When to Get a Knee Replacement: Understanding the Right Time for Surgery

I always joke that as a PT, knee replacement surgeries are my bread and butter. In all seriousness, I have worked with hundreds of people either considering a knee replacement or recovering from a knee replacement surgery. While many knee problems can be managed with physical therapy, medication, or lifestyle changes, sometimes knee replacement surgery becomes the best path forward. But how do you know when it’s time?

In this post, we'll break down the key signs and considerations that can help you or a loved one decide when knee replacement might be the right next step.

What Is Knee Replacement Surgery?

Knee replacement surgery involves removing damaged parts of the knee joint and replacing them with artificial components. It’s most commonly performed to relieve pain and restore function in severely diseased knee joints, often due to osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. Advances in technology have drastically improved the time spent in the hospital after a knee replacement surgery with most people going home the same day, but it is still considered a major orthopedic surgery with considerable rehabilitation considerations. 

Signs It May Be Time for a Knee Replacement

1. Persistent Pain

If you're experiencing chronic knee pain that persists even when resting or keeps you awake at night, and it doesn’t respond to medication or physical therapy, it could be time to consider surgery.

2. Limited Mobility

If walking, climbing stairs, or even getting in and out of a chair has become difficult, and mobility aids like canes or walkers are becoming necessary, knee replacement might improve your quality of life significantly.

3. Deformity

Visible knee deformity, such as bowing in or out of the leg, can indicate advanced joint damage. A knee replacement may be necessary to restore alignment and function.

4. Reduced Quality of Life

When knee pain and immobility start affecting your ability to do things you love—traveling, playing with grandkids, gardening—it might be worth exploring surgical options.

5. Ineffective Non-Surgical Treatments

If you’ve tried physical therapy, weight loss, steroid injections, anti-inflammatory medications, or other non-surgical treatments with little to no relief, it's a sign that conservative management has reached its limits.

Timing Matters: Too Early vs. Too Late

Some patients wait too long, enduring years of pain and mobility loss. This can cause issues and compensations in other areas of the body. Others opt for surgery too soon, missing out on conservative treatments that might have helped. The ideal timing is different for everyone, but a thoughtful discussion with an orthopedist or physical therapist that knows you and your goals can be very helpful. 

Are You a Candidate?

You're likely a candidate for knee replacement if:

• Your pain is severe and disabling, significantly impacting your quality of life

• Conservative treatments have failed

• You're healthy enough to undergo surgery and rehabilitation

The Bottom Line

Knee replacement can be a life-changing procedure, but the timing is key. If knee pain is limiting your daily life and conservative treatments aren't enough, talk to your doctor. An orthopedic evaluation and imaging  will help determine the best course of action.

The goal isn't just to fix a knee—it's to restore your quality of life.

Shannon Hall, PT, DPT