Beyond the Scalpel: How PAAG Could Help Delay Knee Replacement Surgery in Osteoarthritis

Introduction

Knee osteoarthritis (OA) is a common condition where the cartilage in the joint gradually breaks down, leading to pain, stiffness, and reduced mobility. When conservative measures like pain medication or physiotherapy no longer offer relief, many people are faced with the possibility of total knee replacement (TKR) surgery. While TKR can be very effective, it is a major surgery with risks and the replacement joint itself doesn’t last forever. Understandably, patients and their doctors often seek ways to manage symptoms and put off surgery for as long as possible. One promising new treatment is Polyacrylamide Gel (PAAG), a minimally invasive injectable that may relieve symptoms and delay the need for knee replacement. In this article, we’ll discuss why delaying surgery can be a good idea, how PAAG works, what patients can expect, and what the future holds for this innovative approach.

Why Delay Knee Replacement Surgery?

Choosing to delay knee replacement isn’t simply about postponing surgery—it can bring real benefits. Any major operation comes with risks, such as infection, blood clots, or complications from anaesthesia, especially for older adults or people with other health issues. Preserving your natural knee joint also helps maintain the body’s original biomechanics and joint sensation, making movement and balance feel more natural. From a practical perspective, delaying surgery can help reduce medical costs and hospital stays. The challenge is to manage pain and stiffness well enough to keep living life to the fullest—without heading straight to surgery.

That’s where treatments like PAAG come in. Injectable therapies have already shown their value: for example, evidence with another injectable called hylan G-F 20 found that “TKR was delayed for over 7 years in 75% of 1,863 grade IV OA knees…treated with hylan G-F 20” (Joseph & Waddell, 2014). This shows how injectable treatments can prolong the lifespan of the natural knee joint and provide symptom relief, buying precious time before surgery becomes essential.

What Is PAAG and How Does It Work?

Polyacrylamide Gel, or PAAG, is a safe, jelly-like substance designed to work inside the body. When injected into the knee, it acts as a synthetic lubricant, mimicking the joint’s natural fluids. This provides extra cushioning, reducing friction and pressure within the knee. Its high water content helps absorb shock and ease pain, protecting the joint from further damage as you move about your day.

PAAG injections are quick, minimally invasive, and usually performed under local anaesthetic with ultrasound guidance for accuracy. Research has shown that many people experience noticeable improvements in pain and mobility after PAAG treatment. For example, a recent study observed improvements in knee OA symptoms lasting at least 24 months (Gao et al., 2025). While some people may need repeat injections and long-term effects are still being studied, PAAG offers a promising option for managing knee osteoarthritis without resorting to surgery.

How Does PAAG Compare with Knee Replacement?

Patients receiving PAAG often report significant pain relief and increased mobility, allowing them to resume daily activities more comfortably. Compared to knee replacement surgery , PAAG carries several advantages: it avoids the risks of major surgery, involves minimal recovery time, and preserves your natural joint.

However, it’s important to be realistic—total knee replacement is still the most durable and effective solution for people with severe, end-stage osteoarthritis, providing lasting pain relief and improvement in function when all other treatments have been exhausted. PAAG serves best as a middle ground, helping manage symptoms and delay surgery until it’s truly necessary. Tailoring this treatment to the right patient—accounting for factors like age, severity of OA, and general health—will be key to getting the best possible outcome.

Looking Ahead: The Future of PAAG in Osteoarthritis Care

In short, Polyacrylamide Gel is an exciting addition to the toolbox for treating knee osteoarthritis. By improving joint lubrication and cushioning, PAAG can relieve symptoms and may help slow further damage, giving people the freedom to stay active and independent for longer. This may also help reduce the burden on the healthcare system by decreasing the number of immediate, major surgeries. As larger and longer-term studies emerge, we’ll gain a clearer picture of exactly how effective PAAG is, who stands to benefit most, and how it might be used alongside other treatments. With further research, PAAG could become a valuable part of personalised, patient-friendly osteoarthritis care—a true example of moving “beyond the scalpel.”