Shoulder and knee pain during sports: When does conservative therapy help and when is joint replacement useful?

Sport keeps us fit, strengthens the cardiovascular system, and provides the necessary balance in daily life. However, with increasing age or years of intense strain, joints often send warning signals. Shoulder and knee pain, in particular, are common complaints among physically active adults. When do these pains warrant a visit to an orthopedist, and when does joint replacement (prosthesis) truly become a consideration? 
This guide by Senior Physician Dr. Markus Riedl illuminates the causes, outlines treatment paths, and clarifies the crucial question: When is the right time for a prosthesis?
 
<h2>1. The Knee Joint: Stress and Wear in Sports</h2>
In sports like running, tennis, soccer, or skiing, the knee bears many times our body weight. It is exposed to extreme impact and shear forces. 
 
Common Complaints During Sports
<ul>
<li>Start-up pain: The knee feels stiff in the morning or before exercise and only “warms up” after a few minutes.</li>
<li>Load-dependent pain: Pain occurs directly during squats, when walking downhill, or after a long jog.</li>
<li>Resting pain and swelling: The joint becomes hot, swells, or even hurts at night after exercise.</li>
</ul>
 
The Causes: From Meniscus to Osteoarthritis 
Acute pain is often due to overuse of tendon insertions (e.g., patellar tendinopathy) or meniscal damage. However, if the complaints become chronic and occur independently of the sport, the cause is usually the gradual wear and tear of the joint cartilage – gonarthrosis. 
 
 
<h2>2. The Shoulder: Mobility vs. Stability</h2>
Unlike the knee, the shoulder is a purely muscle-tendon-secured joint with an enormous range of motion. It is particularly challenged during strength training, swimming, volleyball, or tennis. 
 
Common Complaints During Sports
<ul>
<li>Impingement syndrome: A stabbing pain when lifting the arm sideways (often between 60° and 120°), caused by narrowing under the shoulder roof.</li>
<li>Rotator cuff lesion: Weakness and pain during overhead work or throwing movements, often due to small tears in the tendons.</li>
<li>Shoulder osteoarthritis (omarthrosis): A deep, dull, persistent pain that increasingly restricts the arm’s mobility in all directions.</li>
</ul>
 
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<h2>3. The Path of Therapy: Conservative Before Operative</h2>
The most important principle in modern orthopedics is: A prosthesis is always at the end of the therapeutic path. Before considering surgery, all conservative options must be exhausted.
<ul>
<li>Physiotherapy & targeted muscle strengthening: Strong muscles relieve the joint. Targeted training of the thigh muscles stabilizes the knee; training of the rotator cuff centers the humeral head in the shoulder socket. </li>
<li>Medication therapy: Temporary treatment with anti-inflammatory painkillers (non-steroidal anti-inflammatory drugs, NSAIDs) and, if necessary, local infiltrations (e.g., with cortisone, hyaluronic acid, or autologous conditioned plasma (ACP)) for pain relief, improved joint function, and – depending on the indication – to support cartilage regeneration. </li>
<li>Change of sport: Temporarily replace impact-heavy sports (stop-and-go sports) with joint-friendly alternatives such as cycling, aqua jogging, or crawl swimming.</li>
</ul>
 
 
<h2>4. When Do I Need a Prosthesis? The Decisive Criteria </h2>
The diagnosis of “osteoarthritis” on an X-ray alone is not a reason for an artificial joint. A prosthesis (knee TEP or shoulder TEP) becomes relevant when the quality of life is severely and permanently restricted. 
 
The following questions serve as decision-making aids:
<ul>
<li>Have conservative measures been exhausted? If physiotherapy, injections, and medication no longer provide significant relief over several months.</li>
<li>Is there permanent resting pain? If the pain regularly wakes you up at night and destroys your sleep quality.</li>
<li>Is daily life severely restricted? If short walks, climbing stairs, or putting on a jacket become agony.</li>
<li>How high is the level of suffering? If giving up movement and social activities leads to a significant loss of joy in life.</li>
</ul>
 
State-of-the-art implants and minimally invasive surgical techniques now enable patients, after successful rehabilitation and an appropriate healing phase, to often resume joint-friendly sports (such as hiking, cycling, or golf) pain-free.
 
 
<h2>Conclusion and Recommendation</h2>
You should not ignore pain during sports or permanently “suppress” it with painkillers. It is a warning signal from the body. The earlier causes such as malpositioning or cartilage damage are identified, the better wear and tear can be halted. A prosthesis is no cause for fear, but a proven step back to an active, pain-free life – but only when your own joint no longer allows you pain-free spaces in everyday life. 
Seek an early consultation with a specialist if you have persistent complaints to create your individual treatment plan.