Rethinking Joint Replacement and When Can a Joint Still Be Saved? – Interview with Professor Paul Lee

Professor Paul Lee is a Regenerative Orthopaedic Surgeon and Cartilage & Joint Preservation Specialist based on Harley Street, London. He was awarded the 2026 Robert Jones Medal by the British Orthopaedic Association for his essay on recovery and decision-making in modern orthopaedics, recognising his contribution to advancing how joint regeneration is understood and delivered.

With over two decades of clinical and research experience, Professor Lee combines surgery, engineering, and regenerative medicine to develop more precise and individualised approaches to joint care. As founder of the London Cartilage Clinic and an internationally recognised leader in cartilage regeneration, his work often centres on a simple but overlooked question: can this joint still be saved?

Paul Lee, Regenerative Orthopaedic Surgeon

What are the key signs that a joint can still be saved instead of replaced?

One of the most common misconceptions I see is that pain inevitably leads to joint replacement. In reality, the decision is rarely that straightforward.

There are, of course, clinical indicators we consider – whether the damage is localised rather than widespread, whether the joint remains mechanically stable, and how symptoms behave over time. These all matter.

But in practice, the more important question is often: what is actually possible for this patient, at this point in time?

That possibility is not defined by the joint alone. It is influenced by experience, by exposure, and by the resources available within a given healthcare system. Two patients with very similar joints may be offered completely different pathways depending on where they are, who they see, and what that clinician has seen work.

This does not make one approach right and another wrong. It simply reflects that medicine is shaped by perspective as much as by evidence.

So when we talk about whether a joint can be “saved”, we are not just describing a biological state – we are describing a decision space. My role is often to help patients pause within that space and explore what may still be possible. Sometimes there are additional options. Sometimes there are not. But that moment of reflection is where better decisions are made.

Why are some patients told they need a joint replacement too early?

In many situations, decisions are understandably guided by what is most visible – often imaging, symptoms, and the pathways that are most established within that system.

However, what is visible is not always the full picture. A scan may show structural change, but it does not always reflect how a joint is functioning, how it is being loaded, or how it may respond if conditions are altered.

There is also the reality that different environments offer different options. What is considered the “right” treatment in one setting may simply reflect what is most accessible or familiar in that context.

So rather than viewing this as a matter of being too early or too late, I think it is more helpful to see it as a question of whether the full range of possibilities has been explored.

Joint replacement is an excellent operation when the time is right. The key is ensuring that the decision is made with clarity, rather than as the only visible option.

What makes cartilage regeneration and joint preservation more viable today than they were a decade ago?

Cartilage regeneration is often misunderstood. It is not simply about adding something into a joint and expecting it to heal.

What has changed is not just the technology, but our understanding.

Cartilage is a very specific tissue. It does not require the same type of healing response as other tissues, and in some cases, introducing the wrong biological signals can be unhelpful. The aim is not to stimulate healing in a general sense, but to create a very specific environment – in the right place, at the right time – that allows the joint to respond.

That is where progress has been made.

We now have better ways to define the problem, deliver targeted support, and consider how the joint behaves as a whole. But perhaps more importantly, we recognise that regeneration is not a single intervention – it is a process that depends on timing, mechanics, and how the joint is used afterward.

In my own practice, I think less in terms of “regenerating cartilage” and more in terms of creating the conditions in which recovery becomes possible.

When applied at the right stage, this can meaningfully delay and sometimes avoid the need for joint replacement. But equally, part of that judgement is recognising when that window is no longer open.

How does your approach to regenerative orthopaedics differ from the standard treatment pathway?

Traditional pathways tend to follow a more linear progression – symptoms develop, structural changes are identified, and treatment moves towards surgery.

My approach is to step back slightly and look at the joint within a wider context.

This includes structure, but also movement, loading patterns, biological capacity, and how the joint behaves over time. Two patients with similar findings on a scan may require very different approaches depending on these factors.

I often describe this as a “Preserve, Repair, Regenerate, Replace” framework – not as a fixed pathway, but as a way of ensuring that each stage is properly considered before moving to the next.

The intention is not to avoid surgery, but to ensure that when it is performed, it is done at the right time, for the right reasons, and with a clear understanding of what has already been explored.

What is the most important advice you would give to someone considering joint replacement today?

The most important advice is simply to pause and make sure you understand the timing of the decision.

Joint replacement is a highly effective operation when it is needed. But it is also a point of no return. Once that step is taken, the focus shifts entirely to managing an artificial joint rather than preserving a natural one.

For many patients, the question is not whether surgery will ever be needed, but whether it is needed now.

Taking the time to look at the joint from a slightly different perspective – to understand what stage it is at, how it is functioning, and whether there are other ways to influence its trajectory – can be very valuable.

Sometimes that reflection confirms that replacement is the right next step. Sometimes it reveals other possibilities.

Either way, it leads to a more informed and confident decision.

Final thoughts: Many patients searching for alternatives to knee replacement are often unaware that joint preservation and cartilage regeneration may still be possible, particularly in the earlier stages of joint change.

Joint care is not defined by a single decision, but by a sequence of decisions over time.

Understanding where you are within that sequence and what may still be possible – is often the most important step.

Because the goal is not simply to treat a joint, but to make the right decision for that joint, at the right time.

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