If you have knee arthritis, you have probably heard about many different treatment options. Exercises. Pills. Injections. Surgery. How do you know which one is right for you?
The truth is, there is no single “best” treatment for everyone. The right approach depends on how severe your arthritis is, your overall health, what you want to be able to do, and what has already been tried. This guide will help you understand all your options so you can have an informed conversation with your doctor.
How Knee Arthritis Treatment Typically Works
Most doctors follow a step-by-step approach to treating knee arthritis. They start with simpler, lower-risk options and move to more intensive treatments only when needed.
Step 1: Lifestyle and Self-Care
- Weight management (losing 10 pounds removes 40 pounds of pressure from your knee)
- Low-impact exercise like walking, swimming, or cycling
- Heat and ice therapy
- Activity modification
Step 2: Physical Therapy and Medications
- Structured exercise programs with a physical therapist
- Over-the-counter pain relievers (acetaminophen, ibuprofen)
- Topical creams and gels
Step 3: Injections
- Cortisone injections for quick, short-term relief
- HA (gel) injections for longer-lasting relief
Step 4: Surgery
- Knee replacement (partial or total) when other options no longer help
Most people can manage their knee arthritis for years without surgery by using the right combination of treatments from steps 1-3.
Treatment Comparison Chart
Here is a side-by-side comparison of the main treatment options for knee osteoarthritis:
| Treatment | How It Works | Relief Duration | Medicare Covered | Best For |
|---|---|---|---|---|
| Exercise/Physical Therapy | Strengthens muscles around the knee to reduce joint stress | Ongoing with continued exercise | Yes | Everyone with knee arthritis; first-line treatment |
| OTC Pain Relievers (Tylenol, Advil) | Reduces pain signals and inflammation | 4-8 hours per dose | No (but inexpensive) | Mild to moderate pain; short-term use |
| Prescription Medications | Stronger pain relief or inflammation control | Varies by medication | Yes | When OTC options are not enough |
| Cortisone Injections | Powerful anti-inflammatory injected into the joint | 4-12 weeks | Yes | Acute flare-ups; quick relief needed |
| HA (Gel) Injections | Restores joint lubrication and cushioning | 6-12 months | Yes | Moderate arthritis; wanting to delay surgery |
| Knee Replacement Surgery | Replaces damaged joint surfaces with artificial parts | 15-20+ years | Yes | Severe arthritis; other treatments have failed |
Understanding Each Treatment Option
Exercise and Physical Therapy
Physical therapy is the foundation of arthritis treatment. Research shows it can reduce knee pain by 40-60% when done consistently. A physical therapist will teach you exercises to strengthen the muscles that support your knee, improve flexibility, and reduce stress on the joint.
What to expect: 8-12 weeks of therapy sessions, plus daily home exercises. Benefits continue as long as you keep exercising.
Cost: Medicare covers PT. Private insurance typically covers 20-60 visits per year.
Over-the-Counter Pain Relievers
Acetaminophen (Tylenol) and NSAIDs like ibuprofen (Advil) or naproxen (Aleve) can help manage mild to moderate arthritis pain. Acetaminophen is generally safer for long-term use, while NSAIDs also reduce inflammation.
Important for seniors: Talk to your doctor before using NSAIDs regularly. They can affect kidney function, blood pressure, and stomach health, especially in people over 65.
Prescription Medications
If OTC options are not enough, your doctor may prescribe stronger medications. Options include prescription-strength NSAIDs, COX-2 inhibitors (like Celebrex), or other pain medications.
Cortisone Injections
Cortisone (steroid) injections deliver powerful anti-inflammatory medication directly into your knee joint. They work fast, often providing relief within days.
The catch: Relief is temporary, typically lasting 4-12 weeks. Most doctors limit these to 3-4 per joint per year because repeated injections may damage cartilage over time.
Best used for: Acute flare-ups or when you need quick relief for a special event or activity.
HA (Gel) Injections
Hyaluronic acid injections (also called gel injections or viscosupplementation) work differently than cortisone. Instead of fighting inflammation, they restore the natural lubrication in your joint. Think of it like adding oil to a squeaky hinge.
Key benefits:
- Relief lasts 6-12 months (much longer than cortisone)
- Safe for repeated use
- May help preserve cartilage
- Medicare covers HA injections for knee osteoarthritis
What to expect: Either a single injection or a series of 3-5 weekly injections, depending on the product. Most people notice improvement within 2-4 weeks.
Knee Replacement Surgery
When other treatments no longer provide adequate relief, knee replacement surgery may be recommended. This major surgery replaces the damaged surfaces of your knee with metal and plastic components.
What to know:
- Very effective for severe arthritis (90%+ success rate)
- Requires 3-6 months of recovery and rehabilitation
- Artificial joints typically last 15-20+ years
- Serious surgery with real risks (infection, blood clots, complications)
Most orthopedic surgeons recommend trying non-surgical options first. Surgery is reserved for when arthritis significantly affects your quality of life despite other treatments.
How to Choose the Right Treatment
The best approach depends on your specific situation. Consider these factors:
Your arthritis severity:
- Mild: Exercise, PT, and OTC medications often work well
- Moderate: May benefit from adding injections (HA gel often provides longer relief)
- Severe: May need surgery if other options have stopped working
Your goals:
- Want to stay active in sports or hobbies? Gel injections can help maintain function
- Need quick relief for an upcoming trip? Cortisone might be appropriate
- Looking for a permanent solution? Surgery may be right if you have severe arthritis
What you have already tried:
- Failed conservative treatments? Time to consider injections
- Cortisone wearing off quickly? Ask about gel injections as an alternative
- Injections no longer helping? Surgery consultation makes sense
Frequently Asked Questions
Can I combine treatments?
Yes, and this often works better than any single treatment alone. For example, many people get gel injections AND continue physical therapy. The injection reduces pain enough to exercise more effectively, and the exercise provides additional long-term benefits.
How long should I try a treatment before moving to something else?
Give physical therapy 6-8 weeks of consistent effort. Cortisone injections work within days to a week. Gel injections may take 2-4 weeks to show full benefit. If a treatment is not helping after an appropriate trial period, talk to your doctor about alternatives.
Will insurance cover these treatments?
Medicare covers physical therapy, cortisone injections, gel injections (for knee osteoarthritis), and knee replacement surgery. Most private insurance plans cover these treatments too, though you may need prior authorization for some options.
When should I consider surgery?
Consider surgery when your arthritis significantly limits your daily life (walking, sleeping, enjoying activities) AND you have tried non-surgical options without adequate relief. Many people delay surgery for years by using the right combination of exercise, medications, and injections.
Next Steps
The best thing you can do is have an informed conversation with your doctor about your options. Bring this information with you and ask:
- What stage is my arthritis?
- Based on what I have tried, what treatment do you recommend next?
- Am I a candidate for gel injections?
- How long should I try this treatment before reassessing?
If you are curious whether you might be a candidate for gel injections, you can take our brief eligibility assessment to learn more.