By Dr. Scott Tarantino — My response to this question as an orthopedic surgeon is usually, “I don’t know, do you?” This is not to be obnoxious, but to make it clear that that the decision to undergo a knee replacement has nothing to do with the doctor and everything to do with the patient. An orthopedic surgeon may suggest knee replacement surgery as a treatment option available to you, but it never “needs” to be done. The word “need” implies that you as a patient have no choice in the matter.

The majority of knee replacements in this country are being done for knee arthritis, or a breakdown of the natural cartilage cushion in the knee. This is most commonly due to osteoarthritis (local wear-and-tear), but can also be due to an inflammatory arthritis, where the joint breaks down due to a systemic disease such as rheumatoid arthritis, lupus, psoriasis, or Lyme disease.

Once arthritis sets into a joint, the natural history is that it will progressively get worse over time, but it is somewhat unpredictable. Some get worse rapidly, some more slowly. The symptoms with an arthritic knee vary, but can include any combination of pain, stiffness, or swelling. Some patients tolerate the symptoms well; others do not.

There are many non-surgical treatment options available to patients to treat an arthritic knee as outlined in our Surgication course on Total Knee Replacement, but none are guaranteed to work. If the symptoms are not responding to these options, knee replacement surgery can be considered.

You may say to your surgeon, “Nothing is working for me. I can’t live like this. What else can I do?” At this point, if your Xrays show substantial joint destruction, your orthopedic surgeon may say to you….”You need a knee replacement!!”

What he/she means is that knee replacement surgery is a viable option for your situation. After learning more about the procedure, you may simply decide to just continue to live with the pain and deal with it any way you can. Not having surgery will not cause any harm to you other than your knee will continue to hurt. You do not NEED a knee replacement. You might DESIRE one given your circumstances, but you never NEED one.

You should never have a knee replacement because your orthopedic surgeon told you that you need one. You should have a knee replacement when it is presented as an option and YOU decide you need it done because you are unwilling to live with your symptoms and they are not responding to anything non-surgical.

Our Surgication course on Total Knee Replacement can provide you with a thorough education on the procedure and help you make that decision!!