Before You Go Under the Scalpel: Why You Should Evaluate Alternatives to Total Knee Replacement

Thinking of trading your arthritic knee for a metal one? The decision to undergo a total knee replacement (TKR) might be premature, especially if you haven’t explored safer, less invasive treatment options like platelet-rich plasma (PRP) therapy or mesenchymal stem cell (MSC) injections.

Modern biological treatments can offer effective knee pain relief, reduce inflammation, and delay surgery by several years, often with far less risk, cost, and recovery time. If you're exploring knee osteoarthritis treatment options, these non-surgical alternatives are worth understanding before committing to an operation.

The Hidden Risks of Total Knee Replacement (TKR)

TKR surgery is one of the most common procedures for advanced osteoarthritis, but it comes with significant risks that aren't always clearly communicated.

Here are three key concerns:

• Risk of failure or revision surgery: Research shows that around 6% of total knee replacements fail within five years and up to 12% require revision within ten years.
• Cost of knee replacement in India: A single TKR procedure can cost anywhere between ₹1.5 to ₹6 lakh, depending on the hospital, surgeon, and implant quality.
• Extended recovery time: Even for patients with sedentary jobs, the average time off work after surgery is four to six weeks, and it can stretch to 12 weeks for more active roles.

In contrast, non-invasive alternatives for knee arthritis such as PRP or MSC injections are faster, safer, and more economical.

What Are PRP and MSC Injections?

Both platelet-rich plasma and mesenchymal stem cell therapies fall under the umbrella of regenerative medicine for joint pain. They aim to treat osteoarthritis by modifying the joint environment rather than replacing it.

Platelet-Rich Plasma (PRP)

PRP therapy involves concentrating growth factors from your own blood and injecting them into the affected joint. This stimulates natural healing and reduces inflammation.

• Benefits last 6–12 months in most patients
• Combining PRP with hyaluronic acid may extend relief duration
• Shown to improve both pain and function in meta-analyses of randomised trials

To learn more about how lifestyle and diet can support joint health alongside therapies like PRP, read our blog on anti-inflammatory habits for long-term joint health.

Mesenchymal Stem Cells (MSC)

MSCs are derived from bone marrow, adipose tissue, or manufactured allogeneically. When injected, they help rebuild cartilage and reduce inflammation through cytokine secretion.

• Excellent safety profile: no serious adverse events reported in meta-analyses
• 2024 studies confirm higher WOMAC scores (pain, stiffness, function) at 12 months compared to placebo

For a broader understanding of how structural degeneration affects joint pain, explore our guide to osteoarthritis.

Comparing Knee Pain Treatment Options

Importantly, neither PRP nor MSC therapy interferes with future surgery. You don’t “lose your shot” if you try biologics first.

Why Do Surgeons Default to Knee Replacement?

Despite mounting evidence supporting non-surgical treatment for knee arthritis, many orthopaedic surgeons still recommend replacement as a first-line solution. Why?

• Medical training bias: Orthopaedic education often ends at the operating theatre. Exposure to newer biologics is limited.
• Hospital economics: Surgical procedures generate more revenue for hospitals, device manufacturers, and pharma companies alike.
• Patient perceptions: Many people mistakenly see injections as temporary solutions, unaware that implants also wear out and may require revision.

Are You a Good Candidate for PRP or MSC Therapy?

These treatments are most effective for patients in the early to moderate stages of osteoarthritis.

You may benefit if:

• Your X-ray shows Kellgren–Lawrence grade 2 or 3 (i.e., visible cartilage still present)
• You do not have severe bow-leg or knock-knee deformities
• Your BMI is under 35 kg/m²
• You are willing to repeat PRP every 9–12 months or get an MSC shot every 2–3 years

If you are already “bone-on-bone” with significant deformity, total knee replacement remains the gold standard. But that is not the case for most people in an outpatient arthritis queue.

Questions to Ask Your Orthopaedic Doctor

Before agreeing to surgery, take control of the conversation. Here are five critical questions that can shift the decision-making dynamic:

1. “What is my Kellgren–Lawrence grade?”
2. “Have we tried all other knee pain treatment options before surgery?”
3. “Will PRP/MSC injections affect future implant success?”
4. “What is your documented complication rate for PRP/MSC?”
5. “Which implant’s 5- and 10-year revision rates are you quoting?”

Always ask for written answers. This shifts the dynamic from persuasion to partnership.

The Bottom Line: Explore Your Options First

Total-knee replacement is a major, irreversible intervention. It can be life-changing for the right patient, but it’s not without risks, costs, and complications.

PRP and MSC injections offer medically validated, minimally invasive alternatives that provide significant pain relief and functional improvement. Most importantly, they preserve your joint until surgery is truly necessary.

Replacing a knee that still has healthy cartilage is like demolishing a house because the paint is peeling. The prudent path is clear: before the scalpel, demand the syringe.

References

• Business Standard. Knee replacement costs and options in India. Business Standard; 2023.
• Quality Care Global. PRP Injection Cost in India: A Complete Guide. Quality Care Global; 2023.
• To Healthy Feet Podiatry. What is the Difference Between PRP and Stem Cell Therapy? To Healthy Feet; 2022.
• thriveMD Denver & Vail, CO. Stem Cell Therapy for Knee Pain. thriveMD; 2022.
• Healthline. PRP for Arthritis: Does It Work? Healthline Media; 2023.
• Frontiers in Medicine. Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Front Med (Lausanne). 2023;10:1221755.
• Frontiers in Medicine. Relative Efficacy and Safety of Mesenchymal Stem Cells for Osteoarthritis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Front Med (Lausanne). 2023;10:1134687.
• PubMed. Total Knee Arthroplasty Revision Rates: A Registry-Based Meta-Analysis. National Library of Medicine; 2022.