The number one question that Dr. Joseph Mejia has fielded in his 25 years of practice is “How could I have avoided knee replacement surgery” or “bone on bone” knee pain?  Avoiding knee replacement or at least delaying it comes down to making strategic health decisions that will greatly mitigate one’s risk as well as making well informed medical decisions if you have been diagnosed with osteoarthritis (OA)/degenerative joint disease of the knee. 

Rest assured, a diagnosis of knee arthritis, even if you are told it is “bone on bone,” does not mean that a knee replacement is your only option. 

For decades, Performance Ortho has helped countless patients with surgical alternatives to avoid or significantly delay a knee replacement. Continue reading to learn more about the root causes of knee pain and the treatment options that are available or make an appointment at one of our NJ ortho clinics for more information.

Understanding the Root Cause of Knee Pain

The root cause of knee pain from OA/degenerative joint disease is often a multifactorial complex process which includes wear and tear of the cushioning and lubricating cartilage found in the knee joint. Often acute or chronic inflammation will occur in the knee joint which is as often described as “water on the knee” by the patient. Some patients experience a less obvious, but equally painful and destructive low-grade swelling that is easily detected on MRI or ultrasound testing.   

When knee pain is left untreated, patients will often alter the way they walk, sleep and engage in other daily activities, often resulting in pain in hip, spine or ankle. 

Conditions and Contributing Factors

There are many factors that contribute to chronic knee pain that evidently may require patients to consider a total knee replacement. Some of the factors are well within the control of the patient, while others, the patient has little or no control over. Let’s identify and discuss them below.

Factors Patients Generally Don’t Have Control Over

• Age – osteoarthritis (OA) /degenerative joint disease comes with age and is a progressive wearing away of the cartilage of the knee-shock absorbing structure.
• Genetics – patients that have significant family history of osteoarthritis /degenerative joint disease are significantly more likely to have joint pain and arthritis.
• Previous joint injury – patients that have experienced previous injury, trauma surgery to the knee and/or surrounding structures like ligament injuries (ACL) or meniscus can experience an increase in joint pain and arthritis years from the initial trauma or surgery. 

Factors Patients Generally Have Control Over

• Body weight – excess body weight increases the stress and strain on weight bearing joints like the knee, wearing away the protective shock absorbing cartilage prematurely.
• Active lifestyle – decrease in muscle strength from inactivity in the thigh, glutes and hip muscles can result in weakness, pain and stiffness in the knee.  Low impact regular exercise is a great way to ensure improved joint health
  
• Early evaluation of symptoms – early onset evaluation and management of symptoms can allow the patient to significantly decrease or eliminate the destructive cycle of knee cartilage erosion and pain.  

Other Risk Factors

• Lifestyle – smoking and tobacco use have been proven to deprive the body of oxygen and essential vitamins for healing and repairing.
• Diet – managing inflammation by reducing or eliminating pro-inflammatory foods such as fried foods, high sugar/ processed food and excessive alcohol consumption.
• Certain Medication – long term use of certain corticosteroids have been shown to damage cartilage, thus accelerating OA/degenerative joint disease. 

How Do You Diagnose Knee Arthritis?

As with most medical conditions, diagnosis consists of a detailed history and exam, which often includes diagnostic testing.

• During the history, the doctor will ask questions about family history, surgical history or trauma, as well as medication history.
• On examination, the doctor will assess the range of motion (ROM) of the knee -moderate to severe reduction on bending and extending of the knee could indicate OA of the knee.
• Observing how the patient walks (gait) and the overall posture of the knees (bowed or knocked) is another assessment to evaluate for OA.
• Standing X-ray analysis is a valuable tool to assess the extent and nature of arthritis. Ultrasound will allow the doctor to evaluate for swelling and other structures like ligaments, meniscus and tendons. MRI evaluation of the knee is helpful but not always necessary for an accurate diagnosis of OA when X-ray and ultrasound findings are correlated. 

Non-Surgical Treatment Options

Most orthopedic specialists agree that the majority of patients with knee osteoarthritis should first pursue conservative, non-surgical treatments before considering surgical options such as knee replacement. Surgery is typically reserved for advanced cases that do not respond to non-operative management.  

The milder cases of knee pain resulting from minimal OA will usually respond well to a more simple treatment approach like activity modification, physical therapy, or a cortisone injection (anti-inflammatory). One or a combination of these recommendations is often enough to reduce any inflammation in the knee while also increasing the surrounding muscles strength around the knee and hip, resulting in lasting relief.  

However, if the patient has had multiple cortisone injections, more than 4-6 weeks of physical therapy and is not reporting a significant (>50%) reduction in pain and noticeable ability to move better, then the patient may be a candidate for a more advanced OA knee treatment plan. 

Advanced Treatment for Knee OA

When patients come to Performance Ortho with knee osteoarthritis that has not responded to previous treatments, or when their condition is found to be moderate to advanced, we often recommend more advanced treatment options tailored to their specific needs. Most often, advanced knee OA is longstanding with high pain levels and limited patient mobility, presenting significant challenges to the orthopedic specialist. 

Years of clinical experience have shown that patients with advanced or complex knee osteoarthritis respond best to a comprehensive, team-based approach like that found at our proprietary Joint Preservation Program. This includes collaboration among pain management physicians, regenerative medicine specialists, and rehabilitation experts. Together, they work to address the three primary drivers of knee pain: inflammation, cartilage degeneration and lower extremity and core dysfunction.

1. Knee swelling and inflammation – Aspirating(draining) the knee with the aid of ultrasound computer guidance to ensure effectiveness of the procedure along with an anti-inflammatory medication to soothe the knee pain. Often Radio frequency ablation is performed on the nerves of the knee to give longer term pain relief after the medication wears off.
2. Knee cartilage erosion – Because osteoarthritis causes the gradual wearing of knee cartilage, physicians must address this process using a range of targeted treatments. Hyaluronic acid injections are often used to help lubricate the joint and improve smooth, pain-free movement. For longer-lasting relief, physicians with advanced training in regenerative medicine may recommend platelet-rich plasma (PRP) or adult stem cell therapy to help stimulate healing and slow joint degeneration.
3. Lower extremity and core weakness – Patients that suffer with chronic knee OA pain demonstrate limited strength and flexibility making even simple activities exhausting and painful. Once the physician has adequately controlled the patient’s knee pain, it is essential for the patient to improve function and a return to normal lifestyle activities, through a structured rehabilitative program including physical or occupational therapy. 

At the heart of the Performance Joint Preservation Program is one of the most exciting advancements in modern orthopedic care: Regenerative Medicine. This cutting-edge field has revolutionized the way we approach chronic joint pain and degenerative conditions, offering patients real hope beyond surgery.

Rather than relying on artificial implants or invasive procedures, regenerative medicine uses the power of the body’s own biology to heal itself. Through targeted techniques such as platelet-rich plasma (PRP), stem cell therapy, and other biologic treatments, we can help stimulate tissue repair, reduce inflammation, and slow or even reverse joint degeneration.

These treatments are especially valuable for patients suffering from osteoarthritis or chronic joint damage in the knees, hips, shoulders, and spine. By preserving the joint instead of replacing it, patients often experience substantial reductions in pain, improvements in mobility, and a return to the activities they love—without the downtime and risks associated with surgery. Learn more about these treatments below:

• Regenerative Medicine – Performance Ortho is a pioneer in the field of Regenerative Medicine, performing over 5,000 stem cell and PRP procedures since 2013.
• Stem cells are adult stem cells derived directly from the patient. These cells have the ability to change into any cell that they are injected to, including cartilage cells.
  • Shown to regenerate cartilage 
  • Reduces inflammation 
  • Support tissue healing
• PRP– derived from a simple blood draw from the patient, prepared and reinjected to injured or damaged tissue, like knee cartilage.
  • Causes a release of growth factor in the body 
  • Provided valuable blood nutrients for cartilage repair
  • Reduce swelling, pain and stiffness. 

Contact Our NJ Ortho Clinics

If you’re struggling with knee pain from osteoarthritis and want to explore options beyond surgery, the team at Performance Ortho is here to help. Discover how advanced, non-surgical treatments like PRP and stem cell therapy can get you back to doing what you love.

HERE’S HOW TO GET STARTED:

1. Contact Us or Request a Visit – 908 756-2424
   Reach our Patient Access Team or use our quick online form to schedule a consultation at any of our locations in Branchburg, Hillsborough, Somerset, and Watchung.
   
2. Get a Personalized Evaluation
   We’ll assess your knee health, review past treatments, and explore regenerative options tailored to you.
3. Start Moving Again — with Less Pain
   Begin your custom care plan and take the first steps toward restored mobility and lasting relief.