When is it Time to Have a Knee Replacement?

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Knowing the risks, when is it time to have the operation? Below are reasons to consider knee replacement.

Marked Disruption of Everyday Activities

One of the main reasons to consider knee replacement is pain that markedly limits everyday activities despite the use of anti-inflammatory medicines. For surgery to be considered, the pain should be disruptive to the activities of daily living, especially if it’s to the point that the person stays in the house more to avoid activity altogether.

Inability to go up and down stairs and needing to use a cane are also signs that it might be time to consider knee replacement. Failure of anti-inflammatory medications to decrease pain and presence of bone-on-bone arthritis that is causing pain on an hourly basis are indications that it is probably time to consider knee replacement for pain relief.

Many patients have trouble sleeping at night because of the pain caused by knee arthritis. Failure of anti-inflammatory medications to allow patients to sleep is another indication that it might be time to consider knee replacement.

Bone-on-Bone Arthritis

Before considering knee replacement, x-rays should be obtained and should show bone touching bone somewhere in the knee. Patients who have only thinning of the cartilage without bone touching bone should not undergo knee replacement surgery except in rare circumstances. Patients who do not have bone-on-bone arthritis but nonetheless undergo knee replacement surgery are much less likely to be satisfied with the knee replacement. Other pain management strategies should be considered to help with the symptoms of thinning cartilage.


Knee arthritis can cause progressive instability of the knee with which the knee becomes much looser and more unstable than the native knee. In some cases, the instability is mild. In other cases, it is substantial enough that when the knee is in a bent position, it becomes markedly unstable.

The instability often is manifested as a "giving way" sensation to the knee. In severe cases, the knee instability causes the patient to fall. It is my feeling that for patients with bone-on-bone arthritis who have started to experience falls because of the knee arthritis, it is probably time to have a knee replacement to improve the stability of the knee and limit the chances of falling.

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