Knee replacement surgery is big business. In the US, there are approximately 700,000 procedures performed each year for a variety of reasons. Arthritis–specifically osteoarthritis–in the knee is the main condition for which individuals seek surgical relief. Other conditions include rheumatoid arthritis, haemophilia, gout, bone dysplasia, avascular necrosis, and painful knee deformities.


Although effective, knee replacement surgery is difficult: for at least six weeks post-op patients must walk with some sort of assistance; driving may be restricted for up to 12 weeks; full recovery can take up to two years, and some patients still report feeling pain long past that.


So before resorting to surgery, many doctors prefer to try less-invasive options first. Encouraging weight loss, prescribing medications, and getting physical therapy are generally the first lines of defense. Generally, the next option is to receive injections directly into the affected knee joint.


Here are four types of injections you can try before agreeing to knee replacement surgery:


1. Corticosteroids

The purpose of corticosteroid injections is to remove pain and inflammation in the affected area. The injections generally include a corticosteroid (such as cortisone) and some sort of local anesthetic. Because corticosteroids are notorious for adverse side effects, the number of shots a person can receive in a year are limited. Usually, individuals are prohibited from receiving additional shots if it’s been less than six weeks since the previous injection; and individuals are discouraged from receiving more than three or four shots per year. But even with adverse side effects and limits to usage, corticosteroids are popular among those with knee pain because they reduce pain and inflammation quickly.


Side effects include joint infection, thinning of the skin and soft tissue around the injection site, nerve damage, osteoporosis, osteonecrosis, increase in blood sugar, weakening of tendons, temporary increase of pain and inflammation, and lightening of the skin near the injection site. Relief can last up to several months.


2. Hyaluronic acid

The body naturally produces hyaluronic acid. It’s a clear, sticky substance found in skin, connective tissue (the area surrounding the joints), and eyes. The main function of hyaluronic acid is to keep those parts of the body hydrated and lubricated. Because it’s such a great lubricant, hyaluronic acid is found in supplements, eye drops, skin serums, and injections. When hyaluronic acid is injected into an affected knee, it restores and replenishes missing lubrication, allowing the knee to once again move freely without the painful grinding that was once present.


Side effects are generally mild and could include slight bleeding, blistering, burning, rashes, itching, skin irritations, headache, nausea, and muscle pain. For those those who find relief with hyaluronic acid, that relief lasts up to six months.


3. Platelet-rich plasma (PRP)

Injections using platelet-rich plasma (PRP) contain a portion of the patient’s own blood that has a high concentration of plasma containing many different growth factors. This type of injection promotes healing and reduces inflammation at the inflamed site. Patients have gained relief from pain and more mobility after receiving PRP injections.


Benefits of PRP include a lower risk of infection and accelerated healing. Side effects are extremely minimal since the patient’s own blood is being used. Some rest is required, but soon after, the patient can begin to work out the joint through stretching and strengthening exercises. Younger people and individuals with mild arthritis tend to have the most success with PRP injections. Results remain good and steady up until about six months post injection when pain starts to return.


4. Stem cells

Stem cell treatment as an alternative to knee replacement is gaining popularity. These types of injections to combat arthritis and other conditions causing pain and inflammation are derived from the patient’s own stem cells, often taken from a sample of their adipose (fat) and bone marrow (not from embryonic cells or from fetuses). Recipients have experienced a wide range of benefits from stem cell injections: regeneration of damaged tissue, relief from pain, and actual regrowth of of bone and cartilage. Patients have also reported that they have experienced relief bilaterally even though only one knee has received an injection.


With samples being taken from a patient’s own tissue, there are minimal side effects and no rejection. Results appear to last indefinitely, even years down the road.


These are just four types of injections available to try before consenting to invasive knee replacement surgery. Results vary from individual to individual, but many people have found relief from corticosteroid shots, hyaluronic acid injections, PRP therapies , and stem cell treatments. Relief from most of these treatments last at least three to six months, and some, such as stem cell treatments, last indefinitely. It’s certainly worth avoiding surgery if relief is available through other means.