International patients · Joint preservation
Told a joint replacement is your only option?For suitable patients, it may not be.
If you have been told a replacement is all that is left, it is worth an honest assessment of whether a joint-preserving option is suitable. This is about options, never about being faster.
Reviewed byProfessor Paul Lee MBBch, FRCS (Tr & Orth), PhDCartilage and joint preservation expertiseThe reframe
Why “replacement is the only option” is often a default
Being told a joint replacement is your only option often reflects what is routinely offered locally, rather than everything that is possible. A few things sit behind that.
Younger patients are often advised to wait. Joint-registry data show that replacements done in younger patients are more likely to need revision later. One large UK study published in The Lancet found a man in his early fifties has roughly a 35% lifetime risk of needing revision surgery, against around 5% for someone over seventy. That is why many surgeons advise deferring replacement where possible.
Regulated regeneration carries strict limits. Regulated cartilage-regeneration procedures carry defined age and defect-size limits that vary by country. In England, for example, the NHS funds one form of cartilage regeneration only for defects above a certain size, with minimal arthritis and no previous repair (NICE TA477). Patients who fall outside such limits are sometimes told replacement is all that remains.
Advanced repair is under-offered. In the Netherlands, for example, a 2023 survey of knee specialists found advanced cartilage repair was offered by only a small minority. So being told replacement is the only route can reflect local practice rather than a universal truth.
Joint preservation is a recognised alternative for suitable patients, and international consensus supports considering it before replacement where appropriate. It is never a blanket replacement for surgery, and it is never about being quicker.
By joint
What may be possible, joint by joint
Knee, the strongest case
The knee is where a joint-preserving alternative most often exists. Depending on your assessment, options can include cartilage repair and regeneration such as STACi, a ChondroFiller injection or Liquid Cartilage surgery, an Arthrosamid injection to cushion an osteoarthritic knee, and ACL repair that preserves your own ligament.
There is an important distinction between the surgical and injection routes. The surgical regeneration route carries age limits, around the mid-fifties, and defect-size limits. A ChondroFiller injection, a technique developed by Professor Lee, does not carry the same age or size limit. His analogy is that surgery digs out and rebuilds one specific defect, whereas the injection coats the whole surface.
Some honesty about the injection route: the manufacturer’s standard method for ChondroFiller, made by Meidrix Biomedicals GmbH, is surgical placement into a prepared defect. Delivering it by injection is a technique developed by Professor Lee that we are not aware of being offered elsewhere; it is not established in published clinical studies and outcomes cannot be guaranteed. Because regeneration relies on the body’s own healing, it is less predictable over the age of about 55, so “no age limit” means eligibility for the injection, not a guarantee of effect. It is joint-preserving, not a cure.
Hip, honestly scoped
At the hip, joint-preserving options are assessed where they are suitable. But the hip is different from the knee, and for many patients with advanced hip arthritis a replacement is genuinely the right operation. Where that is the case, Professor Lee uses a muscle and tendon-sparing approach designed to protect the soft tissues around the joint.
We will not imply a preservation option that is not the right choice for your hip. The honest answer is that it depends on your assessment. See hip replacement and hip arthritis for how the hip is approached.
Shoulder, ankle and other joints
Other joints, such as the shoulder and ankle, are assessed case by case. Some joints are harder to treat by injection than others, so we would rather have an honest conversation about your particular joint than overclaim. Explore shoulder and ankle options, or ask on a discovery call.
Honest suitability
Who this may suit, and who it may not
May be worth assessing
- Focal cartilage damage rather than widespread bone-on-bone arthritis
- Younger patients advised to defer a replacement
- Patients ruled out of a regulated procedure by age or defect size
- Anyone wanting to explore preserving their own joint first
Where replacement may be right
- Established end-stage, bone-on-bone arthritis
- Results are less predictable over the age of about 55
- Not every joint or every defect is treatable this way
- Some joints are harder to treat by injection than the knee
Every alternative-to-replacement statement here is a clinical judgement that depends on your individual assessment. Nothing on this page is a promise of a particular outcome.
By country
Been told this at home?
See how this looks for patients travelling from your country.
Authority
Assessed honestly, by Professor Lee
International patients are usually choosing between a small number of world specialists, so the surgeon matters more than any single treatment. Your consultation, your treatment and your follow-up are all with Professor Paul Lee.
- Consultant Orthopaedic Surgeon and medical engineer, PhD
- Internationally published in cartilage repair and joint preservation, cited over 1,000 times
- Lead of an ICRS teaching centre for cartilage regeneration
- Joint-replacement outcomes recorded in the National Joint Registry, within the expected range
- Member of the British Association for Surgery of the Knee (BASK)
Joint preservation
Frequently asked questions
I have been told I need a joint replacement. Could there really be another option?
For suitable patients, a joint-preserving option may be an alternative, depending on a full assessment of your imaging, the size and location of the damage and your goals. It is not right for everyone, and Professor Lee is honest where replacement is genuinely the best choice.
Is a joint-preserving option better than a replacement?
Neither is universally better. Joint preservation aims to keep your own joint where that is realistic and suitable; a replacement is the right choice for genuine end-stage, bone-on-bone arthritis. The point is that both should be considered, not that one always wins.
Is there an age limit for cartilage regeneration?
Regulated, surgical cartilage-regeneration procedures carry defined age and defect-size limits that vary by country. A ChondroFiller injection, a technique developed by Professor Lee, does not carry the same age or size limit, but it is not established in published clinical studies, outcomes cannot be guaranteed, and because regeneration relies on the body’s own healing it is less predictable over the age of about 55. Suitability is always assessed individually.
What about hips and other joints?
The strongest case for joint preservation is at the knee. At the hip, joint-preserving options are assessed where suitable, and where a replacement is genuinely needed Professor Lee uses a muscle and tendon-sparing approach. Other joints, such as the shoulder and ankle, are assessed case by case, and some are harder to treat by injection.
How do I find out if I am suitable?
Start with a discovery call, then a consultation and assessment of your imaging. That is the only reliable way to know whether a joint-preserving option is realistic for you.
Find out whether you have another option
The only reliable way to know is an honest assessment. Book a discovery call, or a virtual consultation with Professor Lee, to talk it through.