Non‑Surgical Options for Joint Preservation – What’s Evidence‑Based?

As joint replacement rates rise, many wonder: can we preserve joints without going under the knife? In my experience as an orthopaedic surgeon, front-loading conservative care is crucial. These interventions can relieve pain, improve function, and slow the progression of osteoarthritis. While none are miracle cures, understanding the evidence behind each helps patients make informed choices.

1. Intra‑Articular Hyaluronic Acid (HA) Injections

HA, a natural component of joint fluid, is used in viscosupplementation to improve lubrication and reduce inflammation. Some studies suggest HA can significantly improve pain and function—but the benefits may wane after 6 months .

• The impact on cartilage degeneration and disease modification remains unclear .
• A network meta‑analysis ranked HA above placebo and steroids for pain relief with a favourable safety profile .

Takeaway: HA is reasonable for mid‑term relief, but isn’t proven to change disease trajectory.

2. Platelet‑Rich Plasma (PRP) Injections

PRP uses a patient’s own concentrated growth factors to possibly promote healing.

Evidence in Knee OA:

• Multiple systematic reviews show PRP provides better pain relief and function than HA or placebo, particularly at 6–12 months .
• One network meta‑analysis found PRP and PRP+HA outperformed HA and steroids at 3–12 months .
• Side‑effects are low and similar to HA .

Long‑term considerations:

• Despite good clinical effect, structural changes to cartilage haven’t been consistently demonstrated .
• Benefits appear formulation‑dependent: leukocyte‑poor PRP and multiple injections may offer more lasting relief .

Other joints:

• PRP has shown benefit in adhesive capsulitis (frozen shoulder), outperforming steroids and physiotherapy at 3–6 months .

Takeaway: PRP shows promising mid-term outcomes—but it’s not yet proven to slow structural joint degeneration. Still, it’s a safe, patient-owned option with real functional gains.

3. Weight Management & Physiotherapy

These remain true cornerstones.

• Weight loss in overweight individuals leads to meaningful reductions in hip/knee pain and improves joint load .
• Tailored physiotherapy—especially supervised programs involving low-impact aerobic exercise, strength training, and aquatic therapy—improve pain, mobility, and quality of life for up to 6 months post-intervention .
• While evidence on manual therapy or braces is less strong, the combination of exercise, weight loss, and education is medically supported first-line care .

4. When to Refer

Early referral to orthopaedics or a specialist physiotherapist is key when:

1. Persistent symptoms despite 3–6 months of conservative care
2. Evidence of moderate‑to‑severe osteoarthritis on imaging
3. Functional decline—e.g., difficulty walking, working
4. Rapid deterioration or multiple joint involvement
5. Specialised treatments like PRP/HA are being considered

This proactive approach gives you the best chance to prevent irreversible joint damage and avoid/delay surgery.

Recommended Approach Flow

• Step 1: Weight loss + structured exercise – Reduce load, manage symptoms
• Step 2: Optimised analgesia (paracetamol, NSAIDs) – Symptom control
• Step 3: Consider HA or PRP injections – Mid‑term symptom relief
• Step 4: Refer for early specialist review – Evaluate advanced strategies or surgery

Patient Experience (Hypothetical Scenario)

Meet Sarah, a 60‑year‑old with early knee osteoarthritis. She began physiotherapy and lost 8 kg—her pain eased from 7/10 to 4/10. But after 6 months, stiffness and pain re‑emerged. We opted for three leukocyte‑poor PRP injections. At 9‑month review, Sarah walks more comfortably, stairs are easier, and she returns to light tennis twice weekly. Imaging showed no further cartilage loss. We'll continue therapy and monitoring—and refer early if symptoms recur.

Frequently Asked Questions

1. Can these injections delay the need for surgery?

Yes, especially when combined with lifestyle changes and exercise, injections can relieve pain and improve mobility—but they don’t guarantee permanent avoidance of surgery.

2. Are PRP injections safe?

Generally, yes. Because PRP is autologous, infection or allergic reactions are rare. Mild post‑injection soreness can occur.

3. What’s best: HA or PRP?

For symptom relief, PRP tends to outperform HA over 6–12 months, although evidence levels vary. HA is more affordable and widely available.

4. Where does physiotherapy fit?

It’s the backbone. Combine strength training, aerobic exercise, and education to get the most benefit.

5. How early should one consider referral?

If you’re doing structured rehab and self-management for 3–6 months with little improvement—or imaging shows moderate-to-severe damage—it’s time for referral to a specialist.