Degenerative arthritis, also called osteoarthritis, is treatable through a combination of lifestyle changes, physical therapy, medication, and in some cases injections or surgery. No single treatment reverses the cartilage loss that defines the condition, but the right combination can significantly reduce pain, improve joint function, and slow progression. The most effective approach layers several strategies together, starting with the least invasive options.
What Happens Inside the Joint
Understanding why your joint hurts helps explain why certain treatments work. Healthy cartilage is about 65 to 80 percent water, with the rest made up of collagen fibers and cushioning molecules called proteoglycans. This structure lets nutrients flow through and absorbs shock during movement.
In the early stages, the cartilage surface may still look intact, but its internal structure is already changing. The cartilage cells try to repair themselves by multiplying and producing new material, but they have very limited regenerative capacity. Eventually the repair effort fails, the cushioning molecules break down, and the collagen network unravels. As cartilage thins and disappears, bone grinds against bone, causing pain, stiffness, and reduced range of motion. Bone spurs form at the joint margins, and the surrounding muscles and tendons can weaken over time.
Weight Loss Has an Outsized Effect
If you’re carrying extra weight, losing it is one of the most powerful things you can do for an arthritic knee or hip. Research on overweight and obese adults with knee osteoarthritis found that every pound of body weight lost reduces the load on the knee by about four pounds per step. That means losing just 10 pounds takes roughly 40 pounds of force off your knees with every stride you take throughout the day. The cumulative effect across thousands of daily steps is enormous.
Even modest weight loss of 5 to 10 percent of body weight can produce noticeable improvements in pain and mobility. Weight loss also reduces the low-grade inflammation that contributes to cartilage breakdown, so the benefits go beyond simple mechanics.
Exercise and Physical Therapy
Exercise is strongly recommended by every major arthritis guideline, and it works through multiple pathways: strengthening the muscles that support and stabilize the joint, improving flexibility, and boosting the flow of nutrients into cartilage. A well-rounded program includes four components: aerobic activity, strength training, neuromuscular (balance) exercises, and flexibility work.
For knee osteoarthritis, the most important muscles to strengthen are the quadriceps, hamstrings, calves, hip abductors, and hip extensors. These muscle groups act as shock absorbers and stabilizers for the knee. If your time is limited, prioritize whichever groups are weakest, which for most people means the hip abductors, hip extensors, and quadriceps.
Tai chi is strongly recommended by both the American College of Rheumatology and the Osteoarthritis Research Society International for knee and hip osteoarthritis. It combines gentle movement with balance training and has shown consistent benefits for pain and function. Yoga is conditionally recommended for knee osteoarthritis as well. For stretching, hold each position 30 to 45 seconds without bouncing, reaching the point of slight discomfort while still breathing calmly, and repeat one to three times per side.
Medications That Help With Pain
Topical anti-inflammatory creams and gels applied directly to the skin over the affected joint are the most universally recommended first-line medication for knee osteoarthritis. Every major professional guideline strongly recommends them. They deliver pain relief with far fewer side effects than pills because only a small amount enters the bloodstream, largely avoiding the gastrointestinal bleeding and cardiovascular risks associated with oral versions of the same drugs.
Acetaminophen (Tylenol) has long been recommended as a first-line oral option because it’s inexpensive, widely available, and generally well tolerated. Its actual pain-relieving effect in osteoarthritis is modest, though. The recommended ceiling is 4 grams per day, and staying within that limit is important to avoid liver damage.
Oral anti-inflammatory drugs like ibuprofen or naproxen are more effective for pain, especially when there’s visible swelling or inflammation. Guidelines recommend using the lowest effective dose for the shortest time needed. These medications carry real risks: stomach irritation and ulcers, kidney problems, and cardiovascular complications. If you have a history of stomach ulcers or bleeding, oral anti-inflammatories are generally off the table entirely. Topical capsaicin, derived from chili peppers, is another option that can provide localized relief with minimal systemic side effects.
Joint Injections
When topical and oral medications aren’t enough, injections directly into the joint are a common next step. The two most established types are corticosteroid injections and hyaluronic acid injections.
Corticosteroid injections provide strong, fast-acting relief. In clinical trials, they significantly reduced pain in the first few months. However, their effect fades. By 9 to 12 months, fewer than 10 percent of patients in one 200-person study still met the threshold for meaningful improvement. Repeated corticosteroid injections may also accelerate cartilage loss over time, which is why most doctors limit how often they’re given.
Hyaluronic acid injections work differently. They supplement the joint’s natural lubricating fluid. Pain relief builds more gradually but lasts longer. In the same study, hyaluronic acid produced a 33.6 percent reduction in pain at 12 months compared to just 8.2 percent for the corticosteroid group. Function improved by 47.5 percent versus 13.2 percent. At the one-year mark, over 80 percent of hyaluronic acid patients still had clinically meaningful improvement. Despite these results, some guidelines give hyaluronic acid only a conditional recommendation because study quality has been inconsistent across the broader research.
Platelet-rich plasma (PRP) injections, which use concentrated growth factors from your own blood, are increasingly offered but still considered investigational. The FDA has cleared the equipment used to prepare PRP but has not officially approved it for osteoarthritis. Early studies suggest it may reduce pain and inflammation, but the mechanism isn’t fully understood and evidence is still developing.
Braces, Canes, and Other Devices
Assistive devices can make a real difference in daily comfort and mobility. Unloading knee braces, which shift pressure away from the most damaged part of the joint, are strongly recommended for knee osteoarthritis. Studies show clinically meaningful improvements in pain, physical function, and quality of life that persist beyond three months of use. Even compared to simple knee supports or sleeves, structured braces provide greater benefits.
A T-shaped cane used on the opposite side of the affected joint reduces pressure on the leg, improves stability, and encourages physical activity. Research shows meaningful improvements in both pain and quality of life compared to using no walking aid. For thumb osteoarthritis, a stabilizing splint can reduce pain and improve the ability to grip and perform daily tasks. Lateral wedge insoles placed in shoes have also shown benefits for knee pain and function, particularly in the first few months of use.
Supplements: Mixed but Some Promising Results
Glucosamine and chondroitin are the most widely studied supplements for osteoarthritis. A combined analysis of 29 studies with over 6,100 participants found that glucosamine and chondroitin each significantly reduced knee pain when taken separately. Interestingly, combining the two did not produce significant results, which contradicts how they’re commonly marketed together.
Chondroitin taken alone showed significant benefits in a separate analysis of 18 studies, though results varied considerably from study to study. One small trial of 162 people also found that chondroitin improved hand pain and function over six months. If you try these supplements, allow at least three months before judging whether they’re helping, since that’s the minimum duration associated with meaningful pain reduction in clinical trials.
Cognitive and Mind-Body Approaches
Chronic pain isn’t purely a mechanical problem. How your brain processes pain signals matters, and approaches that address the psychological dimension can produce real physical improvements. Cognitive behavioral therapy is conditionally recommended by both the ACR and OARSI for knee, hip, and hand osteoarthritis. It helps you develop strategies for managing pain flares, reducing catastrophizing, and maintaining activity levels despite discomfort. Balance training and thermal therapies (heat and cold) are also conditionally recommended and can be useful additions to a broader treatment plan.
When Joint Replacement Becomes the Right Call
Joint replacement surgery is reserved for people who have exhausted non-surgical treatments. The typical candidate has moderate to severe pain that interferes with daily activities and sleep, visible joint damage on imaging (significant narrowing of joint space, bone spurs, and bone hardening), reduced ability to do routine tasks like walking or climbing stairs, and a history of conservative treatments that haven’t provided adequate relief.
There’s no single test score or X-ray grade that automatically qualifies someone for surgery. The British Orthopaedic Association uses a radiographic severity threshold of Kellgren-Lawrence grade III or higher for knee replacement, but the decision always involves weighing pain severity, functional limitation, and how much the condition affects your life. Patients who don’t meet typical pain criteria but have severe structural damage with progressive deformity and functional disability may still be considered, often with a second opinion.
Total knee and hip replacements have high success rates, with most people experiencing substantial pain relief and improved mobility. Recovery typically involves several weeks of reduced activity followed by months of physical therapy to rebuild strength and range of motion.