Some warning signs need care sooner

Fast swelling, fever or lost strength needs prompt care

Major swelling right after an injury can mean more than a mild flare. A locked joint or sudden loss of strength calls for an exam. After a procedure, spreading redness, drainage or fever needs prompt care before the planned follow-up.

Night sweats, weight loss you can’t explain or steady night pain also deserve medical care. Tell the doctor about cancer or medicine that weakens your body’s defenses. Calf warmth and swelling after surgery or long travel can be serious, so don’t delay.

The visit starts with your account and a hands-on exam

The clinician first listens while you describe the sore spot and how the trouble began. Expect questions about falls, swelling, sleep, walking, earlier care and current medicines. Take an earlier X-ray report if you have one.

Next, the clinician checks movement, strength, swelling and tender areas by hand. An X-ray may help when arthritis or an injury is suspected. The clinician should tell you whether the cause is shown, only suggested or still unknown.

The next choice depends on what the exam finds

The exam may support more exercise, physical therapy or weight loss when extra weight strains the joint. A corticosteroid is the medicine often called cortisone. PRP means a blood treatment in which drawn blood is spun, leaving plasma with a higher platelet level.

Surgery may be discussed when joint damage is severe. Ask what is likely causing your soreness and what each choice may help. You’ll also want clear details about cost, driving, walking and exercise afterward.

Sources

1. The ESSKA-ORBIT European consensus on blood-derived orthobiologics graded 28 question-statement sets; only 9 of 28 had high-level scientific support. Three statements reached grade A: that there is enough preclinical and clinical evidence to support PRP use in knee OA; that clinical evidence shows effectiveness in MILD TO MODERATE knee OA (KL grade 3 or lower); and that PRP provides a longer effect than the short-term effect of corticosteroid with a safer profile. The panel regarded PRP as a valid and possible first-line injectable option for KL grades 1-3.

   Laver L, et al. — The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).. Knee Surgery, Sports Traumatology, Arthroscopy, 2024. DOI: 10.1002/ksa.12077.

2. The companion ESSKA-ORBIT consensus on cell-based therapy (77 experts, 22 countries, 27 statements) found only 5 of 27 statements reached recommendation level A or B; 22 were rated C or D. It concluded that cell-based therapy shows clinical benefit in pain and function up to 12 months for KL grades 1-3 with some benefit in selected KL 4, but that because of limited high-quality studies and NO clear superiority over other injectables it should be considered a SECOND-LINE option, after other non-operative treatment fails.

   de Girolamo L, et al. — The use of injectable orthobiologics for knee osteoarthritis: A formal ESSKA-ORBIT consensus. Part 2-Cell-based therapy.. Knee Surgery, Sports Traumatology, Arthroscopy, 2025. DOI: 10.1002/ksa.70001.

3. A meta-analysis of 6 RCTs (860 patients, 334 receiving BMAC) found overall complication rates of 41.91% for BMAC versus 41.25% for comparator injectables (P=0.85), with knee effusion the commonest BMAC complication at 18.26%. Early and late complication rates did not differ significantly from HA, steroids, PRP, SVF, MSC or saline. The number needed to harm for BMAC relative to other injections was 152.

   Fucaloro S, et al. — Complication rates of bone marrow aspirate concentrate injections versus other injectable therapies for knee osteoarthritis: A systematic review and meta-analysis.. Journal of Orthopaedics, 2025. DOI: 10.1016/j.jor.2024.10.005.

4. FDA states verbatim of stem cell products, stromal vascular fraction (adipose-derived cells), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

5. The 2025 Cochrane review of stem cell injections for knee osteoarthritis pooled 25 randomised trials (1,341 participants) and found that, compared with placebo injection, stem cell injection MAY slightly improve pain (1.2 points better on a 0-10 scale, 7 studies, 445 participants) and function (14.2 points better on a 0-100 scale, 7 studies, 432 participants) up to six months - both rated LOW-certainty evidence, downgraded for indirectness (cell source, preparation and dose varied across studies) and suspected publication bias, since up to three larger RCTs were conducted and withdrawn before reporting results. Radiographic progression was not assessed in any included study.

   Whittle SL, et al. — Stem cell injections for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2025. DOI: 10.1002/14651858.CD013342.pub2.