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.
ONE PATIENT’S EXPERIENCE
He was told he needed two knee replacements.
Here’s what happened first.
One patient’s reported experience. Results vary, and treatment cannot guarantee that knee replacement will be avoided.
Explore other patient experiences. Individual results vary.
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.
How do PRP, bone marrow concentrate and knee replacement differ?
The right choice depends on your symptoms, examination, imaging, prior treatment and goals. These options have different roles and are not interchangeable.
Platelet-rich plasma (PRP)
PRP uses platelets concentrated from your own blood. It may be considered for symptom and function improvement in selected knee arthritis patients. Evidence varies with the patient and preparation. Temporary soreness and an individualized return-to-activity plan are expected; cartilage regrowth is not guaranteed.
Bone marrow concentrate (BMC)
BMC uses components concentrated from your own bone marrow and requires an aspiration. The proposed target may include the joint or selected subchondral bone. Evidence and recovery depend on the diagnosis, target and protocol; findings from one approach do not establish the same result for every BMC procedure.
Knee replacement
An orthopedic surgeon replaces damaged joint surfaces. Replacement may be appropriate when arthritis causes persistent disabling pain despite reasonable nonsurgical care. It has an established role for selected patients and involves surgical risks and rehabilitation. Dr. Westergaard explains when surgical consultation is the appropriate next step.
See the selected BMC studies below and AAOS patient information on PRP and knee replacement. Read about PRP and bone marrow concentrate procedures. Outcomes vary; no option guarantees pain relief or avoidance of further 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
Dr. Westergaard completed an ACGME-accredited Pain Medicine fellowship at Texas Tech University and is double board-certified in Anesthesiology and Pain Medicine. In practice since 1989, she brings deep experience in anesthesiology and image-guided procedures to the evaluation and treatment of spine and joint pain.
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
Frequently Asked Questions About Avoiding Knee Replacement
These answers are educational and cannot determine whether a specific patient should delay or proceed with surgery.
What non-surgical knee pain treatments are available in Dallas?
Where can I get a knee replacement second opinion in Plano?
Can knee replacement always be avoided?
Who may be a candidate for knee joint-preservation treatment?
What imaging should be reviewed before deciding on knee replacement?
Can PRP or bone marrow concentrate regrow an entire arthritic knee?
When is knee replacement more likely to be appropriate?
Is a second opinion reasonable before knee replacement?
Where are knee joint-preservation evaluations available?
Selected Patient Resources
These independent resources provide additional information about knee osteoarthritis, conservative care, surgery, and the responsible evaluation of regenerative medicine claims.
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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.
COSTS & COVERAGE
What will treatment cost?
Your evaluation is billed separately. Procedure costs depend on the treatment plan, so we provide an individualized estimate before scheduling.
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​Orthobiologic procedures are generally not covered by traditional insurance. Regenexx employer benefits may cover eligible treatment, depending on your plan. CareCredit is available, subject to credit approval.