Knee Replacement in the UK: The Complete Patient Guide 2026

Knee Replacement in the UK: Complete Patient Guide

Knee replacement surgery is an operation that replaces damaged parts of the knee joint with artificial components, usually made from metal and plastic. It is most commonly considered when conditions such as osteoarthritis cause persistent pain, stiffness and loss of function, particularly when non-surgical treatments have not provided enough relief and everyday life is being affected.

This guide explains knee replacement in the UK from a patient’s perspective, including both NHS and private treatment pathways. It covers the different types of knee replacement, what happens before and during surgery, the potential risks and complications, recovery, costs and the factors to consider when choosing a knee replacement surgeon and hospital.

Active Again is an independent patient-information resource focused on helping people understand their orthopaedic treatment options. Our aim is to explain the medical information clearly, so you can have more informed conversations with your own healthcare professionals and make decisions that are appropriate for your circumstances.

Whether you are just starting to consider knee replacement or have already been referred for surgery, this guide provides an overview of what the procedure involves, what you can expect and the questions you may want to ask before making a decision.

A knee replacement is a major operation, but it is also a well-established treatment for severe knee pain and loss of function. The decision to have surgery should be made with your healthcare team after considering your symptoms, examination, investigations, treatment options and individual circumstances. The choice between a total or partial replacement, and between NHS and private treatment, depends on factors that are specific to you.

Knee Replacement at a Glance

Question	Quick answer
What is a knee replacement?	Surgery to replace damaged or worn surfaces of the knee joint with artificial components, with the aim of reducing pain and improving function and mobility.
Why is it performed?	Most commonly for severe knee arthritis, particularly osteoarthritis, when pain, stiffness and loss of function significantly affect quality of life and non-surgical treatments have not provided enough benefit.
What are the main types?	The two main types are total knee replacement, which replaces the main damaged joint surfaces, and partial knee replacement, which replaces only the affected compartment in carefully selected patients.
What is robotic-assisted knee replacement?	Robotic assistance is a technology used to help plan and/or perform aspects of knee replacement surgery. It is not a separate type of knee replacement.
How long does the operation take?	The operation itself commonly takes around one to two hours, although the total time spent preparing for and recovering from surgery will be longer.
How long will I stay in hospital?	Hospital stay varies according to your health, recovery, mobility and the hospital’s pathway. Some patients can go home relatively soon after surgery, while others require a longer stay.
How long does recovery take?	Recovery is gradual. Walking and rehabilitation normally begin soon after surgery, with strength, movement and confidence improving progressively over the following weeks and months.
How long does a knee replacement last?	There is no guaranteed lifespan. Implant longevity varies between patients and can be affected by factors including age, activity, weight, implant design, surgical factors, wear and loosening.
What are the main risks?	Potential complications include infection, blood clots, bleeding, stiffness, persistent pain, instability, nerve or blood-vessel injury, fracture, implant wear or loosening and the possible need for further surgery.
Can I have a knee replacement on the NHS?	Yes. Knee replacement is available through the NHS when it is clinically appropriate. The pathway and waiting time vary according to individual circumstances and local services.
Can I have a private knee replacement?	Yes. Private treatment may be available through private medical insurance or as self-pay treatment. Private care may provide greater choice over the consultant or hospital, but this varies and comes with different costs and arrangements.
How much does a private knee replacement cost?	Private prices vary according to the surgeon, hospital, implant, anaesthetic, investigations, hospital stay, rehabilitation and what is included in the package. See our dedicated Knee Replacement Cost UK guide for detailed pricing information.
How do I choose a surgeon?	Look beyond simple “best surgeon” rankings. Consider relevant specialist experience, the type and volume of knee replacement surgery performed, hospital facilities, rehabilitation, follow-up, complication management and the transparency of costs.

Knee replacement is a major operation, and the right treatment depends on your individual symptoms, diagnosis, general health and circumstances. If you are considering surgery, discuss the potential benefits, risks and alternatives with an appropriately qualified clinician and make sure you understand the treatment pathway being offered.

On this page

• What is a knee replacement?
• When is knee replacement needed?
• Types of knee replacement
• What happens before surgery?
• What happens during surgery?
• NHS or private knee replacement?
• Knee replacement cost
• Risks and complications
• How long does a knee replacement last?
• Knee replacement recovery
• Choosing a surgeon and hospital
• Questions to ask your surgeon
• Alternatives to knee replacement
• Frequently asked questions

What Is a Knee Replacement?

A knee replacement is an operation to replace the damaged surfaces of the knee joint with artificial components. It is usually considered when the joint has become sufficiently damaged to cause significant pain, stiffness and difficulty with everyday activities. The aim of knee replacement surgery is to reduce pain, improve function and make movement easier.

Despite the name, a knee replacement does not usually mean replacing the entire knee joint. The knee is a complex joint made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia) and the kneecap (patella), together with cartilage, ligaments, tendons and other soft tissues that help the joint move and remain stable.

What is replaced?

In a total knee replacement, the damaged surfaces of the femur and tibia are carefully removed and replaced with artificial components. The underside of the kneecap may also be resurfaced, depending on the individual operation and the surgeon’s assessment.

The surgeon does not normally remove the whole bones of the knee, and the major muscles and tendons around the joint remain in place. Some of the knee’s ligaments may also be retained, depending on the type of knee implant and surgical technique being used.

This is why the term “knee replacement” can sometimes be misleading. More accurately, the operation replaces the worn or damaged joint surfaces, rather than replacing every part of the knee.

How does an artificial knee work?

A knee implant is designed to recreate the smooth, controlled movement of the natural joint.

A typical total knee replacement has several components:

• Femoral component – a metal component shaped to fit over the prepared end of the thigh bone.
• Tibial component – a metal base fixed to the prepared top of the shin bone.
• Polyethylene bearing – a tough plastic insert that sits between the femoral and tibial components. It provides a smooth surface for the artificial joint to move against.
• Patellar component – a plastic component that may be used to resurface the underside of the kneecap.

Together, these components form an artificial knee that allows the femur and tibia to move against each other without the severely damaged natural joint surfaces rubbing together.

What happens to the damaged cartilage?

Healthy knee cartilage provides a smooth, low-friction surface between the bones. Conditions such as osteoarthritis can progressively damage this cartilage, causing the joint surfaces to become irregular and painful.

During knee replacement surgery, the surgeon removes the damaged areas of bone and cartilage from the joint surfaces and prepares the remaining bone to receive the implant components. The artificial bearing then provides the new smooth contact surface.

The surrounding soft tissues remain important. Muscles, tendons and ligaments contribute to the stability and movement of the knee after surgery, and rehabilitation helps the patient regain strength and function.

Is every knee replacement the same?

No. The exact operation depends on the condition of the knee and the individual patient’s anatomy.

A total knee replacement replaces the main damaged joint surfaces. A partial knee replacement, by contrast, replaces only the damaged compartment of the knee while preserving more of the patient’s natural joint.

The choice of knee implant and surgical technique is therefore not simply a matter of choosing one standard artificial knee. Your surgeon will consider the pattern and severity of joint damage, your anatomy, ligament function, symptoms and other individual factors when deciding which procedure is appropriate.

A knee replacement is therefore best understood as resurfacing the damaged parts of the knee with an artificial joint system, rather than replacing the whole knee. The goal is to create a stable, functional joint that reduces pain and allows you to return to useful everyday movement.

When Is a Knee Replacement Needed?

A knee replacement is generally considered when damage to the knee is causing significant, persistent symptoms that are affecting your quality of life and other treatments have not provided enough relief. The decision is not based on an X-ray, your age or a single symptom alone. An orthopaedic surgeon will consider the overall picture, including your pain, mobility, function, examination findings, imaging and how your knee problem affects your everyday life.

Osteoarthritis and other causes of knee damage

The most common reason for knee replacement is osteoarthritis. This occurs when the tissues within the knee gradually become damaged, including loss or deterioration of the cartilage that normally allows the joint surfaces to move smoothly.

Knee replacement may also be considered in people with inflammatory arthritis, such as rheumatoid arthritis, when the disease has caused substantial damage to the joint. Other conditions or previous injuries can also lead to severe knee damage and, in some circumstances, may eventually result in the need for joint replacement.

The underlying diagnosis is important, but it is only part of the decision. Two people with apparently similar changes on an X-ray can have very different levels of pain and disability.

Pain and loss of function

Persistent knee pain is one of the main reasons people consider surgery. The pain may occur when walking, standing, climbing stairs or carrying out other activities. Some people also experience pain at rest or during the night, which can interfere with sleep.

However, the decision to consider a knee replacement is not simply about how much pain you have. Loss of function can be equally important.

You may find that you can no longer:

• walk as far as you used to;
• climb or descend stairs comfortably;
• get in and out of a chair or car easily;
• work or carry out normal household activities;
• exercise or participate in activities that are important to you; or
• remain independent in the way you would like.

When pain and restricted movement begin to have a substantial effect on everyday life, an orthopaedic assessment may be appropriate.

When other treatments have not been enough

Knee replacement is usually considered after non-surgical approaches have been tried or considered and have not provided sufficient improvement.

Depending on your circumstances, these may include exercise and physiotherapy, activity modification, weight management where appropriate, pain-relieving medication or other treatments recommended by your healthcare professional.

This does not mean that every possible treatment must have been exhausted before surgery can be discussed. The appropriate approach depends on the severity of your symptoms, the underlying condition, previous treatment and your individual circumstances.

Your age is not the only consideration

There is no single age at which someone should have a knee replacement.

Although age can be relevant when considering the potential benefits and risks of surgery, the decision is primarily about the severity of your symptoms, the effect on your quality of life, the condition of your knee and your overall health.

Someone relatively young with severe knee disease and substantial functional limitation may be considered for replacement, while an older person with significant changes on an X-ray but relatively little pain or disability may not need surgery.

What happens during the assessment?

Before recommending knee replacement surgery, an appropriately qualified clinician will normally consider your medical history and symptoms, examine your knee and review relevant investigations.

Imaging, usually including X-rays, can help show the extent and location of joint damage. Other investigations may sometimes be required depending on the circumstances.

Importantly, an abnormal X-ray does not automatically mean that you need a knee replacement. Osteoarthritis and other forms of joint damage can be visible on imaging in people who have relatively few symptoms.

The opposite can also be true: the impact of knee symptoms on a person’s life may be considerable even when the relationship between imaging findings and symptoms is not straightforward.

Making the decision

A knee replacement is a major operation, so the decision should be made after a discussion between you and your healthcare team. Your surgeon should explain the likely benefits, potential risks, alternatives and what recovery may involve, taking into account your individual circumstances and preferences.

The aim is not simply to replace a knee because an X-ray shows arthritis. It is to consider whether surgery is likely to provide a worthwhile improvement in pain, function and quality of life when other appropriate options have not provided sufficient benefit.

If you are considering knee replacement, an assessment by an appropriately qualified orthopaedic professional can help determine whether surgery is appropriate for you and, if so, which type of knee replacement may be most suitable.

What Symptoms May Lead to Knee Replacement?

The symptoms that lead someone to consider a knee replacement can vary considerably. For some people, pain is the main problem. For others, stiffness, reduced mobility or difficulty carrying out everyday activities may have the greatest impact. Often, several symptoms occur together and gradually become more limiting over time.

Having one or more of these symptoms does not automatically mean that you need knee replacement surgery. They are reasons to seek appropriate medical assessment, particularly when they persist, worsen or begin to interfere significantly with your quality of life.

Knee pain

Persistent knee pain is one of the most common reasons people seek assessment for possible knee replacement. Pain may occur when walking, standing, climbing stairs or getting up from a chair. As knee problems progress, some people develop pain during rest or at night.

Pain can also make people reduce activities they previously enjoyed, which can lead to further loss of strength and mobility.

Stiffness and difficulty moving

A damaged knee may become increasingly stiff, particularly after periods of sitting or resting. You may find it harder to fully bend or straighten your knee, or that getting moving after sitting down takes longer than it used to.

Stiffness can make routine activities such as putting on shoes, getting into a car or using stairs increasingly difficult.

Reduced walking distance

A common sign that knee symptoms are having a meaningful functional impact is a gradual reduction in how far you can comfortably walk.

You may find yourself:

• taking shorter walks;
• needing to stop and rest more frequently;
• avoiding hills or uneven ground;
• relying more heavily on a walking aid; or
• planning activities around how much walking they involve.

If knee pain or stiffness is progressively restricting your mobility, it is worth discussing this with your GP or another appropriately qualified healthcare professional.

Difficulty with stairs and getting up from a chair

Activities that place greater demands on the knee can become particularly difficult.

You may notice increasing difficulty:

• climbing or descending stairs;
• getting up from a low chair;
• getting in and out of a car;
• standing for prolonged periods; or
• moving around your home.

These changes can be important because they show how a knee problem is affecting function, rather than simply describing what the knee looks like on an X-ray.

Sleep disturbance

Knee pain can sometimes interfere with sleep, particularly when symptoms become more persistent or occur at night. Regularly waking because of knee pain, struggling to find a comfortable position or feeling tired because your sleep is disrupted can have a significant effect on your overall wellbeing.

Night pain should therefore be discussed with your healthcare professional, particularly if it is persistent or worsening.

Impact on work, exercise and independence

Knee problems can gradually affect much more than walking.

You may find that you can no longer work comfortably, exercise in the way you would like, participate in hobbies or carry out household tasks without significant discomfort.

For some people, the most important change is a loss of independence. Everyday activities that were previously straightforward may require assistance or careful planning.

These effects are important when discussing whether further treatment, including knee replacement, might be appropriate.

Swelling and progressive deterioration

Swelling can occur with arthritis and other conditions affecting the knee, although it is not specific to any one diagnosis. Recurrent or persistent swelling, particularly when accompanied by pain, stiffness or reduced function, should be assessed.

A gradual pattern of deterioration is also relevant. You may notice that activities that were manageable several months ago are becoming increasingly difficult, or that treatments which previously helped no longer provide sufficient relief.

When should you seek medical assessment?

Consider seeking medical advice if knee pain, stiffness, swelling or reduced mobility is persistent, worsening or interfering with your everyday life, sleep, work or ability to remain active.

You do not need to wait until your symptoms become severe before discussing them with a healthcare professional. An assessment can help establish the likely cause of your symptoms and whether treatments such as exercise, physiotherapy, medication or other approaches may be appropriate.

If your symptoms are severe or continue despite appropriate treatment, your healthcare professional may discuss whether referral to an orthopaedic specialist is appropriate.

Importantly, symptoms alone do not determine whether you need a knee replacement. The decision depends on the underlying condition, clinical assessment, imaging where appropriate, the effect on your quality of life, previous treatment and your individual circumstances.

Total Knee Replacement

A total knee replacement is an operation in which the damaged surfaces of the knee joint are replaced with artificial components. It is the most commonly performed type of knee replacement and is generally considered when arthritis or other joint damage has caused persistent pain and significant loss of function that has not improved sufficiently with non-surgical treatment.

Despite the name, a total knee replacement does not mean that the entire knee is removed and replaced. The surgeon removes the damaged surfaces at the end of the thigh bone (femur) and the top of the shin bone (tibia), replacing them with artificial components. The underside of the kneecap (patella) may also be resurfaced, depending on the individual circumstances and surgical approach.

The replacement usually consists of a metal component attached to the femur, a metal baseplate attached to the tibia and a durable plastic bearing between them. The components are designed to provide smooth movement and restore the function of the damaged joint surfaces.

When is a total knee replacement considered?

A total knee replacement may be considered when knee disease is causing substantial problems such as:

• persistent pain, including pain that may interfere with sleep;
• significant stiffness;
• difficulty walking or using stairs;
• increasing difficulty with everyday activities;
• reduced ability to work, exercise or participate in hobbies; or
• a substantial effect on quality of life.

The decision is based on the overall clinical picture rather than an X-ray alone. Your orthopaedic surgeon will consider your symptoms, examination findings, imaging, previous treatments, general health and individual circumstances before recommending surgery.

Total versus partial knee replacement

The key difference between a total knee replacement and a partial knee replacement is how much of the joint is replaced.

A total knee replacement addresses the main damaged joint surfaces, whereas a partial knee replacement replaces only the affected compartment of the knee and preserves more of the patient’s natural joint.

Partial replacement can be appropriate for carefully selected patients whose arthritis is limited to one compartment and whose remaining knee structures are suitable. A total replacement may be considered when damage is more widespread or when a partial replacement is not appropriate.

Neither operation is automatically the better choice for every patient. The most appropriate procedure depends on the pattern of arthritis or other joint damage, the condition of the ligaments and other structures, your symptoms and your surgeon’s assessment.

What can you expect from a total knee replacement?

The principal aim of total knee replacement surgery is to reduce pain and improve function. Many patients experience substantial improvement, but recovery varies and surgery cannot guarantee a completely pain-free or “normal” knee.

A replacement is also not designed to recreate every characteristic of a natural knee. Some patients notice differences in movement, sensation or function after surgery, and rehabilitation is an important part of achieving the best possible result.

Your surgeon should explain what is realistically achievable in your particular circumstances, including the potential benefits, limitations and risks. Understanding these expectations is an important part of deciding whether total knee replacement is right for you.

Partial Knee Replacement

A partial knee replacement is an operation in which only the damaged part, or compartment, of the knee is replaced. Unlike a total knee replacement, which replaces the main damaged surfaces across the knee, partial replacement preserves the parts of the joint that remain healthy.

The knee is commonly described as having three compartments:

• Medial compartment – the inner side of the knee.
• Lateral compartment – the outer side of the knee.
• Patellofemoral compartment – the area where the kneecap (patella) meets the thigh bone (femur).

A partial knee replacement may be considered when arthritis or other damage is largely confined to one of these compartments and the other parts of the knee remain suitable for preservation.

Who may be suitable?

Suitability for partial knee replacement depends on much more than where the arthritis appears on an X-ray. Your orthopaedic surgeon will assess your symptoms, the extent and location of joint damage, the condition of your ligaments and the overall function and stability of your knee.

A partial replacement may be an option when the disease is limited to a single compartment and the remaining parts of the knee are functioning sufficiently well. Your surgeon may also consider your age, activity levels, previous knee problems and other individual factors when deciding which operation is most appropriate.

How does it differ from a total knee replacement?

The fundamental difference is the amount of the knee that is replaced.

With a total knee replacement, the damaged surfaces of the main knee joint are replaced with artificial components, with the kneecap sometimes resurfaced. With a partial knee replacement, only the affected compartment is replaced, leaving the other compartments and more of the patient’s natural knee intact.

This means that partial replacement is not simply a smaller version of a total knee replacement. It is a different procedure intended for a more specific pattern of knee disease.

What are the potential advantages?

For appropriately selected patients, preserving more of the natural knee may have potential advantages. A partial replacement generally involves replacing less of the joint and retaining more of the patient’s original bone, cartilage and supporting structures.

Some patients may also experience a more natural-feeling knee following partial replacement. However, outcomes vary between individuals, and these potential advantages should be considered alongside the limitations and risks of the procedure.

What are the limitations?

A partial knee replacement is not suitable for everyone. If arthritis or other damage affects more than one compartment, or if important supporting structures of the knee are not functioning adequately, a total knee replacement may be more appropriate.

There is also a possibility that disease may subsequently develop or progress in another part of the knee. In some circumstances, further surgery may therefore be required.

The decision between a partial and total knee replacement should be made following an individual assessment by an appropriately qualified orthopaedic surgeon. The aim is not to choose the operation that sounds least invasive, but the procedure most likely to provide a durable and worthwhile improvement for the particular knee being treated.

Robotic-Assisted Knee Replacement

Robotic-assisted knee replacement describes the technology used to plan and assist a knee replacement operation. It is not, in itself, a separate type of knee replacement.

The underlying operation may still be a total knee replacement or a partial knee replacement. The robotic system is an additional technology that can be used by the surgical team during planning and, depending on the system, during the operation.

How does robotic assistance work?

Before surgery, the patient’s knee may be assessed using detailed imaging or other measurements. This information can be used to create a three-dimensional representation of the patient’s anatomy and help the surgical team plan the position and alignment of the implant.

During the operation, the technology may provide the surgeon with information about the patient’s anatomy and the planned position of the components. Some systems can also help the surgeon control or guide the preparation of the bone within defined parameters.

The exact technology varies between systems and hospitals. Robotic assistance does not mean that a robot independently performs the operation. The orthopaedic surgeon remains responsible for the procedure and makes the clinical decisions throughout the operation.

Does robotic-assisted surgery produce better results?

This is an important question for patients considering private knee replacement.

Robotic assistance can provide additional planning and technological tools, and research has shown that computer-assisted and robotic techniques can influence the positioning of knee replacement components. However, greater technological precision does not automatically mean that every patient will experience a better long-term outcome.

The benefits that matter to patients include pain relief, functional improvement, satisfaction, implant survival and avoidance of complications. Evidence comparing robotic-assisted and conventional knee replacement continues to develop, and results can vary according to the technology used, the operation performed, the surgeon and the patient.

Robotic-assisted surgery should therefore not be regarded as automatically better than conventional knee replacement.

Is robotic-assisted knee replacement suitable for everyone?

Not necessarily. The decision to use robotic assistance depends on the patient’s circumstances, the type of knee replacement being considered, the surgeon’s experience and the technology available at the hospital.

It is also important to understand that robotic assistance does not remove the usual risks associated with knee replacement surgery. Patients should still consider the surgeon, hospital, implant, proposed procedure, expected outcomes, rehabilitation and follow-up arrangements when deciding where to have treatment.

If robotic-assisted knee replacement is being offered, ask your surgeon which system they use, why they believe it is appropriate for you, what evidence supports its use in your particular procedure and whether the expected benefits differ from those of conventional surgery.

Ultimately, robotic assistance is a surgical tool, not a guarantee of a better outcome. The most appropriate approach depends on the individual patient and should be discussed with an appropriately qualified orthopaedic surgeon.

What Happens Before Knee Replacement Surgery?

The journey towards knee replacement surgery usually involves several stages, from your initial assessment through to the decision to have an operation and preparation for your admission. The exact pathway varies between patients and between NHS and private healthcare, but the principles are similar: establish the cause and severity of your knee problem, consider appropriate alternatives, assess whether surgery is likely to help and make sure you are suitably prepared for the operation.

1. Initial assessment

For many patients using the NHS, the journey begins with an appointment with a GP or another healthcare professional. Your symptoms, medical history and how your knee affects your daily life will be discussed.

You may be asked about:

• how long you have had knee pain or stiffness;
• how your symptoms have changed;
• how far you can walk;
• whether stairs or other everyday activities have become difficult;
• whether pain affects your sleep;
• what treatments you have already tried; and
• how your knee problem affects work, exercise and independence.

Some patients enter the pathway through other routes, particularly in private healthcare, where they may arrange an appointment directly with an orthopaedic specialist.

2. Referral to an orthopaedic specialist

If your symptoms and initial assessment suggest that specialist advice is appropriate, you may be referred to an orthopaedic surgeon or another member of an appropriate musculoskeletal service.

The route differs between NHS and private care. NHS patients generally follow the referral pathway available in their local area, while private patients may be able to arrange an appointment with a consultant directly or through an insurer, depending on their circumstances.

A referral does not mean that you will automatically need a knee replacement. It is an opportunity for your condition and treatment options to be assessed in more detail.

3. Orthopaedic assessment

At the orthopaedic consultation, your surgeon will take a detailed medical history and ask about your symptoms, previous treatments and the effect your knee has on your life.

Your knee will usually be examined. This may include assessing movement, alignment, stability and other features that can help determine the underlying problem.

The surgeon will also consider your general health and any other medical conditions that could affect treatment or recovery.

4. Imaging and other investigations

Imaging, commonly X-rays, can help show the condition of the knee and the extent and location of joint damage.

The findings need to be interpreted alongside your symptoms and examination. An X-ray showing arthritis does not, by itself, mean that a knee replacement is necessary.

Further investigations may sometimes be required, depending on the diagnosis and the circumstances of the individual patient.

5. Discussing non-surgical treatments

Before proceeding to knee replacement, your healthcare team will consider whether non-surgical treatments may help.

Depending on your circumstances, these can include exercise and physiotherapy, weight management where appropriate, pain management, activity modification and other treatments recommended by your healthcare professional.

The appropriate options depend on the underlying condition, severity of symptoms, previous treatment and your individual circumstances.

The aim is not necessarily to exhaust every conceivable treatment before surgery. Rather, the decision should consider whether the available non-surgical options are providing sufficient benefit and whether knee replacement is likely to offer a worthwhile improvement.

6. Deciding whether surgery is appropriate

If your symptoms remain troublesome and your knee damage is consistent with your clinical assessment, your orthopaedic surgeon may discuss knee replacement with you.

This should be a shared decision rather than simply a decision based on an X-ray.

Your discussion should include:

• the likely benefits of surgery;
• potential risks and complications;
• alternative treatments;
• the type of knee replacement that may be appropriate;
• what the operation involves;
• expected recovery;
• rehabilitation; and
• what you can realistically expect after surgery.

You should have an opportunity to ask questions and consider whether the potential benefits outweigh the disadvantages for you.

7. Choosing the type of knee replacement

If surgery is appropriate, your surgeon will consider which procedure best matches the condition of your knee.

For some patients this will be a total knee replacement, while others may be suitable for a partial knee replacement. Other circumstances may require a different approach, such as revision surgery for an existing knee replacement.

The choice depends on factors including the pattern of joint damage, the condition of the other parts of the knee, ligament function, your symptoms and your individual circumstances.

You should understand why a particular procedure has been recommended rather than assuming that one type of knee replacement is universally better than another.

8. Preparing for surgery

Once you have decided to proceed, you will normally undergo a pre-operative assessment.

This is designed to identify anything that needs to be addressed before surgery and to make sure that you are appropriately prepared.

Depending on your circumstances, this may include reviewing:

• your medical history;
• current medicines;
• previous operations and anaesthetics;
• allergies;
• heart and lung health;
• blood tests or other investigations where indicated; and
• your ability to manage after discharge.

If there are health or lifestyle factors that could increase the risks of surgery, your healthcare team may recommend addressing these beforehand. This process is sometimes referred to as pre-operative optimisation.

9. Anaesthetic assessment

Knee replacement can be performed using different forms of anaesthesia, depending on the patient, procedure and anaesthetic plan.

An anaesthetist or appropriate pre-operative team member may assess your health and discuss the proposed anaesthetic with you. They can explain the options, benefits and risks and answer questions about pain relief during and after surgery.

The final anaesthetic plan is individualised rather than being identical for every patient.

10. Preparing for discharge and rehabilitation

Planning for recovery should begin before the operation.

Your healthcare team may discuss how you will get around after surgery, what equipment or support you may need at home and how your rehabilitation will be organised.

You should understand what to expect after discharge, including wound care, pain management, exercises, mobility and follow-up arrangements.

The exact arrangements vary between hospitals and between NHS and private treatment. Some patients may be discharged relatively quickly, while others require a longer period of hospital care. The decision should be based on your medical condition, mobility and ability to manage safely rather than on a fixed timetable.

NHS and private pathways

The overall stages of assessment are broadly similar whether you are treated through the NHS or privately, but the way you enter the system and the choices available to you can differ.

In private healthcare, you may have greater flexibility over where you are assessed and which consultant you see, depending on whether you are self-paying or using private medical insurance. In the NHS, referral and treatment arrangements depend on the local healthcare pathway.

Whichever route you use, the important principle is the same: knee replacement should be recommended only after an appropriate assessment of your symptoms, knee condition, general health and treatment options.

Taking time to understand the diagnosis, proposed operation, potential risks and expected recovery can help you make a more informed decision about whether knee replacement surgery is right for you.

What Happens During Knee Replacement Surgery?

Knee replacement surgery is a carefully planned procedure in which the damaged surfaces of the knee are removed and replaced with artificial components. Although the fundamental principles are similar, the exact surgical technique, implant system and anaesthetic approach can vary between patients, surgeons and hospitals.

Understanding what happens during the operation can make the process less unfamiliar. Your surgical team should explain the specific procedure planned for you before surgery and give you an opportunity to ask questions.

1. Arrival and preparation

On the day of surgery, you will arrive at the hospital and complete the necessary admission and pre-operative checks. Your identity, medical history, allergies and medicines will be confirmed, and the surgical team will review the planned procedure with you.

Your surgeon will normally confirm which knee is being operated on and discuss the operation before you go to theatre. You may also meet members of the anaesthetic team if this has not already happened.

You will change into hospital clothing and be prepared for theatre. The timing of these steps varies between hospitals.

2. Anaesthesia

Knee replacement surgery can be performed using different forms of anaesthesia.

Two commonly used approach includes a spinal anaesthetic, which temporarily numbs the lower part of the body while you remain conscious, or a General anaesthesia, in which you are completely unconscious.

The anaesthetic team will discuss the options with you and take account of your medical history, preferences and the planned operation.

Additional medicines or techniques may be used to help control pain during and after surgery.

3. Positioning and preparation

Once the anaesthetic is working, you will be positioned on the operating table so that the surgical team can access the knee safely.

The skin around the knee is cleaned with an antiseptic solution and sterile drapes are placed around the operating area. This creates a controlled sterile environment for the procedure.

The surgical team follows measures designed to minimise the risk of infection and other complications.

4. Accessing the knee

The surgeon makes an incision over the front of the knee and carefully works through the tissues to reach the joint.

The precise incision and surgical approach can vary. The surgeon aims to obtain adequate access to the knee while preserving and protecting the surrounding tissues as far as possible.

Once the joint is exposed, the surgeon can assess the damaged surfaces and prepare the knee for the replacement components.

5. Preparing the damaged bone and joint surfaces

In a total knee replacement, the damaged surfaces at the end of the thigh bone (femur) and the top of the shin bone (tibia) are carefully prepared.

The surgeon removes a controlled amount of damaged bone and cartilage to create surfaces onto which the artificial components can be positioned.

The underside of the kneecap (patella) may also be resurfaced, depending on the individual operation and the surgeon’s approach.

The aim is to create appropriately shaped and balanced surfaces for the knee implant while preserving as much suitable bone as possible.

The exact instruments and techniques used vary. Some surgeons use conventional mechanical instruments, while others may use computer-assisted or robotic technology to help plan or guide aspects of the procedure.

6. Implanting the knee replacement

Once the bone has been prepared, the artificial components are positioned.

A typical total knee replacement consists of:

• a metal component attached to the prepared end of the femur;
• a metal base component attached to the top of the tibia;
• a durable plastic bearing between the two components; and
• sometimes a plastic component used to resurface the underside of the kneecap.

The components may be fixed to the bone using bone cement or, depending on the implant and circumstances, another method of fixation.

The choice of implant and fixation method is determined by the surgeon based on the patient’s anatomy, the condition of the knee and other individual factors.

7. Checking movement and stability

Before closing the wound, the surgeon assesses the replacement.

The knee is moved through a range of positions to check its movement, alignment and stability. The surgeon will also assess how the different components interact and whether the knee is functioning appropriately.

This is an important part of the procedure because the replacement needs to provide a balance between movement and stability.

The precise checks performed vary according to the type of knee replacement and surgical technique.

8. Closing the wound

Once the surgeon is satisfied with the position and function of the replacement, the surgical wound is closed.

The tissues are carefully brought back together and the skin is closed using an appropriate technique. A dressing is then applied.

The knee replacement itself is now in place, but the operation is only one part of the treatment process. Recovery and rehabilitation begin soon afterwards.

9. Recovery after the operation

After surgery, you will usually be taken to a recovery area where members of the clinical team monitor you while the effects of the anaesthetic wear off.

They will monitor things such as your blood pressure, heart rate, breathing, pain and overall condition. You may receive medication to control pain and reduce the risk of complications.

Once you are sufficiently recovered, you will be transferred to a ward or other appropriate area of the hospital.

10. Early mobilisation

An important part of modern knee replacement care is early mobilisation.

When it is safe to do so, you will normally be encouraged to get out of bed and begin moving the knee and walking with assistance. A physiotherapist or another member of the healthcare team may show you exercises and advise you on how to use walking aids safely.

Early movement helps you begin restoring strength and mobility and forms the first stage of your rehabilitation.

The exact timing and programme will depend on your operation, medical condition, mobility and the policies of the hospital treating you.

What should you expect overall?

A knee replacement is a major operation, but the procedure itself follows a carefully planned sequence: preparation, anaesthesia, access to the joint, preparation of the damaged surfaces, implantation of the artificial components, checking the knee, closure and recovery.

The details can differ between patients and surgeons. Your surgeon should explain the type of knee replacement being recommended, the surgical approach, the implant being used and any technology involved in your particular operation.

Understanding these steps can help you prepare for surgery, but your own surgical and anaesthetic teams remain the best source of advice about what will happen in your individual case.

NHS or Private Knee Replacement?

If you are considering knee replacement surgery in the UK, you may have a choice between treatment through the NHS, private treatment funded by health insurance, or private self-pay treatment. The right route depends on your circumstances, preferences, eligibility and the options available to you.

Private treatment is not automatically better than NHS treatment, and NHS care is not necessarily the same everywhere. The important consideration is whether the pathway and treatment you choose provide appropriate clinical care, clear information, safe surgery and suitable follow-up.

NHS, insured private or self-pay: how do they compare?

Consideration	NHS	Private – health insurance	Private – self-pay
Referral	Usually begins with a GP or other NHS healthcare professional, followed by the local referral pathway.	Usually requires an eligible diagnosis and may require insurer authorisation or a referral, depending on your policy.	You may be able to arrange an assessment directly with a private orthopaedic consultant, depending on the provider.
Choice of surgeon	The choice available depends on the NHS service and local pathway.	Your insurer may have a network of approved consultants and hospitals.	You can generally choose which consultant you approach, subject to availability and the provider’s arrangements.
Choice of hospital	Depends on the NHS pathway and available services.	Usually restricted or guided by your insurer’s approved providers.	You can generally choose a private hospital or provider yourself.
Waiting time	Varies according to local services, referral pathway, clinical priority and demand.	Depends on consultant, hospital, insurer approval and availability.	Depends on the consultant and hospital you choose and their availability.
Access to treatment	Provided according to NHS eligibility, clinical need and the relevant NHS pathway.	Treatment is subject to your policy terms and insurer authorisation.	You pay directly for the treatment you choose.
Insurance	No private medical insurance is required.	Your insurer normally pays eligible costs subject to your policy, exclusions and limits.	Insurance is not required because you are funding treatment yourself.
Cost to the patient	Normally no direct charge for eligible NHS treatment.	You may have an excess or other costs depending on your policy.	You pay the treatment costs yourself, usually based on a quotation or package.
Continuity of care	Care is provided by the NHS team responsible for your pathway, although the professionals involved may vary.	Usually coordinated through your consultant, hospital and insurer, subject to the arrangements in your policy.	You can generally choose your consultant and provider, although arrangements vary.
Rehabilitation	Rehabilitation is provided according to the local NHS service and your clinical needs.	Rehabilitation arrangements depend on your consultant, hospital and insurance cover.	Rehabilitation is arranged as part of the private pathway, but what is included should be confirmed before treatment.
Follow-up	Follow-up is arranged through the NHS service according to clinical need and local arrangements.	Follow-up is usually provided through the consultant or hospital, subject to insurance cover.	Follow-up arrangements should be confirmed with the provider before surgery.
Main potential advantage	Access to treatment without paying the private treatment cost directly.	Access to private treatment with some or all eligible costs covered by insurance.	Greater flexibility over the consultant, hospital and timing of treatment, depending on availability.
Potential disadvantage	You may have less choice over consultant or hospital, and waiting times vary.	Your choice and treatment may be limited by your insurance policy and approved providers.	Private treatment can represent a substantial financial commitment, and you are responsible for understanding what the quoted price includes.

NHS knee replacement

For most people, the NHS pathway begins with an assessment in primary care or another NHS service. If a joint replacement is considered appropriate, referral is based on clinical assessment and the impact of symptoms on quality of life rather than simply the appearance of an X-ray.

NICE recommends considering referral for joint replacement when symptoms such as pain, stiffness or reduced function substantially affect quality of life and non-surgical management is ineffective or unsuitable. It also recommends that decisions about referral should be based on clinical assessment rather than numerical scoring systems.

The NHS can therefore provide high-quality knee replacement surgery without the patient having to fund the operation privately. However, the exact pathway, available services and waiting time can vary between areas and according to individual circumstances.

The NHS route may be particularly attractive if avoiding the financial cost of private treatment is the most important consideration.

Private knee replacement through health insurance

Private medical insurance can provide access to private knee replacement when the condition and proposed treatment are covered by the policy.

The process normally involves establishing that treatment is covered and obtaining any required authorisation from the insurer. Your insurer may have a list of approved consultants and hospitals, and there may be limits on what it will pay.

It is therefore worth checking your policy before assuming that any consultant, hospital, implant or rehabilitation service will be covered.

You should also establish whether there is an excess or any other contribution you will have to make.

Private self-pay knee replacement

Self-pay treatment means that you fund the operation yourself rather than relying on private medical insurance.

One potential advantage is greater flexibility over which consultant and hospital you approach. Depending on availability, you may also have more control over the timing of treatment.

However, private treatment is a significant financial commitment. The headline price of a knee replacement does not necessarily represent the total amount you will ultimately pay.

A quotation may or may not include items such as the consultant’s fee, anaesthetic fee, hospital and theatre costs, implant, investigations, medications, physiotherapy and follow-up.

Before committing to treatment, ask the provider for a clear explanation of what is included and what could result in additional charges.

For a detailed discussion of private knee replacement pricing, see our dedicated Knee Replacement Cost UK guide.

Is private treatment better than NHS treatment?

There is no simple answer to this question.

Private treatment can offer greater choice and flexibility in some circumstances, but those benefits need to be considered alongside the cost and the particular services being provided.

NHS and private patients can both receive treatment from highly qualified orthopaedic surgeons, and the fundamental principles of safe knee replacement surgery remain the same.

The more useful question is not simply “NHS or private?”, but:

Which treatment pathway is appropriate for my circumstances, and what does it provide?

This includes considering the proposed surgeon, hospital, type of knee replacement, rehabilitation, follow-up arrangements, expected outcomes and costs.

What should you compare before choosing?

If you are considering private treatment, don’t compare providers solely on the advertised price.

Ask:

• Who will perform my operation?
• How often does the surgeon perform knee replacement surgery?
• Which type of knee replacement is being recommended and why?
• Which implant will be used?
• What is included in the quoted price?
• Are the surgeon and anaesthetist fees included?
• Are investigations included?
• What happens if I need to stay in hospital longer than expected?
• What rehabilitation and physiotherapy are included?
• How is follow-up arranged?
• Who should I contact if I develop a problem after surgery?
• What happens if a complication requires further treatment?
• Are there any circumstances in which additional charges could arise?

NICE emphasises shared decision making for people considering joint replacement, including discussion of the benefits and risks of different procedures and implants, anaesthesia and analgesia, recovery and rehabilitation.

Making the decision

Choosing between NHS, insured private and self-pay treatment is ultimately a personal decision.

For some patients, avoiding the cost of private treatment will make NHS care the obvious choice. For others, the ability to choose a particular consultant or hospital, or to have greater flexibility over the timing of treatment, may make private care attractive.

Whichever route you choose, the clinical decision to have a knee replacement should remain separate from the decision about where to have it. Your diagnosis, symptoms, functional limitations, treatment options and individual circumstances should determine whether surgery is appropriate in the first place.

If both partial and total knee replacement are clinically suitable options for someone with isolated medial compartment osteoarthritis, NICE recommends that the benefits and risks of both should be discussed so that the patient can participate in choosing the option that best fits their circumstances and preferences.

The best decision is therefore an informed one: understand your treatment options, understand the pathway you are choosing, establish the full cost if you are paying privately, and make sure you know what care and follow-up you can expect before agreeing to surgery.

How Much Does Knee Replacement Cost in the UK?

The cost of a knee replacement in the UK depends on where you are treated, the type of procedure you need and what is included in the treatment package. There is no single standard private price, and the amount quoted by one hospital or surgeon may not be directly comparable with another.

For patients considering private or self-pay knee replacement, the overall cost can include several separate elements.

What makes up the cost?

The main components may include:

• Surgeon’s fee – the orthopaedic surgeon’s professional fee for performing the operation.
• Hospital and theatre costs – the cost of the hospital stay, operating theatre, nursing care and other hospital services.
• Implant – the artificial knee components used during the operation. The implant selected depends on the type of knee replacement and your individual circumstances.
• Anaesthetic – the anaesthetist’s professional fee and the anaesthetic services provided during surgery.
• Investigations – consultations, imaging, blood tests and other investigations may be charged separately or included within a package.
• Rehabilitation – physiotherapy and other rehabilitation services may form part of the package or may be charged separately.
• Follow-up – post-operative consultations and other follow-up care may or may not be included.

The important point is that a headline price is not necessarily the final price. Before agreeing to self-pay treatment, ask for a clear breakdown of what the quotation includes and whether there are circumstances in which additional charges could arise.

Why do prices vary?

Private knee replacement prices can vary significantly between hospitals and regions. Costs may be influenced by the location of the hospital, the surgeon’s fee, the type of knee replacement, the implant used, the length of your hospital stay and the services included in the package.

Prices can also differ according to whether you need a total or partial knee replacement, and whether additional investigations or treatment are required.

This means that comparing two advertised prices purely on the headline figure can be misleading. A lower quotation may simply include fewer services.

Self-pay or private medical insurance?

If you are self-paying, you are responsible for the cost of your treatment. You should establish the total expected cost before proceeding and ask specifically about anything that is excluded.

If your treatment is covered by private medical insurance, your insurer may pay some or all of the eligible costs, subject to the terms of your policy. You may still have an excess or other costs to pay, and your choice of consultant or hospital may be affected by your insurer’s approved provider arrangements.

For a detailed breakdown of current UK private knee replacement prices, what is typically included in a treatment package, and the factors that can affect the final bill, see our dedicated Knee Replacement Cost UK guide.

Risks and Complications of Knee Replacement

Knee replacement is a well-established operation, but like any major surgery, it carries potential risks and complications. Most people recover without a serious complication, but it is important to understand what can happen before deciding to proceed.

The likelihood of a particular complication varies between individuals. Your age, general health, weight, medical conditions, previous operations, the condition of your knee and the type of procedure being performed can all influence risk. Your surgeon and anaesthetic team should discuss the risks that are particularly relevant to you.

Infection

Infection can occur in the wound or around the knee replacement. This is an important complication because an infection involving the implant can be more difficult to treat than a superficial wound infection.

Treatment depends on the type and timing of the infection and may include antibiotics, further surgery or, in some cases, removal and replacement of the implant.

Your surgical team will use measures designed to reduce the risk of infection, and you will normally receive advice about caring for your wound after surgery.

Blood clots

Surgery to the lower limb can increase the risk of developing a blood clot.

A deep vein thrombosis (DVT) is a clot that forms in a deep vein, usually in the leg. A clot can occasionally travel to the lungs, causing a pulmonary embolism (PE), which can be serious.

Hospitals use measures to reduce the risk of blood clots. These may include medication, compression devices or stockings and getting you moving as soon as it is safe to do so. The exact approach depends on your individual risk and the hospital’s protocol.

Bleeding

Some bleeding is expected during and after knee replacement surgery. Occasionally, bleeding can be more significant and may require additional treatment.

Your medical team will consider factors such as medicines that affect blood clotting and your general health when preparing you for surgery. You should tell your healthcare team about all medicines you take before your operation.

Nerve or blood-vessel injury

Important nerves and blood vessels are located around the knee. Injury to these structures during surgery is uncommon but can occur.

A nerve injury may cause altered sensation, weakness or other changes in the leg or foot. Injury to a blood vessel can affect circulation and may require urgent treatment.

Your surgical team takes precautions to minimise these risks, but they cannot be eliminated completely.

Stiffness

Some patients experience difficulty regaining movement after knee replacement.

Stiffness can be influenced by factors such as the condition of the knee before surgery, the operation itself, pain, swelling and rehabilitation. Your physiotherapy programme and early mobilisation are important parts of recovery.

Persistent stiffness may occasionally require additional treatment, and in some circumstances further surgery may be considered.

Persistent pain

The main aim of knee replacement is to reduce pain and improve function, but a completely pain-free knee cannot be guaranteed.

Some patients continue to experience pain following surgery. There can be several possible causes, including problems with the replacement, stiffness, infection, nerve-related pain or other conditions affecting the leg.

If pain is persistent, severe or worsening rather than gradually improving, it should be discussed with your clinical team so that the cause can be assessed.

Instability

A knee replacement needs to be sufficiently stable while allowing useful movement. Occasionally, the knee can feel unstable or give way.

Instability can have different causes and may sometimes be related to the balance of the soft tissues around the knee, the position of the components or other factors.

Treatment depends on the underlying cause. Some cases can be managed without further surgery, while others may require revision surgery.

Wear and loosening

Knee replacement components are designed to withstand repeated movement over many years, but they can gradually wear or become loose.

The plastic bearing can wear over time, while the fixation between the implant and bone can sometimes deteriorate. Loosening or wear may cause pain or reduced function and can eventually lead to the need for further surgery.

Implant longevity varies between individuals and depends on several factors. A knee replacement does not have a guaranteed lifespan.

Fracture

A fracture can occur around a knee replacement, either during surgery or later following an injury. These are sometimes referred to as periprosthetic fractures.

Treatment depends on the location and severity of the fracture and the stability of the implant. Some fractures can be treated without replacing the implant, while others require surgery.

Further surgery and revision

Some patients eventually require another operation on their knee replacement. This may be necessary because of infection, loosening, instability, wear, fracture or other problems affecting the implant or surrounding tissues.

Revision knee replacement is surgery to replace or revise some or all of an existing knee replacement. Revision procedures can be more complex than the original operation because additional bone and soft tissues may have been affected.

The possibility of further surgery is one of the factors that should be discussed when considering knee replacement.

Other possible problems

There are other complications that can occur around the time of surgery, including problems related to anaesthesia, wound healing, swelling and reduced movement. Your surgeon and anaesthetist should explain the risks relevant to your particular circumstances rather than relying on a generic list alone.

It is also important to understand that complications are not the only limitation of knee replacement. Even when the operation is technically successful, the knee may not feel completely natural and recovery can take time. The outcome can be influenced by your condition before surgery, rehabilitation and individual factors.

When should you seek urgent medical advice?

After knee replacement surgery, contact your surgical or clinical team promptly if you develop symptoms that concern you, particularly if your condition is worsening rather than improving.

Seek urgent medical attention if you develop symptoms that could indicate a serious complication, such as:

• sudden or severe shortness of breath;
• chest pain, particularly if it occurs with breathlessness;
• coughing up blood;
• sudden collapse or severe dizziness;
• a rapidly worsening or severely painful swollen leg;
• significant bleeding that does not stop;
• a high temperature or other signs of a potentially serious infection; or
• sudden loss of movement, sensation or circulation in the leg or foot.

If you think you may be experiencing a medical emergency, seek emergency medical help rather than waiting for a routine appointment.

Understanding your individual risk

The existence of potential complications does not mean that knee replacement is unsafe or unsuitable. It means that, like any major operation, the decision requires a balance between potential benefits and risks.

Before surgery, your orthopaedic surgeon should explain the complications that are particularly relevant to you, including the possibility of needing further treatment. Your anaesthetic team will also assess risks associated with your general health and the proposed anaesthetic.

The most useful question is therefore not simply “What are the risks of knee replacement?”, but “What are my individual risks, what can be done to reduce them, and what would happen if a complication occurred?”

Understanding these issues allows you to make a more informed decision about whether knee replacement is appropriate for you.

How Long Does a Knee Replacement Last?

A knee replacement is designed to provide pain relief and useful function for many years, but no artificial joint has a guaranteed lifespan. How long a knee replacement lasts varies between individuals and depends on the implant, the operation, your physical characteristics and what happens to the knee over time.

When people ask how long a knee replacement “lasts”, they generally mean how long the artificial components continue to function effectively without needing further surgery. A knee replacement can remain in place for many years, but eventually some implants may develop wear, loosening or other problems that affect their function.

What causes a knee replacement to wear?

A knee implant is exposed to repeated loading and movement every time you walk, stand or use your knee. Over many years, the plastic bearing between the metal components can gradually wear.

The body’s response to wear particles can sometimes contribute to changes around the implant and, in some cases, loosening of the components. An implant that becomes loose may cause pain or reduced function and may eventually require further treatment.

Other problems, such as instability, infection, fracture or damage to the surrounding bone, can also affect the long-term performance of a knee replacement.

Does age affect how long a knee replacement lasts?

Age can be relevant because a younger person may place many more years of activity and loading through a knee replacement than someone who has surgery later in life.

This does not mean that younger patients should automatically avoid knee replacement. If severe symptoms and joint damage make surgery appropriate, age is considered alongside the potential benefits, risks and alternatives.

The important point is that implant longevity cannot be predicted from age alone.

Does activity affect implant longevity?

Activity places repeated loads through the artificial joint, but being active after knee replacement is generally an important part of maintaining strength, mobility and overall health.

The type and intensity of activity may nevertheless be relevant to the long-term stresses placed on the implant. Your surgeon or physiotherapy team can advise you about activities that are appropriate for your particular replacement and circumstances.

There is no single activity level that guarantees an implant will last longer or shorter.

Does weight affect a knee replacement?

Body weight can influence the loads transmitted through the knee and may therefore be one factor considered when discussing implant longevity and the risks of surgery.

However, weight is only one part of the overall picture. Decisions about knee replacement should take account of the individual patient’s symptoms, health, mobility and circumstances rather than relying on a single measurement.

Does the implant design matter?

Different knee replacement systems use different implant designs, materials and fixation methods. Implant choice is influenced by factors including the patient’s anatomy, the type of knee replacement required and the surgeon’s assessment.

Long-term evidence about implant performance is therefore important when considering which implant to use. Your surgeon should be able to explain the implant being recommended and why it is appropriate for you.

Does the surgeon affect how long it lasts?

Surgical technique can influence the position and function of a knee replacement. Accurate preparation of the bone, appropriate positioning of the components and good balancing of the knee are among the factors involved in achieving a satisfactory result.

However, even technically successful surgery cannot guarantee a particular lifespan. Implant performance depends on a combination of surgical, implant and patient-related factors.

What happens if a knee replacement wears out?

If a knee replacement eventually becomes painful or stops functioning adequately, your surgeon may investigate the cause. Treatment depends on what is found.

Some problems can be managed without further surgery. If an implant has become significantly worn, loose or damaged, however, revision knee replacement may be considered. Revision surgery involves replacing or revising some or all of the existing knee replacement and can be more complex than the original operation.

There is no guaranteed lifespan

Modern knee replacements can provide durable pain relief and function, but it is not possible to promise that an individual implant will last for a particular number of years.

When considering surgery, ask your surgeon about the expected longevity of the particular knee replacement being recommended for you, the evidence supporting the implant and the circumstances in which further surgery might become necessary.

The aim is not simply to choose an implant that lasts as long as possible in theory. It is to select an appropriate procedure and implant for your individual circumstances and to achieve a knee that provides useful, durable function for as long as reasonably possible.

Knee Replacement Recovery

Recovery from knee replacement surgery is a gradual process. The early focus is on controlling pain and swelling, getting safely mobile and beginning exercises. Over the following weeks and months, strength, movement and confidence usually improve, although the pace of recovery varies considerably between individuals.

The exact recovery pathway depends on factors such as your general health, the type of knee replacement, your condition before surgery and the rehabilitation support available to you.

Immediately after surgery

After the operation, you will spend some time in a recovery area while the effects of the anaesthetic wear off. Your clinical team will monitor your condition and provide pain relief and other treatments as required.

You will normally be encouraged to start moving the knee and getting out of bed as soon as it is safe to do so. A physiotherapist or another member of the healthcare team may show you exercises and help you begin walking with an appropriate walking aid.

Early movement is an important part of recovery. It helps you begin restoring mobility and strength while allowing the team to assess how safely you can move before going home.

Getting mobile and leaving hospital

Your hospital team will assess your mobility and general condition before discharge. You may need to demonstrate that you can move around safely and manage essential activities, although the precise discharge criteria vary between hospitals and individual patients.

Some people leave hospital relatively quickly, while others require a longer stay. The appropriate timing depends on factors such as your medical condition, pain control, mobility and the support available at home.

Before you leave, you should receive information about exercises, medication, wound care, mobility and follow-up. You should also know who to contact if you have concerns after returning home.

The first few weeks

The first few weeks are often the most demanding part of recovery. Pain, swelling and stiffness are common, and your knee may not initially feel or move as you had hoped.

You will usually be encouraged to continue the exercises recommended by your physiotherapy team. Regular, appropriate movement can help you gradually regain strength and mobility.

Walking aids such as crutches or a frame may be needed initially. As your strength, balance and confidence improve, you may be able to reduce your reliance on them.

Recovery is rarely completely linear. It is normal for symptoms and ability to vary from day to day, and increasing activity should be balanced with adequate rest.

Rehabilitation and gradual improvement

Rehabilitation is an important part of knee replacement recovery. Exercise helps restore movement and strength and supports your return to normal activities.

Your rehabilitation programme should be appropriate for you rather than based on a fixed timetable. The exercises and level of activity may change as your knee improves.

Over time, you should gradually become more independent with walking and everyday activities. Activities that initially require planning or assistance can become easier as your strength and confidence return.

Returning to normal activities

There is no single date when everyone can return to normal.

Your ability to drive, work, exercise, travel or resume particular hobbies depends on your recovery, the nature of the activity and advice from your clinical team.

Many everyday activities can be reintroduced progressively as your mobility and strength improve. Higher-impact activities may require more consideration, and your surgeon or physiotherapist can advise you about what is appropriate for your particular knee replacement.

It is important not to judge your recovery solely by how quickly someone else recovered. Your starting point, operation and individual circumstances are different.

Longer-term recovery

Improvement continues beyond the initial weeks. Strength, movement, confidence and function can continue to develop over several months.

Some patients notice substantial improvement relatively quickly, while others take longer to reach their best result. A knee replacement is intended to reduce pain and improve function, but it does not necessarily produce a knee that feels completely identical to a natural joint.

Following your rehabilitation programme and gradually returning to appropriate activity are important parts of achieving the best possible outcome.

A more detailed recovery guide

The recovery journey involves many practical questions, including how to manage pain and swelling, when you can walk without aids, returning to driving and work, exercising after surgery and recognising potential complications.

Our dedicated Knee Replacement Recovery guide provides more detailed information about the recovery process and what patients can expect after surgery.

Choosing a Knee Replacement Surgeon and Hospital

Choosing where to have knee replacement surgery is an important decision. The surgeon performing the operation matters, but so does the hospital, the wider clinical team, the rehabilitation service and the arrangements for follow-up if you have a problem.

There is no single “best” knee replacement surgeon or hospital for every patient. A sensible choice involves looking at the evidence available, asking questions and considering how well the proposed treatment fits your individual circumstances rather than choosing solely on reputation, advertising or price.

Consider the surgeon’s experience

When meeting an orthopaedic surgeon, ask about their experience in knee replacement surgery and whether knee surgery is a significant part of their current practice.

Relevant questions include:

• How frequently do you perform knee replacement surgery?
• How much of your practice involves knee surgery?
• Do you regularly perform the type of replacement I have been offered?
• How do you decide between a total and partial knee replacement?
• What are the main risks and potential benefits in my particular case?

The number of operations a surgeon performs can provide useful context, but volume alone does not determine the quality of an individual’s care. It should be considered alongside training, experience, clinical judgement, outcomes and the suitability of the surgeon for your particular problem.

Look for relevant specialist expertise

Knee replacement is a specialist area of orthopaedic surgery. If you are considering an operation, it is reasonable to ask about the surgeon’s particular areas of expertise.

For example, ask whether they regularly treat the type of knee condition you have and whether they perform the procedure being proposed.

This can be more informative than relying on a general description such as “orthopaedic surgeon”. Your consultation should leave you understanding why a particular procedure has been recommended and what alternatives have been considered.

Consider the hospital as well as the surgeon

A knee replacement is not delivered by the surgeon alone. Your care involves a wider team, including anaesthetic, nursing, physiotherapy and other healthcare professionals.

When choosing a hospital, consider whether it has appropriate facilities and a team experienced in caring for patients undergoing joint replacement.

Important areas to ask about include:

• pre-operative assessment;
• anaesthetic services;
• operating theatre facilities;
• nursing care;
• physiotherapy;
• pain management;
• access to investigations and imaging;
• arrangements for dealing with complications; and
• post-operative follow-up.

The hospital should also have clear arrangements for urgent assessment if a problem develops after you have gone home.

Ask about rehabilitation

Rehabilitation is an important part of knee replacement recovery.

Find out who will provide your physiotherapy, when it will begin and whether treatment is provided in hospital, as an outpatient or through another arrangement.

If you are having private treatment, establish exactly what physiotherapy is included in the package and whether additional sessions will incur further charges.

Good rehabilitation is not simply about the number of physiotherapy sessions. It is about having an appropriate programme, knowing what exercises and activities are expected of you and having access to professional advice when your recovery does not progress as expected.

Look for information about complications and revision surgery

It is reasonable to ask how the surgeon and hospital monitor outcomes following knee replacement.

Where reliable information is available, patients may wish to consider measures such as complications, readmissions, infection and revision surgery. The National Joint Registry provides important UK information about joint replacement procedures and implant performance.

However, outcome figures need to be interpreted carefully. Different patient populations, procedures and follow-up periods can make apparently simple comparisons misleading.

A surgeon or hospital with a higher recorded revision rate is not necessarily providing poorer care without understanding the context, and a low number alone does not prove superior performance.

Ask about infection prevention

Infection involving a knee replacement can be a serious complication. Hospitals use a range of measures designed to reduce infection risk before, during and after surgery.

You can ask your surgical team how infection risk is managed and what you should do before and after surgery to reduce your own risk.

You should also understand what happens if you develop symptoms suggesting an infection after discharge, including who you should contact and how quickly you can be assessed.

Understand the implant being recommended

There are many knee replacement implant systems available. The most expensive or newest implant is not automatically the most appropriate.

Ask your surgeon:

• Which implant are you recommending?
• Why is it appropriate for me?
• Is it a total or partial replacement?
• How much experience do you have with this implant?
• What evidence is available about its long-term performance?
• How is the implant fixed to the bone?
• What happens if the implant eventually needs revision?

The choice should be based on your clinical circumstances and the available evidence rather than marketing claims.

Understand what you are paying for

If you are considering private or self-pay treatment, ask for a detailed written quotation.

A package may include some or all of:

• the surgeon’s fee;
• anaesthetist’s fee;
• hospital and theatre costs;
• implant;
• investigations;
• medicines;
• hospital stay;
• physiotherapy;
• follow-up appointments; and
• treatment of complications.

Do not assume that everything is included simply because a hospital advertises a “knee replacement package”.

Ask specifically what happens if you need to remain in hospital longer than anticipated or develop a complication requiring additional treatment.

For self-pay patients, the cheapest quotation is not necessarily the best value. Equally, a higher price does not demonstrate better clinical care.

Ask what happens if something goes wrong

This is one of the most important questions to ask before surgery.

Find out:

• Who will look after you if you develop a complication?
• Is the operating surgeon available after surgery?
• Who should you contact outside normal working hours?
• Where would you be assessed if you became unwell?
• Would treatment of a complication be provided at the same hospital?
• Could additional costs arise?

A good treatment pathway should make these arrangements clear before you undergo surgery.

Be cautious about “best surgeon” rankings

Patients often encounter websites claiming to identify the “best” knee replacement surgeon or hospital. These lists should be treated cautiously.

There is no single measure that can reliably determine the best surgeon for every patient. Rankings may be based on reviews, marketing information, limited outcome data or criteria that do not reflect the factors most important to an individual patient.

Patient reviews can provide useful information about communication and experience, but they cannot reliably measure surgical quality. Similarly, a surgeon’s prominence, media profile or advertised technology does not necessarily demonstrate better clinical outcomes.

A more useful approach is to gather information from several sources and discuss your individual circumstances directly with a suitably qualified specialist.

Ask questions and take time to decide

A consultation should be a two-way conversation. You should feel able to ask questions about the diagnosis, proposed operation, alternatives, expected outcome, risks and recovery.

You do not need to choose a surgeon simply because they have been recommended to you or because a hospital advertises a particular technology.

Before making a decision, consider the complete pathway:

the surgeon → the proposed operation → the hospital → the anaesthetic team → rehabilitation → follow-up → management of complications → the total cost, where applicable.

The most appropriate choice is the one that provides suitable clinical care for your individual circumstances and gives you a clear understanding of what will happen before, during and after your knee replacement.

A well-informed decision is more valuable than choosing a surgeon or hospital based on a single ranking, headline price or marketing claim.

Questions to Ask Your Knee Replacement Surgeon

Choosing to have a knee replacement is an important decision, and a consultation is your opportunity to understand exactly what is being recommended and why. Asking specific questions can help you compare your options, understand the potential benefits and risks, and make sure you know what to expect before, during and after surgery.

You may find it useful to take this checklist with you to your consultation and write down the answers.

Diagnosis and suitability

• What is causing the damage and pain in my knee?
• How severe is the damage?
• Do my symptoms and examination findings match what you see on my X-rays or other scans?
• Do you think I am suitable for knee replacement surgery now?
• What would happen if I decided not to have surgery at this stage?
• Are there other treatments that I should consider first?
• What makes you think that a knee replacement is likely to improve my symptoms and function?

Type of replacement

• Do I need a total or partial knee replacement, and why?
• If a partial replacement is an option, why would you recommend it rather than a total replacement?
• Which part or compartments of my knee are damaged?
• Would you recommend resurfacing my kneecap?
• Is robotic-assisted or computer-assisted surgery being considered for my operation? If so, what would it add in my particular case?

Your surgeon’s experience

• How frequently do you perform knee replacement surgery?
• How often do you perform the type of knee replacement you are recommending for me?
• Is knee replacement a significant part of your current practice?
• What is your experience with patients with a knee problem similar to mine?
• How do you monitor your outcomes following knee replacement?
• How would you describe your approach to complications or problems after surgery?

The operation

• What exactly will happen during my operation?
• What type of anaesthetic do you recommend, and why?
• How long does the operation usually take?
• How long should I expect to be in hospital?
• What surgical approach will you use?
• Will you use conventional instruments, computer assistance or robotic technology?
• Will I need a drain, catheter or any other temporary equipment?
• What pain-relief measures will be used during and after surgery?

Risks

• What are the most important risks for me personally?
• What complications are you particularly concerned about in my circumstances?
• What is my risk of infection or blood clots?
• What could cause persistent pain or stiffness after surgery?
• What happens if the knee is unstable or does not function as expected?
• What would happen if I developed a complication after I went home?
• How often do patients require further surgery after this type of knee replacement?

Your surgeon should be able to explain risks in the context of your own health rather than simply giving you a generic list.

Implant

• Which knee implant are you recommending?
• Why is this particular implant appropriate for me?
• How long has this implant been used?
• What evidence is available about its long-term performance?
• How will the implant be fixed to my bone?
• Is there a choice of implant that would be appropriate for me?
• What happens if the implant eventually wears out or becomes loose?

You do not need to choose an implant simply because it is the newest, most expensive or most heavily marketed option. The important question is why it is appropriate for your particular knee.

Hospital stay

• Which hospital will perform my operation?
• Who will look after me immediately after surgery?
• When will I be expected to get out of bed and start walking?
• What needs to happen before I can safely go home?
• Will I need someone to stay with me when I first return home?
• What equipment or walking aids will I need?
• Who should I contact if I have a problem after discharge?

Recovery

• What should I realistically expect during the first few weeks?
• When should I expect to walk without crutches or another walking aid?
• When can I drive?
• When might I return to work?
• When can I return to exercise and other activities that are important to me?
• What physiotherapy will I receive?
• How much rehabilitation will I need?
• What should I do if my recovery is slower than expected?

Recovery varies considerably between patients, so ask your surgeon what is realistic for your circumstances rather than relying on another person’s experience.

Follow-up

• When will I have my first follow-up appointment?
• How frequently will I be reviewed after surgery?
• Who will assess my progress?
• How will you monitor the condition of my knee replacement over time?
• What should I do if I develop increasing pain or other symptoms months or years later?
• Who will manage my care if I eventually need revision surgery?

Costs and what is included

If you are having private or self-pay treatment, ask for a clear written breakdown before agreeing to surgery.

• What is the total expected cost of my knee replacement?
• Does the quoted price include the surgeon’s fee?
• Is the anaesthetist’s fee included?
• Are the implant and theatre costs included?
• Are my consultations and investigations included?
• How many nights in hospital are included?
• Is physiotherapy included?
• Are post-operative consultations included?
• Could I incur additional costs if I need to stay in hospital longer?
• What happens financially if I develop a complication requiring further treatment?
• Are there any other costs that I should know about before proceeding?

A clear quotation should make it possible to understand not just the headline price, but what that price actually covers.

Before you make your decision

You do not need to ask every question in one consultation, and some answers will depend on your individual circumstances. The important thing is that you understand why surgery is being recommended, what operation is proposed, who will perform it, what the realistic benefits and risks are, and what care you will receive afterwards.

If you are unsure about any part of the recommendation, ask your surgeon to explain it in different terms or take time to consider your options. For a major operation such as knee replacement, an informed decision is more important than making a quick decision.

Alternatives to Knee Replacement

Knee replacement is not the only treatment available for knee pain and arthritis. Depending on the cause and severity of your knee problem, your symptoms, your general health and the effect on your daily life, your healthcare team may consider non-surgical treatments or, in selected circumstances, another type of surgery.

The most appropriate option is individual. A treatment that helps one person may provide little benefit to another, and some procedures are only suitable for particular patterns of knee damage.

Exercise and physiotherapy

Exercise and physiotherapy are important treatments for many people with knee osteoarthritis, including those who may eventually consider knee replacement.

A structured exercise programme can help maintain or improve muscle strength, joint movement and physical function. Your physiotherapist can help develop exercises appropriate to your symptoms and abilities.

Exercise does not necessarily reverse the underlying arthritis, but it can improve how the knee functions and may reduce pain and disability for some people.

Weight management

If you are overweight or living with obesity, weight management may be recommended as part of your treatment.

Reducing excess body weight can reduce the mechanical load placed on the knee and may improve mobility and symptoms. Weight management can also form part of preparing for surgery if knee replacement is eventually required.

This should be approached in a supportive and individualised way rather than as a prerequisite for treatment.

Pain management

Pain can sometimes be managed with medication and other approaches, depending on the underlying condition and your health.

Your healthcare professional may discuss options such as topical or oral medicines, taking account of potential side effects, other medicines you take and existing medical conditions.

Pain management is not necessarily an alternative that eliminates the need for surgery. For some people, however, appropriate pain management can provide sufficient symptom control to continue with other treatments or delay surgery.

Injections

Injections into the knee are sometimes considered for people with persistent symptoms.

The type of injection and whether it is appropriate depends on the diagnosis and individual circumstances. Different injections have different evidence, potential benefits and risks, and they should not all be regarded as equally effective.

Your clinician can explain whether an injection is appropriate and what you might reasonably expect from it.

Activity modification

Changing how you carry out certain activities may help reduce symptoms.

This does not necessarily mean becoming inactive. Instead, it may involve modifying activities that consistently aggravate your symptoms while maintaining appropriate movement and exercise.

For example, you may be able to substitute lower-impact activities for activities that place greater demands on the knee.

The aim is to maintain mobility and quality of life while finding activities that your knee can tolerate.

Bracing and other supports

A knee brace or other support may be considered in selected circumstances.

Whether a brace is useful depends on the cause of the knee problem, the pattern of joint damage and your symptoms. Bracing is not appropriate for everyone and should not be regarded as a way of correcting severe arthritis.

A healthcare professional can advise whether a brace or another support is likely to be useful for you.

Arthroscopy

Knee arthroscopy involves inserting a small camera and surgical instruments into the joint through small incisions.

Although arthroscopy has an important role in treating some knee conditions, it is not generally an alternative to knee replacement for established osteoarthritis alone. The potential benefit depends on the specific problem being treated.

For this reason, someone with severe arthritis should not assume that arthroscopic surgery can simply replace the need for a knee replacement. Your orthopaedic specialist can explain whether there is a specific problem for which arthroscopy or another procedure may be appropriate.

Partial knee replacement

For some patients, a partial knee replacement can be an alternative to total knee replacement.

A partial replacement replaces only the damaged compartment of the knee while preserving the remaining parts of the joint. It may be suitable when arthritis is confined predominantly to one compartment and the rest of the knee and its supporting structures are appropriate.

It is not suitable for everyone with knee arthritis. The decision requires an individual assessment of the pattern of joint damage, symptoms, ligament function and other factors.

If both partial and total knee replacement are clinically appropriate options, the potential benefits and risks of each should be discussed with your orthopaedic surgeon.

Joint-preserving procedures

In carefully selected patients, other surgical procedures may sometimes be considered to preserve or improve the function of the natural knee.

These can include procedures intended to alter the alignment or load passing through the knee, or other treatments directed at a specific structural problem.

Such operations are highly dependent on the underlying diagnosis, the location of the damage, the patient’s age and activity requirements and the condition of the rest of the knee. They are therefore not general alternatives to knee replacement.

Your orthopaedic surgeon should explain whether there is a realistic role for a joint-preserving procedure in your particular circumstances.

When is knee replacement still considered?

Non-surgical treatment can be appropriate for many people, but symptoms may eventually become severe enough that these approaches no longer provide sufficient benefit.

If persistent pain, stiffness and loss of function continue to have a substantial effect on your quality of life despite appropriate treatment, your healthcare team may discuss knee replacement.

The decision should be based on your symptoms, clinical assessment, imaging where appropriate, previous treatment, general health and personal preferences. It should not be based on an X-ray alone.

Choosing the right treatment

There is no single treatment that is best for everyone with knee arthritis. The appropriate approach depends on what is causing your symptoms, how severely your knee is affected and what matters most to you.

If you are considering knee replacement, ask your orthopaedic surgeon which alternatives are realistically available in your case and what their potential benefits and limitations are. Understanding why a particular treatment has been recommended—and why other options may not be suitable—can help you make a more informed decision.

Frequently Asked Questions

What age is best for a knee replacement?

There is no single age at which a knee replacement is appropriate. The decision is based primarily on symptoms, function, quality of life, the condition of the knee, general health and the likely benefits and risks of surgery. NICE specifically advises that people should not be excluded from referral for joint replacement simply because of age.

Can you have a knee replacement if you are overweight?

Being overweight or living with obesity does not automatically mean that you cannot be considered for knee replacement. NICE recommends that people should not be excluded from referral solely because of BMI, although weight can influence surgical risks and should be discussed as part of your individual assessment.

Do I need an X-ray before having a knee replacement?

Imaging is often used when assessing someone who may need knee replacement, but an X-ray alone does not determine whether surgery is appropriate. The decision should take account of your symptoms, examination findings, functional limitations, general health and previous treatment. NICE recommends clinical assessment rather than relying on numerical scores or imaging alone when considering referral for joint replacement.

Is a total or partial knee replacement better?

Neither is automatically better for every patient. A partial replacement preserves more of the natural knee but is only suitable for particular patterns of disease. A total replacement addresses more extensive joint damage. Where both are clinically suitable, NICE recommends discussing the potential benefits and risks of each so that the patient can participate in choosing the most appropriate option.

Can I have a knee replacement on the NHS?

Yes. Knee replacement is routinely available through the NHS when it is clinically appropriate. The pathway normally involves assessment and referral through NHS services, with treatment provided according to clinical need and the local healthcare pathway.

Can I have a knee replacement privately?

Yes. Private knee replacement may be available through private medical insurance or as self-pay treatment. The private route may offer greater choice over the consultant or hospital, depending on availability and insurance arrangements, but private treatment involves different costs and contractual arrangements.

How much does a private knee replacement cost?

There is no single UK private price. The total cost can depend on the surgeon, hospital, implant, anaesthetic, investigations, length of stay, rehabilitation and what is included in the treatment package. If you are considering self-pay treatment, ask for a detailed written quotation and check what could result in additional charges. See our dedicated Knee Replacement Cost UK guide for a detailed breakdown.

How long does knee replacement surgery take?

The operation itself commonly takes around one to two hours, although the total time in theatre and hospital will be longer. The exact duration varies according to the type of operation, the individual patient and the surgical approach used.

How long will I stay in hospital after knee replacement?

The length of stay varies between patients and hospitals. Some people can leave relatively soon after surgery if they are medically well and can move around safely, while others need longer inpatient care. Discharge planning also takes account of your home circumstances and ability to manage safely after leaving hospital.

How long does it take to recover from a knee replacement?

Recovery is gradual and can take several months or longer. Walking and physiotherapy usually begin soon after surgery, followed by progressively increasing strength, movement and independence. Recovery varies according to factors including your health, the type of replacement and your condition before surgery.

When can I return to normal activities after knee replacement?

There is no single timetable that applies to everyone. Walking, driving, work, exercise and other activities are reintroduced progressively as your strength, movement and confidence improve. Your surgeon and physiotherapist can advise you about specific activities. Recovery guidance should be based on your individual progress rather than another patient’s experience.

How long does a knee replacement last?

A knee replacement is designed to provide durable function, but there is no guaranteed lifespan. NHS guidance states that most knee replacements last about 20 years or more, although some patients may require further surgery sooner and others may have a replacement that continues to function for longer. Wear, loosening, infection and other problems can affect longevity.

Can a knee replacement wear out?

Yes. Over time, components can wear or become loose, and other problems can develop around the artificial joint. If a knee replacement becomes painful or stops functioning adequately, your surgeon may investigate the cause. In some cases, revision surgery may be required to replace or revise some or all of the existing implant.

What are the main risks of knee replacement?

Potential complications include infection, blood clots, bleeding, damage to nerves or blood vessels, stiffness, persistent pain, instability and problems with the implant. Most people do not experience a serious complication, but individual risk varies according to factors such as general health and the procedure being performed.

Can knee replacement surgery fail?

A knee replacement can develop problems, although many patients experience significant improvement in pain and function. Problems can include infection, loosening, instability, persistent pain or wear. If a replacement does not function satisfactorily, further assessment and, in some cases, revision surgery may be necessary.

Can I avoid a knee replacement?

Sometimes. Depending on the cause and severity of your knee problem, options may include therapeutic exercise, weight management where appropriate, pain management, activity modification and selected other treatments. NICE recommends considering joint replacement when symptoms substantially affect quality of life and non-surgical management is ineffective or unsuitable. (Nice)

Is knee arthroscopy an alternative to knee replacement?

Not usually for established osteoarthritis alone. NICE recommends against offering arthroscopic lavage or debridement for people with osteoarthritis. Arthroscopy can have a role in treating particular knee problems, but whether it is appropriate depends on the underlying diagnosis.

How do I choose a knee replacement surgeon?

Look beyond simple “best surgeon” rankings. Consider the surgeon’s experience with knee replacement and with the type of operation being proposed, the hospital’s facilities, rehabilitation and follow-up arrangements, available outcome information and how clearly the surgeon explains the benefits, risks and alternatives. The right choice depends on your individual circumstances rather than a single ranking or headline price.

What should I ask my surgeon before knee replacement?

Ask why surgery is recommended, whether a total or partial replacement is appropriate, what the expected benefits and risks are, which implant is being proposed, who will perform the operation, what recovery will involve and what follow-up is provided. If you are paying privately, also establish exactly what the quoted price includes and what could lead to additional costs. NICE recommends shared decision making and providing information about the procedure, implant, anaesthesia, recovery and rehabilitation.

Medical Review and Sources

Medical review

Medically reviewed by: Active Again Medical Editorial Team
Consultant speciality: Knee and Hip Operations — Knee and Lower Limb Surgery
Date medically reviewed: 28th August 2026
Next review/update: August 2027

Editorial author: Active Again Editorial

Our editorial approach

Active Again aims to provide clear, balanced and useful information for people considering knee replacement surgery in the UK. We distinguish between general patient information and individual medical advice and do not use this guide to diagnose a particular condition or determine whether surgery is appropriate for an individual.

Our content is developed using established UK clinical and patient-information sources, with particular attention to evidence relating to knee replacement, treatment options, risks, recovery, implants and shared decision-making. Where clinical recommendations or evidence can change, the content should be reviewed and updated accordingly.

Medical information should always be considered alongside advice from your own healthcare professionals, who can take account of your medical history, examination, investigations and individual circumstances.

Sources and further reading

The following organisations and resources provide authoritative information relevant to knee replacement and have been used to inform, or should be consulted when reviewing, this guide:

• NHS — Knee replacement: Information covering what knee replacement is, how surgery is performed, recovery and potential complications.
• NICE — Joint replacement (primary): hip, knee and shoulder (NG157): Guidance covering joint replacement, shared decision-making, implants, surgery, anaesthesia, recovery and rehabilitation.
• NICE — Osteoarthritis in over 16s (NG226): Guidance relevant to assessment and management of osteoarthritis and decisions about referral for joint replacement.
• National Joint Registry (NJR): UK registry information covering knee replacement procedures, implants, revision surgery, hospital and surgeon activity and outcomes.
• NJR Annual Report: The Registry’s detailed annual analysis of joint replacement activity, implant performance, revision outcomes and hospital and surgeon data. The 2025 report covers data through the 2024 reporting year.
• British Orthopaedic Association (BOA): Professional information and guidance relating to orthopaedic surgery and musculoskeletal care.
• Versus Arthritis: Patient-focused information and support relating to arthritis, treatment and living with musculoskeletal conditions.

Sources should be reviewed periodically to ensure that links, recommendations and evidence remain current. The National Joint Registry, for example, publishes updated annual analyses of implant and joint-replacement outcomes, making it an important source when discussing implant longevity, revision and provider-level information.

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