Alternatives to Knee Replacement Surgery

Non-surgical options to discuss with your doctor before joint replacement, including one you may not know about: low-dose radiation therapy (LDRT)

Find a Location Interactive Map What Is LDRT? Am I a Candidate? Is It Covered by Insurance?
What to Expect LDRT Side Effects Arthritis Basics LDRT Success Rates American Radium Society Guidance

Where Knee Replacement Fits

Joint replacement can be highly effective for advanced hip or knee osteoarthritis when pain and disability remain severe despite non-surgical care. It's a major procedure with a real recovery period, and it isn't right for everyone or for every stage of disease. Timing the decision depends on more than imaging alone. Symptoms, function, overall health, treatment goals, surgical risk, and the patient's own readiness all matter.

Where LDRT Fits

LDRT is non-invasive and outpatient. No needles, no sedation, and no recovery period, with six treatment sessions given over about two to three weeks. It is usually discussed after diagnosis is clear and standard non-surgical approaches have been tried or considered, for patients with persistent pain who want to discuss a non-surgical option before or instead of surgery. LDRT is non-surgical and does not rebuild cartilage; the goal is to reduce pain and improve function, not to reverse structural joint damage the way a replacement addresses it directly.

Because LDRT can't regrow cartilage, patients with more advanced structural damage may be less likely to improve from it. For that stage of disease, joint replacement may be the more effective option. A radiation oncologist and orthopedic surgeon, together with the patient, are best positioned to weigh which approach, or which order of approaches, fits the specific situation.

What Knee Replacement Involves

In a total knee replacement, a surgeon removes the damaged surfaces of the joint and replaces them with metal and plastic parts. Physical therapy starts soon after surgery and is a big part of recovery. According to the American Academy of Orthopaedic Surgeons, most people return to their normal daily routine within about three to six weeks.[1]

Results are generally good and long-lasting. A large review of national joint registries found that about 82% of total knee replacements were still in place 25 years later.[2] Even so, it does not work out for everyone: in a study of 1,703 knee replacements in Ontario, about 1 in 5 patients were not satisfied with the result, and unmet expectations were the strongest predictor of dissatisfaction.[3]

Side by Side

LDRT

What it does: aims to calm inflammation in the joint and reduce pain. It does not change the joint's structure.

What it involves: six outpatient sessions of about 10 to 15 minutes over two to three weeks. No anesthesia and no recovery period.

Evidence: mixed. A 2025 sham-controlled knee trial found a benefit with 3 Gy,[4] while a 2019 trial using 6 Gy did not.[5]

Best suited to: mild to moderate osteoarthritis with ongoing pain despite other treatments.

Knee Replacement

What it does: replaces the damaged joint surfaces with an artificial joint.

What it involves: surgery with anesthesia, followed by weeks of physical therapy.

Evidence: a long track record. Most implants last for decades.

Best suited to: advanced osteoarthritis with severe pain and disability that other treatments have not controlled.

Can LDRT Delay a Knee Replacement?

Many people ask this. So far, no study has shown that LDRT delays or prevents knee replacement. What LDRT offers is a chance at pain relief without surgery. If it helps, you may feel less need to schedule surgery right away, and if it does not, surgery is still an option to discuss. If you are weighing both, ask your orthopedic surgeon and radiation oncologist how one would affect the timing of the other.

ℹ

For education only. LDRT is not right for every patient. Talk with your doctor about whether it makes sense for your situation.

For the clinical evidence behind LDRT's effectiveness, see our LDRT Success Rates page or the full reference list on FAQ.

References:
1. American Academy of Orthopaedic Surgeons. Activities After Knee Replacement. OrthoInfo. OrthoInfo
2. Evans JT, et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet. 2019. Article record
3. Bourne RB, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clinical Orthopaedics and Related Research. 2010;468:57-63. PubMed
4. Kim BH, et al. Clinical Effectiveness of Single Course Low-Dose Radiation Therapy in Knee Osteoarthritis: Short-term Results from the Randomized, Sham-Controlled Trial. ASTRO 67th Annual Meeting Late-Breaking Abstract LBA 06. 2025. Abstract
5. Mahler EAM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. 2019. PubMed

What to Do Next

What Is LDRT?

How the treatment works, the typical schedule, and what the evidence shows.

Am I a Candidate?

What programs generally look for before recommending LDRT.

Is It Covered by Insurance?

What Medicare and most commercial plans typically cover.

What to Expect

What a typical LDRT appointment and course of treatment looks like.

LDRT Success Rates

What the published response and pain-relief rates actually show.

Arthritis Basics

How common forms of arthritis differ and when to seek care.