Some knee changes shouldn’t wait for another round of care

More care makes sense only when something changes

A new round may change the exercise, brace, medicine, or knee care. Repeating care that didn't help may delay a better choice. Ask exactly what will be different this time. You'll also need a date to check the result.

QC Kinetix can examine your knee without planning surgery

Joint preservation means trying to keep the knee working without replacement surgery. Regenerative treatments at QC Kinetix use a prepared part of your blood for clinic care. Concentrated PRP means platelet-rich plasma made by spinning a blood sample. A medical provider uses the platelet portion for a shot into your knee.

The visit begins with an exam and a review of earlier care. Ask what the exam shows and why the knee shot may help with walking. If the care isn't right for your knee, ask what to do next. You deserve an answer that names the next type of care.

Some symptoms can't wait for a planned visit

Fever with knee heat, redness, and swelling needs prompt medical help. Get quick attention if an injury leaves you unable to stand. Warmth or swelling in the calf also needs a fast exam. Don't wait for a planned consultation when these warning signs appear.

Surgery may be reasonable when daily tasks keep shrinking

Discuss surgery when good care hasn't stopped chores from getting harder. The operation has risks, and recovery takes work. A surgeon can explain those risks using your exam and scans. Waiting isn't safer when there is no clear reason to wait.

Sources

1. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

2. Pooling the OAI and MOST cohorts (8,002 participants followed up to 8 years, 3,417 classifiable knees), validated appropriateness criteria classified only 290 knees (8%) as receiving a TIMELY total knee replacement, 2,833 knees (83%) as potentially appropriate but not replaced more than 2 years after replacement became appropriate, and 294 knees (9% of all knees, 26% of the 1,114 replacements actually performed) as PREMATURE. Of the potentially-appropriate-but-not-replaced knees, 1,204 (42.5%) had severe symptoms.

   Ghomrawi HMK, Mushlin AI, Kang R, et al. — Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts.. Journal of Bone and Joint Surgery (American), 2020. DOI: 10.2106/JBJS.19.00432.

3. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

4. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.

5. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing for tibiofemoral knee OA, topical NSAIDs for knee OA, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA. Radiofrequency ablation for knee OA, acupuncture, thermal modalities, acetaminophen, duloxetine and tramadol are only CONDITIONAL recommendations.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

6. At 10 years, TOPKAT found no clinically meaningful difference between partial and total knee replacement in Oxford Knee Score (mean difference 0.27, 95% CI -1.59 to 2.13). Complications by treatment received were 53/245 (22%) for partial versus 74/270 (27%) for total; reoperations including revision were 9% in both arms; revisions were 15 (6%) versus 11 (4%). Partial replacement was more cost-effective, with lower healthcare costs (mean difference -GBP 731, 95% CI -1352 to -110).

   Beard DJ, Davies LJ, Cook JA, et al. — Assessing clinical and cost effectiveness of total versus partial knee replacement (TOPKAT): 10-year follow-up of a multicentre, randomised controlled trial.. The Lancet Rheumatology, 2026. DOI: 10.1016/S2665-9913(25)00250-4.