The decision for surgery should be made by the patient in conjunction with the orthopaedic surgeon. In the vast majority of cases, the decision should be made by the patient, only rarely should an orthopaedic surgeon persuade a patient to consider a knee replacement sooner rather than later (e.g. concerns that the ball or the socket are wearing out, which would mean that the surgical technique becomes significantly more difficult and this may result in a less successful outcome). Most patients deciding on surgery will be having pain on a daily basis. There is often a constant underlying baseline ache, which is made worse by certain movements, activities or positions (e.g. going for a walk, getting in and out of a car or trying to put on shoes and socks).

In the first instance, simple pain relief such as Panadol may help with these symptoms. Often patients who are able to take anti-inflammatory medication will find good relief of their symptoms and sometimes stronger painkillers, which are prescribed by a medical professional, will be required as the knee pain worsens. Quite often, the pain will get worse at night and may even keep people awake, or wake people up from sleep. Physiotherapy and various activities and movements, such as swimming, may also be beneficial to the joint and may help relieve some of the pain and stiffness. The stiffness typically makes it difficult to sit in a low chair, put on shoes and socks and paint or clip toenails / wash between the toes. Whilst painkillers and anti-inflammatory medication, exercise modification and walking aids, e.g. walking stick may help the symptoms, they will not cure the diseased knee.

The knee will slowly deteriorate and it is at this point when non-operative measures have been tried and exhausted, most orthopaedic surgeons would recommend the consideration of joint replacement.