Knee Arthritis Treatment: Knee Osteoarthritis Care from Exercise to Stem Cells in Bangkok

What is knee osteoarthritis?

Knee osteoarthritis (OA) is a long-term condition in which the cartilage that lines the knee joint gradually thins, and the bone, joint lining and surrounding tissues change. It is the most common form of arthritis and a leading cause of knee pain in people over 50, so most knee arthritis treatment is aimed at osteoarthritis.

Typical symptoms include:

• Knee pain that worsens with walking, stairs, kneeling or standing up
• Stiffness after rest, usually easing within 30 minutes
• Swelling, creaking or grinding (crepitus)
• Reduced range of movement and a feeling of the knee giving way
• In advanced cases, visible bowing (bow legs) or knock knees

The NHS osteoarthritis guide and the Mayo Clinic osteoarthritis overview describe the condition in more detail.

Causes and risk factors

Osteoarthritis develops when the joint’s repair processes cannot keep up with stress and damage. Risk factors include:

• Age and female sex
• Excess body weight, which increases load and promotes inflammation
• Previous knee injury, including meniscus tears, ligament injuries and cartilage damage
• Previous meniscus surgery
• Joint alignment problems and muscle weakness
• Family history and some occupations involving heavy kneeling or lifting

Diagnosis: X-ray grading and when MRI helps

Knee OA is often diagnosed clinically in people over 45 with activity-related pain and short morning stiffness. Weight-bearing X-rays show joint space narrowing, bone spurs and bone changes, and are often graded on the Kellgren-Lawrence scale from 0 (normal) to 4 (severe). MRI shows cartilage, meniscus, ligaments and bone marrow lesions, and helps when symptoms do not match X-rays or when injury is suspected.

The grade matters a great deal when deciding on treatment: regenerative injections are usually only considered for mild to moderate disease (roughly grades 1 to 3), while grade 4 bone-on-bone arthritis is more likely to need surgery. You can send your X-ray or MRI for a doctor review to find out where your knee sits.

Conventional knee arthritis treatment

The UK NICE osteoarthritis guideline NG226 summarises the mainstream approach:

• Exercise. Strengthening (especially the thigh muscles) and general aerobic activity are the core treatment for everyone. Physical therapy for arthritic knees improves pain and function.
• Weight management. Even modest weight loss reduces knee load and pain for people living with overweight.
• Medicines. Topical NSAIDs are the first choice for knee OA; oral NSAIDs can be used for limited periods with caution. Strong opioids are not recommended.
• Steroid injections. Can relieve flares for a few weeks.
• Hyaluronic acid injections. NICE does not recommend them, although they are used in some countries.
• Arthroscopic washout is not recommended for OA unless the knee is locking.
• Knee replacement or osteotomy. For severe symptoms despite non-surgical care. Total knee replacement has strong long-term evidence for pain relief.

Regenerative options: what the evidence says

Knee osteoarthritis is the most studied use of orthobiologic injections.

• PRP therapy: many randomised trials and meta-analyses report better pain and function scores than hyaluronic acid or placebo at 6 to 12 months, particularly in mild to moderate OA. However, the large placebo-controlled RESTORE trial (Bennell and colleagues, JAMA, 2021) found no significant difference between PRP and saline injections in symptoms or cartilage over 12 months. See PubMed randomised trials of PRP for knee osteoarthritis.
• Stem cell therapy: mesenchymal stromal cells from fat, bone marrow or umbilical cord tissue. Small randomised trials report improvements in pain and function for some patients, but study quality and cell products vary widely, and consistent cartilage regrowth has not been demonstrated. In South Korea, an umbilical cord blood-derived cell product (CARTISTEM) is approved for cartilage defects, often used with surgery. See PubMed trials of MSCs for knee osteoarthritis.
• Exosome therapy: promising in animal models of cartilage protection, with very limited human data so far.

In the US, the FDA has not approved stem cell products for osteoarthritis and warns patients about unapproved stem cell therapies.

Comparing knee osteoarthritis treatment options

Option	Best for (OA stage)	Evidence	Duration of effect	Main downside
Exercise and weight loss	All stages	Strong	Ongoing if maintained	Needs consistency
Topical or oral NSAIDs	Flares, all stages	Moderate to strong	While used	Side effects (oral)
Steroid injection	Flares	Moderate	Weeks	Short-lived; limit frequency
Hyaluronic acid	Mild to moderate	Weak to mixed	Months	Not recommended by NICE
PRP injection	Mild to moderate	Mixed (many trials)	Months in positive trials	Inconsistent results
Stem cell (MSC) injection	Mild to moderate	Early, small trials	Uncertain	Experimental; product variability
Knee replacement	Severe	Strong	Many years	Major surgery and recovery

Who may be a candidate for regenerative treatment?

• Mild to moderate knee osteoarthritis on X-ray or MRI (roughly Kellgren-Lawrence grade 1 to 3)
• Persistent pain despite exercise, weight management and medicines
• People who wish to delay surgery or are not yet ready for knee replacement
• Good general health and acceptance that results vary

Who should not have regenerative treatment

• Severe, bone-on-bone arthritis (grade 4) or major deformity, where replacement is more likely to help
• Inflammatory arthritis that is not controlled, or a joint infection
• Active cancer, blood or platelet disorders, or ongoing anticoagulation that cannot be paused safely
• Pregnancy, or recent steroid injection into the same knee (usually a waiting period applies)

Risks and side effects

Knee injections commonly cause temporary pain, swelling and stiffness for a few days. Rare risks include joint infection, bleeding into the joint and allergic reactions. Fat or bone marrow harvesting for autologous cell treatment adds bruising and soreness at the harvest site. Long-term safety data for cell products remain limited. Cells used in our programmes are prepared in ISO 9001:2015-certified partner laboratories.

What a knee osteoarthritis treatment trip to Bangkok looks like

1. Before travel: send your knee X-ray or MRI and reports on WhatsApp. A doctor reviews your arthritis grade and whether a regenerative program makes sense, or whether a surgical opinion would be more useful.
2. Day 1: consultation, knee examination, imaging review and blood tests.
3. Day 2 to 3: ultrasound-guided injection or injections according to the protocol.
4. Remaining days: follow-up check and a strengthening program.

PRP-only programmes may need around 3 to 5 days; stem cell programmes typically 5 to 7 days. Patients travel from Australia, the UK, the US and Canada. See how it works. No result is guaranteed.

Recovery and aftercare at home

• Rest the knee for 24 to 48 hours, then resume walking gradually
• Avoid running, jumping and heavy gym work for several weeks
• Start quadriceps and hip strengthening as directed; exercise remains essential
• Avoid anti-inflammatory medicines for the period advised after PRP or cell injections
• Share pain and activity scores with the medical team on WhatsApp
• Expect any benefit to build gradually over weeks to months

Seek urgent care for a hot, very swollen knee or fever after an injection.