Suggest Treatment For Severe Knee Arthritis

Question: What do these results indicate, and what would be the recommended next step of treatment? MRI was done due to moderate (6-7/10) knee pain. Treatments so far have include NSAIDS, steroid and orthovisc injections, weight reduction, physical therapy, and OTC knee brace. Knee pain reduces ability to tolerate exercise. "There is a large joint effusion. Multifocal grade 4 chondrosis in the medial and lateral patellar facets with subchondral edemal and mild cystic change. Cruciate ligaments are intact. Extensor tendons are intact. There is scarring related to previous arthroscopy. Mild degenerative signal posterior horn medial meniscus but no major meniscal defect. There is vague grade 2-3 chondrosis near the midline femoral throchlear sulcus on the sagittal images. No advanced arthrosis of the knee. IMPRESSION: Large joint effusion. Tricompartmental chondrosis most pronounced throughout the patella up to grade 4. Mild degenerative/post surgical columne loss medial meniscal body. No discrete meniscal tear."