Can You Avoid Knee Replacement? Prolotherapy and Prolozone for Bone on Bone Knees
This is probably the most common question we are asked at Proback Clinic. And it is usually asked by someone who has been on a waiting list for knee replacement, who is scared about what surgery means for their life, and who has been told — directly or by implication — that there is nothing left to try.
The honest answer is: sometimes yes, sometimes no, and we will always tell you which category we genuinely think you fall into rather than simply taking your money and hoping for the best.
What we can say with confidence is that a significant proportion of the patients who come to us facing knee replacement — including patients with bone on bone arthritis, failed steroid injections and long surgical waiting lists — achieve enough improvement through Prolotherapy and Prolozone that they either come off the waiting list entirely or feel that surgery can be meaningfully delayed. That is not a claim we make lightly. It is based on over 10,000 regenerative injection procedures delivered at our Victoria clinic and a 90% rate of meaningful improvement across our patient population.
Why Knee Replacement Is Not Always the Only Answer
Knee replacement is an extraordinary piece of engineering. When it works well it can genuinely transform a life. But it is not without significant limitations that are not always communicated clearly to patients who are in pain and looking for a way out.
Implants last 15 to 20 years. For a patient in their 50s or early 60s this almost certainly means a revision surgery later in life — which is significantly more complex, carries higher risk and produces less predictable outcomes than the original procedure. For a patient in their 70s or 80s the calculus is different.
A meaningful proportion of knee replacement patients — estimates vary between 10 and 20% — experience persistent pain after surgery that is equal to or worse than what they had before. This is not always explained clearly before the decision to operate is made. The joint has been replaced but the nerve sensitisation, the referred pain and the surrounding soft tissue damage that were contributing to the preoperative pain are not addressed by the surgery itself.
None of this means knee replacement is wrong. For the right patient at the right stage of disease it is the right decision. But “bone on bone” does not automatically mean that moment has arrived — and trying every reasonable non-surgical option first is not delay, it is due diligence.
What Happens When We Treat a Bone on Bone Knee
When a patient comes to us with bone on bone arthritis the first thing we do is look. Standing X-rays taken at our clinic show us the actual joint space under load — which is significantly more informative than supine X-rays taken lying down. We review the imaging carefully before recommending anything.
What we are assessing is not just the degree of cartilage loss but the pattern of it — which compartment is most affected, what the alignment of the joint looks like, how the surrounding structures are compensating. A knee that looks bone on bone on an X-ray can have very different characteristics in terms of what is driving the pain and what the realistic potential for improvement is.
Where we decide to proceed Prolozone is our primary tool for the joint itself. Medical grade ozone injected directly into the knee creates a powerful anti-inflammatory and oxygenating effect at the joint level — improving the environment for whatever remaining joint tissue is there and reducing the chronic inflammatory cycle that is generating a significant proportion of the pain.
Prolotherapy addresses the surrounding architecture. The ligaments, the joint capsule, the soft tissue structures that hold the knee together and determine how load is distributed across the joint surface. In bone on bone arthritis these structures are under enormous stress and have typically been damaged or stretched over years of compensating for the deteriorating joint. Strengthening them through Prolotherapy changes the mechanics of the knee in a way that reduces the abnormal loading patterns that have been accelerating the cartilage wear.
The two treatments work together in a way that neither does alone. This is why we see results in bone on bone presentations that single treatment approaches do not consistently produce.
A Typical Patient Journey
The patients we see most commonly are in their 50s or 60s, have had the bone on bone diagnosis for one to three years, have tried physiotherapy and steroid injections with diminishing returns and are on a surgical waiting list they are not entirely sure they want to be on.
After a thorough consultation and review of their imaging we typically recommend four to six sessions of Prolozone and Prolotherapy spaced two to four weeks apart. Most patients notice meaningful improvement from session two or three — walking further, sleeping better, managing stairs with less difficulty. The improvement tends to be progressive rather than dramatic — the joint is not being fixed overnight, it is being given the biological conditions to function better.
Some of those patients come off the surgical waiting list. Others stay on it as a safety net but find they are not in sufficient pain to feel the surgery is urgent. A smaller number proceed to surgery in due course but with a significantly better quality of life in the interim and a clearer sense that they have genuinely exhausted the alternatives.
Before You Book Surgery
Our honest recommendation — before you commit to an irreversible procedure, give yourself the chance to find out whether regenerative treatment can produce enough improvement that surgery is no longer necessary or urgent. The consultation costs £110. The treatment costs a fraction of private surgical fees. And if it does not work, surgery remains available to you exactly as it was before.
Give us a call on 0207 976 6648 or email victoria@proback.co.uk. We are at 4 Evelyn Mansions, Carlisle Place, Victoria, London SW1P 1NH — five minutes from Victoria station. We would love to have an honest conversation about your specific knee.
Frequently Asked Questions
How do I know if I am a good candidate for Prolotherapy instead of knee replacement?
The best way to find out is a thorough consultation and review of your imaging. Generally patients with moderate rather than complete cartilage loss in one or two compartments, who are in their 50s or 60s, and who have not had previous knee surgery respond best. But we have seen meaningful improvement in patients who fall outside these parameters — which is why we always assess individually rather than applying blanket criteria.
How long does it take to see results from Prolotherapy and Prolozone for bone on bone knees?
Most patients notice meaningful improvement from session two or three. The full benefit of a course tends to develop over eight to twelve weeks as the new collagen matures and the joint environment stabilises. Results continue to improve for several weeks after the final session.
What if Prolotherapy does not work — can I still have surgery?
Yes — absolutely. Trying regenerative treatment first does not affect or complicate your surgical options in any way. Surgery remains available to you exactly as it was before treatment.
Is bone on bone the same as needing a knee replacement?
Not necessarily. Bone on bone describes the degree of cartilage loss on imaging but does not automatically mean surgery is the only option or that it is the right time for surgery. The degree of bone on bone, which compartment is affected, your age, activity level and the nature of your symptoms all factor into the decision. We always give an honest individual assessment rather than treating bone on bone as an automatic surgical indication.
Do you treat both knees at the same time?
Yes — both knees can be treated in the same session. One knee is £275 per session and both knees together is £360 — a meaningful saving compared to treating them separately.
How is Proback different from other knee injection clinics in London?
Proback is the official UK training partner of the European School of Prolotherapy and has delivered over 10,000 ultrasound guided regenerative injection procedures. All procedures are performed under live SonoSite ultrasound guidance. We achieve meaningful improvement in 80 to 90% of patients who complete a full course of treatment.
Give us a call on 0207 976 6648 or email victoria@proback.co.uk.
