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Knee pain is an increasingly common presentation to general practitioners worldwide which is thought to be related to the obesity epidemic, an ageing population and increasingly sedentary lifestyles in more developed nations. Degenerative osteoarthritis (OA) accounts for the majority of presentations in older age groups and this has traditionally been treated with analgesia, lifestyle modifications and adjuncts such as physiotherapy, braces and insoles. All these therapies aim to delay the need of total knee replacement (TKR), which is often the end-point for severe knee OA. However, TKR is associated with poor levels of patient satisfaction, low functional outcomes and has recently been shown to have low levels of cost-effectiveness except in patients with severe disabling OA. Increasingly doctors are turning to intra-articular injections which can provide temporary pain relief such as corticosteroids, hyaluronic acid and platelet rich plasma. This article aims to review the current options for intraarticular injections, comment on their efficacy and suggest areas for future development.

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Osteoarthritis of the hip describes a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. Osteoarthritis may not be progressive and most patients will not need surgery, with their symptoms adequately controlled by non-surgical measures. The treatment of hip osteoarthritis is aimed at reducing pain and stiffness and improving joint mobility. Total hip replacement remains the most effective treatment option but it is a major surgery with potential serious complications. NICE guideline has suggested a holistic approach to management of hip osteoarthritis which includes both nonpharmacological and pharmacological treatments. The non-pharmacological treatments range from education ,physical therapy and behavioral changes ,walking aids .The ESCAPE( Enabling Self-Management and Coping of Arthritic Pain Through Exercise) rehabilitation programme for hip and knee osteoarthritis which integrates simple education, self-management and coping strategies, with an exercise regimen has shown to be more cost-effective than usual care. There is a choice of reviewed pharmacological treatments available, but there are few current reviews of possible nonpharmacological methods. This review will focus on the non-pharmacological and non-surgical methods.

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