Do You Need Surgery for Knee Arthritis?
Many people assume that once knee osteoarthritis starts to interfere with daily life, joint replacement must be right around the corner. While knee replacement is an excellent and highly effective option when the time is right, the truth is that many patients can remain comfortable and active for years with the right non-surgical treatment plan.
A helpful way to understand knee osteoarthritis is to compare it to other medical conditions that exist along a spectrum. Consider hypertension. When someone is diagnosed with high blood pressure, treatment does not begin with medication. Physicians typically start with diet, exercise, weight management, and other lifestyle adjustments. Many patients are able to stay well-controlled without ever needing medication.
The same is true in heart valve disease. Some people eventually require a valve replacement, but many do not. Physicians monitor the condition over time and focus on helping patients remain active, healthy, and comfortable for as long as possible before considering surgery.
Knee osteoarthritis works the same way. Treatment should be matched to your specific disease stage, symptoms, and goals, not someone else’s situation.
How Doctors Measure Arthritis Severity
Two main factors determine the severity of knee osteoarthritis: X-ray findings and your symptoms. X-rays show the structural condition of the knee joint, which shows how much cartilage has worn down. This information is important, but it cannot be changed. Symptoms, on the other hand, (pain, stiffness, and difficulty with daily activities) can improve with the right non-surgical treatments.
To track how your knee is doing over time, we use a simple, validated assessment called KOOS, JR (Knee injury and Osteoarthritis Outcome Score for Joint Replacement). KOOS, JR consists of 7 questions asking about pain, stiffness, and everyday functional tasks such as walking, standing, or climbing stairs. Your responses generate a score that provides a clear, easy-to-follow measure of your symptoms. Unlike X-ray findings, your KOOS, JR score can improve with the right interventions. This is the link to the KOOS, JR survey, and this is the link to the scoring instructions.
Why Symptoms Matter More Than Imaging
Many of the things that can improve KOOS JR scores are entirely non-surgical. These include weight optimization, physical therapy, non-steroidal anti-inflammatory medications, joint injections, activity modification, and bracing or footwear adjustments. KOOS JR also improves significantly after knee replacement when the time is right, but long before surgery becomes necessary, it can help guide and monitor non-surgical progress. Much like how blood pressure readings guide the management of hypertension or how valve function is monitored in heart valve disease.
One of the most important principles in treating knee osteoarthritis is that we do not treat X-rays alone. We treat you. If your X-rays show advanced arthritis but your symptoms are manageable, that is good news. We focus on keeping things manageable. If your X-rays show mild arthritis but your symptoms are significantly affecting your daily life, then we prioritize improving how you feel, not how the imaging looks. My goal is always to help you live well, stay active, and align your treatment plan with your symptoms, your activities, and your lifestyle, while also being realistic about the benefits and limitations of knee replacement surgery.
Effective Non-Surgical Treatments for Knee Arthritis
Non-surgical treatments for knee osteoarthritis often work remarkably well, especially when combined thoughtfully and tailored to your needs. A personalized plan may include physical therapy, low-impact strengthening, weight optimization, anti-inflammatory medications, corticosteroid or gel injections, PRP injections, bracing, and selective activity adjustments. Many patients can avoid or postpone surgery for years with the right combination of these approaches.
The bottom line is simple: X-rays measure structure, but KOOS JR measures how you actually feel. Symptoms, not images alone, drive treatment decisions. Non-surgical options can significantly improve knee function and quality of life, and knee replacement becomes the right choice only when symptoms continue to limit your daily life despite a well-executed non-surgical plan.
Yes, non-surgical treatments can work for knee osteoarthritis. And when surgery eventually becomes the right option, it’s because we’ve monitored your progress, measured your symptoms, and made the decision together.
