Do I need a knee replacement?
Dr Cooper's video answer is being filmed and will appear here. The guide below covers the same question in detail.
Understanding knee arthritis
The knee carries you through every step, stair and squat of your life, and its cartilage lining can wear thin with age, injury or simply hard use. Osteoarthritis is that wear process. It can affect the whole knee or mainly one compartment, which is why two people with "knee arthritis" can need very different treatment.
The same principle I apply to hips applies here: the X-ray does not book the operation, your life does. I see many knees that look bad on film but are managed well without surgery for years, and that is a good outcome, not a delay.
Symptoms + when to seek help
What does knee arthritis feel like?
Pain with stairs, kneeling and getting out of chairs; swelling after activity; stiffness after rest; and over time a knee that loses its full bend or no longer straightens. Some knees also feel unstable or give way.
When is it worth seeing a surgeon?
When night pain arrives, when your walking distance keeps shrinking, or when injections, physiotherapy and sensible activity change have stopped holding the line. You do not need to have "failed everything" to deserve an assessment and a plan.
Investigations
Weight-bearing X-rays tell us most of what we need, because they show the joint under load. MRI is useful in younger knees and soft-tissue problems but often adds little in established arthritis. Bring what you have; we review it together on screen.
Treatment without surgery comes first
- Strengthening: a structured quadriceps and hip program is the single best-evidenced non-surgical treatment for knee arthritis. Done properly, it changes lives.
- Activity modification: cycling, swimming and gym work in place of impact, not instead of activity.
- Weight optimisation: each step puts several times body weight through the knee; small losses pay large dividends.
- Braces and supports: helpful for selected patterns of arthritis.
- Medication and injections: simple analgesia used well; injections have a role in the right knee at the right time, and I will be straight with you about what they can and cannot achieve.
The operation
Total knee replacement resurfaces the worn ends of the femur and tibia with metal components and a precision plastic bearing between them. It usually takes around 60 to 90 minutes under spinal or general anaesthetic, with one to four nights in hospital and the knee moving and taking weight on day one.
Where arthritis is confined to one compartment, a partial knee replacement may be an option; it is a smaller operation with a faster recovery for the right knee. I am fellowship-trained and certified in Stryker MAKO robotic-assisted total and partial knee replacement. Robotic assistance is a tool I use in service of a well-balanced knee, not a marketing claim: the planning and the surgeon still matter most.
Honest risks
- Infection: around 1 in 100. Deep infection can require staged further surgery, which is why prevention is taken so seriously.
- Ongoing pain or stiffness: the honest number most websites skip: roughly 1 in 10 people have some degree of persistent symptoms even with a technically sound knee. Most are still glad they had the operation; a small number are not.
- Blood clots (DVT / PE): reduced with blood thinners and early mobilisation.
- Stiffness requiring manipulation: occasionally the knee scars tight and needs a short anaesthetic to regain bend.
- Nerve or vessel injury: rare.
- Wear or loosening over time: most modern knee replacements are still functioning beyond 15 years, but a proportion need revision eventually.
- Anaesthetic and medical risks: assessed and optimised before surgery, not discovered during it.
Why I tell you this: a knee replacement done for the right reasons, at the right time, on a well-prepared patient is a very good operation. Knowing the honest numbers is part of choosing it well.
Recovery, week by week
| Timeframe | What to expect |
|---|---|
| Day 0 to 2 | Standing and walking with support on day one. The early focus is pain control, swelling management and getting the knee bending. |
| Week 1 to 2 | Home with crutches or a stick. Daily exercises for bend and straightening; ice and elevation are your best friends. |
| Week 2 to 6 | Walking further, weaning off supports. Desk work often from week 3 to 6. Driving when safe and off strong pain medication, commonly week 4 to 6. |
| Week 6 to 12 | The corner most people turn. Strength work builds; stairs, longer walks and most daily life return. |
| Month 3 to 12+ | Improvement continues for 12 months or more. Walking, cycling, swimming, golf and doubles tennis are realistic goals; kneeling often stays uncomfortable even in an excellent knee. |
Frequently asked questions
How painful is knee replacement recovery, honestly?
The first two to three weeks are hard work; anyone who tells you otherwise is selling something. Modern anaesthetic techniques, nerve blocks and a written pain plan make it manageable, and it improves steadily from there. Knowing this in advance is half the battle.
▶ Video answer comingWill I be able to kneel on it?
You will not damage the knee by kneeling, but many people find it uncomfortable even long after an otherwise excellent recovery. A cushion helps. If kneeling is central to your work or worship, tell me; it shapes the conversation.
▶ Video answer comingPartial or total: which is right for me?
It depends on where your arthritis actually is. A partial replacement suits a knee with disease confined to one compartment and intact ligaments; it recovers faster and feels more natural, but it is not a lesser version of a total for a fully worn knee. Your X-rays answer most of this question.
▶ Video answer comingHow long will the new knee last?
Registry data shows most modern knee replacements are still working well past 15 years. Weight, activity choices and luck all contribute. If you are younger, we talk openly about the realistic chance of revision surgery within your lifetime.
▶ Video answer comingDownloads
- Preparing for knee replacement (pre-operative guide)PDF coming
- Knee replacement rehabilitation protocol (for you and your physio)PDF coming
This guide is general information, not individual medical advice. The recommendations that matter are the ones made for you in consultation. Content reviewed by Dr Rob Cooper. [Review date TBC]
Get a straight answer about your knee
Whether the answer is "operate", "wait" or "strengthen first", you will leave with a plan.