What questions should I ask before joint replacement? Start here

The exam should name the cause of your soreness

Ask which part of the joint seems to hurt and what else may cause it. Find out whether the X-ray agrees with the exam and your daily limits. An old injury may still matter, so you can ask about that too. The answer shouldn’t hide behind medical words.

You may also ask what could change the advice. Perhaps another exam finding would point away from surgery. Perhaps earlier care needs more time, and a clear answer helps you judge the next step.

A QC Kinetix visit includes an exam and questions

At QC Kinetix, licensed clinic staff work as medical providers who examine your joint and carry out care. The clinic offers regenerative treatments, meaning blood or tissue from your body is prepared and used at the sore joint. You may ask how the treatment is done and what follow-up involves. They’ll also explain whether it may suit you.

Ask about the full cost and the relief you might reasonably notice. Find out how soon you could tell whether treatment helped. You can also ask what happens if it doesn’t, because there’s no need to choose at that visit.

A surgery visit should cover relief, risk, and recovery

Ask how much aching might remain and when normal tasks may be possible. You’ll want infection, blood clots, stiffness, and another operation explained plainly. Ask what help you may need at home during recovery, because your own health may change those answers.

Waiting also deserves a direct answer. Ask whether delay could make walking harder or recovery longer. If waiting is safe, find out when the joint should be checked again. You can bring the answers home.

Sources

1. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.

2. A systematic review of prospective studies in unselected osteoarthritis patients found that the proportion reporting an unfavourable long-term pain outcome ranged from about 7% to 23% after hip replacement and 10% to 34% after knee replacement; in the best-quality studies, 9% or more after hip and about 20% after knee replacement.

   Beswick AD, Wylde V, Gooberman-Hill R, et al. — What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients.. BMJ Open, 2012. DOI: 10.1136/bmjopen-2011-000435.

3. In 63,158 hip and 54,276 knee replacement patients in the Clinical Practice Research Datalink, the lifetime risk of requiring revision surgery was about 5% for patients operated on after age 70 with no sex difference, but rose to 35% (95% CI 30.9-39.1) for men having surgery in their early 50s, with women's risk about 15% lower at the same age. Median time to revision for patients operated on younger than 60 was 4.4 years. The authors state their evidence challenges the trend toward more replacements in younger patients.

   Bayliss LE, Culliford D, Monk AP, et al. — The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.. The Lancet, 2017. DOI: 10.1016/S0140-6736(17)30059-4.

4. The 2023 ACR/AAHKS timing guideline conditionally recommends AGAINST delaying hip or knee arthroplasty to pursue additional non-operative treatment - physical therapy, NSAIDs, ambulatory aids or intra-articular injections - in patients with moderate-to-severe osteoarthritis for whom non-operative therapy has already been ineffective and who have chosen surgery. It conditionally recommends delay for nicotine cessation and for better glycemic control in diabetes, states that obesity by itself is not a reason for delay while weight loss should be strongly encouraged, and conditionally recommends against delay in patients with severe deformity or bone loss. Evidence for all recommendations was graded low or very low quality.

   Hannon CP, Goodman SM, Austin MS, et al. — 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.. Arthritis & Rheumatology, 2023. DOI: 10.1002/art.42630.

5. At 2 years across two parallel randomised trials (200 patients, mean age 66), total knee replacement plus non-surgical treatment beat non-surgical treatment alone by 18.3 KOOS points (95% CI 11.3 to 25.3), and non-surgical treatment in turn beat written advice by 7.0 points (95% CI 0.4 to 13.5). Among patients eligible for replacement, 16 of 50 (32%) in the non-surgical group had surgery within 2 years - meaning two out of three delayed it for at least two years.

   Skou ST, Roos EM, Laursen MB, et al. — Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.. Osteoarthritis and Cartilage, 2018. DOI: 10.1016/j.joca.2018.04.014.

6. A meta-analysis of seven studies (419 patients) of preoperative high-intensity strength training before total knee arthroplasty found statistically significant post-operative improvements versus control in the 6-minute walk test (pooled SMD 0.73, 95% CI 0.04 to 1.41), range-of-motion flexion (0.40, 95% CI 0.08 to 0.72), SF-36 (1.54, 95% CI 0.32 to 2.75) and WOMAC (-0.78, 95% CI -1.22 to -0.34).

   Huang ST, Yang SW. — Preoperative High-Intensity Strength Training and Outcomes After Total Knee Arthroplasty: A Systematic Review and Meta-analysis.. Sports Health, 2026. DOI: 10.1177/19417381251388638.