4 signs it’s time for a knee replacement

Your knee constantly hurts — you can tell it’s starting to wear out. You get swelling, cracking, popping and just aren’t able to be as active as you used to be. When is the right time to think about knee replacement surgery?

I answer this question several times per day in my office for many different types of patients. The bottom line is that there is a different answer for everyone. But let me lay out some important considerations when it comes to deciding when the time is right for you to consider a knee replacement.

1. You’ve tried non-surgical methods.

There are a lot of non-surgical treatments for knee arthritis that can be very effective. These include: 

• Physical therapy
• Anti-inflammatory medications
• Injections
• Bracing

If you haven’t tried any of these first, you probably aren’t ready for surgery. That being said, trying these conservative treatments is not a requirement that needs to be checked off on the way to surgery. Conservative treatment really can be quite effective — especially for early arthritis — and for some patients, it is all they ever need to regain their activity level. 

I am a big believer in the success of knee replacement surgery, but I still think if we can get you feeling better and back to a good quality of life without it, that should be the first option.

2. Knee pain is impacting your quality of life.

There is such a thing as waiting too long to have knee surgery. Ask anyone who has had a knee replacement and they will tell you that the recovery is not easy. You have to put in work with physical therapy 2-3 times per week. You have to make yourself get up and walk every day — even if you don’t feel like it. 

Related: The do’s and don’ts of knee surgery recovery

The first few weeks after a knee replacement are truly a ‘no pain no gain’ situation. If you wait for knee replacement surgery until after you’ve already lost muscle strength and balance, the recovery is even more difficult. 

I tell my patients that if they get to the point where they are making choices to be less active on a daily basis, then it is time to think more seriously about surgery.  

Examples of this would be: 

• Deciding to drive to the mailbox instead of walking
• Using a motorized cart at the grocery store
• Cancelling outings regularly because they would entail too much walking

3. You’re ready to enjoy being active again. 

Knee replacement parts wear out, but not as fast as you might think. In general, we think that today, they will last about 30 years. 

There is some wisdom to putting off surgery if you are still very young — if the implants wear out or loosen up from bone they will need to be revised, and a revision knee replacement is a bigger surgery than a first-time knee replacement. 

However, for patients whose activity level and livelihood become very limited because of knee pain, I would argue that sacrificing years of one’s prime in order to prevent maybe having to have an additional surgery decades down the road is not a very good trade-off.

4. You’re prepared. 

Knee replacement is an elective surgery. Despite all that I have already mentioned, this is a surgery that should be done when it fits best into your life. Schedule your surgery only when you:

• Feel ready for it — both physically and emotionally
• Can take time off from work or personal life without undue stress
• Have supportive family and friends around to help with recovery

If knee pain is keeping you from enjoying life, talk to an orthopedic surgeon about your options to start moving better today.