You'd need to speak to your Dr. about specifics based on your diagnostics and what level of activity you can maintain with what you have. I personally had a large spur on my patella and was able to have a patella ACI (autologous chondrocyte implantation) along with a anteromedialization of my tibial tuburcle (an osteotomy to realign and unload my patella). The bone spur though was not visible on an x-ray and actually was not even noted at the time of my ACI biopsy scope even though the defect was debrided. When my ortho was fully debriding my defect, he noted a large spur that had to be ground down before the ACI patch could be sewn on, as blood is toxic to the cells that would be transplanted. That being said, having a spur is not the ideal situation for an ACI, but since it was done, it still can be done. That was an option for me for my grade 4 chondral defect on my patella.
That being said, I am only 31, so there would be more of a focus on restoration of cartilage. I do not believe that at 51 that they do ACI, but I did see someone else posting that they were having DeNovo NT to treat their cartilage damage.
You could try a clean up, but it probably won't help considerably and if it doesn't, it probably wouldn't for long. You could also try viscosupplementation (Supartz, Synvisc, Orthovisc, etc.), which you already are aware of based on your posting. I had Supartz on my right knee (not the one I just had the ACI/AMZ on) and did not appreciate much of a difference. Although, since my left completely tanked very rapidly and is the one I had surgery on....perhaps it is providing more benefit than I am giving it credit for.
I would speculate your doc would want you to continue with the conservative measures for as long as you can before considering other surgical options which could be a PKR, TKR or a TT (what I had).
