Alternatives to Knee Replacement

With over 100,000 knee replacements performed annually in the UK, many patients seek alternatives to this major surgery. Whether you're too young for replacement, have medical conditions increasing surgical risk, or simply prefer avoiding surgery, understanding your options helps make informed decisions about knee pain management.

Why Consider Alternatives

Knee replacement, while often successful, carries inherent risks and limitations. Surgery requires general or spinal anaesthesia with associated risks. Recovery involves 3-6 months of rehabilitation. Infection occurs in 1-2 percent of cases, sometimes requiring removal of the prosthesis.

Artificial joints last 15-20 years on average, meaning younger patients face revision surgery. Activity restrictions after replacement may limit sports participation. Some patients experience persistent pain despite technically successful surgery.

These factors make joint preservation strategies particularly valuable for patients under 60, those with mild to moderate arthritis, and individuals wanting to maintain active lifestyles.

Platelet-Rich Plasma Therapy

PRP has emerged as a leading non-surgical option for knee arthritis. By concentrating healing factors from your own blood, PRP stimulates tissue repair and reduces inflammation. Multiple studies demonstrate superiority over steroid injections and hyaluronic acid.

A comprehensive review in the British Medical Journal analysed outcomes from 3,826 patients. Those receiving PRP experienced average pain reduction of 50 percent and functional improvement of 45 percent at one year. Effects typically last 12-24 months, with some patients maintaining benefits longer.

PRP works best for mild to moderate arthritis. Patients with bone-on-bone arthritis show limited response. The treatment involves 1-3 injections over several weeks, with improvement beginning around week 6 and peaking at 3-6 months.

Cost ranges from £500-£1,200 per injection in the UK. While not NHS-funded, the investment compares favourably to long-term costs of pain management or eventual surgery.

Stem Cell Therapy

Mesenchymal stem cells (MSCs) show promise for cartilage regeneration. These cells can differentiate into cartilage and release anti-inflammatory factors. Sources include bone marrow (requiring harvest procedure) and adipose tissue (from liposuction).

Current evidence remains mixed. Some studies show significant improvement, while others find minimal benefit beyond placebo. A 2023 systematic review found moderate evidence for pain reduction but limited evidence for actual cartilage regeneration.

UK regulations restrict stem cell treatments to clinical trials or specific licensed applications. Patients should be cautious of clinics offering unregulated stem cell treatments, particularly those requiring travel abroad.

Hyaluronic Acid Injections

Viscosupplementation involves injecting synthetic joint fluid to improve lubrication. While less effective than PRP, hyaluronic acid suits patients who cannot undergo PRP or prefer a non-biological option.

Modern high-molecular-weight formulations provide 6-12 months of relief in 60 percent of patients. The treatment involves 1-3 injections depending on the product used. Side effects are minimal, mainly temporary swelling.

NICE guidelines consider hyaluronic acid when conservative treatments fail and surgery isn't appropriate. Some private insurers cover this treatment, unlike PRP.

Genicular Nerve Ablation

This innovative procedure targets nerves transmitting pain signals from the knee. Using radiofrequency energy, specific nerves are disrupted, reducing pain without affecting joint structure or function.

Studies show 70-80 percent of properly selected patients experience significant pain relief lasting 6-12 months. The procedure can be repeated as nerves regenerate. It's particularly useful for patients with severe arthritis awaiting replacement or those unsuitable for surgery.

The procedure requires precise nerve identification using diagnostic blocks. Only patients responding to test injections proceed to ablation. Risks are minimal, mainly temporary numbness or weakness.

Physical Therapy and Exercise

Structured exercise remains fundamental to knee preservation. The ESCAPE-knee pain programme, developed by King's College London, shows exercise therapy can delay surgery by average 2-3 years.

Effective programmes combine quadriceps strengthening (critical for knee stability), flexibility work (maintaining range of motion), and proprioception training (improving joint position sense). Aquatic therapy reduces joint stress while building strength.

Studies show patients adhering to exercise programmes experience 30-40 percent pain reduction and improved function. Benefits require ongoing commitment but avoid intervention risks.

Weight Management

Every pound of body weight translates to 4 pounds of pressure on knee joints during walking. Weight loss of 10 percent body weight can reduce knee pain by 50 percent in overweight individuals.

The Arthritis Research UK study found that combining weight loss with exercise delayed knee replacement by average 4.5 years. Structured programmes including dietary counselling and group support show best results.

Bracing and Orthotics

Unloader braces shift weight from damaged to healthy knee compartments. For unicompartmental arthritis, these braces can reduce pain and improve function. Studies show 60 percent of users experience meaningful benefit.

Foot orthotics correcting abnormal biomechanics may reduce knee stress. Custom orthotics based on gait analysis show better outcomes than off-the-shelf products.

Pharmaceutical Options

Disease-Modifying Drugs

Emerging evidence suggests certain medications may slow arthritis progression. Strontium ranelate, originally for osteoporosis, shows promise in reducing cartilage loss. Metformin, a diabetes drug, demonstrates anti-inflammatory effects in arthritis.

These remain experimental for arthritis, requiring further research before routine use.

Targeted Injections

Beyond steroids and hyaluronic acid, newer injection therapies show promise. Interleukin-1 receptor antagonists reduce inflammation. Nerve growth factor inhibitors target pain pathways. Botulinum toxin injections may reduce pain and improve function.

Combination Approaches

Optimal outcomes often require multiple strategies. A typical comprehensive programme might include PRP injections for biological stimulation, structured physiotherapy for strength and function, weight management if needed, and appropriate bracing or orthotics.

Studies show combination approaches provide better outcomes than single interventions. The specific combination should be tailored to individual needs and arthritis patterns.

Making Treatment Decisions

Choosing among alternatives requires considering arthritis severity (mild to moderate responds better), age and activity level, overall health and surgical risk, personal preferences and goals, and financial considerations.

Timing matters. Earlier intervention with joint preservation strategies provides better outcomes than waiting until severe arthritis develops. However, insurance and cost factors may influence timing decisions.

When Surgery Becomes Necessary

Despite best efforts, some patients eventually require knee replacement. Indications include pain uncontrolled by conservative measures, significant functional limitation affecting daily activities, structural damage requiring mechanical correction, and failed response to multiple alternative treatments.

Importantly, trying alternatives doesn't compromise eventual surgical outcomes. Studies show patients attempting conservative treatments first have similar surgical results to those proceeding directly to surgery.

Considering alternatives to knee replacement? Book a free consultation via WhatsApp with The London PRP Clinic to discuss your options. Send your recent imaging for personalised assessment and evidence-based recommendations tailored to your specific situation and goals.