How to Avoid a Knee Replacement

Updated Feb. 2024

Knee replacements are the most common orthopedic surgery.

Over a million are performed each year in the United States alone. (source)

Last year, research revealed 10% of people were disappointed following their knee replacements. (source)

That means over 100,000 people in the US are dissatisfied annually.

According to a 2023 article in The Journal of Arthroplasty, "Postoperatively, most dissatisfaction was due to complications, unmet expectations, persistent pain, and stiffness." (source)

Those younger than 65 years old were even more likely to make these complaints.

Are knee replacements the answer for everyone with knee pain?

Very unlikely.

And not everyone wants a knee replacement.

Many of my clients have avoided this surgery.

Roughly seven years ago, a couple reached out to me.

She found me while searching the internet for supportive options for her husband.

And he was very limited by knee pain.

During a zero-cost online Strategy Session, I learned that he was 57 years old and was becoming more and more limited by his left knee pain.

An MRI taken 10 months earlier showed multiple problems:

When he was 50 years old-- following a surgery to trim a torn meniscus-- he had stopped running.

When he was 55 years old, he was walking 3 miles a day.

X-rays taken a year after that revealed "advanced arthritis of the medial compartment."

During a vacation in New Zealand, three months earlier, he felt very limited by how much sight-seeing he could do.

And now he was having discomfort after walking down long hallways.

He could sit comfortably for a few minutes, but if he sat for longer periods of time, his knee would be stiff when he stood up.

He recognized that his knees were getting progressively worse.

Because we lived roughly 1,000 miles apart-- and at that time, it was less common to work remotely-- he was hesitant about working with me via online video sessions.

But within a few months, both of his knees began hurting, even after two cortisone injections.

He contacted me concerned that his knees were "too far gone to save," but also wanting to do something other than surgery.

When we began working together, riding his bike for 30 minutes in his hilly neighborhood felt fine while he was cycling.

But by that evening, he would be "hobbling" around due to the delayed knee pain.

I measured something called Squat Load Tolerance.

Squat Load Tolerance is the amount of pressure his knee could handle-- without any pain-- while squatting.

This measurement helps me prescribe the right exercises and activities to build stronger, healthier knees.

Initially, he could squat pain-free with his right leg using only 34% of his bodyweight, where 100% is optimal.

On his left leg he could only squat pain-free using 28% of his bodyweight.

(Both knees would need to measure at least 50% to prevent problems when sitting down or rising from a chair.)

Three months later, his Squat Load Tolerance for each knee was 60% of his bodyweight.

Per my recommendations, he continued to gradually increase the difficulty of exercises.

And here is the email he sent me several months after we worked together:

Hi, Laurie, I wanted to thank you again for how much you helped me. I have continued to do most of the exercises either 5 or 6 days a week. I have had significant strength increases in my knees. I can't thank you enough!!

Here is a testimonial that you can feel free to use:

"In 2018, I was scheduled for knee replacement surgery on my left knee. My wife found Laurie on the internet and convinced me hold off and try her out first. We did this long distance via a webcam...

It is 18 months later now and I have had no surgeries and I have full strength in my left knee. I am amazed and will be forever grateful for her help. She has my highest endorsement."

Another Success Story:

[ read time ~ 7 minutes ]

“My orthopedic surgeon took only five minutes to tell me I needed to replace both knees. He didn't even explain what other options I could try… He just said, ‘come back and see me when you can not stand the pain any longer,’” Keith* explained.

In someone with strong, healthy knees, the end of the bones are covered with a layer of cartilage. Cartilage is a substance that protects the bones and provides a smooth surface for motion to occur.

When someone is told they need a knee replacement, their X-rays typically reveal significant arthritis, which means their cartilage is not as thick and strong as it once was. Frequently the degeneration inside their knee is considered grade 4, on a scale where grade 1 is mild and grade 4 is severe.

Sometimes people facing a knee replacement have been told their X-rays indicate their knee is “bone-on-bone.” This means that, at best, there’s very little cartilage remaining.

When I talk with people in these situations, I am very clear about what to expect.

It’s unlikely their X-rays will change dramatically.

And it can be difficult to predict how much improvement they’ll be able to make-- even if they carefully follow the personalized plan that I design for them.

Access the free guide to Save Your Knees.

When I explained this to Keith*, he was not deterred.

He wanted to work with me, and he assured me that any improvement was worth it to him.

Most of all, he wanted to avoid knee replacement surgery.

Keith acquired a Variable Incline Plane, a Gray Cook Band, and some household items before we began meeting. Since he lived in Australia, Keith typically scheduled his online video sessions early on Saturday mornings (which corresponded with mid-afternoon on my Fridays).

Perhaps the most critical part of his initial assessment was identifying his Squat Load Tolerance for each leg. (Squat Load Tolerance is the percentage of body weight that someone can squat five times with good control of the movement and without pain.)

Keith’s right leg tolerated 23% of his body weight; if he tried to squat with any more weight than that, it caused right knee pain. The Squat Load Tolerance for his left leg was also 23% body weight.

In an effort to increase his Squat Load Tolerance-- so he could enjoy a more active life with less knee pain and ultimately avoid knee replacements-- Keith needed to do two things:

(1) temporarily limit activities that required him to use more than 23% body weight through each leg, and

(2) perform exercises that would strengthen his joint surface.

Keith had a morning Qigong practice. He continued this practice, but he limited how much he bent his knees as he stepped onto each leg. He also avoided taking the stairs and walking more than was absolutely necessary.

In addition to these daily adjustments, Keith performed an isometric Quadriceps exercise several times a day. (Research supports that this exercise thickens the fluid inside knee joints. And thicker fluid provides more shock absorption and better protection for the cartilage.)

He also completed gentle knee motion periodically during the day. He sat down and placed his foot on a skateboard to assist him in achieving this motion. (Some of my clients use a furniture mover instead of a skateboard.)

During the week following his initial online video session, Keith meticulously kept track of these exercises on a chart I provided:

Ten days later, his left knee Squat Load Tolerance had increased to 28% body weight. And his right Squat Load Tolerance remained at 23% body weight. I added some additional exercises, and sent Keith updated charts to continue to track his exercises.

Within 6 weeks, both knees had improved to 36% body weight. This wasn’t rapid improvement, but Keith’s knees were definitely getting stronger and more resilient.

The isometric Quad exercise continued to be a cornerstone of his daily routine. And in addition to the skateboard exercise, Keith’s gentle knee motion included using his Variable Incline Plane-- positioned at a relatively low angle-- to perform squats with less than a third of his body weight.

I prescribed exercises that strengthened Keith’s knee joint, as well as his hip and core muscles. I divided these exercises into two separate routines that he performed a total of three times per week. One group of exercises included the Plank Sliders and using his Variable Incline Plane to squat on each leg at a specified level.

After working together for 3 months, Keith’s right Squat Load Tolerance was 56%, and his left was 43%. He was pleased with how his knees were feeling and had no plans to schedule surgery. He understood what exercises he needed to continue to maintain his improvements.

Seventeen months later, I contacted Keith. He had just returned from a cruise in Japan, where he walked roughly seven kilometers each day without knee pain.

Keith’s opinion of his knees is very positive; however, his knees are not perfect. When he walks down stairs, he has some knee pain-- not as bad as it was before we worked together, but it is still noticeable.

He admitted that he had been “a bit erratic lately” about performing the exercise program that I designed for him. But he quickly added he was “getting back into the routine.”

Keith was initially told the only option to address his knee pain was knee replacement surgery. But instead, he learned how much of his body weight that his knees tolerated, temporarily avoided activities that overloaded his knees, and performed exercises that increased the strength and resiliency of his knee joints.

He was able to resume his Qigong practice and walking longer distances without knee pain-- provided that he continued performing his joint conditioning exercises.

Keith’s story reveals the commitment and perseverance necessary to avoid knee replacements.

*pseudonym

Access the free guide to Save Your Knees.

Click here.

For more information on safely strengthening your knees, read How to Grow Strong Knee Joints and Can You Rebuild Knee Cartilage?

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