If walking is becoming difficult and physio isn’t working, cutting-edge treatments could be the next step. But which ones are worth trying?
You probably know someone with a dodgy knee, if you don’t suffer yourself. Around 5.4 million people in the UK are estimated to have knee arthritis, according to the National Institute for Health and Care Excellence (Nice), the most common type in the body. This represents about one in five adults over 45 years old accounting for almost 5 per cent of the global population.
The need for effective management and treatment of knee arthritis is critical to avoid the ‘nuclear’ option of a full knee replacement, with current NHS waiting times in excess of a year, recommended firmly as a last resort when pain levels become unbearable.
Dr David Thompson, a consultant orthopaedic surgeon, says: “Managing knee arthritis effectively involves a multidisciplinary approach including physiotherapy, regular gentle exercise, and maintaining a healthy weight to reduce joint stress.”
The sheer range of treatments claiming to offer relief can feel overwhelming: from chemical anti-inflammatories, gels and supplements – such as glucosamine, turmeric or cod liver oil – to physio sessions, knee straps, red light therapy and low-impact activities such as swimming, cycling and walking. If you’re reading this, you’ll probably have tried at least some of these in your quest to make walking down the stairs each morning less excruciating.
If you’re still struggling, an injectable alternative could be the next step before a full knee replacement, especially given there are now a raft of treatments to choose from. The effectiveness of all treatments will largely depend on the severity of the osteoarthritis and the individual patient’s condition. We spoke with the experts and assessed the benefits and risks, considering whether treatments provide lasting relief and if they’re worth the cost.
Injectable treatments
Corticosteroids: £120-£200
Commonly known as steroids (not anabolic), these direct injections into the knee joint reduce inflammation and pain. Available on the NHS with waiting times of up to four and a half months, the effects can last from weeks to a few months. The least expensive of all options, costing £120-£200 per injection, its side effects, including potential bruising and facial flushes, tend to be fairly minimal.
Patients should feel improvement in pain after two to three days, although after three months any beneficial effect is likely to decline. Having tried this myself in 2023, I was slightly disappointed with the lack of noticeable improvement.
Is it worth trying?
If you only have mild to moderate symptoms and wish to reduce inflammation they could reduce the pain; it can also be used for bursitis and nerve entrapment.
Hyaluronic acid: £250-£500
A gel-like substance, also used on the skin to reduce wrinkles and lines, this acts as a shock absorber and lubricant to improve joint movement and reduce pain, mimicking the natural fluid in the knee. Only available privately, costing between £250-£500 per knee and quickly administered, the effects on a patient normally last between three to six months, even longer for some. Severe reactions are rare, though some temporary pain or swelling may occur.
In the UK the NHS doesn’t offer this treatment, primarily due to cost-effectiveness considerations and limited evidence of long-term benefits. Dale Naylor, a consultant physiotherapist, states: “Hyaluronic acid has the same benefits as steroid injections but with an added cushioning effect.”
Is it worth trying?
More beneficial than corticosteroid – but only available privately – and good for those keen to return to activities like walking or running.
Platelet-rich plasma (PRP) therapy: £500-800
A treatment that uses a patient’s own blood to help reduce inflammation and promote tissue regeneration, PRP can slow the progression of osteoarthritis, preventing further structural damage and reducing the need for surgery. Aside from targeting pain in the patient, it can produce a wider range of motion. Patients’ blood is dispensed into a centrifuge container before being spun, mixing in calcium chloride and other agents such as hyaluronic acid and thrombin to concentrate plasma growth. Finally, it is drawn into a syringe and injected into the knee to stimulate the healing process.
Recent studies show around 70 per cent of patients experience noticeable pain relief and improved function, however the Orthobiologics Clinic in Macclesfield suggest that “two to three injections of PRP may maximise benefits for patients”. The injections are available at certain NHS Trusts with a wait time or privately in the UK.
Is it worth trying?
When recovering from a knee injury, PRP might be beneficial for promoting healing and reducing pain. It’s worth speaking to your GP about, but it’s otherwise relatively affordable privately.
Arthrosamid: £2,200-3,200
This state-of-the-art hydrogel therapy is officially launched to the UK market in 2021, injected directly into the knee joint to treat osteoarthritis. Of all injectable treatments, this solution potentially provides the longest lasting pain relief for patients of up to four years. Satisfied customers include former Olympic swimmer Sharron Davies. It works by restoring the thickness of synovial fluid, which is located between your joints and cushions and protects the ends of bones and reduces friction during movement, while integrating with the synovium (connective tissue) that lines the inside of the joint.
This enhances lubrication and creates cushioning. Sean Curry, a consultant at the London Orthopaedic Clinic, which carries out a range of injectable solutions including Arthrosamid says: “It doesn’t turn back the clock or restore the knee to a youngster’s knee but is very helpful in reducing the symptoms from arthritis.” Currently only available privately in the UK, its potential for greatly improving symptoms is reflected in the cost, at around £2,200 to £3,200 per knee. About 80 per cent of patients in the under-70 years group noticed improvements in pain relief and mobility following treatment. Optimal impact is usually seen at 13 or 14 weeks.
Is it worth trying?
If you can afford it, this cutting-edge injectable potentially represents an excellent choice for patients because of its long-lasting effects, which last up to four years.
Stem cell therapy: £3,000-6,000
Regarded as an emerging field in the UK, this has gained popularity as an alternative to traditional therapies. The therapy can reduce pain and improve mobility by regenerating damaged cartilage in the knee joint. Stem cells are harvested from the patient’s bone marrow, typically from the pelvis, or extracted from the patient’s fat tissue like the abdomen or thigh, before being processed in a laboratory and injected during a short procedure.
The treatment can repair torn menisci, the cartilage pads that cushion the knee joint, while some studies suggest stem cells may help heal damaged ligaments, such as the anterior cruciate ligament (ACL).
A report by ALT Treatment suggests 60-70 per cent of patients see positive results. Dr Rosy Jalan, a consultant radiologist, believes there is still some way to go until the treatment becomes a more dependable choice for those in the UK with knee osteoarthritis. Risks include inflammation, tissue damage and unproven effectiveness.
Treatments are offered in various private clinics, regulated by the Human Tissue Authority (HTA) and must comply with stringent guidelines. Relatively expensive, and not widely covered by insurance, the treatment ranges from £3,000 to £6,000 per knee although cheaper clinics can be found abroad in Mexico, India and Thailand.
Is it worth trying?
Though several success stories exist, prospective patients should exercise caution as research on its effectiveness is inconclusive, and potential risks mean conducting your own research is vital.
nSTRIDE autologous protein solution: £1,500-3,000
A new therapy, which claims to be “the only early intervention treatment to target the cause of osteoarthritis,” nSTRIDE is described as the next generation of PRP therapy.
It differs as the patient’s blood is processed to concentrate anti-inflammatory proteins and growth factors. Also, unlike PRP, nSTRIDE is a one-time injection providing results that typically last between one to two years.
Recommended for those with mild to moderate symptoms, blood is taken from a patient’s arm and then processed through multiple steps during preparation. Dr Damian Clark,a knee surgeon from Bristol, says: “Unlike surgery, nSTRIDE is a rapid procedure from which there is little recovery time.”
Success rates vary, but studies report that 60-80 per cent of patients experience significant pain relief and improved mobility following treatment. Relief can last from six months up to 24-36 months, with the injection costing between £1,500-£3,000.
Is it worth trying?
A good choice for those with moderate symptoms, in need of a rapid recovery time (you can return home within the hour) and willing to pay privately.
Prolotherapy injections: £500
Only available privately in the UK, Prolotherapy treats chronic pain and instability in joints, ligaments, and tendons. A small amount of an “irritant,” usually a dextrose solution, is injected into the knee causing deliberate inflammation. This can trigger the healing process through the production of chondrocytes – the cells the body uses to repair and regenerate cartilage.
Additionally, it can strengthen the ligaments, tendons and bones around the joint. However, it often requires three to four shots to take effect, which can become costly with each injection costing approximately £500.
Oliver Eaton – one of the UK’s leading practitioners in the Prolotherapy field – says, “over and above what other injectable solutions do it also helps to stabilise ligaments, which helps to prevent friction that can worsen osteoarthritis, and stimulates the stem cells that patients already possess in their bodies.”
In fact, ‘prolo’ stands for the proliferation of stem cells which convert to cartilage. Mr Eaton cites an 89 per cent success rate in patients taking a three-shot course at the ProHealth Prolotherapy Clinic, with 75 per cent of those patients experiencing relief for nine to 12 months.
Is it worth trying?
Cheaper than some injectables, also benefitting patients with chronic ligament or tendon weakness. It’s not as effective for severe osteoarthritis where there’s significant cartilage loss.
Four alternatives to full knee-replacement surgery
You should always talk to your GP and orthopaedic surgeon to determine the most appropriate treatment plan based on your circumstances, including age, activity level, and severity of your knee degeneration ahead of any surgical treatment.
1. Arthroscopy: £3,000-6,000
This minimally invasive keyhole surgery is performed under anaesthetic to address meniscus tears, ligament injuries and cartilage damage. During the procedure that typically lasts 30-60 minutes, the surgeon may remove or repair damaged tissues, such as torn cartilage, or flush out loose debris.
Most patients go home the same day, with full recovery taking up to six to eight weeks. Something I have personal experience of, sustaining a meniscus tear playing indoor football 20 years ago, I was given a VHS video recording of my procedure.
Jeremy Jarratt, a consultant orthopaedic surgeon at Spire Healthcare in Manchester, says: “The procedure is very successful but patients need to take care with physio and rehabilitation afterwards.”
Available on the NHS (while privately you can expect to pay between £3,000-£6,000 per knee), minor risks include blood clots, knee stiffness and nerve or blood vessel injury. Benefits can last several years, or – if the repair heals properly – more than a decade. Younger patients (below 40) tend to have better long-term outcomes. However, removing part of the meniscus increases the risk of osteoarthritis in the long run, something I have experienced in recent years.
Is it worth trying?
While not always optimal for knee osteoarthritis, beneficial for other knee issues, such as meniscal tears or ligament injuries.
2. Cartilage replacement: £5,000-15,000
Someone without osteoarthritis can still have cartilage repair surgery, as long as the cartilage injury is localised in an otherwise healthy joint. There are four types:
Microfracture
Keyhole surgery involving drilling small holes into the subchondral bone beneath the cartilage defect. It’s available on the NHS or £5,000-£8,000 privately. Saket Tibrewal, a consultant knee surgeon, says: “Once the go-to option for cartilage repair, recent evidence suggests it may not be optimal for active individuals with satisfactory success of 50-70 per cent.”
Is it worth trying?
Can take a year to heal and more advanced techniques are now available, although benefits may last over five years.
Mosaicplasty
Healthy cartilage and underlying bone are harvested and transplanted into the damaged cartilage area. It’s available on the NHS or you can pay between £8,000-£10,000 privately. Recovery includes six weeks on crutches and a return to normal activities in two to four months.
Is it worth trying?
Costly and much more invasive than microfracture, Dr Ademola Adejuwon, a consultant in sports and exercise medicine, suggests it may suit patients with bigger areas of cartilage damage.
Regenerative osteochondral scaffolds
Implants made from biocompatible materials are used to replace damaged cartilage and bone in the knee. Examples include CartiHeal Agili-C and MaioRegen. Rarely available on the NHS, expect to pay between £8,000-£15,000 privately. Success rates range from 70 per cent to over 90 per cent and improved joint function can last five to 10 years.
Is it worth trying?
Expert consensus suggests treatment appropriate for patients aged between 15 and 60 with knee defects.
Autologous chondrocyte implantation (ACI)
Cartilage cells are taken from a non-weight-bearing area of the knee, cultured in a lab and re-implanted. Rehabilitation period can last up to 12 months and graft failure or uneven cartilage growth can occur. It’s available on the NHS, but it’s very expensive at £20,000 per knee, privately. It boasts success rates of around 80-85 per cent.
Is it worth trying?
The Cartilage Clinic at University Hospital Southampton, says: “ACI is regarded as the ‘gold standard’ for cartilage defects within the knee joint”, albeit expensive if choosing privately.
3. Partial knee replacement: £10,000-15,000
Also known arthroplasty, or knee resurfacing, just the damaged portion of the knee joint is replaced with metal and plastic, avoiding a full knee replacement. Available selectively on the NHS or costs £10k-£15,000 privately. Patients can return home the same day but allow three to six weeks to resume activities. Complications can include implant breakage or malalignment.
Is it worth trying?
Recovery is quicker than for full replacements while maintaining the integrity of the healthy bone and cartilage.
4. Osteotomy: From £5,000
Surgical procedure aimed at realigning the bones of the knee joint to shift weight away from the damaged or arthritic area. It’s available on the NHS but cheaper than other private treatments, starting at around £5,000.
Risks include the bone healing slowly or not at all, necessitating further action, or nerve or blood vessel injury. Around 85 per cent of patients report good to excellent results, while three quarters will not require further surgery within 10 years. Dr Adejuwon advises this can be appropriate for younger, active patients with compartmental osteoarthritis or malalignment issues.
Is it worth trying?
Enables patients to maintain a more active lifestyle compared to joint replacement options.
By Dom Hogan
