Before You Consider Knee Surgery – Read This

Arthroscopic knee surgery is one of the most commonly performed orthopedic procedures in the United States, and total knee replacement isn’t far behind. Both procedures are frequently recommended for people suffering from knee pain, especially when imaging shows arthritis, meniscus tears, or other degenerative changes inside the joint.

But here’s what many people don’t realize – the presence of those findings doesn’t automatically mean surgery is necessary. In fact, research over the past two decades has repeatedly shown that many knee surgeries are performed on people who could have improved with conservative treatment like physical therapy and movement-based care.

For people dealing with chronic knee pain in Portsmouth, NH and throughout the Seacoast, understanding your options before committing to surgery is critical.

The Truth About Arthroscopic Knee Surgery

Let’s start with arthroscopic knee surgery.

Arthroscopy is considered minimally invasive. A small camera is inserted into the joint and the surgeon may trim damaged meniscus tissue or “clean up” arthritic debris. Because the incisions are small and recovery is relatively quick, it’s often presented as a simple solution for knee pain.

But research tells a more complicated story.

A landmark study published in the New England Journal of Medicine by Dr. JB Moseley and colleagues compared arthroscopic surgery to placebo surgery in patients with advanced knee arthritis. Some patients received the full procedure – while others only received small incisions without any surgical repair.

The results were surprising. Patients who received the placebo surgery improved just as much as those who had the real operation.

Since that study, numerous others have confirmed similar findings, suggesting that for many cases of degenerative knee pain and arthritis, arthroscopic surgery provides little additional benefit over conservative care like targeted physical therapy, strengthening, and mobility work.

That doesn’t mean arthroscopic surgery never helps. It simply means it’s often used in situations where other treatments could be just as effective.

In some cases, undergoing surgery when it isn’t truly necessary can even accelerate problems inside the knee joint – increasing your likelihood of needing a total knee replacement later on. Ironically, many people choose arthroscopic surgery in hopes of avoiding that major procedure down the road.

When Is Total Knee Replacement Necessary?

Which brings us to total knee replacement surgery – another procedure that has become increasingly common and, in many cases, more avoidable than you might think.

Unlike arthroscopy, knee replacement is a major operation. The damaged joint surfaces are removed and replaced with artificial components designed to restore function and reduce pain.

When performed on the right candidate, knee replacement can be very successful. About 90 percent of patients experience significant improvement, and many implants last 20 years or longer.

However, that doesn’t mean everyone with knee arthritis or chronic knee pain needs one.

Why MRI and X-Ray Findings Can Be Misleading

One of the biggest misconceptions about knee pain is that arthritis on an X-ray automatically explains the symptoms.

What’s not a misconception, however, is that joint degeneration is incredibly common as we age.

Studies show that only about 15 percent of people with evidence of knee osteoarthritis actually experience symptoms. The other 85 percent walk around completely pain free despite having the same findings on imaging.

MRI studies reveal similar patterns.

In one well-known study published in 2012, researchers performed MRI scans on more than 500 people who had no knee pain at all. Seventy-two percent showed signs of arthritis and roughly one quarter had meniscus tears.

In other words – structural changes inside the knee are far more normal than most people realize.

This is why basing a treatment decision solely on imaging can be misleading.

Sometimes Knee Pain Isn’t Actually Coming From the Knee

Over my two decades of treating patients with knee pain, the biggest problems I’ve seen after surgery rarely had anything to do with the procedure itself.

Instead, the issue was an incorrect diagnosis before surgery.

Sometimes the knee wasn’t actually the primary source of pain.

Knee pain can originate from the hip, ankle, or even the lower back. Research has shown that a surprising percentage of people with isolated knee pain actually respond to treatment directed at their spine.

That means someone could have arthritis in their knee and still have their symptoms driven by a problem elsewhere.

If that underlying cause isn’t identified first – surgery may be unnecessary, and it certainly won’t solve your problem.

3 Things to Consider Before Knee Surgery

Before considering any type of knee surgery – whether arthroscopic or a full replacement – there are several important things to evaluate.

1. The severity of your pain

If your discomfort is manageable and you can still participate in most of the activities you enjoy, rushing into surgery may not make sense.

Even successful knee replacements involve risks such as infection, blood clots, or complications related to anesthesia. Full recovery can take six to twelve months.

2. Whether your spine could be involved

If your knee pain fluctuates, appears suddenly, or occurs alongside back discomfort, it is worth having your spine evaluated by someone trained in diagnosing mechanical pain patterns.

In many cases, addressing the spinal issue resolves the knee pain without any treatment directed at the knee itself.

3. How stiff your knee actually is

With truly advanced arthritis, stiffness tends to be constant and progressive.

But if your knee mobility improves with movement, stretching, or specific exercises, the limitation may be mechanical rather than structural.

When that happens, restoring the right movement patterns can dramatically improve symptoms without surgery.

The Bottom Line: Surgery Should Be a Last Resort

To be clear – knee surgery is not always avoidable. For some patients, particularly those with severe arthritis and significant functional limitations, knee replacement can be life changing.

But surgery should almost always be considered a last resort, not the first step.

Before going down that road, it’s essential to make sure your knee pain has been accurately diagnosed and that you have explored all appropriate conservative treatment options.

Arthroscopic surgery and knee replacement may be among the most commonly performed orthopedic procedures in the country, but that does not mean they are always the right solution.

In many cases, the right diagnosis and treatment approach can restore knee function and eliminate pain without ever needing surgery.

Knee Pain Treatment in Portsmouth, NH

Dr. Carrie Jose is a Physical Therapy Specialist and Mechanical Knee Pain expert. She is the owner of CJ Physical Therapy & Pilates in Portsmouth, NH, where she helps people across the Seacoast of New Hampshire overcome chronic knee pain and avoid unnecessary surgery through specialized movement-based treatment.

She also hosts educational workshops and classes for people struggling with knee arthritis, meniscus injuries, and persistent knee pain.

To get a free copy of her Guide to Knee Pain or learn about the next Knee Pain Masterclass in Portsmouth, visit cjphysicaltherapy.com or call 603-380-7902.

Ski Season in New Hampshire Isn’t Over: How to Prevent Knee Pain on the Slopes

Ski season in New Hampshire isn’t over yet – and if your knees are already starting to “talk” to you after a day on the mountain, it’s time to pay attention.

Whether you’re skiing in the White Mountains or making weekend trips north from Portsmouth, NH, your knees take on significant stress with every turn, carve, and correction on uneven terrain.

Skiing is one of the most knee-intensive recreational sports. Add speed, rotation, moguls, and the occasional fall – and your knee joint works overtime.

The good news?

Most ski-related knee pain is mechanical. And mechanical knee pain is often predictable – and preventable.

At our Portsmouth, NH physical therapy clinic, we help active adults stay strong on the slopes by focusing on two essentials: mobility and stability.

Why Knee Pain Happens While Skiing

Your knees need two key things to stay healthy during ski season:

Mobility – the ability to fully bend and straighten to absorb force
Stability – the ability to control rotation and handle load without collapsing inward

When one (or both) is missing, your knee becomes vulnerable to irritation, swelling, or injury.

If you’re experiencing knee pain after skiing in New Hampshire, one of these factors is likely contributing.

1. Don’t Skip Your Warm-Up Before Hitting the Slopes

If you’ve driven an hour or more from Portsmouth to the mountains, your knees have likely been compressed in a bent position the entire time.

Prolonged sitting increases stiffness and pressure in the front of the knee – especially for adults over 40.

Then what happens?

You step out of the car, click into your skis, and immediately head downhill.

That’s a massive transition for your joints.

Instead, spend 5-10 minutes warming up your knees, hips, and ankles before your first run:

Bodyweight squats
Controlled lunges
Gentle hip mobility drills
Ankle mobility work

Your first run should never be your warm-up. Preparing your joints ahead of time improves blood flow, activation, and control – all of which help your knees better tolerate the demands of the day.

2. Build Strength Where Your Knee Needs Support

Your knee does not function in isolation. It relies heavily on the muscles above and below it for protection and control.

Strong quadriceps and hamstrings provide balanced stability to the joint, while strong glutes and a stable core help maintain proper alignment, manage rotation, and prevent the knee from collapsing inward.

When these muscles are weak or not functioning well – your knees are forced to absorb stress they were never meant to handle on their own.

If you want to ski confidently into your 50s, 60s, and beyond, lower body and core strength training are not optional – they are foundational.

Strong, well-coordinated muscles reduce unnecessary strain on your joints and improve both performance and longevity on the slopes.

3. Maintain Full Knee Mobility

Mobility is just as important as strength.

Your knees must be able to fully bend and fully straighten in order to function properly. Any loss of extension or flexion – even minor – compromises the surrounding ligaments and joint structures, forcing them to work harder than they were designed to.

These subtle mobility restrictions become even more apparent under the higher demands of skiing.

If your knee already feels stiff during everyday activities – it will not magically improve once you are on the mountain. In fact, the added stress often exposes underlying limitations.

A consistent mobility routine – particularly one that restores full knee extension – can significantly reduce strain and allow your knee to adapt more effectively to the dynamic demands of skiing.

4. Address Mechanical Knee Pain Early

Approximately 80 percent of knee pain is mechanical in nature, meaning it is driven by how the joint is moving – or not moving – rather than simply wear and tear.

The good news is that mechanical pain responds extremely well to specific corrective movements designed to address the root cause of the problem.

Once the correct movement is identified – it can act like medicine for your knee. Completely natural and highly effective.

The right prescriptive movement will reduce pain quickly, improve motion, and restore confidence in your knee again. It also gives you a tool you can use on your own – so you don’t have to rely on anti-inflammatory medications just to get through the rest of ski season.

If your knee swells after skiing, catches with certain movements, or flares up after a long day on the mountain – it may very well be the result of a mechanical dysfunction.

Small mechanical issues rarely remain small when repetitive stress – like skiing – continues. Addressing them early can prevent more significant problems down the line.

For this, it is important to consult with a specialist trained in mechanical knee pain. Identifying the correct prescriptive movement is key. When done properly – it is the difference between managing symptoms and truly correcting the underlying issue.

Finish Ski Season Strong in Portsmouth, NH

Skiing should feel powerful and controlled – not unstable or uncertain.

Most injuries do not occur because people are too active. They occur because the joint was underprepared for the demand placed upon it.

If you are experiencing knee pain after skiing and live in Portsmouth, NH or the Seacoast area, the specialists at CJ Physical Therapy & Pilates can help.

Led by Dr. Carrie Jose, our team specializes in mechanical knee pain treatment and helping active adults return to skiing with confidence – without relying on injections or surgery.

To request a Free Discovery Visit or receive a free copy of our guide to managing knee pain, visit cjphysicaltherapy.com or call 603-380-7902.

Ski season isn’t over yet. There is still time to protect your knees, ski strong, and finish the season with confidence.

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Before You Consider Knee Surgery: Read This