If you’re dealing with knee or hip pain, stiffness, and reduced mobility making your daily activities difficult, you’ve likely wondered: Should I try physical therapy as an alternative arthritis treatment, or is it time for surgery? What might be the underlying cause?
Arthritis can be the culprit behind it, affecting millions worldwide. Your level of discomfort, joint function, and personal objectives will determine the response. A number of variables, such as age, lifestyle, general health, and the intensity of symptoms, influence the best course of action. Based on research and actual results, this guide explains when each treatment is most effective.
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What Is Knee and Hip Arthritis?
Knee and Hip Arthritis refers to the inflammation and degeneration of the joints in the knee and hip, or, in simple words, a “wear and tear” condition where the cartilage cushioning your joints breaks down over time, leading to pain, stiffness, and reduced mobility. It is a common condition, especially in older adults, but can also affect younger individuals due to injury or other factors.
Types of Arthritis Affecting the Knee and Hip:
1. Osteoarthritis (OA) – "Wear-and-Tear" Arthritis
Osteoarthritis (OA) is the most common form of arthritis, characterized by the progressive breakdown of joint cartilage or when the cushioning between your joints (called cartilage) leads to pain, stiffness, and reduced mobility. Think of it like this:
Imagine the joints in your body are like hinges on a door. If the oil (cartilage) runs out, the metal parts (bones) scrape against each other. That’s what happens in osteoarthritis.
It primarily affects weight-bearing joints like the knees, hips, spine, and hands. It is the most common type, caused by cartilage breakdown over time.
Causes & Risk Factors:
- Aging—most common in people over 50.
- Obesity.
- Joint overuse (repetitive movements, sports injuries, or workers with prolonged standing).
- Genetics—family history of OA.
- Previous joint injuries—e.g., ACL tear, fractures.
Symptoms (Knee & Hip):
- Deep, aching pain that gets better with rest and gets worse with action.
- Stiffness in the morning (lasts more or less than 30 minutes ).
- Soreness and swelling around the joint.
- Crepitus: a clicking or grinding sound.
- Decreased mobility—it is difficult to walk, lift a leg, or bend a knee.
Diagnosis:
- Physical exam shows joint tenderness, swelling, range of motion.
- X-rays showing cartilage loss, bone spurs.
- MRI to be done for detailed soft tissue imaging.
- Joint fluid analysis to rule out infection/gout.
2. Rheumatoid Arthritis (RA)—Autoimmune Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disease where the immune system mistakenly attacks the synovium (lining of the joints), causing pain, swelling, stiffness, and eventual joint damage. Unlike osteoarthritis (OA), which is due to wear and tear, RA involves systemic inflammation and can affect multiple organs.
Causes & Risk Factors:
- Autoimmune disorder: the body attacks its own joints.
- More likely among women aged 30 to 50.
- Genetics—having a family history increases your risk.
- Environmental and smoking-related triggers.
Symptoms (Knee & Hip):
- Symmetrical joint pain affects both knees/hips.
- Morning stiffness (>1 hour).
- Swelling, warmth, redness.Fatigue & fever.
- Joint deformities (if untreated, e.g., "knock knees").
Diagnosis of Rheumatoid Arthritis:
Blood Tests:
- Rheumatoid factor (RF) can be positive in ~70-80% of cases.
- Anti-CCP antibodies (more specific for RA).
- Elevated ESR & CRP (markers of inflammation).
Imaging:
- X-rays show joint erosion in later stages.
- MRI/Ultrasound may help in detecting early synovitis.
Physical Exam:
- Swelling, tenderness, and limited mobility in multiple joints.
3. Post-Traumatic Arthritis (PTA)
Post-traumatic arthritis (PTA) is a form of secondary osteoarthritis that develops after an acute joint injury (e.g., fracture, dislocation, ligament tear). It occurs due to mechanical damage to the joint cartilage, leading to progressive degeneration, pain, and stiffness.
Causes & Risk Factors:
- Previous knee/hip injuries (e.g., ACL tear, meniscus damage, hip dislocation).
- Misaligned joints after trauma.
- Repetitive stress in cases of athletes, laborers, etc.
Symptoms:
- Similar to OA but starts years after injury.
- Pain, swelling, and instability in the affected joint.
Diagnosis:
- Medical History includes previous joint injury.
- Physical Exams may show tenderness, swelling, and limited mobility.
- Imaging:
- X-rays help to rule out narrowed joint space and bone spurs.
- MRI may evaluate cartilage, ligaments, soft tissue damage.
- A CT scan is to be done for complex fractures.
4. Psoriatic Arthritis (PsA)
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that affects some patients who have psoriasis, an autoimmune skin illness. It affects the joints, tendons, and ligaments, causing pain, swelling, and stiffness that, if left untreated, can result in joint damage.
Symptoms :
| Joint Symptoms | Skin & Nail Symptoms | Systemic Symptoms |
| Pain, swelling, and stiffness—often in fingers, toes, knees, and spine. | Psoriasis plaques (scaly, red patches on elbows, knees, scalp). | Fatigue—commonly due to chronic inflammation. |
| Asymmetric or symmetric joint involvement. | Nail changes (pitting, ridges, separation from nail bed). | Eye inflammation—uveitis, conjunctivitis. |
| Dactylitis—whole fingers or toes swelling. | Increased cardiovascular risk. | |
| Enthesitis—heel pain, Achilles tendonitis. | ||
| Spinal involvement |
Diagnosis:
- Clinical Exam shows joint swelling, psoriasis, nail changes.
- Imaging:
- X-rays can rule out joint erosion, "pencil-in-cup" deformity in severe cases.
- MRI/Ultrasound -detects early inflammation, enthesitis.
- Blood Tests:
- Negative RF & anti-CCP -helps rule out rheumatoid arthritis.
- Elevated CRP/ESR -indicates inflammation.
Also read the informative blog on top 10 orthopedic hospitals in india.
5. Avascular Necrosis (Osteonecrosis)
Avascular necrosis (AVN), also called osteonecrosis, is the death of bone tissue due to a loss of blood supply, leading to bone collapse, joint damage, and arthritis. It most commonly affects the hip (femoral head) but can also occur in the knee, shoulder, and jaw.
Causes & Risk Factors:
- Trauma (Disrupted Blood Flow):
- Hip fractures/dislocations -can damage to femoral head blood supply.
- Radiation therapy - can damage blood vessels.
- Non-Traumatic (Medical Conditions):
- Corticosteroid overuse -long-term, high-dose steroids.
- Excessive alcohol use -impairs blood flow.
- Sickle cell disease -blocked blood vessels.
- Autoimmune diseases (e.g., lupus) -vasculitis or steroid use.
- Decompression sickness ("the bends" in divers).
Other Risk Factors: Chemotherapy, HIV, pancreatitis, Gaucher’s disease.
Symptoms:
| Early stage | Later stage |
| Mild joint pain (especially with weight-bearing). | Severe, constant pain (even at rest). |
| Stiffness, reduced range of motion. | Joint deformity, difficulty walking (if hip/knee is affected). |
| Secondary osteoarthritis develops. |
Diagnosis: Imaging
- X-ray -late-stage: shows bone collapse, joint space narrowing.
- MRI -gold standard for early detection—shows bone edema before structural damage.
- CT scan gives a detailed bone structure assessment.
- Bone scan -less common, detects metabolic activity.
When to Start with Physical Therapy
Physical therapy (PT) is the first-line treatment or alternative arthritis treatment recommended for most people with mild to moderate arthritis, severity of symptoms, and individual patient needs.
1. Early-Stage Arthritis treatment and management (Mild Pain, Minimal Joint Damage)
When to Start: As soon as diagnosis is confirmed.
Goals:
- Slow disease progression
- Improve joint mobility
- Strengthen muscles to reduce joint stress
- Prevent stiffness and maintain function
2. Moderate-Stage Arthritis treatment and management (Increasing Pain, Mild to Moderate Joint Damage)
When to Start: Before pain becomes severe or when daily activities are affected.
Goals:
- Reduce pain and inflammation
- Improve joint stability
- Maintain/restore functional mobility
- Delay surgical intervention
3. Advanced-Stage Arthritis treatment and management (Severe Pain, Significant Joint Damage)
When to Start:
- Pre-surgery: To optimize strength and mobility before joint replacement.
- Post-surgery: As early as 24–48 hours after surgery (if cleared by the surgeon).
Goals:
- Pre-surgery physical therapy improves outcomes of surgery.
- Post-surgical rehabilitation helps restore function and prevent complications.
Benefits of Physical Therapy:
Arthritis can be treated through exercises for hip and knee, which helps-
- Strengthens the muscles to support the joint
- Increases range of motion
- Lessens inflammation and joint stress
- Could postpone or avoid surgery
- Improved Capacity for Function
- Decreased Inflammation and Swelling Improved Body Mechanics and Posture
What the Research Says:
A 2020 study in The New England Journal of Medicine showed that physical therapy was as effective as corticosteroid injections in reducing pain and improving function for knee osteoarthritis.
When Surgery Might Be the Right Choice
Surgery can be the next course of action if conservative measures fail to reduce symptoms and arthritis becomes a daily burden.
Usually, surgery is considered when:
- Pain is severe or persistent.
- Joint function is greatly diminished.
- Advanced cartilage loss is seen on X-rays.
- You've tried physical therapy, injections, and meds, but to no avail.
Most Common Arthritis Treatment through Surgery:
- Total knee replacement
- Total hip replacement
- Partial (unicompartmental) replacement
Did You Know?
Total joint replacements have a 90–95% success rate at 10 years and significantly improve quality of life for people with severe arthritis.
Top Hospitals in India for Arthritis Treatment
Joint Replacements for Arthritis Treatment
A Life-Changing Solution for Pain Relief
Joint replacement surgeries are performed to relieve pain and restore function in severely damaged joints, typically due to arthritis (osteoarthritis, rheumatoid arthritis), trauma, or avascular necrosis. The three most common types are Total Knee Replacement (TKR), Total Hip Replacement (THR), and Partial (Unicompartmental) Knee Replacement.
1. Total Knee Replacement (TKR)
What is it? A surgical procedure in which prosthetic components are used to replace the complete knee joint (Total Knee Arthroplasty). Artificial components composed of metal alloys, premium polymers, and polymers are used to replace the injured bone and cartilage from the patella (kneecap), tibia (shin bone), and femur (thigh bone).
Indications (When It’s Needed)
- Severe osteoarthritis
- Rheumatoid arthritis or other inflammatory joint diseases
- Post-traumatic arthritis—after a knee fracture or injury
- Advanced knee deformity like bowleg or knock-knee
- Failure of previous knee surgeries e.g., partial replacement
Recovery & Rehabilitation
- Hospital Stay: 2-3 days.
- Physical Therapy: Starts immediately, with walking aids (walker/cane) for 4–6 weeks.
- Full Recovery: 3–6 months (may take up to a year for full strength).
- Success Rate: Over 90% of implants last 15–20 years.
Also Check: Total Knee Replacement Cost in India
2. Total Hip Replacement (THR)
What is it? A procedure where the damaged femoral head (ball) and acetabulum (hip socket) are replaced with prosthetic implants (Total Hip Arthroplasty). The new joint consists of Metal or ceramic ball (attached to a stem in the femur) and Plastic, metal, or ceramic socket (fitted into the pelvis).
Indications
- Advanced osteoarthritis (most common).
- Rheumatoid arthritis or ankylosing spondylitis.
- Hip fractures (especially in elderly patients).
- Avascular necrosis (bone death due to poor blood supply).
- Failed previous hip surgeries.
Recovery & Rehabilitation Hospital Stay:
- 2-3 days (sometimes in a 1-day discharge).
- Walking: Patients often walk with assistance within 24 hours.
- Physical Therapy: Crucial for regaining strength (6–12 weeks).
- Full Recovery: 3–6 months (some restrictions on high-impact activities).
- Success Rate: 95% last 15+ years.
Also Check: Total Hip Replacement Cost in India
3. Partial (Unicompartmental) Knee Replacement
What It Is? A less invasive option to total knee replacement (TKR) that preserves healthy bone and ligaments by replacing only the injured portion of the knee (one of the three compartments).
Types of Partial Knee Replacements
- Medial Unicompartmental (most common, inner knee).
- Lateral Unicompartmental (outer knee).
- Patellofemoral Replacement (kneecap and groove only).
Indications
- Arthritis confined to one compartment of the knee.
- Intact ligaments (especially ACL).
- Minimal knee deformity.
- Younger, more active patients (though not always)
Recovery & Rehabilitation
- Faster recovery than TKR .
- Walking without aids in 2–4 weeks.
- Full recovery in 4–6 weeks.
- Higher activity levels possible compared to TKR.
Top Joint Replacement Surgeons for Arthritis Treatment
All in all, the type of arthritis, the stage of arthritis, and the body part affected by the arthritis determine which line of treatment is required: either Physical Therapy or Surgery.
How HOSPIDIO Supports You?
At HOSPIDIO, our specialty is putting patients in contact with India's best joint replacement hospitals. We make your journey easier and less stressful by organizing transport, lodging, and appointments in addition to assisting you in understanding your treatment choices.
Whether you're from India or abroad, HOSPIDIO ensures:
- Access to hospitals accredited by JCI and NABH
- Clear direction and cost estimates
- Complete assistance throughout the recovery and treatment process
- Coordination of follow-up after discharge
Surgery vs. Physical Therapy: Quick Comparison
| Factor | Physical therapy | Surgery |
| Pain Level | Mild to moderate | Severe |
| Invasiveness | Non-invasive | Invasive |
| Recovery Time | Weeks- Months | Months |
| Cost | Lower | Higher |
| Longevity of Results | Temporary relief | Long-term improvement |
| Risk | Low | Low- Moderate |
How to Decide: Factors to Discuss with Your Doctor
- How bad is the pain — daily, or only with activity?
- Is your mobility getting worse despite therapy?
- Are you missing out on activities or work?
- Do you have underlying health issues that increase surgical risk?
References:
American Academy of Orthopaedic Surgeons (AAOS). Joint Replacement Surgery.
Dr. Basim Parvez
Author
Dr. Basim Parvez is a licensed physiotherapist and Senior Patient Consultant at HOSPIDIO, holding an MBA in Health Management. With extensive clinical experience and a compassionate approach, he assists patients navigating medical treatments. Dr. Basim also leverages his writing talent to simplify complex healthcare information, empowering patients to make informed decisions and fostering clarity and confidence in their medical journeys.
Sasmita
Reviewer
Sasmita is a Marketing Specialist at Hospidio, a leading medical travel company. With expertise in Google Ads, Facebook Ads, and SEO, she plays a pivotal role in driving international leads for healthcare services in India. In addition to her digital marketing prowess, Sasmita is passionate about creating informative and research-based content. She writes extensively about treatment options available in India, the leading hospitals, and the surgeons that provide specialized care. Her blog posts also explore into new medical technologies and breakthroughs in the healthcare field, with the aim of educating international patients on the benefits of traveling to India for medical treatment.