Knee replacement surgery is not usually the first option for treating knee pain. Various alternative treatments may help bring relief.

If you’re experiencing knee pain, ask your doctor about less invasive ways to address it. Here are some suggestions.

Experts strongly encourage people who are overweight or with obesity to lose weight and exercise. Together, these measures can help slow joint damage and reduce pain.

Research shows that every extra 10 pounds increase the chance of developing knee osteoarthritis by 36 percent. At the same time, losing 10 pounds may mean you have 4 times less force pressing on your knees.

Suitable activities include:

  • walking
  • cycling
  • strengthening exercises
  • neuromuscular training
  • water exercise
  • yoga
  • tai chi

Experts note that exercising with a group or a physical therapist may be more effective than exercising alone. They also recommend choosing an activity that you enjoy and can afford.

A healthcare professional can advise on suitable exercises.

A physical therapist can work out a plan to reduce pain and strengthen the key muscles that affect your knees. They can also work with you to make sure you’re doing the exercises correctly.

They may apply ice and heat to reduce pain and inflammation.

Knee injections of hyaluronic acid are thought to lubricate the knee joint. This may help improve shock absorption, reduce pain, and improve knee mobility.

Experts do not currently recommend using these injections, however, as there is not enough evidence that they are proven to work.

Over-the-counter (OTC) medication may help manage knee pain.

Options include:

  • over-the-counter pain relief drugs, such as acetaminophen
  • topical and oral nonsteroidal anti-inflammatories (NSAIDs)
  • topical creams that contain capsaicin

Prescription options

If OTC treatments do not work, your doctor may prescribe stronger medication, such as duloxetine or tramadol.

Tramadol is an opioid, and opioids can be addictive. Experts only advise using tramadol if you cannot use other medications, and they do not recommend any other type of opioid.

Corticosteroid injections

Another option is to have a steroid injection into the affected area. This can reduce the pain and inflammation in your knee. The pain usually reduces within a few days, and relief lasts several weeks.

Some researchers have questioned the long-term use of steroids. One study found that, after 2 years, people who received steroid injections had less cartilage and no improvement in knee pain.

However, guidelines published in 2019 support their use.

Acupuncture is an ancient Chinese technique that may help relieve pain. It uses sharp, thin needles to change the flow of energy within the body.

Research shows that acupuncture can help manage knee pain in the short term.

Current guidelines tentatively support the use of acupuncture in treating knee pain, but note that its benefits are not entirely clear. Risks of acupuncture are low, so acupuncture may be worth trying.

In prolotherapy, a healthcare professional injects an irritant solution into the ligament or tendon to increase blood flow and supply of nutrients. This treatment aims to stimulate the healing process by irritating the tissue.

A dextrose solution, which is a sugar mixture, is usually used.

In one study, people with knee osteoarthritis received five injections 4 weeks apart. They reported their pain levels had improved 26 weeks after the first injection. After a year, they still felt the improvement.

Researchers say this procedure is likely safe and appears to help relieve pain, but they are still calling for more research.

Current guidelines do not recommend using prolotherapy.

A surgeon may suggest arthroscopic surgery to remove bone fragments, pieces of torn meniscus, or damaged cartilage, as well as repair ligaments.

An arthroscope is a type of camera. It allows a surgeon to view the inside of your joint through a small incision. After making two to four incisions, the surgeon uses the arthroscope to operate on the inside of your knee.

This technique is less invasive than traditional surgery. Most people can go home on the same day. Recovery, too, is likely to be quicker.

However, it may not help in all types of knee arthritis.

This experimental treatment uses bone marrow stem cells from the hip to help regenerate cartilage tissue in the knee.

Studies have shown that stem cell therapy can help reduce knee pain and improve function, but it does not appear to result in cartilage regrowth.

Stem cell treatment for joint injuries is not yet part of medical practice. Experts do not currently recommend stem cell injections for osteoarthritis (OA), as there is no standardized treatment method yet.

Another experimental treatment involves injecting an osteoarthritic knee with plasma-rich protein (PRP) in three steps.

  1. A healthcare provider takes some blood from the person who needs the treatment.
  2. Using a centrifuge, they separate the platelets that contain growth factors from the blood.
  3. Then, they inject these platelets into the knee joint.

Current guidelines advise people not to use this therapy, as there is a lack of standardization in preparing and administering the injections. This means it is not possible to know what the preparation consists of.

People with a knee deformity or damage to only one side of their knee may benefit from an osteotomy.

This procedure shifts the weight-bearing load away from the damaged area of the knee.

However, knee osteotomy is not suitable for everyone. It is usually used for younger people with limited knee damage.

Devices that may help include:

  • a walking cane, which can help with balance
  • a knee brace, to support the knee joint

Kineseo tape is a form of support dressing that encourages the body to heal naturally by increasing blood flow around a muscle. It also supports the joint while allowing it to move freely. It can relieve pain and may help prevent OA from developing or getting worse.

Current guidelines do not recommend using modified shoes or lateral and medial-wedged insoles.

Current guidelines advise people not to use:

  • transcutaneous electrical nerve stimulation (TENS)
  • glucosamine and chondroitin sulfate supplements
  • bisphosphonates
  • hydroxychloroquine
  • methotrexate
  • biologics

Before opting for knee replacement surgery, it’s important to consider all your options.

However, if you feel you have tried everything or your surgeon suggests a total or partial replacement, it may be time to consider surgery.