Knowing When It's Time for Knee Replacement Surgery

Knee replacement surgery can be life-changing for people living with chronic knee pain — but it's not a decision that has to be rushed. "Knee replacement surgery is, at its core, an elective procedure,” says Dr. A. Jack Barnes, Jr., joint replacement specialist at Lexington Orthopaedics and Sports Medicine. "Knee pain is not a life-threatening condition. It's a procedure that you determine when the time is right for you."

Getting the Right Diagnosis

For anyone struggling with long-standing knee pain, the first step is getting the right imaging. "We always start with weight-bearing X-rays," Dr. Barnes< explains. “That's incredibly important. The vast majority of the time, if someone has knee arthritis, it can be easily seen on an X-ray. Most patients don't need an MRI or CT scan."

These images help confirm whether arthritis is causing the pain and guide which treatments to try first.

Non-Surgical Treatments Come First

Before considering surgery, several effective non-surgical options are available. "We think about over-the-counter anti-inflammatories like ibuprofen, naproxen or acetaminophen," says Dr. Barnes. "You can also use topical medications such as diclofenac gel, Biofreeze, Icy Hot, or Salonpas patches."

In addition to medications, many patients benefit from physical therapy or prescription-strength anti-inflammatories such as diclofenac or meloxicam. "During your visit, we can also talk about injections," Dr. Barnes adds. "There are several types, including corticosteroid injections and gel injections — each with its own set of risks and benefits."

Deciding When It's Time for Surgery

Once all non-surgical treatments have been exhausted, knee replacement may become the next step. But Dr. Barnes emphasizes that it's not just about X-ray results or pain levels. "What I tell everyone is that when you've tried everything non-surgical and can no longer do the things you love because of knee pain — that's when it's time to think about surgery," he says.

"It's an elective procedure," he adds. "You should schedule it around your life, not your life around it."

Knee Replacement Longevity

Implant longevity depends on several factors, including age and activity level. "My goal for most patients is 15 to 20 years," Dr. Barnes says. "A younger, more active person may wear it out faster than someone who enjoys lower-impact activities." 

Most modern knee implants are made from cobalt chromium alloy or titanium, with a smooth plastic liner in between. "Instead of bone rubbing on bone, you now have smooth metal on smooth plastic," Dr. Barnes explains.

Recovery: A Journey, Not a Sprint

Recovery after knee replacement takes time and dedication. "It's not easy," Dr. Barnes acknowledges. "I have patients start outpatient physical therapy about a week after surgery, usually two to three times per week for six to eight weeks."

Progress comes gradually. "By about three months, you should start feeling a little better than before surgery,” he says. "Full recovery can take six months to a year. Recovery is a spectrum — not everyone heals at the same pace."

Setting Realistic Expectations

While most patients experience dramatic pain relief and improved mobility, Dr. Barnes reminds them that a knee replacement isn't a brand-new knee. “I hope that your pain will improve significantly and your function will be restored," he says. "But knee replacements aren't perfect. Most people don't forget they have one — they can click, pop, and sometimes feel stiff or swollen."

That's why he makes sure expectations are clear from the start. "One of the biggest risks is that the surgery may not live up to a patient's expectations," Dr. Barnes says. "When we set realistic expectations before surgery, it sets us up for success afterward."

Looking Ahead

While revision surgeries are uncommon, they can occasionally be necessary. "Based on joint replacement literature, the revision rate is about 5 - 10% at ten years out from surgery," says Dr. Barnes. "That number can vary depending on each patient's unique situation."

Ultimately, the goal of knee replacement surgery is straightforward: to help people return to their daily activities without experiencing constant pain. 

"When knee pain limits your quality of life, that's when we talk seriously about surgery," Dr. Barnes says. "The decision is yours — and our job is to help you make it confidently."


A. Jack Barnes, Jr., MD, Lexington Orthopaedics and Sports Medicine