Deciding on Surgery
Knee replacement is usually not the first treatment for knee arthritis. Exercise, weight loss, medication, injections and braces all have a place, and some smaller procedures can help selected patients. This guide summarizes what the American Academy of Orthopaedic Surgeons (AAOS) guideline says about each option, and how to tell when alternatives have stopped working for you.
Key takeaways
The AAOS guideline gives its strongest recommendation to exercise, whether supervised, on your own or in water. It improves pain and function, and it also helps you prepare if you do need surgery later. A physical therapist can build a program around what your knee tolerates.
If you are overweight, sustained weight loss is also recommended. Less load on the knee usually means less pain. A cane can help, too. See Weight, BMI and knee replacement →
If you are thinking about surgery, the timing of injections matters. Gel injections, steroid shots and knee replacement →
| Option | AAOS guideline (2021) |
|---|---|
| Exercise | Recommended (strong) |
| Weight loss, if overweight | Recommended (moderate) |
| Acetaminophen, NSAIDs | Recommended when safe (strong) |
| Opioids, including tramadol | Not recommended (strong) |
| Steroid injections | Short-term relief (moderate) |
| Gel (hyaluronic acid) injections | Not for routine use (moderate) |
| PRP, acupuncture, denervation | May help; limited evidence |
| Braces | Could help (moderate) |
| Lateral wedge insoles | Not recommended (strong) |
| Arthroscopic washout | Not recommended for arthritis (moderate) |
There is no fixed deadline, but these are signs that it may be time to talk to a surgeon:
For US patients, it can also help to know that Medicare’s documentation guidance for knee replacement expects a reasonable trial of non-surgical treatment, typically three months or more, along with imaging that confirms arthritis and pain that limits daily activities. Am I a candidate? →
Dr. Kalender reviews your symptoms, the treatments you have already tried, your X-rays or MRI and your general health. If non-surgical care still has something to offer you, he says so. If it doesn’t, he explains what surgery would mean for you.
When non-surgical care has run its course, the first days after surgery matter most. If surgery is right for you, his own pain-free approach is designed to keep pain low from the first hours, get you walking the day after surgery and, for most patients, mean one night in the hospital. He developed it himself over about ten years.
Learn about the pain-free approach → · What “bone on bone” means →
For many people, exercise, weight loss, medication and occasional injections keep symptoms manageable for years. If pain still limits your daily life after a fair trial, surgery becomes a reasonable option to discuss.
The AAOS guideline does not recommend gel (hyaluronic acid) injections for routine use. Some people report relief, so discuss the evidence with your doctor.
PRP may reduce pain for some people, but the evidence is limited, and it does not replace a worn joint.
There is no single rule. Medicare’s guidance for US coverage typically expects three months or more of documented non-surgical treatment. Your surgeon will look at how much the knee limits you.
Free online consultation
Dr. Kalender reviews your X-rays or MRI and the treatments you have tried, and tells you honestly whether surgery makes sense now. Free, with no obligation.
Pain-free knee replacement in Istanbul for patients traveling from the USA. Orthopedic & trauma surgeon at Dora Hospital.
Dora Hospital · Fulya Mah. Yavuz Sk. No:7, 34394 Şişli / Istanbul, Türkiye
The information on this website is for general guidance and does not replace a medical consultation. © Dr. Mahmut Kalender