If you have been told you need a total knee replacement, this page is for you. Knee replacement is one of the most common orthopedic surgeries in the United States, and for joints that have truly failed, it can be life-changing. But not every knee that hurts needs to be replaced. And the decision to operate should never be made without a thorough evaluation of whether regenerative medicine can restore enough function and reduce enough pain to keep your natural knee working.
Many patients I see at Dynamic Athlete were told a knee replacement was their only option. Some were told at 45, 50, or 55 years old. They were not told that PRP, stem cell therapy, and shockwave therapy could delay or eliminate the need for surgery. They were not told that their knee pain might actually be coming from their SI joint, not their knee at all. They were given one option when several existed. This page exists because every patient deserves to know what is possible before committing to a surgery that cannot be undone.
Total knee replacement involves removing the damaged surfaces of your knee joint and replacing them with metal and plastic components. Recovery takes three to six months of intensive rehabilitation, with full recovery often taking a year. The implant has a finite lifespan, typically 15 to 20 years, meaning patients who receive a replacement in their 50s may face revision surgery in their 70s.
Surgical risks include infection, blood clots, implant loosening, persistent stiffness, and chronic pain that affects up to 20% of knee replacement patients. Many patients also report that the replaced knee never feels “normal,” describing a mechanical sensation that limits confidence during activity. For active adults in Boulder who ski, hike, bike, and climb, the activity restrictions that follow knee replacement, including limitations on high-impact activities, represent a fundamental change to their lifestyle. These trade-offs deserve careful consideration against alternatives that preserve your natural joint.
At Dynamic Athlete, we help patients avoid or delay knee replacement using a combination of regenerative protocols tailored to the severity of their joint damage.
Dynamic PRP+ concentrates your own platelets and growth factors, then delivers them directly into the knee joint under ultrasound guidance. PRP reduces inflammation and improves the joint environment. For patients with mild to moderate cartilage loss who have been told they need replacement based on imaging alone, PRP often produces enough improvement in pain and function to take surgery off the table entirely.
Dynamic Stem Cell+ uses your body’s own regenerative cells from bone marrow aspirate (BMA) or adipose tissue through micro-fragmented adipose tissue (MFAT) for more advanced cartilage loss. These autologous, minimally manipulated cells are most accurately called mesenchymal signaling cells. Patients with moderate to severe cartilage loss who are not yet candidates for joint failure may gain years of active function through this approach.
Dynamic Shockwave+ combines focused shockwave with EMTT using Storz Medical devices. For knees approaching replacement, shockwave reduces chronic pain signaling, stimulates blood flow, and enhances the tissue environment for regenerative injections. EMTT penetrates deeper to accelerate cellular metabolism. I founded ASTI and train clinicians nationally on these protocols.
Critically, we also evaluate whether your knee pain is actually coming from your knee. SI joint dysfunction, referred hip pain, and periarticular soft tissue problems can all create symptoms that mimic end-stage knee arthritis. Dynamic Core+ (EMSELLA) strengthens the core and pelvic floor muscles that support knee mechanics. Dynamic Mind+ (EXOMIND) enhances neurological recovery. Dynamic Athlete is the only practice in the country offering all five proprietary modalities under one roof, giving us the ability to address every dimension of your knee condition in one coordinated treatment plan.
You were told you need a knee replacement. Before you commit to a surgery that cannot be undone, you deserve an evaluation from a physician trained at the facility where professional athletes receive joint-preserving care. Aneesh Garg, DO, CAQ completed his fellowship at Andrews Sports Medicine and his residency at Yale. He is double board-certified in Sports Medicine and Internal Medicine and serves as Team Physician for USA Hockey and U.S. Soccer. If your knee needs replacement, he will say so. If it does not, he will show you what else is possible.
His dual training is why this evaluation matters. He has the expertise to assess whether your knee truly needs replacement or has a better path forward through regenerative medicine. He will not tell you to skip surgery if you need it, and he will not replace a knee that can be restored.
Our patients who were told they needed knee replacement consistently report dramatically different outcomes after evaluation and treatment at Dynamic Athlete.
One patient was told she needed a full knee replacement. Dr. Garg identified the actual source of her problem at her SI joint, treated it with stem cell and PRP, and she is now pain-free, climbing, and ready for ski season. Surgery on her knee would not have solved her problem.
Another patient visited several practices and was told a knee replacement was her only option. She described being blown away by how well her knee is doing after treatment at Dynamic Athlete.
One patient with degeneration in both knees uses MFAT, PRP, and HA as her ongoing protocol to continue running and hiking pain-free and avoid surgeries as the years go on.
For many patients, yes. Regenerative medicine can delay or eliminate the need for total knee replacement by restoring joint tissue, reducing inflammation, and improving function. The key is whether your joint has enough remaining structure to respond to treatment. Patients with mild to moderate cartilage loss often see significant improvement with Dynamic PRP+ and Dynamic Shockwave+. Even patients with more advanced arthritis may gain years of active function before replacement becomes necessary. Over 90% of our patients self-report a 75% or greater improvement, all without surgery. One patient told she needed a full knee replacement is now pain-free, climbing, and skiing after regenerative treatment here.
PRP concentrates your own platelets and growth factors, then delivers them directly into the knee joint under ultrasound guidance. These growth factors reduce chronic inflammation and improve the joint environment. For patients whose knee replacement recommendation was based primarily on imaging (X-ray showing narrowed joint space) rather than complete joint failure, PRP often produces enough improvement in pain and function to remove surgery from the conversation. Our Dynamic PRP+ protocol uses precise concentration ratios and image-guided delivery. Dr. Garg has performed hundreds of these procedures with fellowship training from Andrews Sports Medicine. One patient who struggled for years after ACL surgery and explored several clinics received PRP at Dynamic Athlete, and his knee now feels remarkably close to normal.
It depends on your knee. Dynamic Stem Cell+ uses your own bone marrow aspirate (BMA) or micro-fragmented adipose tissue (MFAT), processed in the same visit and injected under live ultrasound; these autologous, minimally manipulated cells are most accurately called mesenchymal signaling cells. Whether it fits a severely arthritic knee depends on your imaging, your symptoms and your goals, and advanced bone-on-bone disease is sometimes better served by other options. If surgery is the right answer, we will say so. One patient with degeneration in both knees uses MFAT, PRP, and HA as her ongoing protocol to keep running and hiking.
Yes, and this is one of the most important questions to ask before committing to knee surgery. The sacroiliac (SI) joint at the base of your spine can refer pain directly into your knee. Referred hip pain and periarticular soft tissue problems can also mimic knee arthritis symptoms. At Dynamic Athlete, we evaluate the full kinetic chain before recommending any treatment. One patient was told she needed a full knee replacement. Dr. Garg identified the actual source at her SI joint, treated it, and she is now pain-free. Surgery on her knee would not have solved the problem. This diagnostic precision is what separates a thorough evaluation from a rushed surgical recommendation.
A knee truly needs replacement when the joint has completely failed: the cartilage is fully gone, the bone is severely damaged, and non-surgical treatments no longer provide meaningful function. But many patients are recommended replacement based on X-ray findings alone, without a trial of regenerative medicine, without evaluating alternative pain sources like the SI joint, and without considering that imaging does not always correlate with symptoms. Dr. Garg’s dual training in surgical and regenerative orthopedics means he can honestly assess where your knee falls on this spectrum. He trained at Andrews Sports Medicine, where joint preservation is prioritized over replacement. One patient was told knee replacement was her only option, and Dynamic Athlete changed everything for her.
Even bone-on-bone arthritis does not automatically mean replacement. The term refers to severe cartilage loss on imaging, but the correlation between imaging findings and symptoms is imperfect. Some patients with bone-on-bone X-rays have manageable symptoms, while others with moderate imaging findings have severe pain. Our Dynamic Stem Cell+ protocol with MFAT and HA is designed for advanced cartilage loss. Dynamic Shockwave+ with EMTT reduces pain signaling and improves the joint environment. Dynamic Mind+ (EXOMIND) can enhance neurological pain modulation. These combined modalities can provide meaningful improvement even in advanced cases. The goal is functional restoration, not necessarily cartilage regrowth.
We layer Dynamic PRP+, Dynamic Stem Cell+, Dynamic Shockwave+ with EMTT, Dynamic Core+ for stability, and Dynamic Mind+ for healing optimization. It is Boulder’s only combined regenerative system. More importantly, we start with thorough diagnostic evaluation including SI joint assessment. Dr. Garg’s fellowship at Andrews Sports Medicine, where joint preservation is the priority, combined with his role as Team Physician for USA Hockey and U.S. Soccer, means your knee gets the same level of assessment and care given to professional athletes. One patient told she needed replacement described being blown away by her results.
How to evaluate any clinic for a knee procedure, and our answers
Before you commit to knee surgery, get a physician’s second opinion on your imaging. Dr. Garg reviews it himself and tells you what he sees, including when an injection is the wrong answer and surgery is the right one. Below are seven questions to put to any clinic before a knee procedure, with our answers.
Aneesh Garg, DO, CAQ, performs every PRP and stem cell injection personally. He is double board-certified in Sports Medicine and Internal Medicine, and injections are not delegated to assistants or technicians.
Yes. Every PRP and stem cell injection is placed under live ultrasound, so the needle is watched reaching the target tissue.
PRP is prepared from your own blood in multiple spins, and our Dynamic PRP+ protocol is designed to concentrate platelets 12 to 20 times baseline, over 10 billion platelets, with exosome-containing fibrin-rich plasma (FRP). Stem cell procedures use your own bone marrow aspirate (BMA) or micro-fragmented adipose tissue (MFAT), selected by the physician for the tissue being treated, and these cells are most accurately called mesenchymal signaling cells. Nothing comes from a donor.
We screen before we schedule, and some people are not candidates: a complete structural tear that needs surgical repair, an active infection, or certain cancers generally rules out an injection. Severe deformity, gross instability, or a locked or mechanically blocked knee may call for surgical evaluation first, and we tell you which category you are in after imaging and diagnostic ultrasound. If surgery is the right answer, I will tell you.
A 2025 systematic review of six randomized trials in mild-to-moderate knee osteoarthritis, comparing PRP with hyaluronic acid, corticosteroid or placebo, concluded that PRP gave significant short- to mid-term improvements in pain and function with a favorable safety profile, while evidence of structural benefit remains limited and results are not uniformly superior to placebo. A 2026 network meta-analysis of 56 randomized trials concluded that PRP is effective for knee osteoarthritis but that its findings do not support a “more is better” approach to platelet and leukocyte enrichment, and an AAOS technology overview of studies through August 2021, which makes no recommendation for or against PRP, states that the optimal preparation and products remain to be determined. Each calls for further, larger or better-designed trials. Sources: Nawaz et al., Cureus 2025 (https://doi.org/10.7759/cureus.94288); Anitua et al., Knee Surgery & Related Research 2026 (https://doi.org/10.1186/s43019-026-00318-4); AAOS Technology Overview, PRP for Knee Osteoarthritis (https://www.aaos.org/globalassets/quality-and-practice-resources/biologics/technology-overview_prp-for-knee-oa.pdf).
We track patient-reported outcomes in practice. Separately, we run retrospective studies approved by the Rocky Vista University IRB.
We give a quote after a thorough evaluation, and we price the plan for optimal outcomes, not line items off a menu. Every patient leaves with a good understanding of the next steps. PRP and stem cell procedures are out of pocket, and Cherry financing is available.
Talk with our team about whether you're a candidate. Care is directed by Aneesh Garg, DO, CAQ, here in Boulder.
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