Start knee care with steps that help movement

Strength and steady movement help many knees

Strong thigh and hip muscles help your knee. They'll share the load when you stand or climb. Weak muscles make the joint work harder.

Begin with movement you can repeat safely. Add a little time or effort slowly. If tomorrow feels worse, you've moved too fast.

A cane can steady some people. A fitted brace may support certain knees. Your doctor can help you choose either one.

Medicine may ease a stubborn bout. Creams may cause fewer side effects away from your knee than pills. Your health and other drugs still matter.

PRP is a knee shot made from your blood

The letters PRP stand for platelet-rich plasma. A medical team draws some of your blood. A machine spins it so platelets gather together.

The team puts that part into your knee through a shot. Clinics may keep different amounts of platelets and white blood cells. That's why two PRP shots may not be alike.

Studies on knee soreness show mixed results. Some people say they're briefly sore afterward. Those personal reports don't promise what you'll feel.

Ask how the clinic makes its PRP. Ask why that kind may fit your knee. Don't pay until cost and follow-up are clear.

Surgery fits when daily tasks stay hard

Replacement may help when your knee greatly limits daily life. It also brings recovery work and real risks. One rough X-ray isn't enough reason alone.

Look at your usual day first. Can you shop, sleep, or use stairs? A surgery talk may fit if those stay hard.

Keep a short record before seeking care. Note the motion that hurts and what helps. You'll give the doctor a clear starting point.

Ask about each choice and its risks. Make sure the doctor explains what will happen. For its regenerative, non-surgical PRP care, the Peoria QC Kinetix team spins a blood sample, collects the platelet-heavy part, and uses it for a knee shot.

Sources

1. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing, topical NSAIDs, oral NSAIDs and intra-articular glucocorticoid injections in knee OA; radiofrequency ablation for knee OA is only a conditional recommendation.

   Kolasinski SL, 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.

2. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA; topical NSAIDs are strongly recommended (Level 1A); oral and transdermal opioids are strongly NOT recommended (Level 5).

   Bannuru RR, 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.

3. In a 2-year, double-blind RCT of 140 patients with symptomatic knee OA and ultrasound synovitis, intra-articular triamcinolone 40 mg every 12 weeks caused significantly GREATER cartilage volume loss than saline (index-compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain (-1.2 vs -1.9 on the WOMAC Likert pain subscale).

   McAlindon TE, LaValley MP, Harvey WF, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

4. The RESTORE trial randomized 288 adults aged 50+ with symptomatic mild-to-moderate medial knee OA to three weekly leukocyte-poor PRP injections or saline placebo. At 12 months, pain change was -2.1 vs -1.8 points (difference -0.4; 95% CI -0.9 to 0.2; P=.17) and medial tibial cartilage volume change was -1.4% vs -1.2% (P=.81). 29 of 31 prespecified secondary outcomes showed no significant between-group difference. The authors concluded the findings 'do not support use of PRP for the management of knee OA.'

   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.

5. FDA states verbatim: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production. There are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

6. A Cochrane review of topical NSAIDs for chronic musculoskeletal pain in adults synthesised randomised double-blind trials with stringent quality criteria, supporting topical NSAIDs as a route to pain relief without the systemic adverse events of oral NSAIDs — the basis for their strong guideline recommendation in knee OA.

   Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA. — Topical NSAIDs for chronic musculoskeletal pain in adults.. Cochrane Database of Systematic Reviews, 2016. DOI: 10.1002/14651858.CD007400.pub3.

7. A phase II multicentre RCT randomized 60 knee OA patients to three weekly PRGF injections or 100 million cultured autologous bone marrow mesenchymal stromal cells plus PRGF. No adverse effects were reported. VAS pain improved significantly in the BM-MSC+PRGF arm (5.3 to 3.5, p=0.01) but not in the PRGF-alone arm (5.0 to 4.5, p=0.389) at 12 months — a positive signal at small scale, in an unblinded active-control design.

   Lamo-Espinosa JM, et al. — Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis.. Journal of Translational Medicine, 2020. DOI: 10.1186/s12967-020-02530-6.

8. A 150-patient randomized trial reported that an absolute count of 10 billion platelets was needed for a PRP formulation to sustain benefit to one year versus hyaluronic acid (WOMAC and IKDC differences p<0.001; +120 m vs +4 m in 6-minute pain-free walking distance). Because clinic PRP systems vary widely in platelet yield, 'PRP' is not one intervention and results are not transferable between preparations.

   Bansal H, Leon J, Pont JL, et al. — Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy.. Scientific Reports, 2021. DOI: 10.1038/s41598-021-83025-2.

9. An individual-participant-data meta-analysis of 621 placebo participants across 10 intra-articular injection trials found placebo response (>=20% pain reduction) was itself predictable: use of local anaesthetic and ultrasound guidance were associated with REDUCED odds of short-term placebo response, and longer trial duration with increased odds at midterm. Any single-arm 'our patients got better' claim about an injection is therefore uninterpretable.

   Zou K, et al. — Predictors of Placebo Response to Local (Intra-Articular) Therapy In Osteoarthritis: An Individual Participant Data Meta-Analysis.. Arthritis Care & Research, 2024. DOI: 10.1002/acr.25212.

10. In a randomized trial of 100 patients with moderate-to-severe knee OA eligible for total knee replacement, TKR followed by 12 weeks of non-surgical care improved the KOOS4 score more than the same non-surgical programme alone (32.5 vs 16.0 points; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) — but produced four times as many serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group had chosen surgery within 12 months, meaning roughly three-quarters had not.

    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.

11. A cross-sectional study of 1,703 primary total knee arthroplasties in Ontario found approximately one in five patients (19%) were NOT satisfied with the outcome. Satisfaction with pain relief ranged 72-86% and with function 70-84% by activity. The strongest predictor of dissatisfaction was expectations not being met (10.7x greater risk).

    Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. — Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clinical Orthopaedics and Related Research, 2010. DOI: 10.1007/s11999-009-1119-9.