Do I need a knee replacement?

If your osteoarthritis in your knee is causing you a lot of pain or making it difficult to do everyday activities, you may be wondering if you would benefit from knee replacement surgery. 

Many people mistakenly think their symptoms will get worse no matter what they do. Fortunately, strengthening exercises, increasing physical activity and losing weight can all effectively manage osteoarthritis. You might experience “flare-ups” from time to time, but these more intense symptoms usually don’t last. It’s best not to make decisions about surgery when you are experiencing a flare-up. 

But how do you know if it’s time to consider knee replacement surgery?

When should you discuss the risks and benefits of knee replacement surgery with your doctor?

You experience extreme pain and/or stiffness that profoundly limits your ability to do everyday activities or affects your quality of life, such as:

• You have trouble getting up from the toilet  
• Your pain keeps you awake or wakes you up at night  
• You can’t walk up or down stairs 
• You are so afraid of falling or not being able to get home because of pain that you don’t leave your house, say no to activities or feel socially isolated. 

You have worked with qualified health professionals to try all of the following: 

• Losing weight (if you are overweight) 
• A targeted exercise program designed and supervised by a physiotherapist 
• Specialised equipment such as a knee brace or walking aid 
• Pain management including heat, TENS, pain coping activities, medicine.

If you answered yes to all the above questions and are still experiencing extreme pain or symptoms that prevent you from participating in activities, you may want to talk to your GP about whether a referral to a specialist is appropriate. A specialist will be able to discuss the risks and benefits of knee replacement surgery with you. 

Total knee replacement surgery is not recommended for everyone even if you answered ‘yes’ to all the above questions, so it’s important to discuss your individual situation with your specialist.

When is knee replacement surgery less likely to benefit you?

1 or 2 out of every 10 people continue to experience pain and/or struggle with everyday activities following total knee replacement surgery.

Knee replacement surgery may not benefit you if:

• Your symptoms aren’t severe. Total knee replacement surgery works best in people with advanced osteoarthritis who experience extreme pain or other symptoms which limit their activity. 
• You are experiencing depression or anxiety, or another mental health issue. Make sure your specialist is aware of any mental health condition you may have.
• Your weight is in the obese category (your body mass index is >40). Losing weight is usually recommended before knee replacement surgery. 
• You are relatively young (e.g.<60 yrs). If you are young or middle-aged, there is a higher risk of needing revision surgery later on because you will have more years living with the artificial joint. This usually does not perform as well as the first joint replacement.