By Marie Suszynski

Medically Reviewed by Pat F. Bass III, MD, MPH

More than a million people undergo surgery to replace a knee or hip every year, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. If you have painful knee osteoarthritis, you might be wondering if you’ll be one of them.

Knee surgery can bring relief for osteoarthritis knee pain, but there are other treatments you should try first that could delay your need for surgery.

How Knee Osteoarthritis Impacts Your Life

Osteoarthritis — sometimes called wear-and-tear arthritis — occurs when cartilage on the ends of your bones deteriorates, making the joint painful and swollen. As arthritis progresses, growths called bone spurs may form, and small pieces of bone and cartilage may break off in the joint. Inflammation can make cartilage wear down even more.

Osteoarthritis is “probably one of the more dramatic musculoskeletal disorders,” says Scott C. Faucett, MD, an orthopedic surgeon at the Centers for Advanced Orthopaedics in Washington, D.C.

At first, the joint disease may cause some pain and stiffness, but it can progress to the point where it’s difficult to get out of bed, get dressed, and walk up and down stairs, Dr. Faucett says. It can also put you at higher risk for falls and, if you become sedentary because of the pain, lead to obesity, diabetes, heart disease, and high blood pressure.

Treatment Options Before Knee Surgery

You can’t cure osteoarthritis, but you can take steps to better manage it. That may mean losing weight and cutting back on high-impact activities that bother your knees. After all, every step you take puts three times your body weight on your knee, says William Bryan, MD, an orthopedic surgeon at Houston Methodist Hospital in Texas — and running puts five times your weight on your knees.

This doesn’t mean that you should become inactive. Activities that are gentle on your knees — such as swimming, using an elliptical trainer, and riding a bike (if your arthritis isn’t behind your knee cap) — can help you lose weight, which puts less strain on your joints, and strengthen the muscles around your knees. Stretching, yoga, and tai chi may ease stiffness. Using an ambulatory aid, such as a cane, is another option to take pressure off of your knee, Faucett says.

Taking these steps may help you manage osteoarthritis and delay surgery.

Physical therapy. Your doctor may suggest physical therapy to strengthen and stretch the muscles around your knee.

Oral medications. Over-the-counter or prescription anti-inflammatory drugs or supplements may be the first step in pain relief. But Dr. Bryan says they haven’t been very effective at treating osteoarthritis. In addition, anti-inflammatories have side effects such as stomach pain, heartburn, and liver damage.

Topicals. Anti-inflammatory gels and creams are available over the counter and through prescription, and they help relieve joint pain for some people, according to the Arthritis Foundation.

Injections. The next step is often corticosteroid injections, which Bryan describes as very effective at reducing pain and decreasing inflammation. However, the benefit is short-term and corticosteroid injections may cause damage if used frequently. Injecting hyaluronic acid into the joint is another option that can improve symptoms of knee osteoarthritis.

When Is It Time to Consider Surgery?

Because osteoarthritis tends to get worse over time, you may get to the point where other treatments are no longer effective.

Your doctor will look at your joint on an X-ray, and when the test shows a substantial issue — bone rubbing against bone — it may be time to consider knee replacement surgery.

As you consider surgery, keep these questions in mind, Bryan says:

• Is the pain unbearable?
• Has your knee become unstable?
• Are your daily activities, such as walking, being affected?
• Is pain impacting your job, thereby threatening your livelihood?
• Is osteoarthritis causing problems with sleep?

Another factor is your age. People in their forties and fifties tend to be less satisfied with knee replacement surgery because they often want to be more active than knee implants allow, Bryan says.

After a recovery period, most people experience a return to all function, including going back to day-to-day activities without pain, Faucett says. However, running or jumping should be avoided when you have an implant, and it may be difficult to kneel after surgery, according to the American Association of Hip and Knee Surgeons.

For a younger person who has kids, this may be an issue, explains Bryan. But for someone who isn't particularly active, being able to walk and climb stairs following surgery may be a valuable improvement.

Once you’ve decided to have surgery, consider the recovery time: Bryan recommends setting aside 8 to 10 weeks. People who go back to work before they’re ready, who don’t rest when needed, or who don’t do the necessary exercises after surgery may experience stiffness and problems with range of motion, he says.

As with any surgery, you're likely to have some post-operative pain, as well as general risks of infection, blood clots, or pneumonia.

But most people don't have to be sold on surgery, Bryan says. “They come to us with their hat in the hand and they know it’s time,” he says.

Talk to your doctor about your options for osteoarthritis knee pain to determine if and when surgery is right for you.

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