Should I have physio or knee surgery for arthritis?
NICE requires that all people with knee OA are offered a structured exercise and physio programme first — surgery (partial or total knee replacement) is a last-resort option when pain and function haven't improved despite consistent physio, weight management, and pain relief. Around 100,000 knee replacements are done in the UK each year, and outcomes are best for those who've maintained muscle strength through physio beforehand.
Last updated 2026-07-04. This is general information, not a substitute for personalised medical advice.
Frequently asked questions
When would you pick Physiotherapy-led exercise programme?
First-line for everyone with knee OA; before considering surgery; for maintenance long-term.
When would you pick Knee replacement surgery?
Severe daily pain despite 12+ weeks of physio; night pain that disturbs sleep; imaging shows advanced bone-on-bone changes.
What should I be careful about?
Even after surgery, physiotherapy is essential for recovery — muscle strength before surgery predicts recovery speed.