Arthritis: Should I Have Knee Replacement Surgery? You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Arthritis: Should I Have Knee Replacement Surgery? Get the facts
Your options Have surgery to replace your knee. Don't have this surgery. Instead, use other treatments, like exercise, weight loss (if you're overweight), medicines, or another type of surgery. Key points to remember The decision you and your doctor make depends on your age, health, and activity level, and on how much pain and disability you have. Most people have knee replacement only when they can no longer control arthritis pain with medicine and other treatments and when the pain really interferes with their lives. Rehabilitation after knee replacement requires daily exercises for several weeks. Most knee replacements last about 20 years. Some people need to have the knee replaced again. If you wait so long to have a knee replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities. Compare your options
Compare Option 1 Have knee replacement surgery Try other treatment
Compare Option 2 Have knee replacement surgery Try other treatment
What is usually involved?
What are the benefits?
What are the risks and side effects?
Have knee replacement surgery Have knee replacement surgery You may be asleep during this surgery. Or you may be awake but numb from the waist down. You may have a short stay in the hospital, but some people go home the day of surgery. You will need several weeks of physiotherapy, including exercises you can do at home. It usually takes people 4 to 16 weeks to get back to doing their usual activities. But it may take a little longer than that for some people. A full recovery may take up to a year. Most people have much less pain and are able to do many of their daily activities more easily. Risks include: A blood clot. Infection or wound-healing problems. A heart attack. Instability in the joint. Dislocated kneecap. The usual risks of general anesthesia Possible side effects: Your knee won't bend as far as it did before you started having knee problems. You may need to avoid activities that put a lot of stress on the joint, like running or playing tennis. You may eventually need another replacement, because the artificial joint can wear out. Try other treatment Try other treatment You can try exercise, weight loss (if you're overweight), medicines, joint injections, or, in some cases, another type of surgery. You can try using crutches, braces, and other types of walking support to help ease the stress on your knee. You avoid the risks and side effects of surgery. You avoid months of physiotherapy, although exercise is still important. The strong medicines used for severe pain may cause constipation, mental confusion, drowsiness, and nausea and vomiting. Steroid injections can cause pain and swelling in the knee. There are no bad effects from home treatments such as staying at a healthy weight, exercising, and using heat and cold therapy. If you decide to have surgery later, and your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities. The pain in my knees, especially my left one, has gotten steadily worse in the last 20 years. The medicines just weren't working. It got so bad last year that I gave up on my flower garden. My doctor and I discussed knee replacement, but I consider that my last resort. My doctor and I developed a plan of swimming and healthy eating habits that will help me take off the extra weight I've put on. We agree that's the best thing I can do to keep my osteoarthritis from getting worse. We're going to try some different medicines too.
I was an avid tennis player for years, and it finally caught up with my knees. I had an osteotomy years ago, and it helped for a while. But now so much of my time is focused on the pain. I'm an active grandmother with no intention of missing out on my grandkids' activities. I know that surgery will mean a long period of exercising and rehabilitation, but it will be worth it to lose this stiffness and discomfort.
I've skied competitively since I was 6 years old. In my 20s, I had several knee injuries and surgeries. About 7 years ago, I started having a lot of pain in one knee, and my doctor said the only surgery left to do was to replace the knee. If I have the knee replaced, I won't be able to ski or run or do anything that puts a lot of stress on it. I can't do any of those things now because of the pain anyway. I don't know how I'm going to deal with that, since being an athlete has always been a big part of who I am. I'm worried about having my knee replaced when I'm so young, but with the amount of pain I'm having, I don't see any other choice.
I feel like I'm too young to have my knee replaced. But I definitely need something other than Tylenol for the pain. I asked my doctor about my other options. She said we can try joint injections and see how that works. I can always have the surgery later if I need it, but I'd sure like to put it off for as long as I can. I'll see if these joint injections make the pain better. My doctor says that as long as I can handle the pain, we can hold off on the surgery.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Each pair of questions uses a 3 point scale where 3 is more important, 1 is less important and 0 is equally important. Use the right and left arrow keys to navigate the scale. Reasons to have knee replacement surgery
Reasons not to have knee replacement surgery
I want to be able to do low-impact activities, such as swimming and golf, as well as chores and housework.
My knee doesn't really get in the way of the physical activities I like or need to do.
More important
Equally important
More important
I have more bad days than good.
I have more good days than bad.
More important
Equally important
More important
I'm not worried about the chance of needing another replacement surgery later in life.
I'm worried about needing another surgery later in life.
More important
Equally important
More important
I'm ready and willing to do several weeks of physiotherapy after the surgery.
I don't want, or I won't be able, to have several weeks of physiotherapy.
More important
Equally important
More important
I know that problems sometimes occur with surgery, but getting pain relief and getting back some use of my knee is worth the risk.
I'm very worried about problems from surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Use the following 3 point scale where 3 is leaning toward, 1 is may be leaning toward, and 0 is undecided. Use the right and left arrow keys to navigate the scale. Having knee replacement surgery
NOT having knee replacement
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
Check the facts 1. 1, Knee replacement surgery should be my first choice if I have osteoarthritis of the knee. 2. 2, I will be able to return to all my normal activities right after I have this surgery. 3. 3, Although most surgeries last for at least 20 years, I may need to have my knee replaced again. Decide what's next 1. 1, Do you understand the options available to you?
2. 2, Are you clear about which benefits and side effects matter most to you?
3. 3, Do you have enough support and advice from others to make a choice?
Certainty 1. How sure do you feel right now about your decision? Use a 7 point scale where 1 is not sure at all, 4 is somewhat sure, and 7 is very sure. Use the right and left arrow keys to navigate the scale.
Not sure at all
Somewhat sure
Very sure
2. 2, Check what you need to do before you make this decision. 3. Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Incomplete section
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Arthritis: Should I Have Knee Replacement Surgery? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Get the facts Compare your options What matters most to you? Where are you leaning now? What else do you need to make your decision? 1. Get the Facts Your options Have surgery to replace your knee. Don't have this surgery. Instead, use other treatments, like exercise, weight loss (if you're overweight), medicines, or another type of surgery. Key points to remember The decision you and your doctor make depends on your age, health, and activity level, and on how much pain and disability you have. Most people have knee replacement only when they can no longer control arthritis pain with medicine and other treatments and when the pain really interferes with their lives. Rehabilitation after knee replacement requires daily exercises for several weeks. Most knee replacements last about 20 years. Some people need to have the knee replaced again. If you wait so long to have a knee replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities. FAQs
What is osteoarthritis? Osteoarthritis is a problem that affects all parts of the joint. For example, when cartilage
What is knee replacement surgery? Knee replacement surgery
The surgeon covers the ends of the damaged thigh bone and lower leg bone, and usually the kneecap, with artificial (man-made) surfaces that are lined with metal and plastic. The artificial pieces are usually cemented to the bones.
Rehabilitation, or rehab, is usually intense after surgery. Most people start to walk with a walker or crutches the day of surgery. And they begin physiotherapy right away. Your doctor may advise you to ride a stationary bike to strengthen your leg muscles and improve how well you can bend your knee. Rehab will take several weeks, but you should be able to start walking, climbing stairs, sitting in and getting up from chairs, and doing other daily activities within a few days.
Surgery is only for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other methods and who have lost a lot of cartilage. Surgery relieves severe, disabling pain and may restore the knee's ability to work properly.
What other surgeries are used to treat osteoarthritis? Besides knee replacement, the other types of surgeries used are:
Other types of surgery Surgery Description Arthroscopy
Arthroscopy may be used to smooth a rough joint surface or remove loose cartilage or bone fragments. But it is not usually recommended for osteoarthritis of the knee.
Osteotomy
This surgery corrects knee problems such as bowleg and knock-knee. It is usually done for younger, active people who have mild arthritis and who want to delay knee replacement.
What other treatments are available? There are a number of treatments for arthritis in the knee that don't involve surgery:
Medicine. If your pain is mild, over-the-counter pain medicines may help. These include acetaminophen (for example, Tylenol) and non-steroidal anti-inflammatory drugs, such as ibuprofen (for example, Advil, Motrin) or naproxen (for example, Aleve). But if these don't get rid of your pain, you may need a stronger prescription medicine. Be safe with medicines. Read and follow all instructions on the label.Pain-relieving gels or creams , such as capsaicin Steroid shots. Steroid shots may provide rapid pain relief. But for some people, this benefit only lasts a few weeks.Ice or heat. Heat may help you loosen up your joints before an activity. Ice is a good pain reliever after activity or exercise. Exercise. Exercise helps because it makes your muscles stronger, which lowers the stress on your knees. But make sure to talk to your doctor about what kind of activity is best for you.Losing weight, if you're overweight. Losing weight helps take some of the stress off of your joints.Physiotherapy. This includes specific exercises that can help you stretch and strengthen your muscles and reduce pain and stiffness.Walking aids. There are many devices you can use to take some of the stress off of your knee. These include crutches, walkers, braces, and tape. You may also be able to reduce the stress on your knee by wearing the right shoes or by adding insoles to your shoes. Talk to your doctor or physiotherapist about what would be best for you.Some other things that you may try include:
Acupuncture. It involves putting very tiny needles into your skin at certain places on your body to try to relieve pain. Some people find that acupuncture helps. But there is not a lot of medical research to support the use of acupuncture for knee arthritis. Natural health products , such as glucosamine and chondroitin, fish oil, or SAM-e. Some people feel that these supplements help. But medical research does not prove that they work. Talk to your doctor before you take these supplements.What are the risks of knee replacement surgery? Most people have much less pain after knee replacement surgery and are able to return to many of their activities. But as with any surgery, there are some risks, including:
Lack of good range of motion. After surgery, some people can't bend their knee far enough to do their daily activities, even after several weeks.Dislocated kneecap. If this happens, the kneecap may move to one side of the knee, and it will "pop" back when you bend your knee. It usually needs to be treated with another surgery. But this problem is not common.Blood clots. These can be dangerous if they block blood flow from the leg back to the heart or move to the lungs. They are more common in older people, those who are very overweight, those who have had blood clots before, and those who have cancer.Wound-healing problems. These are more common in people who take steroid medicines or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes. People who have any sort of artificial material in their bodies, including artificial joints, have a risk of infection around the material. But infection is rare. There is also a small risk of infection with any surgery.Instability in the joint. The knee may be unstable or wobbly if the replacement parts are not properly aligned. You may need a second surgery to align the parts correctly so that your knee is stable. The usual risks of general anesthesia. Problems from anesthesia are not common, especially in people who are in good health overall. But all anesthesia has some risk. What do numbers tell us about the benefits and risks of knee replacement? Pain relief with surgery The evidence about knee replacement surgery suggests that most people are happy with the results.
Take a group of 100 people who have the surgery 1
Need for repeat surgery Most artificial knees last for many years. But they can wear out or have other problems. Some people have to repeat the surgery to have the joint replaced again.
Take a group of 100 people who have the surgery 2
Problems after surgery The evidence suggests that, like most surgeries, knee replacement may have some risks.
Take a group of 100 people who have the surgery 6 , 4 , 5 , 3 7
Why might your doctor recommend knee replacement surgery? Your doctor might recommend knee replacement if:
You have very bad arthritis pain, and other treatments have not helped. You have lost a large amount of cartilage. Your knee pain is keeping you from being active enough to keep up your strength, flexibility, balance, or endurance. You don't have health problems that would make it dangerous for you to have surgery. 2. Compare your options Have knee replacement surgery Try other treatment What is usually involved? You may be asleep during this surgery. Or you may be awake but numb from the waist down. You may have a short stay in the hospital, but some people go home the day of surgery. You will need several weeks of physiotherapy, including exercises you can do at home. It usually takes people 4 to 16 weeks to get back to doing their usual activities. But it may take a little longer than that for some people. A full recovery may take up to a year. You can try exercise, weight loss (if you're overweight), medicines, joint injections, or, in some cases, another type of surgery. You can try using crutches, braces, and other types of walking support to help ease the stress on your knee. What are the benefits? Most people have much less pain and are able to do many of their daily activities more easily. You avoid the risks and side effects of surgery. You avoid months of physiotherapy, although exercise is still important. What are the risks and side effects? Risks include: A blood clot. Infection or wound-healing problems. A heart attack. Instability in the joint. Dislocated kneecap. The usual risks of general anesthesia Possible side effects: Your knee won't bend as far as it did before you started having knee problems. You may need to avoid activities that put a lot of stress on the joint, like running or playing tennis. You may eventually need another replacement, because the artificial joint can wear out. The strong medicines used for severe pain may cause constipation, mental confusion, drowsiness, and nausea and vomiting. Steroid injections can cause pain and swelling in the knee. There are no bad effects from home treatments such as staying at a healthy weight, exercising, and using heat and cold therapy. If you decide to have surgery later, and your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities.
Personal stories Personal stories about knee replacement surgery for osteoarthritis These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I've skied competitively since I was 6 years old. In my 20s, I had several knee injuries and surgeries. About 7 years ago, I started having a lot of pain in one knee, and my doctor said the only surgery left to do was to replace the knee. If I have the knee replaced, I won't be able to ski or run or do anything that puts a lot of stress on it. I can't do any of those things now because of the pain anyway. I don't know how I'm going to deal with that, since being an athlete has always been a big part of who I am. I'm worried about having my knee replaced when I'm so young, but with the amount of pain I'm having, I don't see any other choice."
"The pain in my knees, especially my left one, has gotten steadily worse in the last 20 years. The medicines just weren't working. It got so bad last year that I gave up on my flower garden. My doctor and I discussed knee replacement, but I consider that my last resort. My doctor and I developed a plan of swimming and healthy eating habits that will help me take off the extra weight I've put on. We agree that's the best thing I can do to keep my osteoarthritis from getting worse. We're going to try some different medicines too."
"I feel like I'm too young to have my knee replaced. But I definitely need something other than Tylenol for the pain. I asked my doctor about my other options. She said we can try joint injections and see how that works. I can always have the surgery later if I need it, but I'd sure like to put it off for as long as I can. I'll see if these joint injections make the pain better. My doctor says that as long as I can handle the pain, we can hold off on the surgery."
"I was an avid tennis player for years, and it finally caught up with my knees. I had an osteotomy years ago, and it helped for a while. But now so much of my time is focused on the pain. I'm an active grandmother with no intention of missing out on my grandkids' activities. I know that surgery will mean a long period of exercising and rehabilitation, but it will be worth it to lose this stiffness and discomfort."
3. What matters most to you? Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have knee replacement surgery
Reasons not to have knee replacement surgery
I want to be able to do low-impact activities, such as swimming and golf, as well as chores and housework.
My knee doesn't really get in the way of the physical activities I like or need to do.
More important
Equally important
More important
I have more bad days than good.
I have more good days than bad.
More important
Equally important
More important
I'm not worried about the chance of needing another replacement surgery later in life.
I'm worried about needing another surgery later in life.
More important
Equally important
More important
I'm ready and willing to do several weeks of physiotherapy after the surgery.
I don't want, or I won't be able, to have several weeks of physiotherapy.
More important
Equally important
More important
I know that problems sometimes occur with surgery, but getting pain relief and getting back some use of my knee is worth the risk.
I'm very worried about problems from surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now? Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having knee replacement surgery
NOT having knee replacement
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision? Check the facts 1. Knee replacement surgery should be my first choice if I have osteoarthritis of the knee.
You're right. Knee replacement surgery should be considered only when other treatments—such as exercise, medicines, physiotherapy, and a change in your daily activities—haven't worked to ease your symptoms.
2. I will be able to return to all my normal activities right after I have this surgery.
You are right. Rehabilitation after knee replacement surgery is usually intense and requires daily exercises for several weeks.
3. Although most surgeries last for at least 20 years, I may need to have my knee replaced again.
You are right. Most knee replacement surgeries last for at least 20 years. But some people do need to have another replacement later.
Decide what's next 1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty 1. How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
Credits
References
Citations
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: July 31, 2024
Beswick AD, et al. (2012). What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2(1). DOI: 10.1136/bmjopen-2011-000435. Accessed April 24, 2016.
Evans JT, et al. (2019). How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet, 393(10172): 655–663. DOI: 10.1016/S0140-6736(18)32531-5. Accessed September 15, 2020.
Singh JA, et al. (2011). Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Annals of the Rheumatic Diseases, 70(12): 2082–2088. DOI: 10.1136/ard.2010.148726. Accessed May 25, 2016.
Kurtz SM, et al (2010). Prosthetic joint infection risk after TKA in the Medicare population. Clinical Orthopaedics and Related Research, 468(1): 52–56. DOI: 10.1007/s11999-009-1013-5. Accessed May 25, 2016.
Mahomed NN, et al. (2005). Epidemiology of total knee replacement in the United States Medicare population. The Journal of Bone and Joint Surgery. American Volume, 87(6): 1222–1228. http://dx.doi.org/10.2106/JBJS.D.02546 Accessed May 25, 2016.
Namba RS et al. (2013). Risk factors associated with deep surgical site infections after primary total knee arthroplasty: An analysis of 56,216 knees. The Journal of Bone and Joint Surgery. American Volume 95(9): 775–782. DOI: 10.2106/JBJS.L.00211. Accessed May 25, 2016.
Katz JN, et al. (2004). Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. Journal of Bone and Joint Surgery. American Volume, 86-A(9): 1909–1916. http://jbjs.org/content/86/9/1909.long. Accessed May 25, 2016.
