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When to consider hip or knee replacement: the signs orthopaedic surgeons look for, what can be tried before surgery, and why the decision is made together with your physician.
How the decision is made
There is no single X-ray or test that says “it is time”. The orthopaedic surgeon weighs pain, limitations in daily life, the X-ray and whether conservative treatment still helps. Joint replacement is one of the most successful operations in orthopaedics: registry data show that most implants last 20–25 years or longer.
Signs that it is worth discussing joint replacement
- Pain at rest and at night that wakes you up.
- X-ray: the joint space has almost disappeared (Kellgren–Lawrence grade IV). The image alone does not decide — what matters is how you live with the joint.
- Movement is so limited that putting on socks, sitting on a low chair or climbing stairs is difficult.
- Increasing leg deformity (bow-legs or knock-knees).
- Painkillers no longer help or cannot be taken because of the stomach, kidneys or heart.
- Walking distance has shrunk to a few hundred metres.
- You give up everyday activities — shopping, walks, trips.
- The joint gives way or feels unstable.
- Avascular necrosis of the femoral head with collapse of the joint surface (see avascular necrosis).
What can be tried before surgery
Weight loss, regular exercise therapy, a walking stick and painkillers as prescribed. A corticosteroid injection relieves a flare-up for a few weeks. Hyaluronic acid and PRP give a moderate and variable effect in knee osteoarthritis. Cell-based methods (bone marrow concentrate, microfragmented fat) are being studied: in some patients at early stages they reduce pain, but they do not restore cartilage. Younger patients with leg deformity are sometimes offered a corrective osteotomy.
Age and timing
There is no lower age limit. Younger patients are more likely to need a revision during their lifetime, so the decision is weighed more carefully. But postponing surgery for severe osteoarthritis just to “keep your own joint” is not always wise: months of inactivity weaken the muscles and make recovery harder.
How we help
Send your X-ray or MRI and describe your symptoms. We forward your request to several clinics: physicians assess whether surgery is needed now or other options are worth trying, and quote their own conditions and price. Knee replacement · hip osteoarthritis.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.
- Skou ST et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med, 2015.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised · Contact a coordinator
Frequently asked questions
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request
