Were You Told You Need a Joint Replacement? There May Be Another Option — and It Starts With Exhausting Every Biological Solution First.
Joint replacement is a remarkable operation. For the right patient at the right stage of disease, a metal and plastic joint can restore function, eliminate pain, and dramatically improve quality of life. Dr. Mirzayan has deep respect for what joint replacement surgery achieves — and he refers patients for replacement when it is genuinely the right answer.
But joint replacement is also irreversible. Once a biological joint is removed and replaced with a metal and plastic implant, that decision cannot be undone. The implant has a finite lifespan — typically 15 to 20 years — after which revision surgery is required. Revision joint replacement is significantly more complex, more morbid, and less reliably successful than the index procedure. And for active patients in their 40s and 50s who receive a joint replacement, the math is unforgiving: they will almost certainly need at least one revision surgery during their lifetime.
For patients who are too young, too active, or too unwilling to accept these trade-offs, the question is not whether joint replacement works. The question is whether everything possible has been done to delay or avoid it — using treatments that are scientifically proven, biologically sound, and honestly applied.
That is what joint preservation means in Dr. Mirzayan's practice. Joint preservation means applying every tool that has demonstrated genuine clinical value — platelet-rich plasma, bone marrow aspirate concentrate, and fresh osteochondral allograft transplantation — in the right patient, at the right stage, with realistic expectations and honest outcomes data.
Call (310) 746-5918 to find out whether joint preservation is an option for you. Virtual consultations are available for patients traveling from out of state.
The Joint Preservation Philosophy: Biology First, Replacement Last
Dr. Mirzayan's approach to joint preservation is grounded in a simple principle: the biological joint you were born with — even a damaged one — is almost always preferable to a metal and plastic substitute, provided it can be made to function acceptably. Every treatment decision he makes is evaluated against that standard.
This philosophy has several practical implications.
He does not recommend joint replacement prematurely. A patient in their 40s with moderate knee arthritis and a significant cartilage defect is not automatically a joint replacement candidate. They are a joint preservation candidate — until the evidence clearly shows that preservation is no longer sufficient to meet their functional goals.
He does not offer treatments without scientific support. The joint preservation space is crowded with unproven therapies that are marketed aggressively to patients who are motivated to avoid replacement. Dr. Mirzayan does not offer these treatments. He offers what works: biologically active treatments with peer-reviewed evidence, applied by a surgeon who understands the science behind them.
He is honest about limitations. Joint preservation is not appropriate for every patient or every stage of disease. Severe, end-stage arthritis affecting the entire joint surface cannot be reliably addressed with preservation techniques. When replacement is genuinely the right answer, Dr. Mirzayan will tell you that directly — and refer you to the right surgeon.
He thinks in decades, not months. The goal of joint preservation is not to make a joint feel acceptable for the next year. It is to preserve the biological joint long enough that the patient can live an active, functional life without metal and plastic — or at minimum, to delay replacement to an age where the revision burden is manageable.
The Tools: What Joint Preservation Actually Means
Joint preservation is not a single treatment. It is a spectrum of interventions — applied individually or in combination — based on the specific joint, the stage of disease, the patient's age and activity level, and the biological environment of the joint at the time of treatment.
Dr. Mirzayan uses three evidence-based tools in his joint preservation practice: platelet-rich plasma, bone marrow aspirate concentrate, and fresh osteochondral allograft transplantation. Each has a specific role, specific indications, and specific evidence supporting its use.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma is prepared from the patient's own blood — drawn at the time of the office visit, spun in a centrifuge to concentrate the platelets, and injected directly into the affected joint. Platelets are not simply clotting agents. They are reservoirs of growth factors — including platelet-derived growth factor, transforming growth factor beta, vascular endothelial growth factor, and others — that play a central role in tissue repair, inflammation modulation, and the biological environment of the joint.
In the joint preservation context, PRP serves two primary functions. For patients with early to moderate arthritis or focal cartilage damage who are not yet candidates for surgical intervention, PRP injections can modulate the inflammatory environment of the joint, reduce pain, and slow the progression of cartilage degradation. For patients who have undergone cartilage restoration surgery — including osteochondral allograft transplantation — PRP is used to optimize the biological environment during healing.
The evidence for PRP in knee osteoarthritis is the strongest in the joint preservation literature — multiple randomized controlled trials and systematic reviews have demonstrated superiority over hyaluronic acid and corticosteroid injections for pain reduction and functional improvement in early to moderate knee arthritis. Dr. Mirzayan uses leukocyte-poor PRP for intra-articular applications — the formulation with the most consistent evidence for joint applications — and applies it as part of a structured treatment plan rather than as a standalone cure.
Learn more about PRP at Dr. Mirzayan's practice
Bone Marrow Aspirate Concentrate (BMAC)
Bone marrow aspirate concentrate takes the biological principle of PRP further. BMAC is prepared by aspirating bone marrow — typically from the posterior iliac crest or pelvis bone — and concentrating it through centrifugation to produce a preparation rich in mesenchymal bone marrow cells, platelets, growth factors, and anti-inflammatory cytokines. The resulting concentrate delivers a far more complex and biologically potent mixture than PRP alone.
In Dr. Mirzayan's practice, BMAC is used primarily in the surgical setting — applied at the time of cartilage restoration procedures to optimize the biological environment at the repair site. For distal biceps repairs augmented with dermal allograft, Dr. Mirzayan soaks the allograft in BMAC before insertion, saturating the collagen scaffold with the patient's own regenerative cells. For osteochondral allograft transplantation procedures, BMAC is applied at the graft-host interface to support integration and healing. For selected patients with moderate arthritis who are not yet surgical candidates, BMAC injection can provide a more potent and durable biological stimulus than PRP alone.
The evidence for BMAC is earlier stage than for PRP — but the biological rationale is sound, the safety profile is excellent, and the clinical results in appropriate patients are meaningful. Dr. Mirzayan uses BMAC where the evidence supports it and is transparent with patients about what the current literature shows.
Learn more about BMAC at Dr. Mirzayan's practice
Fresh Osteochondral Allograft Transplantation — The Most Powerful Joint Preservation Tool Available
When cartilage damage has progressed beyond what injections can meaningfully address — when a significant focal defect exists on the joint surface and the surrounding cartilage and bone are still in reasonable condition — fresh osteochondral allograft transplantation is the most powerful joint preservation tool available. It replaces the damaged cartilage with living, matched donor tissue — restoring the joint surface with real hyaline cartilage rather than a substitute.
This is not a minor intervention. It is a surgical procedure that requires precise technical execution, careful patient selection, and a surgeon with the volume and experience to perform it reliably. But for the right patient it offers what no injection or conservative measure can: actual restoration of the joint surface with biological tissue that integrates, functions, and lasts.
Dr. Raffy Mirzayan has performed more than 350 fresh osteochondral allograft transplantation procedures across the knee, shoulder, and elbow over 25 years — more than any surgeon in Los Angeles. He invented BioPFJ™ — the world's first complete biological reconstruction of the patellofemoral joint using fresh matched donor tissue. He was the first surgeon in the world to use this technique for osteochondritis dissecans of the capitellum in the elbow. And he has been applying osteochondral allograft transplantation to the shoulder since 2011 — among the earliest surgeons in the country to do so systematically.
His published outcomes across all three joints demonstrate what is achievable with this approach in experienced hands: 100% graft integration in his BioPFJ™ series, 100% return to overhead sport in his OCD capitellum series, and outstanding functional outcomes in his shoulder series — with zero re-operations for graft failure across the entire body of work.
Learn more about Dr. Mirzayan's cartilage restoration and transplantation experience
Who Is a Candidate for Joint Preservation?
Joint preservation is appropriate for a specific and well-defined group of patients — and Dr. Mirzayan evaluates each one individually.
The ideal joint preservation candidate is an active patient, with pain and functional limitation from arthritis or cartilage damage that has not yet reached the stage where the entire joint surface is destroyed. The damage may be focal — confined to one area of the joint — or more diffuse but not yet end-stage. The patient is motivated to avoid or delay replacement, understands the realistic expectations of preservation techniques, and is committed to the rehabilitation and lifestyle modifications that maximize the longevity of the preserved joint.
Patients who are not good joint preservation candidates include those with severe, end-stage arthritis affecting the entire joint surface, significant mechanical malalignment that cannot be corrected, active infection, or medical conditions that make surgical intervention prohibitively risky. For these patients, joint replacement — performed by the right surgeon at the right time — is the appropriate answer, and Dr. Mirzayan will tell them so directly.
What to Expect: Evaluation and Treatment
Every joint preservation evaluation begins with a detailed history and physical examination, followed by appropriate imaging — standing X-rays to assess alignment and joint space, MRI to characterize cartilage quality and the extent of damage, and prior arthroscopy photos (if available)
Based on that evaluation, Dr. Mirzayan will give you an honest assessment of where you are in the spectrum of joint disease — and which preservation tools are appropriate for your specific situation. For some patients, the right answer is a structured course of PRP or BMAC injections and physical therapy. For others, it is surgical cartilage restoration with osteochondral allograft transplantation. For many, it is a combination — biological augmentation at the time of surgery, followed by PRP to support healing and a structured rehabilitation program to protect the restored joint.
Every treatment plan is individualized. There is no protocol that applies to every patient with knee pain or shoulder arthritis. The right treatment depends on the joint, the stage of disease, the patient's age and activity level, and their goals — and getting that assessment right from the beginning is what determines whether preservation succeeds.
Coming from Las Vegas, Phoenix, or Out of State?
Joint preservation surgery at the level Dr. Mirzayan performs it — with published outcomes across three joints, invented procedures, and a commitment to evidence-based biological treatments — is not available at most orthopedic practices. For patients who have been told their only option is joint replacement and want a comprehensive evaluation of every preservation alternative that science currently supports, traveling to Los Angeles for a consultation with Dr. Mirzayan is worth serious consideration.
Dr. Mirzayan regularly treats patients from Las Vegas, Henderson, Phoenix, Scottsdale, and across the country. If you carry a commercial insurance plan — Blue Cross Blue Shield PPO, Aetna, Cigna, United Healthcare, or a self-funded employer plan — you likely have out-of-network benefits that cover a substantial portion of the cost of evaluation and treatment. His office will verify your coverage before you commit to anything.
Virtual consultations are available. You can submit your imaging in advance, meet Dr. Mirzayan on video, and get an honest assessment of whether joint preservation is realistic for your specific situation — before committing to travel or making any treatment decisions.
Call (310) 746-5918 or contact us online to schedule your consultation.
Frequently Asked Questions
What is joint preservation surgery?
Joint preservation surgery refers to any surgical or interventional procedure designed to restore, protect, or extend the life of a biological joint — delaying or avoiding the need for metal and plastic joint replacement. In Dr. Mirzayan's practice, joint preservation includes platelet-rich plasma injections, bone marrow aspirate concentrate, and fresh osteochondral allograft transplantation — applied individually or in combination based on the specific joint, the stage of disease, and the patient's goals.
How is joint preservation different from joint replacement?
Joint replacement removes the damaged biological joint surfaces and replaces them with metal and plastic components. Joint preservation restores or supports the biological joint — keeping the patient's own tissue intact. Replacement is irreversible and carries a finite implant lifespan. Preservation maintains the option of replacement in the future while extending the life of the native joint.
Does Dr. Mirzayan offer stem cell injections?
No. Unregulated stem cell injections — marketed at concierge clinics and wellness centers — are not supported by peer-reviewed clinical evidence for joint disease and are not approved by the FDA for this purpose. Dr. Mirzayan holds every treatment he offers to the standard of demonstrated clinical evidence. He offers PRP and BMAC — both of which are prepared from the patient's own blood or bone marrow and have meaningful peer-reviewed evidence supporting their use — and fresh osteochondral allograft transplantation for patients with significant cartilage defects.
What is the difference between PRP and BMAC?
PRP is prepared from the patient's blood and delivers a concentrated payload of platelets and growth factors to the joint. BMAC is prepared from the patient's bone marrow and delivers a more complex mixture that includes mesenchymal stem cells, platelets, growth factors, and anti-inflammatory cytokines. BMAC is more biologically potent than PRP and is used primarily in the surgical setting or for patients with more advanced disease. Both are prepared from the patient's own tissue — there is no donor material and no risk of rejection.
Is joint preservation appropriate for bone-on-bone arthritis?
It depends. Severe, end-stage arthritis affecting the entire joint surface is generally not well served by preservation techniques — the damage is too diffuse and too advanced for focal cartilage restoration or injections to meaningfully address. But the term "bone-on-bone" is used loosely by many patients and even some physicians, and many patients who believe they are bone-on-bone actually have focal or moderate disease that is very much addressable with preservation techniques. Dr. Mirzayan will review your imaging and give you an honest assessment of where you actually are in the spectrum of joint disease.
How long can joint preservation delay the need for replacement?
This depends entirely on the patient, the joint, the stage of disease, and the specific preservation techniques used. For patients with focal cartilage defects treated with osteochondral allograft transplantation, Dr. Mirzayan's published series demonstrate durable results across nearly a decade of follow-up with no conversions to replacement. For patients managed with PRP and BMAC for early to moderate arthritis, the goal is to slow progression and maintain function for as long as possible. There is no universal answer — but the honest goal of joint preservation is to give the patient the best possible biological joint for as long as possible.
Do you offer virtual consultations for out-of-state patients?
Yes. Dr. Mirzayan offers virtual consultations for patients traveling from out of state. Please submit your imaging — X-rays and MRI — in advance so the extent and distribution of cartilage damage can be fully assessed before your visit. Call (310) 746-5918 to schedule.
Does being out-of-network mean I will pay full price out of pocket?
Not necessarily. Many patients with commercial insurance — especially PPO plans and self-funded employer plans — have strong out-of-network benefits. Dr. Mirzayan's office will verify your coverage before your consultation so you have a clear picture of what to expect before making any decisions.
Who is the best joint preservation surgeon in Los Angeles?
Dr. Raffy Mirzayan is one of the most experienced joint preservation surgeons in Los Angeles — with more than 350 fresh osteochondral allograft transplantation procedures performed across the knee, shoulder, and elbow, invented procedures including BioPFJ™ and Biologic Tuberoplasty™, and published outcomes demonstrating durable results across multiple joints and nearly two decades of follow-up. His joint preservation practice is grounded exclusively in evidence-based treatments — PRP, BMAC, and cartilage transplantation — without the unproven therapies that crowd the joint preservation marketplace. For patients who want an honest, comprehensive evaluation of every biological option before committing to joint replacement, Dr. Mirzayan offers the experience, the evidence, and the surgical capability to give them the right answer. Virtual consultations are available — call (310) 746-5918.
About Dr. Raffy Mirzayan, MD — Joint Preservation Specialist in Los Angeles
Dr. Raffy Mirzayan, MD is a double-board certified orthopedic sports medicine surgeon and one of the most experienced joint preservation specialists in Los Angeles — with a practice built on the principle that the biological joint you were born with is almost always preferable to a metal and plastic substitute, provided every scientifically proven option to preserve it has been genuinely exhausted.
His joint preservation practice spans three joints and three decades. He invented BioPFJ™ — the world's first complete biological reconstruction of the patellofemoral joint — and was the first surgeon in the world to use fresh osteochondral allograft transplantation for osteochondritis dissecans of the capitellum in the elbow. He developed and published the use of dermal allograft augmentation for distal biceps repair. He invented Biologic Tuberoplasty™ — a 30-minute arthroscopic alternative to reverse shoulder replacement for massive irreparable rotator cuff tears. In every corner of his practice, the same philosophy applies: exhaust the biological options first, replace only when necessary, and be honest about where the line between preservation and replacement actually is.
His joint preservation toolkit is evidence-based and deliberately limited. He uses leukocyte-poor PRP for intra-articular applications, BMAC in the surgical and selected non-surgical setting, and fresh osteochondral allograft transplantation for patients with significant focal cartilage defects. He does not offer unregulated stem cell injections, peptide therapies, exosome treatments, or other interventions that have not demonstrated clinical efficacy in peer-reviewed human trials. Patients who come to Dr. Mirzayan for joint preservation get an honest answer — not a menu of expensive unproven treatments designed to exploit their desire to avoid surgery.
With 88 peer-reviewed publications, 4 edited textbooks, more than 200 invited lectures globally, and a role as Co-Founder of Shoulder360™ — one of the largest upper extremity surgical education courses in the United States — Dr. Mirzayan brings academic depth to every clinical decision he makes. He is a Clinical Professor of Orthopaedic Surgery at USC and an Arthrex consultant and educator. He practices at DOCS Health in Los Angeles and welcomes patients from across the United States — including Las Vegas, Phoenix, and Scottsdale — for virtual consultations and in-person care.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 | (310) 746-5918 | raffymirzayan.com
