I've been doing fine so far without a knee replacement

Photo of a man walking with a dog

Rick, 58 years old

“When I was in my mid-40s, a senior physician said I ought to start thinking about a knee replacement in the long term. But that I should wait as long as possible.”

I first started having problems with my knee very early in life, when I was about 20. I used to play a lot of volleyball. I never had any severe injuries or accidents. But still my knee hurt, made grinding noises and swelled up time and again, probably due to constantly being put under a lot of strain. It was a real hindrance, not only when doing sports.

Knee problems seem to be a family thing. My father has had two knee replacements. My aunt and uncle also have knee problems.

Lots of doctors and lots of operations, but not much success

My sports club sent me to all sorts of doctors to find out what was causing my knee problems. I was given injections into my knee and had several minimally invasive arthroscopies. The cartilage was smoothed out and a bursa [note from editor: a small fluid-filled cushion between the joint and the tendons] was removed.

I was initially able to go back to training and playing volleyball again after the operations. But that didn't last long. My knee kept on swelling up and it hurt. I suspect that those operations were not actually that good for my knee. Either way, they only gave me short-term relief.

When I was in my mid-40s, a senior physician said I ought to start thinking about a knee replacement in the long term. But that I should wait as long as possible. If I had had a knee replacement at such a relatively young age, it is very likely that it would need to be replaced again when I was older.

A lot of problems at first after cartilage transplant

He recommended a cartilage transplant in the meantime. I was open to that. It seemed like a plausible solution and I wanted to give it a go. They took cartilage from my body and cloned it in a lab for the transplant. It was then put into my knee a few weeks later. My knee was extremely painful right after that operation. There was no way I could have put any strain on it. But it did slowly start to get better after rehabilitation, muscle training and gradually increasing strain.

That was about twelve years ago, and I am managing well now. I can go running and even dancing again!

My knee swells up if I overdo it. If I stick to my limits, though, everything is brilliant.

I only rarely take painkillers. I don’t want to completely block out the pain, so that I know when I am putting too much strain on my knee.

Building up muscles before and after the operation was important to me

I heard that strong muscles help to speed up the recovery. That's why I worked together with my before and right after the cartilage transplantation to put strain on my knee, training my thigh muscles as well to build them up.

It is often difficult to follow the doctors’ advice to take regular exercise, build up muscles and stabilize the knee. You have to know your limits. Overstraining your knee, perhaps without even noticing, can often cause it to swell up. And then you have to take a break from training again.

I found it very difficult to manage that on my own and gradually increasing the strain didn't work out very well. I am an athlete and often overdid it. I needed support from my .

After the operation, I was prescribed a three-month outpatient rehabilitation program where I could train my knee in a targeted way with support.

A lack of willpower and doing exercises at home

I was very disciplined at first, but I don't do any of the special knee exercises anymore. I often don’t have the necessary willpower. The discipline and obligation that comes with group training was slightly lacking. I often find it easier to stick to things when I'm in a group than when I'm on my own at home. But I do a lot of daily exercise. I go for walks, do Nordic walking and go cycling, sometimes on my exercise bike at home.

It is very important to keep exercising my knee. That works best for me outdoors, in the fresh air, with the right level of exertion. Lots of exercise without too much strain. I also find regular, shorter exercises better than two hours once a week. Ten minutes in the morning and ten minutes in the evening every day. That’s perfect for me.

If my knee swells up, I just do less and elevate my leg. If I know in advance that it's going to be a tough day, I'll wear a bandage to support my knee.

A knee replacement is a future option

I can entertain the idea of a knee replacement in the future – if it's necessary. As long as I can put up with the relatively bearable symptoms, I'll leave things as they are.

I'd definitely seek a second opinion before that kind of surgery, from independent knee specialists. I did that before the cartilage transplantation as well. Lots of doctors do surgery, but there are centers and clinics with a lot of experience, too. It's also important to find the right time for your operation, and the right doctor. A trusting patient-doctor relationship is now essential for me when making that kind of decision.


Our real-life stories summarize interviews with people who are affected by the medical condition. Our interview partners have given us permission to publish their stories. We would like to express our sincere thanks to them.

The real-life stories give an insight into how other people cope and live with a medical condition. Their opinions and comments are not recommendations by IQWiG.

Please note: The names of our interview partners have been changed to protect their identity. The photos are of models.

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Created on January 17, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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