Thank you for the great responses! My client is in the care of a doctor who tells her to walk, do Pilates, and that eventually she will need a replacement. His approach is to drain, give her a cort. shot occasionally, and just wait. She is one of those bullish people who wants to push through, which I believe is why she is in this shape-she pushed too hard too soon after surgery. She comes twice a week, and has benefited SO much, but it is getting harder.