How to compare knee replacement alternatives

What to finish before choosing a procedure

Gentle movement and steady strength can make daily work easier. A walking aid or knee brace won't help everyone, though either can add support. Medicine can help some people, but other health needs still matter. A fair trial means doing the agreed plan regularly until its review date.

Ask whether that review comes in days, weeks, or months.

Can one choice replace knee surgery? It can't for every knee. The cause, joint damage, your health, and your daily limits all count. If a treatment isn't helping by the planned review, discuss what comes next.

What to ask before a joint procedure

Ask which ache the procedure aims to ease. Get a date for judging the result. Steroid or gel shots can bring relief for some people. That relief might be small or last only a short time.

PRP is short for platelet-rich plasma, a liquid prepared after staff spin your blood and collect the portion holding more platelets. A needle delivers it beside the aching area. It isn't the same medicine as a steroid or gel shot.

The evidence has limits. A careful knee study found PRP worked no better than a salt-water shot after twelve months. Ask about the likely result, the full price, and what happens if it doesn't help.

When to include surgery in the talk

Surgery may make more sense when walking, sleep, work, or dressing stays hard after steady care. The exam must show that the joint you plan to replace causes those limits. Hip soreness can travel toward the knee, so location alone isn't enough.

More waiting may mean less sleep, shorter walks, or lost strength.

Partial knee replacement and total replacement are different operations. Hip surgery has different details. Ask about risks, help at home, and the time away from driving. Also ask how long the replacement parts may last with your usual activity.

What to bring when you compare the choices

Bring the names of earlier treatments and how each one went. Add the activity you'd most like to regain. Clinic staff can then check how the joint moves and discuss those results. You won't have to decide during the first talk.

Keep money, travel, and follow-up in the same conversation.

QC Kinetix calls these regenerative biologic therapies: licensed clinic staff use a needle to return the prepared blood portion beside the aching area.

Sources

1. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA, and education plus structured land-based exercise as core for hip and polyarticular OA. Topical NSAIDs are strongly recommended for knee OA (Level 1A). Intra-articular corticosteroids and hyaluronic acid are Level 1B/2 for knee OA depending on comorbidity and are NOT recommended for hip or polyarticular OA. Oral NSAIDs are not recommended for people with cardiovascular comorbidity or frailty, and oral and transdermal opioids are strongly not recommended (Level 5).

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

2. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, tibiofemoral bracing for tibiofemoral knee OA, topical NSAIDs for knee OA, oral NSAIDs, and intra-articular glucocorticoid injections for knee OA. Radiofrequency ablation for knee OA, acupuncture, thermal modalities, acetaminophen, duloxetine and tramadol are only CONDITIONAL recommendations.

   Kolasinski SL, Neogi T, Hochberg MC, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis & Rheumatology, 2020. DOI: 10.1002/art.41142.

3. In 156 patients with knee osteoarthritis randomised in the US Military Health System, physical therapy produced a mean WOMAC total score of 37.0 at one year versus 55.8 for a single intra-articular glucocorticoid injection (mean between-group difference 18.8 points favouring physical therapy, 95% CI 5.0 to 32.6, on a 0-240 scale where higher is worse). Secondary outcomes moved in the same direction.

   Deyle GD, Allen CS, Allison SC, et al. — Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.. New England Journal of Medicine, 2020. DOI: 10.1056/NEJMoa1905877.

4. In a 2-year double-blind randomised trial in 140 patients with symptomatic knee OA (Kellgren-Lawrence grade 2 or 3) and ultrasonic synovitis, intra-articular triamcinolone 40mg every 12 weeks produced significantly greater cartilage volume loss than saline (index-compartment cartilage thickness change -0.21mm vs -0.10mm; between-group difference -0.11mm, 95% CI -0.20 to -0.03) with no significant difference in pain.

   McAlindon TE, LaValley MP, Harvey WF, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

5. A systematic review and meta-analysis of 169 randomised trials (21,163 participants) of viscosupplementation for knee OA found clear evidence of small-study effects and publication bias. The prespecified main analysis, restricted to 24 large placebo-controlled trials with at least 100 participants per group (8,997 randomised), found a pain reduction of SMD -0.08 (95% CI -0.15 to -0.02) - the confidence interval excluding the prespecified minimal clinically important difference of -0.37.

   Pereira TV, Jüni P, Saadat P, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

6. The RESTORE trial randomised 288 community-based participants aged 50+ with symptomatic medial knee OA (Kellgren-Lawrence grade 2 or 3) to three weekly intra-articular injections of leukocyte-poor PRP or saline placebo, with participants, injectors and assessors all blinded. 93% completed the 12-month follow-up. PRP did not produce a clinically meaningful improvement in knee pain over placebo, and did not slow medial tibial cartilage volume loss on MRI.

   Bennell KL, Paterson KL, Metcalf BR, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

7. FDA states directly that regenerative medicine therapies - including stem cells, stromal vascular fraction, umbilical cord blood, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes - have NOT been approved for the treatment of any orthopedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain. FDA further states that being charged for these products, or being offered them outside an FDA-overseen clinical trial, means a patient is likely being deceived and offered a product illegally, and that a product's presence on clinicaltrials.gov or a firm's FDA registration does not mean the product is legally marketed. Reported harms include blindness, tumor formation, neurological events and life-threatening bacterial infections.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA.gov, 2021.

8. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.