Understanding your joints

Hip and knee arthritis: options before surgery

Arthritis can make walking, climbing stairs and getting out of a chair uncomfortable. Understanding the cause can help you choose a treatment that fits your symptoms and goals.

What is arthritis?

The ends of the bones in a healthy joint have a smooth covering called cartilage. Think of it as a slippery cushion that helps the bones glide. In osteoarthritis, this covering gradually breaks down. The joint can become irritated, stiff and painful. Arthritis affects the whole joint, not just the cartilage.

The hip is a ball-and-socket joint; the knee bends and straightens like a hinge. Hip arthritis often causes groin or thigh pain, sometimes felt at the knee. Knee arthritis commonly causes aching, swelling and stiffness.

How do you get it?

There is rarely one single cause. Age, family history, previous injuries, joint shape and extra weight can contribute to osteoarthritis. An old injury may lead to arthritis years later. It is not simply the result of having been active, and it is not contagious.

Other forms, such as rheumatoid arthritis, involve the immune system attacking the joint. Dr. Hirshorn can assess your symptoms and imaging to help determine the type of arthritis and the appropriate treatment.

Nonsurgical treatment options

Often, several approaches work together. The aim is to reduce pain and help you move more comfortably; these options do not reliably rebuild worn cartilage.

Movement, physical therapy and weight management

Low-impact activities such as cycling, swimming or comfortable walking can help maintain movement. Physical therapy builds strength and teaches exercises suited to your joint. If you carry extra weight, gradual weight loss can reduce stress on the hips and knees. Activity adjustments, a cane or a suitable knee brace may also help.

Anti-inflammatory and other pain medicines

Anti-inflammatory medicines, such as ibuprofen or naproxen, can reduce pain and inflammation. A topical anti-inflammatory may be an option for knee pain. Oral medicines can cause stomach ulcers or bleeding, kidney problems and cardiovascular effects, and may interact with other medicines. Your clinician can help choose an option suited to your medical history.

Cortisone injections

Cortisone is a steroid medicine injected into the joint to reduce inflammation and provide temporary relief. It can be helpful during a painful flare, but the effect varies. Risks include a temporary pain flare, raised blood sugar, infection and potential cartilage effects with repeated injections. Discuss timing and frequency with your surgeon, particularly if replacement surgery is being considered.

An option to discuss

PRP: a nonsurgical option worth discussing

Looking for relief without surgery? PRP may help reduce pain and improve function in selected patients, especially those with mild to moderate knee osteoarthritis. It is generally well tolerated and uses your own blood. Dr. Hirshorn can help you weigh its potential benefits against other treatment options.

PRP is made from a small sample of your own blood. The sample is processed to concentrate platelets, which contain proteins involved in the body’s repair response. The preparation is then injected into the treatment area.

Potential benefits

Some patients with mild to moderate knee osteoarthritis experience improved pain and function.
It uses your own blood and contains no cortisone.
It may be an option for people who want to discuss an alternative to repeated steroid injections or ongoing oral anti-inflammatory medicine.

PRP does not carry the same medication-specific risks as oral anti-inflammatories or cortisone. However, this does not make it risk-free or prove that it is the best option for every patient.

What are the limitations and risks?

Temporary pain, swelling or bruising can occur. Infection, bleeding, tissue injury and nerve injury are possible complications of injections. Benefits vary, and PRP preparations and treatment schedules are not standardized. Evidence is more developed for knee arthritis than for hip arthritis, and professional recommendations differ. PRP has not been proven to regrow worn cartilage or guarantee that surgery can be avoided.

Hip arthritis and inflammatory pain

For hip arthritis, the evidence is less certain than for knee osteoarthritis. Pain from an inflamed joint can have several causes, so an accurate diagnosis matters. PRP is not an established treatment for autoimmune inflammatory arthritis, such as rheumatoid arthritis, and should not replace treatment directed at that disease. Dr. Hirshorn can assess the source of your hip or knee pain and discuss whether PRP is appropriate.

Is PRP right for me?

Dr. Hirshorn can help determine whether you are an appropriate candidate for PRP. He will consider the joint involved, the severity of arthritis, previous treatments, your health and medicines, and your goals. Advanced arthritis or other medical factors may make another option more appropriate.

Insurance and out-of-pocket cost

Plan for PRP to be a self-pay treatment with an out-of-pocket charge. PRP for arthritis is generally not covered by insurance. Coverage can vary by plan; confirm any benefits with your insurer. Ask the office for the current fee and what is included before treatment. The number of recommended injections can affect the total cost.

Schedule a visit to discuss your arthritis and whether PRP or another nonsurgical option fits your needs.

Schedule an appointment with Dr. Hirshorn

When is surgery considered?

If pain continues to limit daily life despite appropriate nonsurgical care, Dr. Hirshorn can discuss hip or knee replacement. The decision depends on your symptoms, health and priorities.

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