Sometimes—but not always. A careful evaluation can clarify whether reasonable joint-preservation options remain or whether knee replacement is likely to provide the most predictable result.
CLARITY BEFORE AN IRREVERSIBLE DECISION
Your MRI Is Important. It Is Not the Entire Story.
Knee pain may arise from cartilage loss, the meniscus, ligaments, tendons, subchondral bone, alignment, instability, or a combination of factors. The goal is not to promise that surgery can always be avoided. The goal is to understand the whole knee and make a sound, individualized decision.
A COMPLETE EVALUATION
What Should Be Reviewed Before Knee Replacement?
A thoughtful consultation connects your symptoms, examination, imaging, function, and goals.
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Your pain pattern, limitations, prior care, and personal goals
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A focused examination of motion, stability, alignment, and pain generators
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Weight-bearing X-rays and MRI images when appropriate
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The condition of cartilage, meniscus, ligaments, tendons, and subchondral bone
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Whether nonsurgical options are medically reasonable—and what they cannot accomplish
NOT ONE TREATMENT FOR EVERY KNEE
Possible Joint-Preservation Options
Targeted Rehabilitation
Strength, movement, load management, and biomechanical contributors may be addressed through an individualized program.
Targeted
Rehabilitation
Strength, movement, load management, and biomechanical contributors may be addressed through an individualized program.
Image-Guided Procedures
Selected injections or orthobiologic procedures may be considered when the diagnosis and treatment target support their use.
Structural Planning
Bracing, activity modification, alignment, and the condition of the osteochondral unit may affect the treatment plan.
Orthobiologic procedures are not appropriate for every patient and should not be represented as reliably regrowing an entire arthritic joint. Individual outcomes vary.
Treatment plans are individualized, and cost depends on which structures are involved and what the evaluation shows — so we don't publish fixed prices. What we do commit to: you will receive a cost estimate before any procedure is scheduled, and nothing is booked until you've reviewed it. These procedures are generally not covered by insurance. If you have Regenexx benefits, they may be covered. The evaluation itself is billed separately from any treatment.
WHEN SURGERY MAY BE APPROPRIATE
A Responsible Evaluation Must Be Willing to Recommend Replacement
Knee replacement may be the more predictable option when arthritis is advanced and widespread, pain is severe and persistent, function or sleep is substantially limited, reasonable nonsurgical care has failed, or joint-preservation options are unlikely to provide meaningful benefit.
The purpose of a second opinion is clarity—not delaying appropriate surgery.
Educational Videos
Understand Your Knee Before You Decide
PHYSICIAN-LED CARE
Meet Deborah Westergaard, MD
Dr. Westergaard completed an ACGME-accredited Pain Medicine fellowship at Texas Tech University and is double board-certified in Anesthesiology and Pain Medicine. She has more than 35 years of experience in anesthesiology and image-guided procedures, with nearly three decades focused on chronic pain management.
When nonsurgical treatment is appropriate, Dr. Westergaard performs these procedures herself — including image-guided injections and orthobiologic procedures using ultrasound and fluoroscopic guidance. Her role is to explain the findings, define realistic expectations, and identify which patients are reasonable candidates for joint-preservation treatment and which are better served by surgical consultation.
SELECTED PUBLISHED EVIDENCE
What the Research Shows
Two long-term randomized studies from Hernigou and colleagues examined whether delivering bone marrow concentrate into the subchondral bone — rather than into the joint space — affects whether patients ultimately undergo knee replacement.
In the first, 140 patients scheduled for staged bilateral knee replacement received the surgery on one side and subchondral cell therapy on the other, with injections targeting bone marrow lesions identified on MRI. At fifteen years, 18% of the cell-therapy knees had gone on to replacement. Persistent large bone marrow lesions after treatment strongly predicted eventual surgery.
In the second, patients received bone marrow concentrate into the subchondral bone of one knee and into the joint space of the other, without targeting specific lesions. At fifteen years, 20% of the subchondral-treated knees had gone on to replacement, compared with 70% of those treated intra-articularly.
These findings are encouraging but do not establish that any individual patient will avoid surgery. The studies examined specific patient populations under specific conditions. Whether a similar approach is medically reasonable for you depends on your imaging, examination, and overall health.
REGENEXX NETWORK AFFILIATION
REGENEXX
Dr. Westergaard is a Regenexx-affiliated physician. Regenexx maintains standardized protocols for bone marrow concentrate and platelet procedures, along with a proprietary laboratory process performed on site rather than with a bedside centrifuge. Affiliated physicians are trained and credentialed in these protocols, and the network maintains a patient outcomes registry supporting ongoing published research in orthobiologics.
Frequently Asked Questions About Avoiding Knee Replacement
These answers are educational and cannot determine whether a specific patient should delay or proceed with surgery.
Can knee replacement always be avoided?
No. Some patients have advanced, widespread arthritis or functional limitations for which knee replacement is the most predictable option. The purpose of a joint-preservation evaluation is to determine whether reasonable nonsurgical options remain, not to discourage appropriate surgery.
Who may be a candidate for knee joint-preservation treatment?
A candidate may have persistent knee pain from osteoarthritis, meniscal disease, tendon or ligament injury, subchondral bone changes, instability, or another defined pain generator. Candidacy depends on symptoms, examination, weight-bearing imaging, overall health, prior treatment, and personal goals.
What imaging should be reviewed before deciding on knee replacement?
Weight-bearing X-rays are often important for evaluating joint-space loss and alignment. MRI may provide additional information about cartilage, menisci, ligaments, tendons, bone marrow lesions, and the subchondral bone. Imaging should be interpreted together with the history and physical examination.
Can PRP or bone marrow concentrate regrow an entire arthritic knee?
No responsible evaluation should promise that PRP or bone marrow concentrate will regrow an entire arthritic joint. Orthobiologic procedures may be considered for selected patients to address specific tissues and support function, but results vary and treatment is not appropriate for every knee.
When is knee replacement more likely to be appropriate?
Replacement may be more appropriate when arthritis is advanced and widespread, pain remains severe despite reasonable nonsurgical care, sleep or daily function is substantially impaired, deformity or instability is significant, or joint-preservation options are unlikely to provide meaningful benefit.
Is a second opinion reasonable before knee replacement?
Yes. A second opinion can help confirm the diagnosis, review the imaging, explain realistic alternatives, and identify when surgical consultation is appropriate. It should provide clarity without creating unrealistic expectations or delaying necessary care.
Where are knee joint-preservation evaluations available?
Dr. Deborah Westergaard provides physician-led evaluations for patients in Dallas and Plano, Texas. A consultation is required to determine whether any treatment is medically appropriate.
Selected Patient Resources
These independent resources provide additional information about knee osteoarthritis, conservative care, surgery, and the responsible evaluation of regenerative medicine claims.
American Academy of Orthopaedic Surgeons: Management of Osteoarthritis of the Knee
American College of Rheumatology/Arthritis Foundation guidance
U.S. FDA consumer information about regenerative medicine therapies
MOVE FORWARD WITH CLARITY
Request a Knee Evaluation
If you are considering knee replacement—or have been told it is your only option—request a careful review of your symptoms, examination, and imaging.
Schedule an Evaluation
Educational information only. A consultation is required to determine whether any treatment is medically appropriate. Outcomes vary.