Surgery for knee pain

Is surgery right for knee pain?

Surgery is not the first step for most people with knee pain. Many improve with education, exercise, weight management, and changes in daily or sports activities, especially when osteoarthritis, patellofemoral pain, or degenerative meniscal tears are involved. ^{1 2 3 5 6 7}

Doctors usually think about surgery when:

• You have ongoing pain and stiffness that makes walking, stairs, or sleep difficult, even after a strong course of physical therapy, exercise, and medications where appropriate. ^{1 2}
• Your knee feels unstable, gives way, or cannot support twisting and pivoting, and this has not improved with a structured rehab program after a ligament injury. ⁴
• You have a true locked knee that cannot straighten fully because of a displaced meniscal tear or loose body. ^{5 7}
• You have end stage osteoarthritis that has not responded to non surgical care and strongly limits your work, daily life, or independence. ^{1 2}

The decision to have surgery is always individual. It depends on your goals, age, overall health, type of knee problem, and how well non surgical options have worked. Shared decision making with your surgeon and care team helps you weigh likely benefits, risks, and alternatives so you can choose what feels right for you. ^{1 2 4}

Common surgical options for knee pain

Not everyone with knee pain needs surgery. When surgery is considered, it is usually matched to a specific problem in the joint.

• Arthroscopic meniscal surgery: Through small keyhole cuts, the surgeon can trim or repair certain meniscal tears. Today, this is mainly used for knees with true mechanical locking or persistent catching after a full course of high quality rehabilitation, rather than for routine wear and tear changes. For some irreparable injuries, the surgeon can use cadaveris or sintetic graft to replace your own meniscus ^{5 6 7 13}
• Ligament reconstruction or repair: For people with significant instability after ligament injuries, the surgeon may reconstruct the ligament using a tendon graft, or repair it in some cases. This aims to restore stability for daily life or high demand sports, but still requires long, structured rehab.⁴
• Realignment or joint preserving procedures: In some younger or middle aged adults with one sided arthritis and malalignment, surgeons may perform an osteotomy. This means cutting and reshaping the bone to shift load away from the damaged area and protect the joint for longer. ^{1 2}
• Partial or total knee replacement (arthroplasty): In advanced osteoarthritis, worn joint surfaces can be removed and replaced with metal and plastic implants. A partial replacement targets only one side of the knee, while a total replacement resurfaces the whole joint. These surgeries aim to reduce pain and improve function when other treatments have not helped enough.^{1 2}

Your surgeon will consider your age, activity level, knee structure, and goals when discussing which, if any, of these procedures fits your situation.

What to expect during recovery

Recovery after knee surgery is a process that takes time and active work. The exact plan depends on the type of surgery, your health, and how strong and mobile your knee was before the operation. ^{1 2 4 5 6 7}

Right after surgery (days to early weeks)

• Your knee may be bandaged or in a brace. You will be given instructions about how much weight you can put on the leg and how to use crutches or a walker if needed. ^{1 2 4}
• Swelling, pain, and stiffness are common. Pain medicines, ice, elevation, and early gentle movement are often used to help control symptoms.
• The team will watch for signs of infection or blood clots, such as fever, increasing redness, or sudden calf pain and swelling, which need urgent review. ^{1 2 11}

Early rehab phase (several weeks)

• Physical therapy often focuses on regaining knee bend and straightening, reducing swelling, and waking up the quadriceps and hip muscles. ^{1 2 4}
• You gradually increase walking and daily activities within your surgeon’s guidelines. Some people use a stationary bike or pool exercises when allowed.

Rebuilding strength and function (months)

• Rehab progresses to stronger exercises for the quadriceps, hamstrings, hips, and core, along with balance and movement training. This is important after meniscal surgery, ligament reconstruction, or knee replacement. ^{2 4 5 6}
• If you are returning to sport, you will likely follow a structured program with hopping, cutting, and agility drills when the knee and graft are ready. This return is usually based on strength, balance, and movement tests, not just time on the calendar. ⁴

Long term recovery

• Many people feel big improvements in pain and function compared with before surgery, but it can take many months for the knee to feel more natural and for swelling to fully settle. ^{1 2 5 6 7}
• Some people continue to notice stiffness, noise, or mild aching, especially with weather changes or long days, even after a successful surgery.

Possible risks and complications

All surgeries carry risk. For knee surgery, these can include:

• Infection or bleeding in the joint or wound
• Blood clots in the leg or lungs
• Ongoing stiffness or pain
• Limited benefit compared with expectations
• Graft failure, re tear, or need for revision surgery after ligament procedures
• Wear or loosening of knee replacement implants over time, sometimes needing another operation ^{1 2 4 5 7 11}

Good preparation, clear expectations, and an active role in rehab can help you navigate these risks and make the most of your surgery if you choose to have it.

Can surgery be avoided?

Often, yes. For many people, knee pain improves with a thoughtful non surgical plan that targets strength, movement, weight, and daily habits.

Key options include:

1. Exercise based rehabilitation For osteoarthritis, land based exercise that builds strength, fitness, and balance is a core treatment and can reduce pain and improve function. ^{1 2} In degenerative meniscal tears, multiple large trials show that a structured twelve week physical therapy program can work as well as arthroscopic partial meniscectomy over several years for most adults. ^{5 6 7}
2. Weight management and lifestyle changes For people with higher body mass index, even modest weight loss can ease knee load and improve symptoms. Staying active in joint friendly ways, such as walking, cycling, or water exercise, also supports joint and heart health. ^{1 2 15}
3. Activity and training adjustments Changing how much you squat, kneel, run, or use stairs at first, then building back up gradually, can calm pain while you work on strength and movement control, especially for patellofemoral pain or tendon problems.^{3 12 15}
4. Supports and medications when needed Taping, braces, and short courses of medicines like topical or oral non steroidal anti inflammatory drugs (when safe for you) can help manage flares while you stay engaged in rehab. ^{1 2 3 12}

There is also growing evidence that digital physical therapy programs can offer similar improvements to in person care for other chronic joint and spine problems, such as shoulder and low back pain, with high adherence and satisfaction. ^{16 17} This suggests that, when designed well, remote programs can deliver guideline based knee rehabilitation in a way that fits more easily into daily life.

If you are unsure whether you can avoid surgery, a good first step is a guided, consistent trial of exercise based care. After that, you and your clinician can revisit the question of surgery with clearer information about how your knee responds.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

The recommended starting point for most adults with long lasting knee pain is a plan that combines education, progressive strengthening, weight management when needed, and behavior support, with surgery reserved for specific situations after this plan has been tried. ^{1 2}