Understanding Knee Osteoarthritis: When is it Time for a Knee Replacement?

Knee osteoarthritis (OA) is one of the most common joint conditions affecting Australians, particularly those over the age of 50. It occurs when the protective cartilage within the knee joint gradually wears down, leading to pain, stiffness, swelling and loss of function. If you're living with knee pain, you're not alone—and importantly, there are many effective ways to manage your symptoms before considering surgery.

What is Knee Osteoarthritis?

Osteoarthritis is a degenerative condition that affects the articular cartilage—the smooth, slippery tissue that covers the ends of bones in the joint. Over time, this cartilage wears away, leading to bone-on-bone contact. This can cause:

• Pain during activity or even at rest
• Swelling and warmth around the joint
• Reduced range of motion
• Difficulty with everyday tasks like walking, climbing stairs, or kneeling

OA is often gradual in onset but can become debilitating if left untreated.

Non-Surgical Management Options

For many patients, surgery is not the first step. Non-operative management can successfully reduce pain and improve function for months or even years. Some of the mainstay options include:

1. Physiotherapy

A structured physiotherapy program is often the cornerstone of OA treatment. It focuses on:

• Strengthening the quadriceps and hamstrings
• Improving joint mobility and gait mechanics
• Enhancing balance and proprioception
• Developing strategies to reduce strain on the knee

Evidence shows that consistent physiotherapy can significantly reduce pain and delay the need for surgery.

2. Oral Analgesia

Medications can help control pain and inflammation. Options include:

• Paracetamol: A good first-line option for mild pain.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen or meloxicam, these are effective but must be used with caution in patients with gastrointestinal, cardiovascular, or kidney concerns.
• Topical NSAIDs: These can be a safer alternative for localised pain without systemic side effects.

Always consult your GP or pharmacist about long-term use and potential interactions.

3. Injectable Therapies

Injection-based therapies can offer temporary relief and may be helpful in delaying joint replacement:

• Corticosteroids: Anti-inflammatory injections that can reduce swelling and pain for several weeks or months.
• Viscosupplementation (Hyaluronic Acid): A gel-like substance injected into the knee to improve lubrication. Results are variable, but some patients experience significant relief.
• Platelet-Rich Plasma (PRP): An emerging therapy using components of your own blood to promote joint healing. Evidence is still evolving, but promising in early OA.

4. Knee Bracing

Bracing can help offload the affected compartment of the knee:

• Unloader braces are particularly useful in patients with isolated medial or lateral compartment OA.
• These are best used during activity and in combination with a physiotherapy plan.

So When is it Time to Consider a Knee Replacement?

Despite the best non-surgical care, there may come a point where the joint is too worn and symptoms too severe to manage conservatively. You might be a candidate for a knee replacement if:

• You have persistent knee pain that affects your sleep and daily activities
• You’ve exhausted non-operative treatments with little relief
• You experience frequent knee instability or “giving way”
• X-rays show advanced joint space narrowing and bone-on-bone contact
• Your quality of life is significantly impaired

A total knee replacement is a reliable and effective surgery with excellent long-term outcomes. Most patients experience significant pain relief, improved mobility, and return to activities like walking, gardening, or cycling.

Final Thoughts

Knee osteoarthritis is a progressive condition, but with the right approach, you can delay—or in some cases, avoid—surgery. At our practice, we take a tailored, stepwise approach to care, combining the best of non-operative treatment with surgical expertise when it’s needed.

If you're unsure about the next step in your treatment journey, book an appointment for a personalised assessment and management plan.

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