Alternatives to knee replacement surgery for severe arthritis
Executive summary
Minimally invasive and non‑surgical alternatives to knee replacement include injections (steroids, hyaluronic acid), physical therapy and bracing, procedures such as genicular artery embolization (GAE), subchondroplasty/arthroscopy/osteotomy, and emerging biologic or drug options; major centers list these as options to delay or avoid arthroplasty [1] [2] [3]. GAE is singled out in multiple 2024–25 reports as a promising outpatient embolization option being piloted at UChicago and studied at other centers, intended to reduce pain and inflammation and postpone replacement for some patients [4] [5] [6].
1. The mainstream first line: conservative care that still matters
Doctors start with weight loss, physical therapy, activity modification, analgesics and braces because these reduce symptoms for many patients and can postpone surgery; health systems and clinics list physiotherapy and supportive devices among primary alternatives to replacement [1] [7]. Expert guidance notes injections such as corticosteroids provide temporary relief “typically a few months,” useful to bridge pain crises or improve function before other treatments [2].
2. Injectable therapies: what’s established and what’s experimental
Corticosteroid injections remain a commonly used, short‑term option; hyaluronic acid (“lubrication”) is widely offered as an alternative and may improve mobility [1]. Platelet‑rich plasma (PRP), concentrated bone marrow/stem cell injections and other biologics are being used but reviewers say evidence is limited and further studies are needed to prove consistent benefit [2] [8]. Clinics and promotional pieces tout PRP/Arthrosamid and similar agents, but authoritative sources urge caution on long‑term effectiveness [2] [9].
3. Minimally invasive procedures gaining traction: embolization, subchondroplasty, ablation
Genicular artery embolization (GAE), also called knee embolization, is an interventional radiology procedure that targets abnormal blood vessels feeding inflammation; it is being piloted at UChicago and described at Columbia and other clinics as providing rapid relief for patients not helped by conservative care [4] [6] [5]. Subchondroplasty (targeting bone defects) and radiofrequency nerve ablation also appear in 2025 lists of options; hospitals and specialty centers promote these as ways to delay or avert full joint replacement in selected patients [10] [11] [7].
4. Surgery that isn’t “full replacement”: osteotomy and partial solutions
When disease is limited to one compartment or the patient is younger, osteotomy or partial (unicompartmental) knee replacement can redistribute load or replace only the damaged section—options that may delay total arthroplasty but can complicate future operations and are recommended selectively [1] [12]. Arthroscopic procedures have a narrow role and are considered minimally invasive but are not a panacea for advanced osteoarthritis [1].
5. New drugs and systemic approaches that could change the picture
Research into drugs and repurposed medicines is active: some trials suggest metformin may reduce pain in overweight patients and large genomic studies point to drug targets that might yield therapies to alter disease progression, but no treatment yet reverses osteoarthritis damage at scale [13] [14]. For inflammatory arthritis like rheumatoid arthritis, newer systemic agents (JAK inhibitors, biologics and device‑based neurostimulation) are reshaping care but address a different disease mechanism than osteoarthritis [15] [16].
6. What the evidence and experts say about durability and who benefits
Several sources underline limits: injections and many novel options often give temporary relief and evidence quality varies; Johns Hopkins notes limited evidence for PRP and similar injectables and frames most as temporizing measures, while interventional radiologists and pilot studies present encouraging short‑term outcomes for GAE [2] [6] [4]. Clinics marketing new devices and procedures sometimes report high potential but may overstate applicability—patient selection remains central [11] [3].
7. Practical guidance and trade‑offs patients should weigh
If you are not a surgical candidate due to comorbidities or want to avoid major surgery, consider staged care: optimize weight and therapy, try injections or bracing, and discuss minimally invasive procedures like GAE or subchondroplasty with specialists who can review imaging and risks [1] [10] [6]. Remember informed consent must include discussion that many alternatives may only delay rather than permanently replace arthroplasty and that long‑term comparative data remain limited [17] [2].
Limitations of this brief: available sources document a mix of peer‑reviewed reports, institutional pilot trials, clinic summaries and promotional pages; they do not provide a single definitive guideline ranking all alternatives by long‑term outcomes. For personalized decisions, seek an orthopedic surgeon and, where appropriate, an interventional radiologist to review imaging, comorbidities and the latest trial data [4] [1] [6].