Does knee pain definitely need surgery?

“The doctor said you have to have an operation.” Or “My knee clicks, do I definitely need surgery?” We hear these sentences often. The short answer is: not always. Knee pain has many causes, and its treatment is not only an operation.

Where does knee pain come from?

A few common causes:

• Osteoarthritis. Cartilage, the smooth layer that covers the ends of the bones, wears away over the years. The result is pain, stiffness in the morning and occasional swelling. Sources say osteoarthritis has no definite cure, but it does not necessarily get worse over time.
• A torn meniscus. The meniscus is a cartilage pad that absorbs shock between the thigh bone and the shin bone. A tear may cause pain, locking and swelling.
• Ligament injury. After a twist or blow, the knee becomes loose or unstable.
• Kneecap and muscle problems. Sometimes muscle weakness or wrong loading causes pain at the front of the knee.

The doctor finds the cause of the pain by examination and sometimes imaging. Without a diagnosis, no one can give an opinion about surgery.

What can be done before surgery?

For many patients, especially with osteoarthritis, treatment starts with non-surgical options. Sources list these:

• Exercise. It is one of the most important treatments for osteoarthritis. Walking, swimming, cycling and strengthening the thigh muscles. The wrong kind of exercise, or too much, can irritate the joint, so it is best for a physiotherapist to write the programme.
• Losing weight. If weight is high, losing it takes load off the knee.
• Walking aids. A stick, insoles and suitable shoes, sometimes a knee brace.
• Medicine. To control pain, on your doctor’s advice. The doctor decides the type and dose.
• Injections into the joint. Some injections reduce pain for weeks to months. This is usually considered when the others have not been enough.
• Heat and cold for temporary relief.

Surgery is also not only joint replacement. Depending on the problem, the doctor may raise smaller operations such as arthroscopy (working with a camera inside the joint) or realigning the bone. These are not suitable for everyone, and the decision is the doctor’s.

When does a doctor think about surgery?

Usually when several things come together:

• Severe pain or stiffness that has taken over walking, stairs, getting up from a chair or sleep
• Pain at rest or at night
• Constant swelling that does not settle with rest and treatment
• The knee bending out of line
• Non-surgical treatments that have not worked

Sources stress that there is no set age or weight for surgery, and that the decision is based on pain and how much it limits you. If the meniscus is torn or a ligament is damaged, the criteria differ: for example, a locking or unstable knee points more towards surgery.

Questions to ask your doctor

• What exactly is my problem?
• What happens if I do not have surgery? Is the joint at risk, or is it only pain and limitation?
• How long will non-surgical treatments take before I see a result?
• If I have surgery, what should I expect from the result and what are the risks?
• How long will my recovery take and what help will I need at home?

Summary

Knee pain alone is not a reason for surgery. First find out the cause of the pain, try non-surgical treatments seriously with your doctor and physiotherapist, and if they are not enough, talk about surgery. Whether you need an operation can only be known after examination. Ask your doctor about your own situation.