Medically Reviewed By: Dr. David Warmflash (MD), Dr. Omar Samara (MD)
14 Alternatives to Knee Replacement Surgery in 2023
Are you seeking alternatives to knee replacement surgery to combat nagging knee pain? We all know how joint pain, swelling, and stiffness can hinder our daily activities. But don’t worry; we’re diving into some non-surgical treatments for knee arthritis. So, do these treatments truly work, and can they help you avoid knee surgery? Let’s find out as we read on.
Knee Surgery Alternatives - Testimonial
Alternative Treatment for Knee Replacement - Reviews
Stem Cell Therapy
Gold Injection Treatment
Stem Cells
Knee Arthroscopy
Did you know?
Over 32 million US adults are living with osteoarthritis. Since there is no cure, they manage it with exercise, therapy, medications, and injections.[1]
If you have knee osteoarthritis, knee replacement is an option. But it's only sometimes immediate or suitable for everyone. Some cannot have surgery for various reasons.
Younger patients may delay it due to the limited lifespan of artificial knees, usually 15 to 20 years.[2]
Fortunately, there are several non-surgical options to relieve knee pain.
Here, we explore 14 different options for the better health of an arthritic patient. You’ll see a range from home remedies to conventional methods to new-age non-surgical solutions.
From these, you can choose to put your faith in any that feels and fits the best.
Latest Knee Replacement Alternatives
1. Gold Injections
This new gold microbeads injection is a drug-delivery system devised by US & Danish scientists.[3] Recent research reveals that injecting gold microparticles into KOA joints reduces inflammation and alleviates pain.[4]
So, how does the new gold injection treat osteoarthritic pain?
Watch the video below, which explains the procedure and benefits of this treatment.
Alternatives to Knee Replacement Surgery: Gold Injections Treatment
You will receive an intra-articular (IA) injection of 20mg gold microbeads into the affected knee joint. Ideally, you will see pain reduction in a day or so.
However, immediate improvement in your gait is visible within 1-2 hours. Hence, it’s an on-demand pain reliever. In case there is no inflammation, these injected particles will remain inert.
Outcomes, Risks & Benefits of Gold Micro-particles Injection for Osteoarthritis
The new approach comes with a set of advantages and disadvantages. Despite the drawbacks, you will find the results are quite reliable. Check out this list to know the benefits, risks, and expected results of the treatment:[5]
Benefits
- Non-invasive: No scar, less pain
- No blood transfusion: Low infection risk
- Non-immune-suppressing: No risk of infection
- Fast-acting: Quick recovery
- One sitting (under 30 min): Time-saving
- One-time: Saves on cost, time
- Pure gold: Non-toxic, unlike other gold injections
- Low price: Save money
Risks
- Not yet approved by FDA
- Long-term results not available
Outcomes
- Reduced friction between bones while moving
- Alleviates knee pain
- Less inflammation & swelling
- Provide long-term relief
- Improves joint mobility
DMARD Gold Injections vs New Gold Micro-Particles Injections
- Not to be confused with older DMARD gold injections for rheumatoid arthritis! They reduce the immune system’s response. Therefore, older gold injections cannot be a long-term treatment due to the increased risk of infection.[6]
- Connect with our team to know more about new gold therapy.
2. Stem Cell Therapy
Stem cell therapy uses the body's healing processes to repair and slow tissue deterioration, including cartilage.
Stem Cells for Chronic Pain
Recent studies demonstrate its effectiveness in treating mild, moderate, and severe knee osteoarthritis.[7] However, it's important to note that the US FDA has not yet approved stem cell therapy for arthritis.[8]
Like many investigational therapies, further research is required to establish its benefits.
3. Platelet Rich Plasma (PRP) Therapy
Platelets are rich in growth factors, hence help to treat the knee.
PRP therapy involves three steps:
Step 1: Draw blood from the patient
Step 2: Extract platelets from the whole blood
Step 3: Injecting these in the knee joint
Research indicates PRP is effective for mild to moderate knee osteoarthritis.[9]
It offers pain relief and improved activity levels for a year after one injection.[10]
However, the evidence of its efficacy is insufficient & requires more research.
Ultrasound-guided PRP
4. Prolotherapy
In prolotherapy, the physician injects dextrose solution into the affected area.
This solution stimulates the healing by increasing the blood flow to that area.
It's often called "regenerative injection" or "proliferation therapy."
Research shows that prolotherapy reduces pain and stiffness.[11]
Moreover, you may see a constant and significant improvement in joint function.
While this procedure is safe, it requires more research.
Prolotherapy
Hence, the Arthritis Foundation guidelines do not recommend its use.[12] You should follow your doctor’s advice to see if this can help you.
5. Hyaluronic Acid (HLA) Injections
Hyaluronic acid is similar to a substance that is produced endogenously by special cells in joints called type B synovial cells.
It acts as a lubricant and shock absorber for the joints, ensuring their proper function.[13]
It's injected directly into the knee joint, typically around 2 ml.[14]
Despite being the most researched joint injection, rigorous studies have yet to demonstrate significant patient benefits.[15]
Thus, the Arthritis Foundation guidelines do not currently recommend their use.[16]
HLA Injection
Hyaluronic Acid (HLA) vs Gold Injection
- Compared to HLA, the gold injections can be a better alternative for you.
- Doctors use HLA injections to provide symptomatic pain relief for osteoarthritic patients.
- On the other hand, gold injections, like other DMARD therapies, actually slow the progression of the disease.
6. Genicular Artery Embolization (GAE) – Minimally invasive
GAE is one of the non-surgical alternatives to knee replacement surgery.
This minimally invasive procedure is performed by an Interventional Radiologist (IR).
GAE restricts blood flow to inflamed knee linings.[14]
This reduces inflammation and may alleviate or eliminate knee pain in osteoarthritis.
In 2020, a study found it effectively reduced knee pain, especially in those with moderate to severe knee pain.[15]
However, there's limited evidence on the safety and effectiveness of GAE for knee osteoarthritis. Only three systematic reviews have been published on this topic so far.[16]
Genicular Artery Embolization
7. Unispacer - Minimally Invasive
A Unispacer or Unicondylar Interpositional Spacer is one of the less invasive alternatives to knee replacement surgery.
An Unispacer is a device inserted into the affected knee joint.[17]
It serves as a spacer to separate worn knee surfaces.
It doesn’t require cutting bone and cementing an implant.[18]
However, only a few individuals are eligible for this device.[19]
A recent study revealed a 53% 10-year survival rate for the Unispacer.[20]
Patients with the implant experienced satisfactory clinical outcomes.
Unispacer
Its affordability and ease of insertion make it a viable alternative for those unfit for major surgery.[21]
8. Radiofrequency Ablation (RFA) - Minimally Invasive
RFA controls knee pain by destroying the sensory nerves that transmit pain signals from the knee to the brain.
Its non-invasive nature and low complication rate make it an excellent alternative to knee replacement surgery.
Research indicates RFA is safe and effective for osteoarthritis pain and knee function.
The procedure is approved by the FDA.
RFA
Despite its popularity, there's insufficient reliable evidence to support its use. Also, it's often a temporary fix. Nerves tend to regenerate within 6 months to 2 years, potentially causing pain to return.
Source: Johns Hopkins Medicine,[22] Sage Journals,[23] NBC News[24]
Conventional Knee Replacement Alternatives
9. Medication and Steroid Shots
NSAIDs may reduce pain, inflammation, and swelling.
However, its prolonged consumption may cause stomach ulcers, kidney damage, and gastrointestinal bleeding.
OTC drugs may also help manage pain.
Another option is Corticosteroid injections. This can reduce knee pain and inflammation.
Pain relief works for 1 to 6 weeks, but no evidence of lasting relief.
Medication and Steroid Shots
Source: NCBI,[25] Rheumatology Advisor[26]
10. Acupuncture (Therapeutic Option)
Acupuncture uses thin, sharp needles to alter the energy flow within the body.
It brings relief from joint pain and has a low risk.
Research suggests it can provide short-term relief (up to 13 weeks) for severe osteoarthritis.[27]
The Arthritis Foundation guidelines support its use.[28]
An important caveat, however, is that acupuncture research studies are notoriously challenging to placebo control. Unlike a medication for which a placebo (sham treatment) can be employed, such that neither patients nor researchers, are aware of who receives the real treatment or the placebo, acupuncture trials require sham treatments that look and feel like needles, both to patients and researchers. Not only is this a tall order, but the methodology has varied widely between studies attempting to do this.
-Dr David Warmflash
Acupuncture
11. Physical Therapy – Yoga and Other Exercises
Physical therapy aims to reduce pain and strengthen knee muscles.[29]
A physical therapist will guide you to ensure you do the exercises correctly.
The therapy approach may include
- Ice and heat application
- Neuromuscular training
- Strengthening exercises
- Stretching exercises
Yoga
12. Assisting Aids
Assisting aids include walking canes and braces.
These devices perform the following functions:
- Improve mobility
- Better stability and support
- Help prevent knee pain and inflammation from getting worse.
Knee Brace
13. Ancient Medicine (Ayurveda)
Ayurveda treatment involves a combination of massage, meditation, exercise, and a nutritional diet.
However, it is an individualized treatment according to the patient’s condition.
Ayurveda naturally revives damaged cartilage and prevents further deterioration in the knee joint.[30]
Recent research found that Ayurveda notably improved knee pain and function in severe osteoarthritis (Grade IV).[31]
Leg Massage - Ayurveda
14. Weight-Loss Strategy
Obesity can put excess stress on the knee joint.
When walking on level ground, your knees endure 1.5 times the force that they endure from your body weight when you stand still.
So, with each step, a 200-pound person exerts a combined force of 300 pounds distributed over the two knee joints or 150 pounds of force per knee joint.
Research shows that a 10- to 15-pound weight loss in obese young individuals significantly reduces their future risk of osteoarthritis.
Bariatric surgery can also reduce excessive load on weight-bearing joints.
This can help reduce osteoarthritic symptoms such as difficulty walking and joint pain.
Diet Plan for Weight Loss
Source: Harvard Medical School[32]
Surgical Alternatives to Knee Replacement Surgery
Osteotomy
Osteotomy involves removing weight from the affected part of the knee.
Hence, this weight shift helps in relieving symptoms.
This procedure helps if there is less damage on only one side of the knee.
However, it works better on younger people.[33]
Knee Osteotomy
Arthroscopy
Arthroscopy can repair a meniscus tear, ligament, bone, or cartilage inside the knee.
It involves the use of a camera inserted through small incisions.
Still, this technique may only help for some types of knee problems.
It’s possible to go home a few hours after the procedure.
Knee Arthroscopy
Not sure if you want to go for surgical alternatives to knee replacement surgery? Get your case medically reviewed by our team of doctors.
Alternatives to Knee Replacement Surgery Compared
When considering alternatives to knee replacement, you have various options. Each comes with its price tag. Physical therapy & medications are budget-friendly, but their effectiveness varies.
Injections like corticosteroids, HLA, PRP, and stem cell therapies offer potential pain relief but come at a higher cost.
Braces & supports are cost-effective & less invasive, though their effectiveness can differ. It depends on your knee's condition, health, and budget, so consult your doctor for the best plan.
The table below compares the costs of some popular knee surgery alternatives.
Treatment | Cost |
Gold injection* | $5,000 - $10,000 |
Stem Cell Therapy | $5,000 - $8,000 |
PRP Therapy** | $600 - $1,500 |
Prolotherapy** | $200 |
HLA Injections | $300 - $850 |
Medications | >$15 |
Corticosteroids^ | $120 - $140 |
Acupuncture | $75 - $200 |
Physical Therapy** | $50 - $350 |
Assisting Aids (knee brace, walking cane) | $30 - $300 |
Ayurveda** | $100 - $160 |
Osteotomy | <$6,000 |
Arthroscopy | $3,200 - $6,700 |
Genicular Artery Embolization (GAE) | $3,000 - $6,000 |
Radiofrequency Ablation (RFA) | $2,000 - $4,000 |
Knee Replacement Surgery | >$30,000 |
*First Knee: $10,000; Subsequent: $5,000 per joint, **per session, ^per shot |
*Prices are case-dependent.
Knee Replacement Alternatives That Don’t Work
The Arthritis Foundation guidelines recommend people not to use:[34]
- Modified shoes and insoles
- Paraffin
- Biologics
- Iontophoresis
- Kinesiotaping
- Bisphosphonates
- Chondroitin sulfate and glucosamine supplements
- Colchicine
- Methotrexate
- Hydroxychloroquine
- Radiofrequency ablation
- Pulsed vibration therapy
- Tramadol opioids
- TENS (Transcutaneous Electrical Nerve Stimulation)
What is the Right Time for Knee Replacement Surgery?
- Already tried most of these?
- Do you find a significant improvement in your symptoms?
- If not, you may likely consider knee replacement surgery.
- Your doctor could advise a Total Knee Replacement Surgery (TKR) or a Partial Knee Replacement Surgery (PKR). It varies with the case.
- You can connect with us to find a licensed and celebrated surgeon overseas for free.
FAQs About Alternatives to Knee Replacement Surgery
There are several non-invasive options for addressing knee pain, even in cases of arthritis. Here are our recommended safe and effective methods for treating knee pain without surgery
- Physical therapy (Exercise, yoga)
- Anti-inflammatory medications
- Injections (Gold ions, corticosteroid, hyaluronic acid)
- Stem cell therapy, PRP therapy, prolotherapy
- Acupuncture, ayurveda
- Braces & supports
- GAE, RFA
Before considering knee replacement, you may explore other treatment options. Your doctor will discuss non-surgical approaches for knee repair. These can include lifestyle changes and various pain relief methods, such as:[35]
- Weight loss to reduce knee strain if overweight
- Physical therapy & low-impact exercises like swimming, walking, or cycling
- The use of walking aids
- Pain relief medications, gels, or creams
- Hydrocortisone (steroid) injections for pain and swelling
Studies reveal that NSAIDs, weight loss, injections, and physical therapy are effective non-surgical knee OA treatments. These options have their limitations but can work well when used together.
Knee braces are a non-invasive, non-drug option. It can reduce pain and enhance function with minimal side effects. Using knee braces with other non-surgical methods is vital for managing knee OA, reducing pain, and enhancing mobility.
Source: NCBI[36]
The Upshot
As you can see, these 14 alternatives to knee replacement surgery save costs and alleviate symptoms. Moreover, a lot of risks are involved in knee replacement surgery.[37] In that case, why not give them a try? Ultimately, you and your physician should determine the best possible option.
But remember, there is a great chance to return to your pain-free mobile life without knee replacement.
References
- STAT News: Common injections don’t help knee osteoarthritis
- Johns Hopkins: Health
- EJP: Gold micro-particles for knee osteoarthritis
- Medical News Today: Can gold injections treat rheumatoid arthritis?
- Future Medicine: Real-world evidence of mesenchymal stem cell therapy in knee osteoarthritis
- Arthritis Foundation: Considerations for stem cell interventions
- Orthoinfo: Platelet-Rich Plasma (PRP)
- Forbes: Platelet Rich Plasma: Everything You Need To Know
- Orthopedic Reviews: Prolotherapy in the Management of Osteoarthritis of the Knee
- Arthritis Foundation: Prolotherapy for Osteoarthritis
- Mayo Clinic: Hyaluronic Acid (Injection Route)
- Arthritis Health: Hyaluronic Acid Injections for Knee Osteoarthritis
- Rheumatology: Arthritis Foundation Guidelines for Hand, Hip, and Knee Osteoarthritis
- NIH: GAE for the Treatment of Knee Pain Secondary to Osteoarthritis
- NCBI: GAE for treatment of knee osteoarthritis pain
- eMedicinehealth: Minimally Invasive Knee Replacement
- NIH: The knee implant UniSpacer™: Ten-year outcomes
- Johns Hopkins Medicine: Knee Replacement Alternatives to Consider
- SAGE Journals: Efficacy and safety of RFA for treatment of knee osteoarthritis
- NBC News: 'Cool' New Knee Procedure Eases Arthritis Pain Without Surgery
- NCBI: Safety of Oral Non-Selective NSAIDS Drugs in Osteoarthritis
- Verywellhealth: How Acupuncture Helps Knee Pain
- Healthline: Alternatives to Knee Replacement Surgery
- Namayush.gov: Osteoarthritis
- ResearchGate: Ayurvedic Management of Osteoarthritis Knee with Grade IV Severity & Obesity
- Harvard Medical School: Why weight matters when it comes to joint pain
- ScienceDirect: Management of knee osteoarthritis using tibial osteotomy..
- NHS: Alternatives to a knee replacement
- NCBI: Non-operative treatment options for knee osteoarthritis
- DrugWatch: Knee Replacement Complications