Prepare in advance if you need new knee

By Howard LeWine, M.D.
Posted on July 26, 2024

Q: I have knee osteoarthritis that will eventually require knee replacement surgery, perhaps in the next 12 to 18 months. What steps can I take now to prepare for it and perhaps delay it even longer?

A: It’s great you are thinking about this well in advance. Here are some suggestions.

Consider pain-reducing options. A few things may enable you to go a little longer without a knee replacement.

For example, getting occasional injections of a corticosteroid (to reduce inflammation) or hyaluronic acid (to supplement fluid that naturally lubricates the joints).

These temporary fixes may reduce pain enough so that you can strengthen your leg muscles, which helps absorb pressure you place on the knee.

Wearing a medial unloader brace might also help if arthritis damage is on the inside of the knee.

Modify activities that aggravate knee pain. Some activities are harder on the knees than others.

If you’re a runner, you might need to switch to walking or using an elliptical machine for aerobic exercise. If going up and down stairs is painful, try taking them one at a time.

Lose weight if necessary. Every pound of your body weight places 4 to 6 pounds of pressure on the knee. That means losing just 5 pounds can take 20 to 30 pounds of pressure off the joint.

But weight loss (if you need it) isn’t easy, and it won’t last if you try a crash diet. Instead, aim for gradual weight loss with exercise and a healthy diet. Start by getting rid of processed and sugary foods.

Exercise more. Among its many health benefits, exercise plays an important role in weight loss and weight control.

But knee arthritis can make exercising painful. One workaround is to modify your preferred activities, as mentioned earlier.

Consider exercising in a pool. You’re buoyant in the water, so your knees don’t take a pounding. And the pressure of the water may help reduce knee swelling.

Seek physical therapy. Physical therapists can tailor a program of cardio exercise, stretching and strengthening to meet your specific needs.

They can also do some manual therapy on the knee to help it move better. And when it is time for a knee replacement, you’ll want to be as strong and flexible as possible.

Get underlying health conditions under control. This is important for your overall health, and it also helps prepare you to undergo anesthesia safely.

Stabilizing underlying conditions can take time — but time is something you have if you’re expecting a knee replacement within the next couple of years.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit health.harvard.edu.