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If your knee becomes suddenly hot, swollen and intensely painful with fever, seek medical care the same day. This may indicate infection in the joint, which needs urgent treatment. Also seek urgent care if the knee locks completely or gives way with severe pain after an injury.

Home  /  Treatments  /  Joint replacement  /  Knee osteoarthritis

Knee osteoarthritis: when replacement is the right answer

The cartilage lining the knee wears away until bone rubs on bone. It is the commonest reason for joint replacement worldwide, and also the condition where surgery is most often performed earlier than it needed to be.

A knee replacement is an excellent operation for the right patient at the right time. This page is about establishing whether you are that patient, because the alternatives are better than most people are told.

Clinically reviewed by Dr. Annie Varughese, Consultant Orthopaedic Surgeon Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Grading
Kellgren-Lawrence 1–4
Grade 4 is bone on bone
Try first
Weight, exercise, injections
Many patients defer surgery for years
Best predictor of a good result
Severe X-ray change
Replacing a mildly arthritic knee disappoints
Time in India
3 to 4 weeks
Including supervised physiotherapy
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What knee osteoarthritis is

Cartilage is the smooth, slippery surface covering the ends of the bones. In osteoarthritis it thins and roughens until, in advanced disease, it disappears entirely and the exposed bone surfaces grind against one another. The bone reacts by thickening and forming spurs at the edges, and the joint lining becomes inflamed and produces fluid.

It is not simply wear from use. Weight is the strongest modifiable factor — every extra kilogram is multiplied several times across the knee with each step. Previous injury, particularly a meniscal tear or ligament rupture, accelerates it. So does malalignment, where bow legs or knock knees concentrate load onto one side of the joint.

X-rays are graded from one to four on the Kellgren-Lawrence scale. Grade one shows minimal change; grade four shows bone on bone with no joint space remaining. This grade matters enormously, because the single strongest predictor of satisfaction after a knee replacement is that the X-ray showed severe arthritis beforehand.

The uncomfortable corollary is that replacing a knee with only moderate X-ray change frequently disappoints. The pain may not have been coming from the arthritis, and a new knee cannot fix pain it did not cause.

Symptoms

Symptoms and warning signs

Common symptoms
  • Pain on walking, climbing stairs and rising from a chair
  • Stiffness after sitting or on waking, easing within half an hour
  • Swelling after activity
  • Grinding or crunching sensation on movement
  • Reduced walking distance, gradually shortening over years
  • Bow-legged or knock-kneed deformity developing
  • Pain at night, in advanced disease, disturbing sleep
Warning signs of an emergency
  • Sudden hot, swollen, intensely painful knee with fever
  • Inability to bear any weight after an injury
  • The knee locking so it cannot be straightened
  • Sudden severe calf pain and swelling
  • Rapid deformity with severe pain over weeks
  • Unexplained weight loss with bone pain

Night pain is the symptom that changes the argument

Pain on walking can be managed in many ways. Pain that wakes you at night, or that is present at rest, generally indicates advanced disease and is the point at which replacement becomes clearly justified. If your pain is limited to activity and your X-ray shows moderate change, there is usually a great deal worth trying first — and this page sets it out.

Diagnosis

How it is diagnosed

One imaging test does nearly all the work, and it must be done standing.

Initial tests

  • Standing X-ray of both knees — weight-bearing films show the true joint space; lying-down X-rays understate arthritis considerably
  • Skyline or patellar view — assesses the joint behind the kneecap, a common source of pain
  • Long-leg alignment film — where deformity is present, this guides surgical correction
  • Blood tests — to exclude inflammatory arthritis or infection where the picture is atypical

The deciding tests

  • MRI — rarely needed in established osteoarthritis, but useful where a mechanical symptom such as locking suggests a meniscal problem
  • Assessment of walking distance and night pain — a more useful measure of severity than any scan
  • HbA1c and BMI — both directly affect surgical risk and are worth optimising before travel

Send standing X-rays, not lying-down ones

An X-ray taken lying down can show a joint space that looks reasonable in a knee that is bone on bone when you stand on it. This single technical detail changes the grade and therefore the recommendation. If your X-rays were taken lying down, ask for repeat weight-bearing films — it is a five-minute test and it may change the entire advice you receive.

Options

Treatment options

There is a great deal worth trying before replacement, and for many patients it defers surgery by years.

Option one

Weight loss and exercise

The most effective non-surgical treatment, and the least popular. Load through the knee is several times body weight when walking, so even modest weight loss produces disproportionate relief. Strengthening the quadriceps reduces pain independently of weight. Together they outperform most injections in published trials, and they also improve your surgical outcome if replacement is eventually needed.

Usually appropriate whenAlways worth trying, at any stage, and particularly where BMI is raised.
Option two

Medication and injections

Simple analgesics, anti-inflammatory tablets or gels, and where those are insufficient, a steroid injection into the joint. Steroid gives relief for weeks to a few months and can be repeated within limits. Hyaluronic acid injections help some patients, though the evidence is mixed and they are frequently sold at prices that exceed their demonstrated benefit.

Usually appropriate whenModerate arthritis with activity-related pain, or as a means of managing symptoms while other measures take effect.
Option three

Partial knee replacement

Where arthritis is confined to one compartment of the knee — most commonly the inner side — only that compartment is resurfaced. It preserves the ligaments, feels more like a natural knee, recovery is faster and the hospital stay shorter. It is not suitable if arthritis is widespread, and revision rates are somewhat higher than for total replacement.

Usually appropriate whenArthritis confined to one compartment, intact ligaments, and deformity that corrects passively.
Option four

Total knee replacement

All three compartments are resurfaced with metal and polyethylene. It is highly reliable for pain relief in advanced arthritis, and modern implants commonly last fifteen to twenty years or more. The result depends heavily on achieving good range of movement in the first six weeks, which is why the physiotherapy period matters as much as the surgery.

Usually appropriate whenAdvanced arthritis on standing X-ray, with night pain or substantially restricted walking, after non-surgical measures have been tried.
The decision

How the choice is made

X-ray grade against symptoms

Severe X-ray change with severe symptoms is the clearest indication. Mild X-ray change with severe symptoms warrants looking for another cause before operating.

Whether one compartment or all three

This determines whether a partial replacement is possible, which is a meaningfully different operation with a faster recovery.

Your weight, diabetes control and general fitness

These affect infection risk, wound healing and the durability of the result. Optimising them before travel is part of the treatment.

If your X-ray shows moderate change and you have not tried weight loss, exercise and injections, we will suggest that first. It is honest advice and it means no case for us.

Urgency

How urgent is your case

Usually safe to plan travel
  • Stable arthritis with gradually worsening pain
  • X-rays and assessment complete
  • No active infection anywhere
  • Diabetes and weight optimised
Needs local assessment before travel
  • Hot, swollen knee with fever
  • Active infection anywhere, including dental
  • HbA1c poorly controlled
  • Recent deep vein thrombosis
  • Unexplained rapid joint destruction

We will tell you which column you are in

Osteoarthritis is not an emergency and time spent preparing properly improves the result. A hot swollen joint with fever is different and needs seeing locally today.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Standing X-rays of both knees
  • Skyline or patellar view if available
  • Your walking distance, and whether pain wakes you at night
  • A list of treatments already tried

Also helpful

  • Long-leg alignment film if taken
  • HbA1c and recent blood tests
  • Your height and weight
  • Details of any previous knee surgery or injury
Send my reports for review See published cost ranges
Questions

Questions patients ask

The strongest indications are severe change on a standing X-ray combined with pain at night or at rest, and a walking distance that has fallen to the point where it limits your life. If your X-ray shows only moderate change and your pain is activity-related, there is usually a great deal worth trying first — and replacing a knee too early tends to disappoint.

Often yes, and for a fit patient with severe arthritis in both it means one trip and usually costs less than two. It demands more of your heart and lungs and the first fortnight of rehabilitation is harder. Your general fitness rather than your knees decides this, which is why we assess it carefully.

Where arthritis affects only one compartment, usually the inner side, only that part is resurfaced. It preserves your ligaments, tends to feel more natural, and recovery is faster. It requires the other compartments to be reasonably preserved and the ligaments intact. Ask whether you are a candidate — many patients are never told the option exists.

Commonly fifteen to twenty years or more, depending on your age, weight and activity level. A patient of seventy-five is unlikely ever to need a revision. A patient of fifty-five may well, which is a reason to try non-surgical measures thoroughly first and to think carefully about implant choice.

Kneeling is uncomfortable for many people after a knee replacement, and full squatting is often not achievable. This matters a great deal if you pray in a kneeling position or sit cross-legged habitually, and it should be discussed before surgery rather than discovered afterwards. Tell us if this is important to you — it affects both the implant choice and the rehabilitation plan.

Repeated steroid injections at short intervals are best avoided, and most surgeons limit them to a few per year. An injection within roughly three months before a replacement raises the infection risk, so tell us the date of your last one. Used sensibly, injections are a reasonable way to manage symptoms while you work on weight and strength.

RelatedOn this site
Joint replacement in IndiaRead → Joint replacement costRead → Hip osteoarthritisRead → Failed joint replacementRead → Rheumatoid arthritisRead →
Contact

Send us your reports

Send standing X-rays of both knees, tell us how far you can walk and whether pain wakes you at night. Those three things decide the recommendation.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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