Alternatives to Knee Replacement: My Honest Take on Each

Nobody wants a knee replacement if something else will do. Patients come to me having read about injections, nerve procedures, implants, and cartilage “regrowth,” and they want to know what’s real. Here is my honest take on each, in the order I actually use them.

What I recommend first

The simplest treatments are the most important ones, and most patients start here:

• Physical therapy to strengthen the muscles that support the knee.
• Medication, such as acetaminophen or an anti-inflammatory, when it’s safe for you. See arthritis medications.
• Bracing for support during activity.
• Activity changes and, where it applies, weight loss, which takes load off the knee with every step.

Injections

When the simple steps aren’t enough, injections are next.

• Cortisone: calms a flare quickly. Relief varies from person to person.
• Gel (hyaluronic acid): a lubricating injection for the knee, often covered by insurance.
• PRP: made from your own blood. I offer it for the right patient with mild to moderate arthritis. It doesn’t regrow cartilage, but it can help pain.

Not sure which fits? See my guide to injection options. If you’ve read about stem cell injections, I cover those in stem cell injections and other regenerative treatments.

Smaller surgeries

For arthritis mostly on one side of the knee, there are two proven options short of a total knee replacement:

• Knee osteotomy: the bone is cut and realigned so your weight shifts away from the worn side. It’s best suited to younger, active patients with the right alignment.
• Partial knee replacement: replaces only the worn part and keeps the rest of your own knee. For the right knee, it does the job, with decades of results behind it.

Wondering whether a scope can clean out an arthritic knee? Usually not; see do you need a knee scope?

Pain procedures

These quiet the pain signal from the knee. They don’t change the joint.

• Radiofrequency ablation (RFA): a needle uses heat to quiet the small nerves that carry pain from the knee. I sometimes send patients for it, usually for chronic pain, or when someone isn’t a candidate for surgery. The arthritis is still there, so I see it as a pain treatment rather than a long-term answer.
• Iovera (nerve freezing): uses cold instead of heat on the same kind of nerves. Some surgeons have used it before knee replacement to ease recovery. In my view, that hasn’t panned out the way people hoped.

Newer options I have concerns about

These get a lot of attention online. Each has its own page with my full reasoning:

• The knee spring (MISHA Knee System): a shock absorber screwed to the outside of the knee. Springs wear out, and a partial knee does that job better.
• The coral implant (CartiHeal Agili-C): a plug for a damaged spot of cartilage, placed during surgery. It isn’t a treatment for arthritis.
• Genicular artery embolization (GAE): blocks small blood vessels around the knee to reduce pain. It leaves the arthritis in place and is still being studied.

Anything that regrows cartilage?

Not in a knee with arthritis, whether it’s an injection, a gel, or a supplement. I explain why in can you regrow cartilage in your knee or hip?

When replacement is the answer

When the knee keeps limiting your life despite these treatments, a knee replacement is the lasting answer. It isn’t about a particular age or a single X-ray. For how to tell, see bone-on-bone knee: do I need surgery?

I see patients in Washington, D.C. and Germantown, Maryland. Request an appointment.

This article is general education and reflects my professional opinion. It isn’t advice about your specific knee.