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Total knee replacement surgery has come a long way, offering a safe and effective way to help relieve chronic pain, correct poor knee alignment, and restore everyday mobility. If you’re someone with severe arthritis, surgery can mean walking comfortably again, sleeping without pain, and returning to activities you enjoy.

Osteoarthritis—the gradual wear-and-tear of cartilage that cushions the knee joint—is the most common reason people eventually consider knee replacement. As the cartilage wears down, bones begin to rub together, causing pain, stiffness, and swelling that can make everyday movement difficult.

How do you know when it’s time to consider knee replacement surgery—or whether you’re a good candidate in the first place?

“It should be a shared decision between you and your doctor based on pain, function, and daily life limitations,” explains Anna Cohen-Rosenblum, MD, an orthopedic surgeon at NYU Langone Health who specializes in hip and knee joint replacements. “You can always choose surgery later, but you can’t undo it, so the timing must feel right.”

Here are five signs that a replacement might be the right step toward your knee’s recovery.

Sign No. 1: You Can No Longer Do Things You Enjoy

How your knee looks on imaging is less important than how it works in your daily life. “We treat the person, not their X-ray or MRI,” says Dr. Cohen-Rosenblum.

If knee pain interferes with work or caregiving or prevents you from performing activities you enjoy, a knee replacement procedure can return you to those activities—and help you regain independence.

“Having a knee replacement is about reclaiming life—walking with family, traveling, staying active—without constantly negotiating with the knee,” Dr. Cohen-Rosenblum says.

Sign No. 2: Your Knee Is Always on Your Mind

When knee pain steals your attention not only during workouts or sports but throughout your day—and even at night, disturbing your sleep—that’s a strong sign that you may want to consider knee replacement surgery.

“If you’re sitting at the dinner table and all you’re thinking about is your knee, that’s a problem,” says Dr. Cohen-Rosenblum.

Pain can be such a constant presence, she adds, that people begin planning their days around their knee. “At that point, a knee problem becomes a quality-of-life issue,” and surgery might be recommended.

Sign No. 3: You’ve Exhausted Other Options

A knee replacement may be needed if you’ve tried other treatment options and they no longer relieve your symptoms. Before discussing total knee replacement, doctors typically recommend strategies like these:

• physical therapy to strengthen surrounding muscles, including the quadriceps and hip muscles, and improve knee mechanics
• anti-inflammatory medications such as acetaminophen or non-steroidal anti-inflammatory drugs such as ibuprofen or prescription options
• injections of corticosteroid for inflammation or hyaluronic acid gel as a lubricant for the knee joint
• weight loss when appropriate, as this can ease the knee joint’s load and pain

“If someone has truly worked through these options and still can’t live pain-free or do what matters to them, surgery becomes a reasonable recommendation,” says Dr. Cohen-Rosenblum.

Sign No. 4: You Have a Knee Misalignment

In addition to osteoarthritis, conditions such as valgus (“knock-knee”) or varus (“bow leg”), can lead to knee replacement. These structural issues can stretch ligaments and make future reconstruction more complex.

“The more severe the misalignment, the bigger the operation and the faster an implant may wear,” Dr. Cohen-Rosenblum explains. In these cases, alignment changes in the knee—especially when those changes impact function—are a good reason to pursue surgery sooner.

Sign No. 5: You’re in Good Health for Surgery

Sometimes the timing is right for knee replacement because a person is in good shape.

“We want patients to be medically well for surgery,” explains Dr. Cohen-Rosenblum. “Making sure any issues are addressed is key to a safe surgery and a good outcome.”

Before performing surgery, your doctor considers certain factors to ensure the best possible outcome:

• Are chronic conditions such as diabetes or high blood pressure well controlled?
• Have other health issues, such as dental infections, been addressed?
• Have you lost weight or quit smoking?

Better yet, having a total knee replacement when you’re on a path to good health can only help extend that path. “If your activities have been limited by your knee but you can move again after surgery, your increased physical activity will then support your long-term health,” says Dr. Cohen Rosenblum.

What to Expect if Surgery Is the Next Step

If you and your doctor decide surgery is the right next step, there’s good news: modern knee replacement surgery has come a long way. Thanks to advances in anesthesia, surgical precision, and pain management, people often go home the same day, instead of days later.

“The way we manage surgery today is completely different from even a decade ago,” explains Dr. Cohen-Rosenblum. “For instance, we use spinal anesthesia and nerve blocks rather than general anesthesia, so patients wake up more comfortable and alert.” In addition, she explains, the care team encourages people to move and start gentle physical therapy almost immediately after surgery, promoting early healing and reducing the risk of complications.

Knee replacement is major surgery, and Dr. Cohen-Rosenblum cautions that there’s no way to predict how you’ll respond or how quickly you’ll recover. Still, outcomes from total knee replacement are better than ever. “For many patients, it not only takes away significant pain—it returns them to the activities that make them feel like themselves again,” she adds.

To learn more about knee replacement and consult with a NYU Langone surgeon, visit our Joint Replacement Center.