When is it time for a knee or hip replacement?
Joint replacement is generally considered when pain and loss of function are severe and have not improved despite proper non-surgical treatment. If you are trying to work out whether you have reached that point, the next step is a conversation with your GP/specialist.
How joint pain can slowly reshape your quality of life
For many people with persistent hip or knee pain, it’s something that’s become slowly absorbed into daily life. You might find yourself walking the dog on a shorter loop. You’d rather wait a little longer for the lift than tackle the stairs. You choose the cafe with the higher chairs, because getting out of a low one has become a production. By the time you have made enough of those small adjustments, it can be genuinely difficult to tell whether you are managing well or simply managing less.
The good news is that there is a national standard that sets out what good care looks like for knee osteoarthritis, and it is written for patients as much as for clinicians. It notes that nine out of ten people with the condition can manage without joint replacement surgery.
What the national standard says
The Australian Commission on Safety and Quality in Health Care publishes the Osteoarthritis of the Knee Clinical Care Standard. It contains eight quality statements describing the care you should expect if you have knee pain and suspected osteoarthritis. (There is no equivalent national standard for hips, so where a point below applies only to knees, we have said so.)
On surgery, the standard is direct. A patient with knee osteoarthritis who has severe functional impairment despite optimal non-surgical management is considered for timely joint replacement surgery, or for joint-conserving surgery such as an osteotomy, which realigns the knee to take pressure off the damaged area. This applies to around 10% of people with knee osteoarthritis.
For the rest, the standard sets out ways to manage without needing joint replacement surgery.
What optimal non-surgical management actually involves
Physical activity and exercise: Being active can reduce knee pain, strengthen the muscles around the joint and improve mobility and balance. Your healthcare provider or clinician can help you with a program of exercises that are achievable. Advice should be tailored to what you can do and what you want to get back to, and you may be referred to a physiotherapist, an exercise physiologist, or a specific program.
Weight and nutrition: Losing weight can help to reduce knee pain for people carrying excess weight, and may delay surgery or avoid it altogether. Support may include a referral to a dietitian or a weight management program, or in some cases the prescription of weight loss medications.
Medicines: Pain and mobility medicines should follow current evidence-based guidelines. The standard says opioids are not offered for knee osteoarthritis, because the risk of harm outweighs the benefit.
A plan, and planned review: You should have a self-management plan you helped build, and check-ups at agreed intervals where treatment is adjusted as things change. That review is the mechanism by which a change in your knee gets noticed.
Some health funds run structured programs of this kind. Medibank, for instance, offers Better Knee, Better Me to eligible members with painful knee osteoarthritis, described as designed to reduce knee pain, improve quality of life and lower the chances of needing joint replacement surgery. It is worth asking your own fund what they have.
Why you may not need a scan to be diagnosed
Where a proper clinical assessment has been done, imaging may not be required to confirm the diagnosis. Your history, your symptoms, and a physical examination are enough for most people.
There are times when imaging is warranted, such as unusual symptoms or signs pointing to a different diagnosis, and X-ray is the preferred first test in those cases. If you are diagnosed and considering surgery, X-rays or other scans may be needed at that point.
When it is worth going back to your GP
The Osteoarthritis of the Knee Clinical Care Standard says that a patient with worsening symptoms and severe functional impairment that persists despite optimal non-surgical management is referred for assessment to a specialist or a multidisciplinary service. Most often that is a rheumatologist, an orthopaedic surgeon, or a sport and exercise physician.
These specialists are likely to ask you about:
- Pain that’s there when you are resting, or that wakes you at night.
- Function that’s gone backwards even though you have been doing the exercise and taking the treatment.
- Activities you have stopped doing and would like back.
- Aids you didn’t need a year ago: a stick, a support rail, a helping hand to stand up.
- The effect on your sleep and your mood.
If some of that describes where you are, it may be worth another conversation with your GP. That conversation is not a decision about surgery. It is a review of whether your current treatment is doing its job, and whether a specialist assessment would help.
How long does a joint replacement last?
A systematic review published in The Lancet in 2019 pooled data from national joint replacement registries, including Australia’s, and estimated that around 82% of total knee replacements are still in place 25 years after surgery.
A much larger study published in The Lancet in February 2026, drawing on eight national joint registries and close to two million hip replacement operations, reported an estimated survival of around 92% at 30 years, based on modern implant materials now in use.
What happens if you are referred
Seeing a specialist is not a commitment to having surgery. The appointment is an assessment. They will take a history, examine the joint, arrange imaging if it is needed at that stage, and talk through what is available, which may include joint-conserving surgery rather than a replacement.
The standard says you should receive comprehensive information about the procedure and the outcomes you can expect, so that you can make the decision. If you decide not to proceed, or to wait, you can go back to your GP and carry on with non-surgical management.
If you do go ahead
Where the operation happens is one of the choices you are part of, and cost is a fair thing to ask about early rather than late. Ask your specialist which hospitals they operate at and what you would pay at each.
At Adeney Private Hospital in Kew, Medibank and Bupa members with eligible hospital cover are not charged anything extra at the point of care for surgeon and surgical assistant fees, anaesthetist fees, perioperative physician fees, onsite radiology, inpatient pathology and inpatient pharmacy. An excess or co-payment may still apply depending on your level of cover, and some exclusions apply. There is a fuller explanation in our Zero out-of-pocket, explained blog.
Common questions
How do I know if I need a knee or hip replacement?
Australia’s clinical care standard for knee osteoarthritis describes surgery as something considered when there is severe functional impairment that persists despite optimal non-surgical management. If your pain and function have gone backwards despite doing the exercise and the other treatment, that is the point to go back to your GP and ask whether a specialist assessment would help.
What counts as optimal non-surgical management?
Tailored exercise and physical activity, support with weight and nutrition where that is relevant, pain medicines in line with current guidelines, and a self-management plan with planned reviews. If you have had none of that, or only part of it, it is reasonable to ask your GP what a full course would look like for you.
Do I need an MRI to diagnose knee osteoarthritis?
Generally, no. The standard says imaging is not routinely used to diagnose knee osteoarthritis and that MRI, CT and ultrasound are not appropriate investigations for it. Where imaging is clinically warranted, X-ray is first-line.
What is the best age for a hip or knee replacement?
There is no set age. The national standard describes the trigger as severe functional impairment despite optimal non-surgical management.
How long does a knee or hip replacement last?
Most are never replaced. For knees, a systematic review published in The Lancet in 2019 pooled national joint registry data, including the Australian registry, and estimated that around 82% of total knee replacements were still in place 25 years after surgery. For hips, a 2026 study in the same journal looked at eight national registries and close to two million operations, using only the implant materials fitted today, and estimated around 92% at 30 years.
Is arthroscopy useful for knee osteoarthritis?
The standard says arthroscopic procedures are not offered to treat uncomplicated knee osteoarthritis, because there is no evidence they help. Arthroscopy is still used for other knee conditions, such as repairing cartilage or menisci, reconstructing the anterior cruciate ligament (ACL), and treating patellar issues.
Do I need a referral to see an orthopaedic surgeon?
You need one for Medicare to pay a rebate on the consultation. You can see a specialist without a referral, but you would pay the full fee yourself. Our article on how to get referred to a private hospital in Melbourne covers how referrals work.
Does seeing a surgeon mean I will end up having surgery?
No. The consultation is an assessment. Some people are advised to keep going with non-surgical management, some are offered joint-conserving surgery rather than a replacement, and some decide to wait. The decision is yours to make with the information the specialist gives you.
Sources
Australian Commission on Safety and Quality in Health Care, Osteoarthritis of the Knee Clinical Care Standard (2024) and the accompanying consumer guide. safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard
Australian Institute of Health and Welfare, Chronic musculoskeletal conditions: Osteoarthritis. aihw.gov.au/reports/musculoskeletal-conditions/osteoarthritis
Australian Orthopaedic Association National Joint Replacement Registry, Annual Reports. aoanjrr.sahmri.com
Medibank, Better Knee, Better Me. medibank.com.au/health-support/health-services/better-knee-better-me
Services Australia, Referrals for specialist treatment. servicesaustralia.gov.au/referrals-for-specialist-treatment
Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02305-0/abstract
How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext
Figures cited accessed September 2026. Last updated: September 2026
