Introduction

Knee osteoarthritis is one of the main causes of pain and disability, especially as we get older. It can make everyday activities like walking, climbing stairs, or even standing for a while very challenging. While many people get relief through treatments like physiotherapy or medication, surgery often becomes an option when those don’t work anymore.

This guide aims to give you a clear and up-to-date overview of knee surgery for osteoarthritis in 2024. We’ll explore the types of surgery available, what benefits and risks you should be aware of, and look at other treatment options so you can make informed decisions with your healthcare team.

Understanding Osteoarthritis and When Surgery is Considered

Osteoarthritis of the knee happens when the smooth cartilage that cushions the joint gradually wears away. This causes the bones to rub directly against each other, leading to pain, stiffness and difficulty moving the knee. In the most severe cases, known as stage 4 osteoarthritis, there may be significant joint damage and deformity.

In fact, osteoarthritis is quite common among athletes too. One study looking at professional footballers found that knee osteoarthritis affected 13% of current players and 28% of retired players, with the risk increasing as they got older (Gouttebarge et al., 2018). This highlights how injuries and wear over time can impact knee health.

Surgery is generally considered when everyday treatments, including lifestyle changes, physiotherapy and painkillers, are no longer effective. Doctors will assess your pain levels, how much your knee is damaged using scans, and whether your symptoms are limiting your quality of life. Your overall health and age are also important factors in deciding if surgery is the right step.

Types of Knee Surgery You Should Know About

When it comes to surgery for knee osteoarthritis, there are several types to consider:

• Total Knee Replacement (TKR): This is the most common surgery for advanced osteoarthritis. The surgeon removes damaged bone and cartilage and replaces them with artificial parts made from metal and plastic. The goal is to reduce pain and help you move more easily. In the UK, newer techniques like minimally invasive surgery and computer-assisted surgery help improve accuracy and speed up recovery.
• Partial Knee Replacement (PKR): This is suitable if only one part of your knee is affected. It involves replacing just that damaged section, which means less surgery overall and often a quicker recovery.
• Newer Approaches: In 2024, robotic-assisted surgeries and improved implant materials are becoming more widely used. These innovations aim to make surgeries more precise and the implants longer lasting.

It’s also important to be aware of recent evidence questioning the value of some procedures. For example, a key review found that “arthroscopic surgery provides little or no clinically important benefit in pain or function” for degenerative knee problems (O’Connor et al., 2022). Always discuss all options carefully with your surgeon.

Risks, Complications, and Common Pitfalls After Surgery

Like any surgery, knee replacement comes with risks. These can include ongoing pain, infection, blood clots, or problems with the implant over time. While serious complications and death are rare, they are more likely in older or less healthy patients.

It’s also worth noting that repeated knee injuries and surgeries increase the chance of developing osteoarthritis. Research shows that “current and retired professional footballers were nearly twice as likely to suffer from knee OA by every additional severe knee injury and knee surgery” (Gouttebarge et al., 2018). This underscores the importance of carefully weighing surgical benefits against risks.

After surgery, there are common mistakes that can slow down recovery or cause problems:

• Skipping or not fully engaging in physiotherapy exercises
• Pushing too hard too soon with walking or activities
• Not managing pain adequately, which can limit movement
• Neglecting wound care, increasing infection risk
• Not taking prescribed medications correctly

Following your healthcare team's advice closely can help you avoid these pitfalls and improve your recovery.

What to Expect: Success Rates and Recovery

In the UK, knee replacement surgery works well for most people. About 90-95% of patients report less pain and better movement within the first year. Recovery usually takes 3 to 6 months, starting with a short hospital stay and continuing with physiotherapy at home or outpatient clinics.

Age alone doesn’t rule out surgery, but older patients may take longer to recover and might face more complications. If you have a history of knee injuries or surgeries, this can affect your long-term knee function. For instance, professional footballers with knee osteoarthritis reported “lower physical knee function than those without OA, and also lower than healthy adults or amateur players” (Gouttebarge et al., 2018).

While surgery often improves quality of life significantly, costs—especially if privately funded—can influence decisions.

It is also important to remember that some surgeries, like arthroscopic procedures, may not improve outcomes markedly over placebo, with “little or no difference in participant-reported success at up to five years” (O’Connor et al, 2022).

Alternatives and Future Treatments You Should Know

If you prefer to avoid surgery or aren’t a good candidate, there are other options to help manage knee osteoarthritis:

• Medications like painkillers and anti-inflammatory drugs
• Tailored exercise and weight management plans
• Injections such as corticosteroids or hyaluronic acid for temporary relief
• Emerging biologic treatments, including platelet-rich plasma (PRP) injections

According to a recent European expert consensus, “there is enough preclinical and clinical evidence to support the use of PRP in knee OA,” especially for mild to moderate cases. PRP is now considered “a valid and possible first-line injectable treatment option for non-operative management of knee OA” (Laver et al., 2024).

Supportive knee braces or orthotics can also help improve stability and reduce pain.

Importantly, guidelines continue to advise against arthroscopic surgery in most degenerative knee cases due to lack of proven benefit (O’Connor et al., 2022).

Conclusion

Knee osteoarthritis can be challenging, but understanding your treatment options is the key to managing it well. Whether you’re considering surgery, exploring alternatives, or simply wanting to know what lies ahead, working closely with your healthcare team will help you find the best plan for you.

With the right information and support in 2024, you can take confident steps towards relieving pain, improving mobility, and enjoying a better quality of life.

References

• O’Connor, D. A., Johnston, R. V., Brignardello-Petersen, R., Poolman, R., Cyril, S., Vandvik, P., & Buchbinder, R. (2022). Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database of Systematic Reviews, 2022. https://doi.org/10.1002/14651858.CD014328
• Laver, L., Filardo, G., Sánchez, M., Magalon, J., Tischer, T., Abat, F., Bastos, R., Cugat, R., Iosifidis, M., Kocaoğlu, B., Kon, E., Marinescu, R., Ostojić, M., Beaufils, P., & de Girolamo, L. (2024). The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma). Knee Surgery & Related Research, 32. https://doi.org/10.1002/ksa.12077
• Gouttebarge, V., Aoki, H., & Kerkhoffs, G. (2018). Knee osteoarthritis in professional football is related to severe knee injury and knee surgery. Journal of Experimental Orthopaedics, 5(1), 7. https://doi.org/10.1186/s40621-018-0157-8