--- title: "Do I Need a Knee Replacement? What to Try First" id: "8346" type: "post" slug: "do-i-need-a-knee-replacement" published_at: "2026-09-30T07:57:07+00:00" modified_at: "2026-10-01T21:00:26+00:00" url: "https://www.allforone.com.au/do-i-need-a-knee-replacement/" markdown_url: "https://www.allforone.com.au/do-i-need-a-knee-replacement.md" excerpt: "Told your knee is bone on bone? What Australian guidelines say to try before a knee replacement, how many people put surgery off, and when surgery is right." taxonomy_category: - "All in" - "Physiotherapy" --- Physio · 8 minute read If you have been told your knee is bone on bone, a replacement can start to feel like the only road left. For most people it is not the first step, and knowing what comes before it takes a lot of the fear out of the diagnosis. ### The short version - Australian guidelines say knee osteoarthritis is treated first with education, exercise and support with weight. Surgery is considered when those have been done properly and are no longer enough. - An X-ray on its own does not decide whether you need a new knee. How much the knee is limiting your life does. - In a well-known trial of people who were already eligible for a knee replacement, two in three of those who did a structured exercise and education program first had still not had surgery two years later. ## What “bone on bone” actually tells you An X-ray of an arthritic knee shows the space between the bones getting narrower. People often hear that described as bone on bone, and it sounds final. It is a picture of the joint, not a measure of how much it hurts or how well you can move. A review of the research found that X-ray findings and knee pain often do not line up. Some people with worrying-looking X-rays have little pain, and some with mild changes have a lot. The authors concluded that knee X-rays should not be used on their own to judge a person’s knee. Australia’s clinical care standard for knee osteoarthritis goes further. It says the diagnosis can usually be made from your symptoms and an examination, and that imaging is not routinely needed to diagnose it at all. An X-ray is a picture of your knee. It is not a prediction of your future. ## What the guidelines say to try first The Australian Commission on Safety and Quality in Health Care sets out the care a person with knee osteoarthritis should receive in its *Osteoarthritis of the Knee Clinical Care Standard* (2024). The Royal Australian College of General Practitioners guideline for knee and hip osteoarthritis points the same way. Before surgery, they put: 1. 1**Understanding what is going on**Learning what osteoarthritis is, what makes it flare and how to manage it is a core part of care in the standard, not an optional extra. 2. 2**Staying active and exercising**The standard says being active can help manage knee pain and improve function. The RACGP guideline strongly recommends exercise for knee osteoarthritis, including walking and strengthening the muscles around the knee. 3. 3**Support with weight, if it applies to you**The standard says people should be told how body weight affects their symptoms and offered support to manage it, in a way that suits their own priorities. 4. 4**Using pain medicines carefully**Medicines can help some people. The standard advises that opioids should not be offered for knee osteoarthritis, because the risk of harm outweighs the benefit. Your GP can talk through what suits you. 5. 5**Regular review**Checking in on how things are going, and adjusting the plan, is part of the standard too. One thing the standard specifically does not recommend: arthroscopy, sometimes called a knee clean-out. It says arthroscopic procedures should not be offered to treat uncomplicated knee osteoarthritis. ## What happens to people who try exercise first? The clearest answer comes from a Danish trial published in the *New England Journal of Medicine*. It took 100 people with moderate to severe knee osteoarthritis who were all eligible for a knee replacement, and split them into two groups by chance. One group had the replacement followed by rehabilitation. The other had twelve weeks of non-surgical care instead: supervised exercise, education, dietary advice, insoles and pain medication, delivered by physiotherapists and dietitians. In the non-surgical group, 26% had gone on to have the operation by one year and 32% by two years. Put the other way, two in three people who were eligible for surgery were still going without it two years later. It is worth being honest about the rest of the result, because it helps with the decision. On average, the people who had the replacement improved more. They also had more serious complications in the first year: 24 serious adverse events in the surgery group, compared with 6 in the non-surgical group. Both paths helped. Surgery gave bigger gains for the people who went on to need it, with more risk, and the non-surgical path let most people put surgery off. Australian data points the same way. In GLA:D Australia’s national results, about 1 in 2 people who wanted a joint replacement when they started the [GLA:D program](https://www.allforone.com.au/treatment/glad-program/) no longer wanted one, and had not had one, a year later. Those results have no comparison group, so they show what typically happened rather than what will happen for you. ## When is a knee replacement the right call? The clinical care standard is clear on this. A person whose symptoms keep getting worse, and whose daily life is severely limited even after good non-surgical care, should be referred on for further assessment, such as with an orthopaedic surgeon. In plain terms, surgery is worth talking about when the knee keeps getting worse and is seriously restricting what you can do, even though you have given exercise and the other first steps a proper go. At that point your GP can refer you to an orthopaedic surgeon, and a knee replacement is a sensible option to discuss. If you do go on to have surgery, the work you put in beforehand is not wasted. GLA:D Australia notes that people who complete the program before a joint replacement tend to recover faster afterwards. ## A plan you can start this week 1. 1**Keep walking**Walking is one of the exercises the guidelines recommend for knee osteoarthritis. Start with what is comfortable and build slowly. Our guide on [walking with knee and hip arthritis](https://www.allforone.com.au/is-walking-good-for-arthritis/) covers how much, which shoes, and what soreness is normal. 2. 2**Practise standing up from a chair**Sit on a firm chair and stand up without using your hands, then sit back down slowly. Do as many as feel comfortable, a few times a day. It builds the muscles that support the knee, and it is one of the tests physios use to track progress. 3. 3**Use the 24-hour rule**A little discomfort during or after exercise that settles within 24 hours is normal when you start exercising. If it is worse the next day, do a bit less next time rather than stopping altogether. 4. 4**Talk to your GP**About pain relief that suits you, support with weight if it applies, and whether a GP Chronic Condition Management Plan makes sense. Our [guide to using a care plan for physio](https://www.allforone.com.au/how-to-use-a-cdm-plan-for-physio-medicare-guide/) explains how Medicare can help. 5. 5**Get a structured program**Exercise works best when it is set at the right level and progressed. That is what a physio-led program like GLA:D is for. ### See your GP promptly if - The knee is suddenly hot, red and swollen, especially if you feel unwell or have a fever - You cannot put weight on the leg after a fall or injury - The knee keeps locking or giving way - Pain is suddenly much worse, or is waking you every night and getting worse Want to try the first steps properly? GLA:D is a structured education and exercise program for knee and hip osteoarthritis, run by our physios at Yarraville and Hampton East. No referral or X-ray needed. [About the GLA:D program](https://www.allforone.com.au/treatment/glad-program/) ## Common questions ### Do I need a knee replacement if I have bone on bone? Not automatically. An X-ray showing little space in the joint does not decide it on its own, and X-ray findings and pain often do not match. Australian guidelines base the decision on how much your symptoms limit your life after good non-surgical care, not on the X-ray alone. ### How do I know when I need a knee replacement? According to Australia’s clinical care standard, it is time to be referred on for further assessment when your symptoms keep getting worse and your daily life is severely limited, despite a proper go at non-surgical care such as exercise, education and support with weight. Your GP can refer you to an orthopaedic surgeon. ### Can exercise help me avoid a knee replacement? For many people it can avoid or put off surgery. In a trial of people who were already eligible for a knee replacement, two in three of those who did twelve weeks of supervised exercise and education first had not had surgery two years later. In GLA:D Australia’s results, about 1 in 2 people who wanted a joint replacement no longer wanted one a year after starting. ### Is a knee arthroscopy worth trying first? For knee osteoarthritis, no. Australia’s clinical care standard says arthroscopic procedures, sometimes called a knee clean-out, should not be offered to treat uncomplicated knee osteoarthritis. ### Am I too old to start exercising for my knee? No. The average person starting GLA:D in Australia is 66, and people from 18 to 95 have taken part. Every exercise can be made easier or harder, so you start at a level that suits your knee today. ### If I end up having surgery, was the exercise a waste of time? No. GLA:D Australia notes that people who complete the program before a joint replacement tend to recover faster afterwards. ### Keep reading - [Is walking good for knee and hip arthritis?](https://www.allforone.com.au/is-walking-good-for-arthritis/) - [Hip arthritis symptoms: where it hurts and what helps](https://www.allforone.com.au/hip-arthritis-symptoms/) - [Why do my knees hurt going down stairs?](https://www.allforone.com.au/why-do-my-knees-hurt-going-down-stairs/) **General information only.** This article is general information, not advice for your situation. Everyone’s joints and health are different, so talk to your physio, GP or another health professional about your own symptoms before you start or change any treatment. ### Sources - Australian Commission on Safety and Quality in Health Care. [Osteoarthritis of the Knee Clinical Care Standard](https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard) , 2024. - Royal Australian College of General Practitioners. [Guideline for the management of knee and hip osteoarthritis](https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/hip-and-knee-osteoarthritis) , 2nd edition, 2018. - Skou ST and others. [A randomized, controlled trial of total knee replacement](https://www.nejm.org/doi/full/10.1056/NEJMoa1505467) . New England Journal of Medicine, 2015. - Skou ST and others. [Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome](https://pubmed.ncbi.nlm.nih.gov/29723634/) . Osteoarthritis and Cartilage, 2018. - Bedson J, Croft PR. [The discordance between clinical and radiographic knee osteoarthritis](https://pubmed.ncbi.nlm.nih.gov/18764949/) . BMC Musculoskeletal Disorders, 2008. - GLA:D Australia. [Annual Report 2025](https://gladaustralia.com.au/wp-content/uploads/2026/07/GLAD-Annual-Report-2025.pdf) .