Question: I am a 74-year-old man with very sore left knee that swells at times. I’m trying to delay having joint replacement surgery. What do you recommend for the pain and to keep swelling down?

Dr. Hibberd’s answer:

I would expect you be screened for other causes of mono-articular arthritis, and to be sure you do not have gout, crystalline, or infectious disease of your left knee, hip or foot/ankles.

Knee pain from loss of cartilage loss — a shock-absorbing tissue — often comes with age and overuse with advanced degenerative changes. It is best treated conservatively with Tylenol, weight loss, and physical therapy. Anti-inflammatories (such as ibuprofen) may be used, but be aware that they can cause gastrointestinal problems.

Recurrent pain can be relieved by joint injection of cortisone mixed with some local anesthetic for flare-ups of pain. Avoid oral cortisone use. There are agents we can inject into a knee that has lost protective cartilage that will stimulate new cartilage growth and even delay knee surgery. The newer stem cell treatments also appear to be very successful at regenerating cartilage growth. These treatments are worth your discussing with an orthopedic specialist before you agree to a knee replacement.

Total knee replacement should be considered a last choice. There is no going back after surgery, and operative and anesthesia risks need to be considered carefully.