Choosing treatment and surgery
Will postponing surgery make my knee worse?
Consider daily limitations, structural change and the reason for waiting together.
At a glance
- Do not use age or imaging grade alone.
- Review function, strength and movement over time.
- Agree on a reason for waiting and a review plan.
It can be difficult to balance fear of operating too early with fear of waiting too long. No single age or osteoarthritis grade provides the answer. Review daily function, response to nonsurgical care and what needs preparation while waiting.
Three checks while waiting
- 01
Function
Walking, sleep, strength and deformity
- 02
Reason
Health preparation, preference and support
- 03
Plan
Pain care, activity and consultation point
Current life, reason for waiting and review plan
Progression is not identical for everyone
Structural changes and pain vary. Some people maintain daily life despite severe imaging findings; others have major walking and sleep limitations despite suitable treatment.
Rather than predicting an exact period you can endure, review recent walking, movement and pain. New swelling or rapidly reduced function may warrant earlier assessment.
Watch for shrinking daily life
Less activity because of pain can affect strength, fitness and independence. Review worsening fixed deformity or reduced movement, while recognizing these do not occur in every patient.
If sleep and daily life remain badly affected and suitable nonsurgical care is insufficient, revisit surgical consultation. Having to endure symptoms until the last possible moment is not a useful universal rule.
Distinguish useful care from unnecessary repetition
The 2023 ACR/AAHKS guideline conditionally advises against delaying surgery for more medicines, exercise or injections in patients with moderate-to-severe disease whose nonsurgical care has failed and who have chosen replacement.
Evidence is low or very low quality. This is not an instruction that everyone needs immediate surgery. Discuss whether repeating previous treatment adds value in your circumstances.
Set the reason and review point for waiting
Preparing glucose control, smoking cessation and general health differs from indefinitely repeating ineffective care. Family support and work arrangements also belong in the plan.
If you wait, agree on pain management, feasible activity and follow-up. Ask what changes should prompt reconsideration so that waiting remains planned care rather than neglect.
Can I have a joint injection before knee replacement?
If you are planning knee replacement, tell the surgical team what was injected into that knee and when. Discuss avoiding corticosteroid or hyaluronic acid joint injections during the three months before surgery. If you have already had an injection, ask your surgeon about the timing of surgery rather than cancelling it yourself.
A 2019 study of 58,337 knee replacements found higher odds of infection around the prosthesis when an injection had been given within the preceding three months. The odds ratio was 1.21 for corticosteroid and 1.55 for hyaluronic acid. This was an observational study of insurance records. These figures do not establish causation or predict an individual patient’s infection risk.
Common Questions
Does grade 4 mean immediate surgery?
Consider symptoms, quality of life, suitability and benefit of other care, and overall health.
Will waiting always reduce the eventual benefit?
No. Assess individual changes in deformity, movement and fitness.
Must I try every injection before surgery?
Every nonsurgical option need not be completed as a formality. Review appropriate prior care and response.
Evidence and references
01When to seek medical care
Each warning sign is a separate reason to seek care. Follow the action below if any one applies.
Emergency department · call 119 in Korea
- Call 119 for sudden breathlessness or chest pain, severe faintness or loss of consciousness. Do not wait for calf swelling to appear.
- Go to an emergency department if you suddenly cannot bear any weight, or if an injured knee swells rapidly or looks deformed. A cold or numb foot after injury also needs immediate assessment.
- Seek emergency care for a hot, swollen and severely painful joint with high fever, shaking chills, confusion or inability to bear weight.
- With back or leg pain, go immediately to an emergency department for new difficulty passing urine, loss of bladder or bowel control, or numbness around the genitals or anus. Severe or rapidly worsening weakness or numbness in both legs also needs immediate assessment.
Same-day assessment
- Arrange assessment today for a newly hot, swollen joint, sudden severe pain, or a knee locked so that it cannot fully straighten. Joint infection can occur without fever.
- Have new swelling or pain in one calf assessed today for a possible blood clot. Call 119 immediately if breathlessness or chest pain develops.
- Severe knee pain or a new limp in a growing adolescent may come from a hip condition such as slipped capital femoral epiphysis. Stop walking and sport and arrange assessment today. Go directly to emergency care if they cannot bear weight.
- Stop running and seek assessment today for new recurring groin pain, pain with walking or at night, or a limp. A femoral neck stress fracture needs to be considered. Keep weight off the painful leg until assessed. Go to emergency care if you cannot bear weight.
Book an outpatient appointment
- If none of the warning signs above is present, book an appointment for pain lasting a few weeks, repeated swelling or reduced daily activity and exercise.