Surgery only when it is actually needed
Most knee and hip pain does not need an operation. As a joint replacement surgeon, I spend a large part of every OPD keeping people away from surgery: structured physiotherapy, carefully timed injections, and honest conversations about what will and will not help. When surgery does become the right answer, you will hear that honestly too.
Why a surgeon leads with non-surgical care
Joint replacement transforms lives when it is done for the right person at the right time. Done too early, it trades a manageable problem for an artificial joint that has its own rules and lifespan. That is why international guidelines place exercise, weight management, and education at the centre of arthritis care, with surgery reserved for joints that have failed a proper trial of these measures.
In my OPD at Aster MIMS Kannur, the first consultation for joint pain is about staging: how worn is the joint on a standing X-ray, how much is it limiting your life, and what has genuinely been tried so far. A surprising number of patients arrive convinced they need an operation and leave with a physiotherapy plan and a follow-up date instead.
Every treatment on this page is available in-house, and each comes with an honest conversation about what the evidence says it can do for a joint like yours. Nothing here is sold as a cure, because none of it is one.
Staged, not rushed
Treatment matches the stage of the arthritis. Early wear is managed very differently from bone-on-bone damage, and the plan is reviewed at follow-up rather than fixed forever.
Evidence, stated plainly
Some options here have strong evidence; others, like PRP, have evidence that is still evolving. You will always be told which is which before you spend money on anything.
One team, one roof
Assessment, imaging, physiotherapy, and injections all happen at Aster MIMS Kannur, so your progress is tracked by the same team that would look after you if surgery were ever needed.
The foundation every plan is built on
Stay active, within comfort
Resting a painful joint weakens the muscles that protect it. Walking, cycling, and swimming keep joints moving without pounding them.
Weight management
Every extra kilogram multiplies across the knee with each step. Even modest weight loss meaningfully reduces daily load on the joint.
Sensible pain relief
Simple analgesics used correctly, under medical advice, are safer than unsupervised long-term painkiller habits. We review what you are taking.
Understanding your joint
Knowing what arthritis is, and is not, removes fear. Pain with activity does not mean you are causing damage; hurt and harm are different things.
Structured physiotherapy
The single most effective non-surgical treatment for knee and hip arthritis is not an injection. It is a properly designed, properly supervised strengthening programme. The quadriceps, hip abductors, and calf muscles act as shock absorbers for the joint; when they are strong, the worn surfaces carry less load and hurt less.
"Physiotherapy" that consists of a heat pack and ten minutes of massage is not what we mean. A real programme is progressive: exercises get measurably harder as you get stronger, technique is corrected in person, and the programme transitions into a home routine you can sustain. Most people need six to twelve weeks of consistent work before judging the result, and the ones who continue at home keep the benefit.
What to expect
- An assessment of strength, movement, and walking pattern before any exercise is prescribed
- A written, progressive programme: supervised sessions first, then a home routine
- Some muscle soreness in the first weeks; this is normal and settles as strength builds
- A review with me to measure progress, usually after six to twelve weeks
Best suited to: nearly everyone with knee or hip arthritis, at every stage, including patients preparing for or recovering from surgery.
Corticosteroid injections
A corticosteroid injection places a strong anti-inflammatory directly inside the joint. When an arthritic knee flares up, becoming hot, swollen, and suddenly more painful, a steroid injection can settle that inflammation and give weeks to a few months of relief. It is a good tool for calming a flare, getting through a wedding season or a journey, or making physiotherapy possible when pain is blocking it.
It is equally important to say what it does not do: it does not repair cartilage or slow the arthritis. Repeated frequent injections are avoided, both because the benefit tends to shorten each time and because injections close to a future joint replacement raise infection concerns. As a rule I do not inject a joint within three months of planned surgery, and a joint that keeps demanding injections is telling us the plan needs reassessment.
What to expect
- An OPD procedure taking a few minutes, done with sterile precautions
- Possible soreness for a day or two before the relief begins
- Relief that typically lasts weeks to a few months, varying between patients
- A deliberate limit on how often it is repeated, reviewed at each visit
Best suited to: painful flares of arthritis, and short-term relief with a specific purpose. Diabetic patients: blood sugar may rise for a few days after injection; we plan around this.
Viscosupplementation (gel injections)
Hyaluronic acid is a natural component of joint fluid that gives it its thick, lubricating quality. In arthritis, the joint fluid becomes thinner. A viscosupplementation injection tops the joint up with a gel-like hyaluronic acid preparation, aiming to improve lubrication and comfort.
The evidence here deserves honesty: international guidelines disagree about gel injections, and studies show benefits that are modest on average. In practice, some patients with early to moderate knee arthritis report several months of meaningful relief, while others notice little change. I offer it selectively, to patients whose stage of arthritis gives it a realistic chance of helping, and I say clearly beforehand that the response varies. It is not offered as a way of avoiding surgery in a joint that is already bone on bone, where it has little to offer.
What to expect
- A single injection or a short series, depending on the preparation used
- Any benefit builds gradually over weeks rather than overnight
- When it works, relief is typically measured in months
- An honest pre-injection conversation about the mixed evidence and the cost
Best suited to: selected patients with early to moderate knee arthritis, usually alongside a strengthening programme, never instead of one.
PRP and orthobiologics
Platelet-rich plasma is prepared from your own blood: a sample is spun in a centrifuge to concentrate the platelets, which carry growth factors involved in healing, and the concentrate is injected into the joint or around a tendon. Because it comes from your own body, serious reactions are rare.
PRP attracts more marketing hype than almost anything else in orthopedics, so let me be direct. The evidence is still evolving: some well-conducted studies suggest improvement in pain and function in early knee arthritis and certain tendon problems, while other studies show little advantage over simpler treatments, and major international guidelines have not endorsed it as routine care. It is not a cure, it does not regrow cartilage, and anyone promising that is selling, not treating.
I offer PRP to selected patients, usually with early arthritis or specific tendon conditions, after a plain-language discussion of what it may realistically achieve for their joint and what it costs. If I think your money is better spent on physiotherapy, I will say exactly that.
What to expect
- A blood draw and centrifuge preparation, then the injection, in one OPD visit
- Soreness for a few days afterwards; anti-inflammatory tablets are paused around the injection
- Any benefit appears gradually over weeks; a single session or a short series may be advised
- A frank discussion of evidence and cost before you commit to anything
Best suited to: selected patients with early knee arthritis or specific tendon conditions, chosen case by case after examination and imaging.
When surgery becomes the right conversation
Non-surgical care has a limit, and pretending otherwise helps no one. When pain limits your walking, wakes you at night, or shrinks your life despite a genuine trial of the treatments above, and the X-ray shows advanced damage, it is time to talk honestly about joint replacement. That conversation is a shared decision, made with clear information and no pressure.
Take the self-assessment
An 8-question educational check of how much your joint is affecting daily life.
About knee replacement
What the operation involves, who needs it, and what modern implants achieve.
Recovery timelines
Phase-by-phase guides to recovery after knee, hip, ACL, and shoulder surgery.
From the published literature
Dr. Vishnu's published research on this topic
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Intraosseous Infiltration of Platelet-Rich Plasma for Knee Osteoarthritis
Dr. Vishnu's own published research on PRP for knee osteoarthritis, the direct basis for this page's honest framing of where PRP evidence stands.
30+ peer-reviewed publications · 450+ citations · H-index 13 · View all research
Non-surgical care, answered honestly
Can knee or hip arthritis be cured without surgery?
Worn cartilage does not grow back, so arthritis itself cannot be reversed by any injection or medicine. What non-surgical treatment can genuinely do is control pain, keep the muscles around the joint strong, and keep you active, often for years. For many people with early or moderate arthritis, that is enough to live well without an operation.
How long does a corticosteroid injection last?
Relief varies from person to person. Many patients get weeks to a few months of reduced pain, which is most useful for settling a painful flare or getting through an important period. Steroid injections do not slow the arthritis itself, and we deliberately limit how often they are repeated. If a joint keeps needing injections to stay comfortable, that is a signal to reassess the overall plan.
Is PRP effective for knee arthritis?
The honest answer is that the evidence is still evolving. Some studies suggest PRP can improve pain and function in early knee arthritis, while others show little benefit over simpler options, and international guidelines differ on it. I offer PRP after a frank discussion of what it may and may not do for your particular joint, and I will tell you plainly if I think it is not worth your money.
How do I know when it is time to consider surgery?
The pattern I look for is pain that limits your walking, disturbs your sleep, or stops daily activities despite a proper trial of non-surgical care, along with X-rays that show advanced joint damage. Surgery is a shared decision made over one or more consultations, never a snap judgement. Many of my patients continue non-surgical care for years first; others with severe damage benefit from surgery sooner.
Do I have to try every non-surgical option before surgery?
No. The right sequence depends on the stage of your arthritis, your symptoms, and your goals. Someone with early arthritis should rarely be discussing surgery, while someone with bone-on-bone damage and severe daily pain should not be pushed through every injection first. What matters is an honest assessment of which treatments have a realistic chance of helping you.
This page is for education only. It is not a diagnosis or a treatment plan, and it does not replace an examination. Your plan is made with you in the OPD, based on your joint, your X-rays, and your goals.