Signs You Might Need a Knee Replacement

Knee arthritis usually progresses slowly… You adapt, you compensate, you find workarounds. You stop going for long walks, take the lift instead of the stairs and plan outings around “good or bad” knee days.

Somewhere along the way, it starts getting to a point that you might start questioning: “Is my knee pain bad enough for a knee replacement?” A lot of people are worried they are too young or that it could possibly make things worse.

Knee replacement may not be the right answer for everyone, but when arthritis is affecting your sleep, walking, work or independence, it is worth getting the professional opinion of an orthopaedic specialist.

Dr David Kitchen is an orthopaedic surgeon in Adelaide who treats knee conditions, including knee arthritis, partial or total knee replacement and robotic-assisted or patient-specific knee replacement.

Knee Replacement | Knee Surgery | Dr David Kitchen | Orthopaedic Surgeon Adelaide | Hip & Knee Surgeon

What are the signs that you might need a knee replacement?

Knee replacement should be discussed when arthritis is causing ongoing pain, stiffness or loss of function, and non-surgical treatment is no longer giving enough relief.

It does not mean surgery is automatic but that your knee deserves a specialist assessment.

Here are some signs that suggest it is time to speak with your GP about referral to an orthopaedic surgeon.

Your knee pain is no longer responding to non-surgical treatment    

Knee pain from osteoarthritis often responds initially to physiotherapy, anti-inflammatory medications, weight loss, activity modification and injections. When these measures have been tried consistently but are no longer providing adequate relief, it’s time to ask what is happening inside the joint.

You might notice:

  • Pain returning as soon as medication wears off
  • Swelling after simple errands or short walks
  • Less benefit from injections than before
  • Avoiding exercise because recovery takes too long
  • Needing more rest days after ordinary activity

Surgery is generally considered only after reasonable conservative treatment has been explored.                                                         +

Knee pain that interrupts your sleep           

As arthritis becomes more advanced, pain can start appearing at rest. Night pain can be especially frustrating because it affects sleep, mood, energy and how you cope the next day.

You might find yourself changing position often, sleeping with a pillow under your knee, taking pain relief before bed, or waking in the early hours with a deep ache around the joint.

Pain at rest does not always mean you need surgery, but it is a strong indicator that the joint is significantly degenerated.                          +

Difficulty with everyday activities    

When knee pain starts limiting ordinary tasks, it’s past the point of a painful knee to the point that it is impacting independence. Dr Kitchen doesn’t only look at X-rays, he will also look at what your knee is stopping you from doing, any functional limitations around:

  • Getting in and out of the car
  • Walking through the supermarket
  • Climbing stairs
  • Standing at work
  • Kneeling in the garden
  • Walking the dog
  • Playing golf, bowls, tennis or social sport
  • Keeping up with children or grandchildren                                  

Your knee feels stiff or will not move properly      

Arthritis causes stiffness as well as pain.

You may notice your knee does not fully straighten or bend. Getting up from a chair may take a few steps before the knee “warms up.” Stairs may feel awkward and difficult because the knee does not move smoothly.

Reduced range of motion can also change the way you walk and your gait. Over time, that compensation can place extra strain on your hip, back or your other knee.

If stiffness is progressing, it is a sign to have your knee assessed, because it is more than likely to worsen without treatment.

 

Your leg shape has changed, or the knee feels unstable     

Advanced knee arthritis can wear unevenly across the joint which can develop a visibly noticeable bowed-leg or knock-kneed appearance. Patients also describe the knee shifting, giving way, or feeling unreliable on uneven ground.

This can make simple things feel risky, like stepping off a kerb, walking down a slope or moving through a busy shopping centre.

Visible change in alignment or a feeling of instability suggest the joint is under structural stress.

Your X-rays show joint space narrowing

Symptoms and imaging findings give the clearest picture when considered together.

Your GP will usually arrange standing X-rays before referring you to an orthopaedic surgeon. X-rays that show significant narrowing of the joint space, bone-on-bone contact, bone cysts or osteophytes (bony outgrowths) indicate advanced arthritis.

But some patients have severe-looking arthritis with manageable symptoms and some have imaging that looks moderate, yet their day-to-day function is badly affected.

The important part, for Dr David Kitchen, is matching the scan with your lived experience.

Am I too young for a knee replacement?   

Age matters, but it is not the only thing to consider and the decision for knee replacement is absolutely individual.

If you are younger and more active, there will be a detailed discussion and careful thought encouraged about implant wear, activity goals and the possibility of revision surgery later in life. But living for years with severe pain just to “wait until you are older” is not the right answer.

Dr Kitchen will look at your knee, your imaging, your work, your activity level, your health and what you want to get back to doing. Because for one person, that might be walking without pain, and for another, it might be returning to travel, golf, cycling or active work.

Does needing an opinion mean I will be told that I have to have surgery?

No, seeing an orthopaedic surgeon does not mean you have committed to surgery.

A consultation is about understanding what is causing your symptoms, what stage the arthritis is at and what options are reasonable from here. Dr Kitchen will advise some patients to continue non-surgical treatment or offer alternatives. Only when it is suitable, he will recommend partial knee replacement, total knee replacement, robotic-assisted surgery or a patient-specific approach.

The right recommendation comes from the details of your knee, your health and your goals.

What to expect at your knee replacement consultation

At your first appointment, Dr Kitchen will:

  • Ask about your symptoms and how they affect daily life
  • Review your X-rays, imaging, reports and medical history
  • Examine your knee for movement, alignment and stability
  • Talk through all appropriate treatment options
  • If surgery is suitable, what it may involve, including risks, recovery and expectations

You will also be given some time to ask any questions you may have, so you are able to make an informed decision about your next steps.

What comes next if knee replacement is suitable?

If knee replacement is recommended, Dr David Kitchen will discuss the type of knee replacement that fits your specific joint damage and goals.

Partial knee replacement may be suitable when arthritis is limited to one area of the knee, to preserve healthy areas of the joint where possible.

Total knee replacement might be used when arthritis affects more than one part of the knee and the damaged joint surfaces need to be replaced throughout the majority of the knee.

Robotic-assisted knee replacement using Mako technology is only used in selected procedures to support detailed pre-operative planning. During surgery, the system can also provide real-time guidance and haptic boundaries, help with keep bone preparation and support more precision in implant positioning.

Patient-specific knee replacement uses 3D planning and custom guides designed around your knee anatomy, which can be helpful in more complex cases.

Your recommendation will be based on your anatomy, imaging, arthritis pattern, health and goals.

When should you ask for a referral?

If your knee pain is affecting your sleep, walking, stairs, work, exercise, travel or independence, and the usual non-surgical options are no longer giving enough relief, speak with your GP about specialist referral.

In Adelaide? Request a referral to Dr David Kitchen, Orthopaedic Specialist, with consultations available at sportsmed Stepney and Henley Beach, as well as at The Specialist Clinic in Port Pirie.

You do not need to know if you are ready for surgery before asking for an opinion. That is what a consultation is about.

References:

Arthritis-Health. (n.d.). Knock-Kneed or Bow-Legged Realignment by Osteotomy. https://www.arthritis-health.com/surgery/knee-surgery/knock-kneed-or-bow-legged-realignment-osteotomy

Harvard Medical School. (2021). Am I too young for a knee replacement? Harvard Health. https://www.health.harvard.edu/healthy-aging-and-longevity/am-i-too-young-for-a-knee-replacement

Lloyd-Jones, G. (2020). Imaging of Musculoskeletal Disorders. https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/imaging-joints-bones/osteoarthritis

Mayo Clinic. (2023). Arthritis – symptoms and causes. https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772

Medibank. (2023). The truth about knee replacement surgery. https://www.medibank.com.au/health-support/joint-health/article/the-truth-about-knee-replacement-surgery/ 

*This article is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment, and does not establish a doctor-patient relationship. All surgical procedures carry risks and results vary between individuals. Consult with Dr David Kitchen MBBS MA (Cantab) BA Hons PhD FRACS FAOrthA (MED0001951664), Orthopaedic Specialist, for a personalised treatment plan.