The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Arthritis & Joint Preservation

What is arthritis & joint preservation?

Osteoarthritis is the most common form of arthritis, affecting an estimated 32.5 million adults in the United States and representing one of the leading reasons patients seek orthopedic care. At Maryland Orthopedic Specialists, our board-certified orthopedic physicians take a joint-preservation-first philosophy: before any surgical option is discussed, we systematically explore every appropriate conservative, minimally invasive, and biologic treatment.

Understanding Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterized by the gradual breakdown of articular cartilage — the smooth, protective tissue that covers the ends of bones and allows joints to move freely and without pain. As cartilage wears away, the joint space narrows and bone surfaces begin to come into closer contact, leading to the hallmark symptoms of osteoarthritis: joint pain that worsens with activity and improves with rest, morning stiffness that generally resolves within 30 minutes, intermittent swelling or warmth around the joint, and a sensation of grinding or crepitus with movement. Over time, bony outgrowths called osteophytes may form at the joint margins, further contributing to stiffness and discomfort. Osteoarthritis is most strongly associated with advancing age, prior joint injury, repetitive occupational or athletic loading, obesity, and genetic predisposition. The joints most commonly affected include the knee, hip, shoulder, base of the thumb (CMC joint), and the small joints of the hand, though OA can develop in virtually any joint in the body. While there is currently no cure that reverses established OA, a great deal can be done to manage symptoms effectively, protect remaining cartilage, and maintain an active, fulfilling quality of life.

Our Joint Preservation Philosophy

The Staged Approach to Arthritis Care

At Maryland Orthopedic Specialists, we use a structured, stepwise approach to arthritis management — a care ladder that ensures each patient receives the most appropriate intervention for their stage of disease. We begin with the least invasive options and advance only when clinically indicated, in full partnership with the patient.

  1. Activity Modification, Weight Management & Anti-Inflammatory Diet Counseling

Reducing mechanical load on arthritic joints through activity modification and healthy weight management is among the most impactful steps a patient can take. Our physicians provide personalized guidance on exercise selection, impact reduction strategies, and dietary approaches that support joint health, including anti-inflammatory nutrition principles. For every pound of body weight lost, the load on the knee joint decreases by approximately four pounds — making even modest weight reduction clinically meaningful.

  1. Physical Therapy & Occupational Therapy (On-Site)

Strengthening the muscles that support an arthritic joint reduces the mechanical burden on cartilage and improves joint stability. Our on-site physical therapists at Bethesda and Germantown develop individualized programs targeting strength, flexibility, proprioception, and functional movement. Occupational therapy is also available for patients whose arthritis affects hand and wrist function, enabling them to perform daily activities with less pain and greater ease.

  1. Bracing and Orthotics

Offloading braces for knee osteoarthritis can redistribute compressive forces away from the most affected compartment, providing meaningful pain relief without medication or injections. Custom orthotics for the foot and ankle can similarly alter lower extremity loading patterns to reduce joint stress. Our team will assess whether bracing or orthotics are appropriate as part of your overall care plan.

  1. Joint Injection Therapy (Corticosteroid & Viscosupplementation)

When symptoms persist despite physical measures, in-office joint injection therapy is often the next step. Corticosteroid injections provide rapid anti-inflammatory relief during acute flares, while hyaluronic acid (viscosupplementation) injections restore lubrication and cushioning to the joint, particularly in knee osteoarthritis, and are FDA-approved for this indication. Both are performed under ultrasound guidance in our offices for optimal accuracy.

  1. Platelet-Rich Plasma (PRP) Therapy

For patients who have had limited or short-lived benefit from cortisone, or who wish to take a more regenerative approach, PRP therapy offers a biologic option with a growing evidence base. PRP harnesses the healing potential of your own blood's growth factors to address the underlying degenerative process — not just the symptoms. It is particularly well-studied and clinically supported for knee osteoarthritis, where multiple randomized controlled trials have demonstrated its superiority over hyaluronic acid and placebo.

  1. Minimally Invasive Surgical Intervention

In carefully selected patients, minimally invasive joint preservation surgery may be an appropriate option before joint replacement is considered. This includes arthroscopic procedures to address mechanical symptoms (loose bodies, unstable tissue), osteotomy to correct alignment and redistribute load away from damaged cartilage, and cartilage restoration techniques for focal defects. These procedures are performed by our orthopedic surgeons with the goal of extending the functional life of the native joint.

  1. Joint Replacement Consultation (Referred as Needed)

When all appropriate joint preservation measures have been exhausted and a patient's quality of life is significantly impaired by advanced arthritis, joint replacement surgery may be the most appropriate path. In those cases, we provide a thorough, transparent discussion about what to expect, and we coordinate referral to a joint replacement specialist. Our goal is always to ensure that surgery is recommended for the right patient at the right time — not prematurely and not unnecessarily delayed.

Conditions We Treat

Our arthritis and joint preservation specialists manage a comprehensive range of arthritic and degenerative joint conditions, including:

  • Knee osteoarthritis — the most commonly treated arthritic condition; ranging from early-stage cartilage loss to bone-on-bone disease
  • Hip osteoarthritis — groin pain, reduced internal rotation, and stiffness limiting walking and daily activities
  • Shoulder arthritis (glenohumeral) — degenerative changes of the ball-and-socket joint causing deep shoulder pain and restricted range of motion
  • Thumb / CMC joint arthritis — basal joint arthritis causing pain at the base of the thumb with gripping, pinching, and twisting
  • Ankle arthritis — post-traumatic or primary OA causing pain, stiffness, and difficulty walking or ascending stairs
  • Elbow arthritis — loss of terminal extension and flexion with activity-related pain, often post-traumatic in origin
  • Inflammatory arthritis (managed in coordination with rheumatology) — rheumatoid arthritis, psoriatic arthritis, and related conditions managed in partnership with rheumatology for comprehensive care
  • Post-traumatic arthritis — arthritis developing in a joint after prior fracture, dislocation, or ligament injury — a common long-term consequence of significant musculoskeletal trauma

What Makes Osteoarthritis Treatment at Maryland Orthopedic Specialists Different

A Full Spectrum of Care in One Practice From the first appointment through rehabilitation, the majority of the arthritis care ladder can be completed within Maryland Orthopedic Specialists — without the need to navigate multiple specialists across different health systems. Our physicians, physical therapists, and injection specialists work together under one roof, ensuring seamless communication, consistent clinical oversight, and a coordinated approach to your care.

Advanced Biologic Options Including PRP We offer evidence-based regenerative therapy as part of our standard arthritis care toolkit — not as an upsell, but as a clinically appropriate option for the right patients. Our PRP program is grounded in the peer-reviewed literature and delivered with ultrasound guidance for precision. Patients can expect an honest conversation about realistic outcomes based on their specific stage of disease.

On-Site Physical Therapy Physical therapy is not an afterthought in our practice — it is a core component of every arthritis care plan. Our licensed physical therapists at Bethesda and Germantown are integrated into the clinical team, enabling real-time collaboration between physician and therapist. Patients benefit from programs that evolve with their progress, supported by direct physician oversight and clear milestones.

Transparent Conversations About Surgery We believe patients deserve an honest, evidence-based conversation about when joint replacement surgery is — and is not — the right answer. At Maryland Orthopedic Specialists, we do not rush patients toward surgery, and we do not withhold it when it is genuinely needed. You will always understand the reasoning behind our recommendations, the alternatives considered, and realistic expectations for each path forward.

Frequently Asked Questions

What is the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis and rheumatoid arthritis are both forms of arthritis but have fundamentally different causes, patterns, and treatments. Osteoarthritis is a degenerative disease driven by mechanical wear and cartilage breakdown — it typically affects older adults and is most prominent in weight-bearing joints like the knee and hip. Rheumatoid arthritis (RA) is an autoimmune disease in which the body's immune system attacks the synovial lining of joints, causing inflammation, pain, and progressive joint damage. RA tends to present symmetrically, often affecting smaller joints such as the hands and wrists first, and can occur at any age. While an orthopedic specialist can evaluate and manage the musculoskeletal manifestations of both conditions, rheumatoid arthritis is primarily managed by a rheumatologist with disease-modifying medications. Maryland Orthopedic Specialists works collaboratively with rheumatology for patients with inflammatory arthritis requiring dual management.
Can osteoarthritis be reversed?
At this time, there is no treatment that reverses the structural cartilage loss of established osteoarthritis. However, the disease can often be managed very effectively — symptoms can be significantly reduced, functional capacity can be maintained or improved, and disease progression can be slowed with appropriate treatment. For small, focal cartilage defects (particularly in younger patients), certain cartilage restoration procedures may repair localized damage. The most important steps are early recognition, activity and weight management, and consistent engagement with an evidence-based care plan. Do not accept a "nothing can be done" message — there is a great deal that can be done to improve your quality of life with osteoarthritis.
How do I know if I need a joint replacement for arthritis?
Joint replacement is generally considered when a patient has advanced osteoarthritis that has caused significant, persistent pain and functional limitation despite a comprehensive trial of conservative measures — including physical therapy, injections, activity modification, and biologic therapy. Imaging showing severe joint space narrowing or bone-on-bone changes is typically required. Equally important is the patient's subjective experience: if arthritis is meaningfully limiting your ability to walk, sleep, work, or participate in activities that matter to you, and conservative measures are no longer providing adequate relief, it may be time to have a candidacy discussion. Our physicians will give you an honest, unbiased evaluation of whether you are at that threshold.
What is viscosupplementation and does it work?
Viscosupplementation is the injection of hyaluronic acid — a naturally occurring component of healthy synovial fluid — into an arthritic joint, most commonly the knee. The goal is to restore the viscous, lubricating quality of joint fluid that is diminished in osteoarthritis, reducing friction and improving joint mechanics. Viscosupplementation is FDA-approved for knee osteoarthritis and is typically administered as a series of one to five injections. The evidence is mixed — some studies show meaningful benefit while others show modest or no benefit compared to placebo — and patient response varies. In our clinical experience, viscosupplementation works best in patients with mild-to-moderate knee OA who have had limited duration of benefit from cortisone and who are not yet candidates for PRP or surgery. We provide a candid, evidence-based assessment of whether it is a reasonable option for you.
Is walking good or bad for knee osteoarthritis?
Walking is generally beneficial for knee osteoarthritis and is recommended by virtually all major orthopedic and rheumatology guidelines. Regular low-impact aerobic activity strengthens the muscles that support the knee, helps maintain healthy body weight, promotes synovial fluid circulation that nourishes cartilage, and has well-documented benefits for pain and function. Walking does not wear out the knee faster. However, the type, intensity, and duration of walking should be appropriate to your current symptom level — starting with shorter, flatter walks and progressing gradually is a sensible approach. High-impact activities such as running or jumping on hard surfaces may be less well-tolerated in advanced arthritis. Our physical therapists and physicians will help you develop an activity plan that supports your joints while keeping you moving.
What is the best injection for knee osteoarthritis?
This is one of the most common questions we receive, and the honest answer depends on where you are in the disease course and what you have tried before. For an acute inflammatory flare, a corticosteroid injection often provides the fastest relief. For patients with mild-to-moderate OA who have exhausted or wish to avoid cortisone, PRP has the strongest current evidence base for durable benefit — multiple randomized controlled trials have found PRP superior to both hyaluronic acid and placebo for pain and function over 6 to 12 months. Hyaluronic acid (viscosupplementation) is a reasonable intermediate option for patients who are not candidates for PRP or who prefer a non-biologic approach. There is no single "best" injection for all patients; our physicians will recommend the most appropriate option based on your clinical history, imaging, and goals.
Medically reviewed by Christopher S. Raffo, MD
Last reviewed May 1, 2026

References

  1. American Academy of Orthopaedic Surgeons (AAOS). orthoinfo.aaos.org