effective than anti-inflammatory medications.
• Important note: High doses can damage the liver. Avoid combining with other acetaminophen-containing products unless your clinician approves.

Opioids / Narcotics

Examples: tramadol (Ultram), hydrocodone/acetaminophen (Norco, Vicodin), oxycodone (OxyContin, Percocet)

• What they are: Prescription pain medicines that act on opioid receptors.
• How they are taken: By mouth (and sometimes other forms), usually short term for severe pain when other options are not appropriate.
• Generally not recommended for long term arthritis care due to limited benefit and meaningful risks (constipation, drowsiness, dependence, falls, overdose).

Injection Treatments

Cortisone (Steroid) Injections

What it is: A corticosteroid medicine injected into the joint (intra-articular injection).

How it is thought to help: Reduces inflammation inside the joint, which can decrease pain during flares.

How it is given: A clinician injects the medication into the joint, sometimes using ultrasound guidance.

• May provide short term pain relief (weeks to a few months)
• Repeated injections over time may be associated with cartilage thinning (in one study, injections every 3 months for 2 years—8 injections total—were associated with greater cartilage loss compared with saline)

Often used for symptom flares or to improve function temporarily.

Hyaluronic Acid (“Gel”) Injections

Also called: viscosupplementation, “gel shots,” “rooster comb injections”

Common brand/marketing names (vary by region/insurance): Synvisc / Synvisc-One (hylan G-F 20), Monovisc, Orthovisc, Euflexxa, Gel-One, Durolane, Hyalgan, Supartz

What is hyaluronic acid? A naturally occurring “lubricant” molecule found in normal joint fluid (synovial fluid). In arthritis, the amount and quality of this fluid can change.

How it is hypothesized to work: May improve joint lubrication and shock absorption, and may reduce inflammation in some patients. It does not regrow cartilage or reverse arthritis.

How it is given: Injected into the knee joint (most commonly). Depending on the product, it may be given as a single injection or as a short series.

• May help some patients, especially with mild to moderate knee arthritis
• Results vary
• Does not regrow cartilage or reverse arthritis

Platelet Rich Plasma (PRP)

What it is: A concentrated portion of your own blood that contains a higher platelet concentration than normal blood.

How it is obtained: Blood is drawn from your arm and processed (typically spun in a centrifuge) to concentrate platelets.

How it is hypothesized to work: Platelets contain growth factors and signaling proteins that may influence inflammation and tissue healing responses. PRP does not reliably regrow cartilage, and results vary based on preparation method and patient factors.

How it is given: Injected into the joint (intra-articular). Some protocols use a series of injections.

• May improve pain and function in some patients
• Results vary depending on preparation and patient factors
• Has not been shown to reliably regrow cartilage

Stem Cell Injections

What it is: Injections that aim to deliver cells (often marketed as “stem cells”) into the joint, usually derived from bone marrow or fat tissue.

How it is obtained: Typically involves a procedure to collect tissue (bone marrow aspirate or fat), then processing and injecting into the joint.

How it is hypothesized to work: May influence inflammation and the joint environment.

Reliable cartilage regrowth or arthritis reversal has not been proven. Stem cell treatments are still being studied.

Current research shows:

• Some patients report symptom improvement
• Results are inconsistent
• Reliable cartilage regrowth or arthritis reversal has not been proven

These treatments are generally considered investigational.

Supplements

Glucosamine & Chondroitin

What they are: Over-the-counter supplements often marketed for “joint health.”

How they are hypothesized to work: Proposed to support cartilage building blocks; however, high quality studies do not show consistent benefit.

How they are taken: Oral pills or powders.

High quality studies show no consistent benefit over placebo for arthritis pain or function.

Turmeric (Curcumin)

What it is: Turmeric is a plant/spice (Curcuma longa). Curcumin is one of its main active compounds.

How it is hypothesized to work: Curcumin may have anti-inflammatory and antioxidant effects in the body, which may reduce arthritis-related pain in some people.

How it is taken: Oral capsules or powders (doses and formulations vary widely).

May provide mild pain relief for some patients.

Best used as an add on, not a replacement for proven treatments.

Peptides & Newer Therapies Patients Commonly Ask About

Collagen Peptides (Oral Supplements)

What they are: Processed (hydrolyzed) collagen proteins taken by mouth.

How they are hypothesized to work: May influence connective tissue metabolism and inflammation. They do not rebuild cartilage or reverse arthritis.

How they are taken: Oral powders, pills, or drinks.

• May provide modest symptom relief for some people
• Do not rebuild cartilage or reverse arthritis

Prescription Weight Loss Peptides (GLP 1 Medications)

Examples: semaglutide (Wegovy, Ozempic), tirzepatide (Zepbound, Mounjaro), liraglutide (Saxenda, Victoza)

What they are: Prescription medicines that mimic or activate gut-hormone pathways to reduce appetite and improve metabolic health.

How they are administered: Usually a once-weekly or daily injection under the skin (depending on the medication).

How they are hypothesized to help arthritis: By helping with weight loss, which reduces load on the joint and can improve pain and function. These benefits appear largely related to weight reduction, not direct cartilage repair.

In patients with arthritis and obesity, medications that promote weight loss have been shown to:

• Reduce knee pain
• Improve function

These benefits appear largely related to weight reduction, not direct cartilage repair.

Investigational Joint Injections (e.g., Sprifermin, TPX 100)

Some newer injectable treatments are being studied for possible effects on joint structure.

What they are: Research (investigational) injections designed to potentially affect cartilage or joint biology.

How they are administered: Injected into the joint (intra-articular) as part of clinical trials or specialized investigational protocols.

How they are hypothesized to work:

• Sprifermin (FGF-18) is being studied for effects on cartilage thickness on MRI.
• TPX 100 is a peptide being studied for possible effects on cartilage/bone changes and symptoms.

Important note: Imaging changes have been observed in some studies, but consistent pain relief or arthritis reversal has not been proven. These treatments remain investigational.

• Imaging changes have been observed in some studies
• Consistent pain relief or arthritis reversal has not been proven
• These treatments remain investigational

Peptides Marketed Online (e.g., BPC 157)

Patients often ask about peptides sold online for “joint repair.”

What they are: Peptides marketed as “research chemicals” or “healing peptides,” often not regulated or standardized.

How they are obtained: Often purchased online from non-medical sources, with variable purity and labeling.

How they are hypothesized to work: Many claims are based on animal or lab studies; high-quality human clinical evidence is very limited.

Current research shows:

• Human clinical evidence is very limited
• Most data come from animal or laboratory studies
• Claims of cartilage regeneration are not supported by strong human evidence

Key Take Home Points

• Exercise, weight management, and physical therapy are the most effective non-surgical treatments
• Medications and injections can help symptoms but do not cure arthritis
• No injection or supplement has been proven to reliably regrow cartilage
• Many newer treatments are still being studied

Common Misconceptions About Arthritis

“Exercise makes arthritis worse.”

This is a very common concern, but it is not true.

Appropriate exercise reduces pain, improves strength and balance, and helps people stay active longer.

“Supplements rebuild cartilage.”

High quality medical studies have not shown reliable cartilage regrowth from supplements.

“Stem cells cure severe arthritis.”

There is no strong evidence that stem cells reliably cure arthritis or regrow cartilage.

“Nothing helps bone on bone arthritis except surgery.”

Non-surgical treatments can still reduce pain and improve function.

Disclaimer: This material is provided for informational and educational purposes only and is not intended as medical advice, diagnosis, or treatment. Medical research and clinical guidelines are continually evolving. Although efforts are made to ensure the accuracy and timeliness of the information presented, updates may occur as new evidence emerges.