JEFFREY PENG MD
SPORTS MEDICINE & FAMILY MEDICINE
KNEE OSTEOARTHRITIS
TREATMENT IN SAN JOSE, CA
Knee osteoarthritis is the most common form of arthritis and is characterized by the progressive loss
of cartilage in the knee joint. If left untreated, it can lead to chronic pain, reduced mobility, and difficulty performing everyday activities like walking or climbing stairs.
Dr. Jeffrey Peng is a board-certified sports medicine physician in Campbell, CA specializing in non-surgical, evidence-based treatment for knee osteoarthritis — including PRP injections, targeted exercise therapy, weight management strategies, and nutritional counseling. His approach focuses on treating the whole person, not just the joint.
What Is Knee Osteoarthritis?
Osteoarthritis is the most common type of arthritis, affecting millions of Americans — particularly those over 50. It occurs when the cartilage that cushions the ends of the bones in your knee gradually deteriorates over time, leading to pain, swelling, stiffness, and restricted movement.
Genetics, age, previous joint injuries, and prior knee surgeries are all well-established risk factors. However, recent research has revealed that osteoarthritis is as much a metabolic disease as it is a wear-and-tear disease. Metabolic factors like blood sugar levels, triglycerides, cholesterol, blood pressure, and body weight all play major roles in the onset and progression of arthritis.
Studies show that individuals with metabolic syndrome experience more severe pain, worse swelling, increased stiffness, and faster cartilage deterioration — including increased bone spurring, more significant bone marrow lesions, and more pronounced cartilage defects. This is why a multimodal approach to treatment is essential — addressing the joint, the muscles, the metabolism, and the inflammation all at once.
Symptoms of Knee Osteoarthritis
Knee osteoarthritis typically develops gradually. You may notice pain during or after activity, morning stiffness that improves with movement, swelling around the joint, a grinding or clicking sensation during motion, reduced range of motion, and difficulty with stairs, squatting, or prolonged standing. Some people also experience a feeling of the knee "giving way" or buckling.
It's important to note that the amount of joint damage visible on an X-ray does not always correlate with the level of pain or disability a person experiences. Many patients with severe radiographic arthritis function well with the right treatment plan, while some with mild arthritis on imaging struggle significantly. This is one of many reasons Dr. Peng focuses on treating symptoms and function — not X-rays.
Knee Osteoarthritis Treatment Options — Complete Comparison
Dr. Peng takes a multimodal approach to treating knee osteoarthritis, combining targeted exercise, nutrition, weight management, and injection therapy. The following table compares all major treatment options across six categories: short-term pain relief, long-term pain relief, impact on disease progression, risk of major side effects, cost, and Dr. Peng's clinical recommendation.
Exercise & Rehabilitation for Knee Osteoarthritis
Clinical trials consistently show that exercise therapy is one of the most effective treatments for knee osteoarthritis — systematic reviews have found it is just as effective at reducing pain and improving function as medications like ibuprofen and naproxen, without the side effects.
Exercise works in two ways. Aerobic exercise — daily walking, cycling, swimming, or elliptical training — benefits cardiovascular health, immune function, mental health, and weight management. Aim for at least 30 minutes daily. Strength training — particularly targeting the quadriceps and glutes — is equally critical and often overlooked. Muscles act as shock absorbers for the knee joint. Weaker leg muscles have been linked to both worsening symptoms and faster radiographic progression of arthritis.
A common myth is that running or exercise contributes to arthritis. This is not supported by research. A major survey among marathon runners found no link between running history and increased arthritis risk. The most significant risk factors were age, BMI, prior injuries or surgeries, and family history — not exercise.
Dr. Peng prescribes specific, progressive strengthening of the muscles that offload the affected joint — not a generic "go walk for 30 minutes" recommendation. The right type of exercise, at the right dose, with the right progression for your joint is what produces real results.
Diet, Nutrition & Weight Management
Every additional pound of body weight translates to roughly 3 to 4 pounds of force across your knee joint. Losing even 10 pounds means 40 fewer pounds of pressure through your arthritic knee with every step. A 10% reduction in body weight has been shown to produce moderate to large improvements in pain, self-reported disability, and quality of life.
But it's not just the mechanical offloading. Obesity is associated with chronic, low-grade systemic inflammation. Fat tissue actively releases inflammatory molecules called adipokines, which circulate throughout the body and damage joint cartilage. This explains why obese individuals also have higher rates of osteoarthritis in non-weight-bearing joints like the hands and wrists.
Metabolic factors compound the problem. Higher blood glucose levels are associated with worse knee symptoms. Those with type 2 diabetes have worse osteoarthritis even when controlling for BMI. High triglycerides and cholesterol are associated with higher rates of knee pain and worse clinical outcomes.
Dietary recommendations: Limit processed meats, ultra processed foods, fried foods, and added sugars — all of which trigger inflammation. Focus on an anti-inflammatory diet rich in fruits, vegetables, lean proteins (chicken, fish, nuts, seeds, legumes), and healthy fats containing omega-3 fatty acids (avocados, olive oil, salmon).
PRP Injections for Knee Osteoarthritis
Platelet-rich plasma (PRP) is a cutting-edge treatment that utilizes the healing properties of your own blood. The procedure involves a simple blood draw, followed by centrifugation to isolate the platelet-rich layer — which is packed with growth factors — and then injection under ultrasound guidance directly into the knee joint.
The evidence for PRP in knee osteoarthritis is substantial and growing. A comprehensive meta-analysis of 35 randomized controlled trials with over 3,100 participants found that PRP injections were the most effective treatment in improving function and reducing pain at 3, 6, and 12 months of follow-up — outperforming corticosteroids, hyaluronic acid, and placebo. Importantly, there were no differences in side effects or adverse events compared to placebo.
Perhaps most compelling is the disease-modifying potential. A landmark randomized controlled trial involving 610 patients compared PRP to saline placebo, with MRI scans at baseline and 5 years. PRP injections led to an almost 50% reduction in the progression of arthritis compared to placebo. Analysis of synovial fluid showed that PRP significantly decreased inflammatory markers inside the knee at 6 months — helping to keep healthy cartilage intact.
Both the American Academy of Orthopedic Surgeons and the American Medical Society for Sports Medicine have acknowledged PRP's effectiveness, releasing summaries highlighting significant benefits in reducing pain and enhancing joint function. A European consensus group described PRP as a "valid treatment option for knee osteoarthritis and a possible first-line injectable treatment option."
PRP injections are not currently covered by insurance. However, they are considerably more affordable than stem cell treatments or surgery, and the clinical evidence supporting their use continues to grow.
Other Injection Options for Knee Osteoarthritis
Platelet Rich Plasma
Utilizes the healing properties of your own platelets and growth factors. Has disease modifying effects and may slow progression of arthritis by up to ~50%. No significant side effects. Recognized by American orthopedic societies as a highly effective treatment for knee osteoarthritis. Not covered by insurance.
Hyaluronic Acid
Naturally occurring joint lubricant. Anti-inflammatory and pain-relieving properties. Outcomes improve dramatically with ultrasound-guided technique. Covered by most insurance for knees — worth trying if available to you. Make sure your doctor administers it under ultrasound guidance.
Corticosteroids
Provides short-term relief only. Research shows cortisone weakens and damages healthy cartilage. Clinical trials found cortisone injections led to greater cartilage loss without significant pain benefit vs. placebo. Dr. Peng limits use to specific situations like acute flare-ups before transitioning to alternative therapies.
Stem Cells
Currently not recommended. A large RCT of 400+ patients showed no difference in pain scores between stem cell treatments and cortisone at 1 year. No treatment group saw improvement to arthritis on MRI. Very high cost ($3,000–$10,000+) with uncertain effectiveness.
Do I Need a Knee Replacement?
Knee replacement surgery can be a life-changing procedure for many people with advanced arthritis. Research shows that approximately 75% of patients have their expectations met or exceeded after surgery, with significant improvements in pain being the most reliably achieved outcome.
However, about 25% of patients report dissatisfaction. The expectations least likely to be fulfilled were related to physical function — activities like climbing stairs, prolonged standing, physical endurance, and participation in sports. Patients with the highest expectations for knee-intensive activities were the most likely to be disappointed.
If your primary symptom is pain, knee replacement may be a highly effective option. If your main concern is physical function limitations, it's worth having a detailed conversation about realistic outcomes before committing to surgery.
Ultimately, getting a knee replacement is a personal decision — not one that should be made by your X-rays alone. Even patients with severe bone-on-bone osteoarthritis can maintain function and manage symptoms through targeted non-surgical treatment. Dr. Peng helps patients explore all options before considering surgery, and supports patients who ultimately decide surgery is the right path for them.
Watch: Knee Arthritis Treatments Explained
Dr. Peng breaks down every major knee osteoarthritis treatment — from exercise and diet to PRP, cortisone, stem cells, supplements, braces, and surgery — with the clinical research behind each one.
Frequently Asked Questions
Frequently asked questions
Why Choose Dr. Jeffrey Peng for Knee Osteoarthritis Treatment in San Jose?
Dr. Jeffrey Peng is a board-certified sports medicine and family medicine physician specializing in non-surgical treatments for sports injuries and orthopedic conditions. He completed his residency with the Stanford Family Medicine Residency Program and his sports medicine fellowship with the Stanford Primary Care Sports Medicine Fellowship in San Jose.
Dr. Peng has co-authored peer-reviewed research on platelet rich plasma with leading orthobiologics researchers and clinicians — no other PRP provider in the San Jose, Los Gatos, and Campbell area combines published research credentials with this level of clinical experience. He is an active faculty member training the next generation of sports medicine physicians and runs a popular YouTube channel with over 400,000 subscribers, making complex PRP research accessible to patients worldwide.
Every PRP injection is performed under real-time ultrasound guidance to ensure accurate placement into the targeted tissue. Studies show that ultrasound-guided injections are significantly more accurate than blind injections, which directly impacts treatment effectiveness.