What to do when a sore knee is limiting your day

What to try when daily use is still steady

Non-surgical care may still help when soreness is mild or moderate. That's more likely when guided exercise hasn't been done steadily.

A physical therapist can guide the work for several weeks before judging it. Walking, strength work, and weight loss may help some people stay active.

A brace or cane may reduce strain during ordinary tasks. Note what brings on soreness, what eases it, and whether the knee swells.

Also record sleep trouble, falls, and lost motion. Those details show the clinician how the knee affects your day and whether care helps.

What to bring to a QC Kinetix visit

Take your medicines, earlier X-rays, and a short account of past care. Choose loose clothing so the clinician can examine and bend the knee.

QC Kinetix may discuss regenerative treatments, meaning blood-based procedures done by medical providers in the clinic. The visit begins with questions about your health and an exam of the joint.

Spinning your blood separates the platelet-heavy portion known as platelet-rich plasma, or PRP. A provider puts it into the joint and may offer concentrated PRP.

The clinic can explain the hoped-for relief and the limits of these options. Sometimes the useful next step is a surgeon's opinion instead.

When to get care today

Get same-day care when fever comes with a red, swollen joint. Seek prompt help if an injury leaves the leg unable to hold you.

A knee that locks and won't straighten also needs a timely exam. Calf warmth, redness, or swelling after rest could mean a blood clot.

Get same-day medical care for those calf signs. Treat new weakness, numbness, or lost bladder or bowel control as urgent.

Banner Ironwood Medical Center is on Gantzel Road. Its emergency department operates around the clock.

Sources

1. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

2. 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.

3. 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.

4. 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.

5. In 63,158 hip and 54,276 knee replacement patients in the Clinical Practice Research Datalink, the lifetime risk of requiring revision surgery was about 5% for patients operated on after age 70 with no sex difference, but rose to 35% (95% CI 30.9-39.1) for men having surgery in their early 50s, with women's risk about 15% lower at the same age. Median time to revision for patients operated on younger than 60 was 4.4 years. The authors state their evidence challenges the trend toward more replacements in younger patients.

   Bayliss LE, Culliford D, Monk AP, et al. — The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.. The Lancet, 2017. DOI: 10.1016/S0140-6736(17)30059-4.

6. In a prospective cohort of 134 patients on an Australian public orthopedic waiting list for hip or knee replacement, 69% waited at least 6 months (median 286 days, IQR 169-375). Health-related quality of life deteriorated overall during the wait (mean AQoL change -0.04, 95% CI -0.08 to -0.01), with 53% of participants experiencing a clinically important decline.

   Ackerman IN, Bennell KL, Osborne RH. — Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study.. BMC Musculoskeletal Disorders, 2011. DOI: 10.1186/1471-2474-12-108.

7. 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.

8. 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.

9. A 2021 JAMA review states that osteoarthritis affects an estimated 240 million people worldwide including more than 32 million in the US, that 33% of people older than 75 have symptomatic and radiographic knee OA, that diagnosis is clinical despite widespread overuse of imaging, that people with OA are more sedentary and carry a 20% higher age-adjusted mortality, and that the cornerstones of management are exercise, weight loss where appropriate and education, complemented by topical or oral NSAIDs, with opiates to be avoided.

   Katz JN, Arant KR, Loeser RF. — Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review.. JAMA, 2021. DOI: 10.1001/jama.2020.22171.

10. A lifetime cost-effectiveness analysis using the Osteoarthritis Policy Model found total knee replacement in patients with a BMI of 40 or greater increased quality-adjusted life-years by 0.71 and lifetime medical costs by USD 25,200 in those aged 50-65, giving an incremental cost-effectiveness ratio of USD 35,200 per QALY; in those older than 65 it added 0.39 QALYs and USD 21,100 in costs. Higher complication risk in this population does not by itself make the operation poor value.

    Chen AT, Bronsther CI, Stanley EE, et al. — The Value of Total Knee Replacement in Patients With Knee Osteoarthritis and a Body Mass Index of 40 kg/m(2) or Greater : A Cost-Effectiveness Analysis.. Annals of Internal Medicine, 2021. DOI: 10.7326/M20-4722.