Is it hard to decide about total knee replacement? Totally!

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

It’s a big decision: Should you have surgery for your painful knee?

Many people say yes. In fact, each year, nearly 700,000 people in the United States who have the most common form of knee arthritis undergo knee replacement surgery.

But how well does it work? That’s a question that’s been answered in large part by asking people who have had the surgery if they’re glad they had it. Most say yes. But high-quality research comparing surgery with non-surgical treatments has not been performed…until now.

In the current issue of The New England Journal of Medicine, researchers in Denmark are reporting the results of a study that randomly assigned 95 people considered eligible for knee replacement surgery to either have the surgery or stick with more conservative treatments, such as exercise and a diet to lose excess weight. Here’s what they found:

  • Those who had surgery had more pain relief and better function a year later than those assigned to non-surgical treatment.
  • Function and quality of life were better in those who had surgery.

Does this mean surgery is right for most people with knee arthritis? Not necessarily. Here’s why:

  • Those enrolled in this study were carefully selected — it included only 95 people out of nearly 1,500 who were initially screened.
  • This study excluded those who had had severe pain in the week prior to study enrollment.
  • Only people with osteoarthritis — the age-related, “wear-and-tear” type of arthritis — were included. People with other types, such as rheumatoid arthritis, were not eligible.
  • Although the improvement in those receiving surgery was greater than that for the non-surgical group, both groups improved. And the difference between them was not large.
  • Serious side effects or complications were more common in the surgery group. For example, three of the 50 people who had surgery (compared with none in the non-surgical group) developed blood clots that required treatment with blood thinners. Such clots can cause dangerous, potentially fatal, complications.
  • This study lasted for just one year, so it cannot tell us which type of treatment is best over the longer term. That’s important because osteoarthritis, and the impact of major surgery, may affect pain and function for decades.

If you have osteoarthritis of the knee, talk to your doctor about your treatment options. Surgery may be a good choice if your symptoms are quite bothersome, other treatments have failed, and your overall health is good enough to withstand the operation. However, your personal preferences matter a lot. For example:

  • How does your arthritis affect you? An avid walker may make a different decision about having knee surgery than a person who is less active.
  • How do you feel about the risks? All surgery comes with a significant potential for complications, such as infection or bleeding. Some people are more focused on the potential improvement provided by the operation, while others are more concerned about the risks.
  • Do you have other conditions or take medications that might make the surgery riskier than average?
  • How do you feel about the weeks of rehabilitation needed after surgery?

We still don’t have an easy answer for whether knee replacement surgery is best for people with osteoarthritis. This study helps. But your personal preferences, health, and lifestyle goals matter more.


  1. sdorttuii plmnr

    wonderful post, very informative. I wonder why the other experts of this sector do not notice this. You must continue your writing. I’m confident, you’ve a huge readers’ base already!

  2. Donna

    In 2001 I had a total knee replacement. Prior to surgery I had steroid injections, su-part injections and every thing else my ortho doc suggested. Knee pain was prohibiting me from fully living an active life.

    I admit, following the surgery I woke up to tremendous pain. The first night, the pain was unimaginable. I did three months of therapy and water aerobics as soon as possible.

    Fourteen years later I’m happy to say I’m so glad I had surgery. I’ve had no problems with my replacement.

    I know technique has improved in 14 years. Pain pills are not a solution. Once a joint wears out it doesn’t get better on its own.

  3. Agnes Masselink

    I had a total knee replacement over a year ago and had very little discomfort after two months What was affected was my memory, more than likely from too many pain medications.