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Understanding Your Options for Hip and Knee Arthritis: Exercise vs. Surgery



If you've recently been informed that you may need a hip or knee replacement due to osteoarthritis, you're probably wondering if there are alternative options to consider. While joint replacement surgery can be a viable solution, it's worth exploring non-operative treatments before making a final decision. In this blog post, we aim to provide you with factual information and dispel common myths surrounding hip and knee replacement, so you can make an informed choice that's right for you.


Can Exercise Help Manage Hip and Knee Arthritis? The Evidence:


Research on individuals with osteoarthritic changes in the hip or knee who were considered candidates for joint replacement surgery has shown promising results for non-operative approaches. Those who engaged in two one-hour exercise sessions per week for a minimum of six weeks, focusing on neuromuscular exercises to enhance joint stability, confidence in movement, and strength, experienced the following benefits:

  • Reduced sick leave due to hip or knee pain.

  • One in three individuals stopped taking pain medications like paracetamol, non-steroidal anti-inflammatories, and opioids.

  • On average, a 25% reduction in pain was observed.

  • Improved functionality, quality of life, and increased physical activity.

  • Two out of three people postponed their need for hip or knee replacement by up to two years.

It must be noted however there are times that a patient has deteriorated so far that conservative management can no longer provide meaningful improvement in function and pain. It is important to ensure that you do not deteriorate too much physically before making the choice of a replacement as declines in your strength and cardiovascular fitness are harder to reverse as you get older.


Facts: What We Know to Be True

  • Scans may not be reliable indicators of pain and disability. Being told your joint is "bone on bone" or that there's no cartilage left doesn't necessarily mean you're destined for surgery. Even healthy individuals without hip or knee pain can exhibit similar scan findings.

  • Rest and avoiding physical activity can exacerbate pain.

  • Gradual and supervised exercise is both safe and beneficial.

  • Around 20% of individuals don't experience pain relief from knee joint replacement surgery.

  • Pain does not necessarily reflect the level of damage at a tissue level.

Myths: What You May Have Heard, But Aren't True

  • The severity of arthritis on a scan doesn't always predict pain and disability levels.

  • Rest may not always be helpful.

  • Surgery is not the exclusive solution; non-operative treatments should be considered.

  • Exercise is generally safe when done correctly and can benefit those with hip or knee arthritis.

The Best Approach for Managing Osteoarthritic Hip or Knee:

A comprehensive approach to osteoarthritis (OA) treatment is considered the most effective.


This includes:

  • Therapeutic exercise, which relieves pain and does not harm knee cartilage.

  • Weight control, as even a small reduction in body weight significantly reduces knee stress.

  • Patient education, helping individuals understand the benefits of appropriate movement and exercise.

  • A surgical review following a 6-12 week block of therapeutic exercise if pain, function, and quality of life are still unsatisfactory.

Our Perspective:

As physiotherapists, we're aware that conservative management may not eliminate the need for hip or knee replacement for everyone. However, the substantial body of research supporting exercise as a treatment for hip and knee osteoarthritis suggests it's a sensible approach. Combining the global benefits of exercise on both physical and mental health, along with the fact that building strength before surgery leads to improved post-surgery outcomes, we strongly encourage you to consider a 6-12 week exercise trial before committing to surgery. In the worst-case scenario, you proceed with surgery well prepared.


Body Fit Physiotherapy

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