Nonoperative hip and knee care

Pain around the hip and knee has many causes, and arthritis is only one of them. Pain felt at the hip can come from the spine, and pain felt at the knee can come from the hip. Treatment works best when the source is identified first.

Your first visit includes a history and a physical examination of the hip, knee, spine and walking pattern, along with X-rays. When they are needed to clarify the diagnosis, MRI or other imaging is ordered. The result is a plain explanation of what is wrong and a plan matched to it.

Most people with hip or knee arthritis, and many with other joint problems, can be helped for a time without surgery. The options below are used alone or together.

• Targeted physical therapy. A program built around your diagnosis and your goals, for strength, motion and walking mechanics, rather than a generic set of exercises.
• Activity changes and everyday measures. Pacing activity, supportive footwear, a cane when it helps, anti-inflammatory medication when it is safe for you, and weight management.
• Corticosteroid injections. A steroid placed in the joint to calm inflammation and pain. Relief is temporary, lasting weeks to months, and is meant to help you stay active and move through therapy.
• Viscosupplementation (gel injections). A gel-like lubricant injected into the joint, most often the knee. Some patients get meaningful relief and others get little, so we discuss whether it is a reasonable trial for you.
• Platelet-rich plasma (PRP) injections. Your own blood is processed to concentrate platelets, and the concentrate is injected into the joint. PRP is a cash-pay treatment that insurance does not cover, so we go over what to expect and what it costs before you decide.

No single treatment works for everyone. The aim is to choose the right ones for your joint, your health and your goals, and to adjust the plan if it is not helping.

Nonoperative care is largely managed by Dr. Cooper's two experienced physician assistants, Madison Lucido, MS, PA-C, and Chloe Beam, MS, PA-C. They examine you, review your imaging, perform injections, adjust your plan and answer questions between visits, and they are available to see patients promptly. Dr. Cooper supervises their care and is involved in decisions about your treatment.

If nonoperative care stops working, or your examination and imaging show that surgery is likely to help, you will already be known to the practice and can move directly to a consultation with Dr. Cooper.

Nonoperative treatment can sometimes improve symptoms but does not reverse advanced arthritis. Surgery is worth discussing when pain limits daily activities or sleep despite a fair trial of nonoperative care, or when imaging shows advanced “bone on bone” joint damage.

The timing of injections matters if you may need a joint replacement. A recent injection can affect when surgery is safest, so tell your surgical team about any injections you have had, wherever you had them.

Injections are low-risk, but they are not risk-free. Possible effects include temporary soreness or a flare of pain after the injection, a short rise in blood sugar after a steroid injection in people with diabetes, and, rarely, infection or bleeding in the joint. Your clinician will go through the risks that apply to you before any injection.