When is it time for a hip or knee replacement?

Signs it may be time to talk about surgery

• Pain that limits how far you can walk, or stops you doing things you enjoy
• Pain that wakes you at night or stops you getting to sleep
• Difficulty with stairs, getting out of a chair or a car, or putting on shoes and socks
• Pain that affects your work, or your ability to care for others
• Exercise, weight loss and painkillers no longer helping enough
• Relying on painkillers more than you would like

Try these first

For most people, the first treatments are exercise and physiotherapy, losing weight if you are overweight, and painkillers or anti-inflammatory gels. A steroid injection can give short-term relief for some people. These help many people, and they also make recovery easier if you do have surgery later. See hip arthritis and knee arthritis.

You do not have to wait until the pain is unbearable

National guidance (NICE) says that people should be referred for a joint replacement assessment when their symptoms have a substantial effect on their quality of life and non-surgical treatments have not helped. It also says that age, weight, smoking or other health conditions should not on their own stop someone being referred. They do affect the balance of benefits and risks, which we will discuss together.

Is there a risk in waiting?

For most people, waiting does not make the operation less successful, and it is reasonable to wait until you feel ready. However, very severe stiffness, deformity or muscle weakness can make recovery slower, so it is worth being assessed if your joint is getting steadily worse.

How we decide together

At your consultation, I will examine your joint, review X-rays and ask how arthritis affects your daily life. I will explain the likely benefits and risks of surgery for you. Most people have much less pain after a joint replacement, but some still have pain or are not fully satisfied, and I will help you weigh this up. If surgery is not the right step yet, I will tell you. There is no pressure to decide on the day. See my hip and knee clinic.

Written and reviewed by Mr Krishna Boddu FRCS (Tr & Orth), consultant orthopaedic surgeon, GMC 5206961. Last reviewed: 3 November 2026.

Sources

• NICE guideline NG226: Osteoarthritis in over 16s: diagnosis and management (2022)
• NICE guideline NG157: Joint replacement (primary): hip, knee and shoulder (2020)
• Beswick AD et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review. BMJ Open 2012;2:e000435.