Hello, You have had all modalities of treatment for knee osteoarthritis. So, you can continue having synvisc and steroid injections and oral pain medications. You have one more option that is total knee replacement. Knee replacement is one of the safest and most effective orthopedic procedures available today. Knee replacement has two primary advantages: It can reduce the arthritis pain you feel and increase your mobility. One year after the surgery, many patients say they experience significant improvements in multiple areas, including mobility, pain levels, social functioning, joint stiffness, and vitality. It can be done in outpatient basis too now a days.90% of people that have the surgery say their pain diminished afterwards. With the pain gone and the limb working again, you can return to walking, golfing, and going up and down stairs. Even better, once you have the surgery you rarely need it again; more than 90% of artificial knees still function 20-years later. Complications stemming from knee replacement are exceedingly rare, affecting just 2% of the entire knee surgery patient pool. Some risks of knee surgery include blood clots, which can develop after any surgery, break off, and cause life-threatening illnesses, infection occurring at the incision site; however, most patients receive antibiotics before and after surgery to lessen this risk, occasional flare-ups of pain, or pain that never lessens following the surgery, and stiffness from the scar tissue that forms over the knee after surgery. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Pallavi M., Anesthesiologist