You have options before joint replacement

Movement, a cane, and an unloader knee brace can help

Slow strength work supports your sore joint. Bend only as far as feels firm, not sharp. You'll do better with steady practice.

A cane can take weight off your sore side. Hold it on your stronger side. A doctor can check its height.

An unloader knee brace moves weight off the worn side. It sends more weight through the stronger side. It won't fit every sore knee.

Your health decides which medicines are safe

Creams used on the knee may ease soreness. Pills can help some people too. They aren't safe for every heart, kidney, or stomach.

Tell your doctor about every medicine you take. Don't add a pain drug without asking first. Some medicines don't mix safely.

Notice your sleep, walking, and stairs. Short relief may not last. Those three changes show whether the medicine helps.

Knee replacement alternatives must match the sore part

The pain may start in cartilage, tendon, or bone. Your exam helps find the sore part. That finding changes which care may fit.

Knee studies haven't given one clear result. Some people reported less soreness after blood-based care. Others didn't feel much change.

Choose a date to check your progress. Don't repeat care that hasn't helped your sleep or walking. Ask the doctor what else is safe to try.

Sources

1. 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.

2. 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.

3. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 randomised trials, assessing pain, physical function and quality of life immediately after treatment and the sustained effect at 2-6 months and beyond 6 months. Only 19 of the included studies (20%) met all three low-risk-of-bias criteria the authors applied.

   Fransen M, McConnell S, Harmer AR, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2015. DOI: 10.1002/14651858.CD004376.pub3.

4. A systematic review and meta-analysis of 120 randomised trials (10,253 participants) covering resistance training across the knee osteoarthritis continuum - 88 trials in early OA, 13 preoperative, 19 after knee replacement - found improvements in mobility, walking capacity and knee extension strength in early OA (SMD 0.46-0.81, moderate-to-high GRADE), in preoperative knee extension strength (SMD 0.47, high GRADE) and in mobility after knee replacement (SMD 0.58). Resistance training improved pain, symptoms, function and quality of life in early OA but showed NO significant effect on those outcomes preoperatively, with no increased risk versus controls at any stage.

   Brown RCC, Mora-Traverso M, Fernández-González M, et al. — Efficacy and safety of resistance training for knee osteoarthritis and subsequent knee replacement: A systematic review and meta-analysis.. Annals of Physical and Rehabilitation Medicine, 2026. DOI: 10.1016/j.rehab.2026.102122.

5. The RESTORE trial randomised 288 community-based participants aged 50+ with symptomatic medial knee OA (Kellgren-Lawrence grade 2 or 3) to three weekly intra-articular injections of leukocyte-poor PRP or saline placebo, with participants, injectors and assessors all blinded. 93% completed the 12-month follow-up. PRP did not produce a clinically meaningful improvement in knee pain over placebo, and did not slow medial tibial cartilage volume loss on MRI.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

6. A meta-analysis of 16 randomised trials (807 participants) of intra-articular mesenchymal stem cells for chronic knee pain from osteoarthritis found that at 3-6 months MSC therapy probably produces little to no difference in pain (WMD -0.74cm on a 10cm VAS, 95% CI -1.16 to -0.33, against a minimally important difference of 1.5cm) or physical function, both moderate certainty; at 12 months, probably little to no difference in pain. MSC therapy may increase the risk of any adverse event (RR 2.67, 95% CI 1.19 to 5.99) and of knee pain and swelling (RR 1.58, 95% CI 1.04 to 2.38).

   Sadeghirad B, Rehman Y, Khosravirad A, et al. — Mesenchymal stem cells for chronic knee pain secondary to osteoarthritis: A systematic review and meta-analysis of randomized trials.. Osteoarthritis and Cartilage, 2024. DOI: 10.1016/j.joca.2024.04.021.

7. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

8. A Cochrane overview of 21 systematic reviews (381 studies, 37,143 participants) covering rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, neck disorder and other chronic pain conditions concluded that physical activity and exercise are interventions with few adverse events that may improve pain severity and physical function - but that the quality of the evidence is low, effects on pain were inconsistent across reviews, and physical function improved significantly in 14 reviews with only small-to-moderate effect sizes. The commonest reported adverse event was increased muscle soreness that settled within weeks.

   Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH — Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.. Cochrane Database of Systematic Reviews, 2017. DOI: 10.1002/14651858.CD011279.pub3.