Ask the Doctor, December 2022

Michael Duch, MD

When is it time for a knee replacement?

Whether it’s in the knee or hip, severe joint pain may mean you have a decision to make.

You’ve had the X-rays and your doctor says that your knee or hip is in bad shape. The doctor says you’re a candidate for joint replacement surgery. But is surgery the best answer for you?

“Ultimately, joint replacement surgery is a personal decision,” says Michael R. Duch, MD, orthopedic surgeon in the Orthopedic and Spine Institute (OSI) at Robert Wood Johnson University Hospital Hamilton (RWJUH Hamilton). “Orthopedic surgeons can help to make the diagnosis, but in the end the patient needs to decide what the best solution is for them.”

A Rising Trend

Joint replacement surgery removes a damaged or diseased joint and replaces it with a combination of plastic, metal and/or ceramic parts that replicate the movements of a healthy joint. Sometimes the whole joint is replaced, and sometimes only the damaged parts are replaced. More than 1 million total joint arthroplasties (reconstructions or replacements) are done in the United States each year, according to the American Joint Replacement Registry—700,000 of the knee and 400,000 of the hip. The number is expected to increase to nearly 4 million by 2030.

Non-Surgical Treatment

Surgery isn’t for everyone, however. Many times, a patient’s arthritis—the major reason for joint replacement—stabilizes. “Patients with arthritic joints who aren’t experiencing pain and who are still functioning well may not need surgery,” Dr. Duch says. In addition, a person who is medically frail may not be a good candidate, since overall health plays an important role in healing.

In these instances, patients are offered non-surgical interventions including weight loss recommendations, cortisone and “gel shot” injections, joint supplements and anti-inflammatory medications (now available both orally and in a topical cream form). Physical therapy and assistive walking devices, such as braces, canes and walkers, can also help relieve discomfort and restore mobility. Finally, by modifying activity and being “mindful” of the arthritic joint, patients can learn to live with their symptoms.

Signs That It’s Time

The most important factor in choosing to have hip or knee replacement surgery is how the joint is affecting quality of life— physically and emotionally. “If you can’t live with your arthritic joint, or realize it’s not going to get better and the pain is interfering with your quality of life, it may be time for surgery,” says Dr. Duch.

Ultimately, only the patient can make the final decision as to whether to undergo this type of major elective surgery. “It’s my job to help guide patients to the best decision for their specific situation, by laying out the medical facts and by sharing my experience of having performed thousands of these procedures,” Dr. Duch says. “That way, they can make the best informed decision.”

Orthopedic Open House: Joint Replacement

Join Michael R. Duch, MD, on January 17, 2023, 6:30 p.m. to 8:00 p.m., RWJ Fitness and Wellness Center, 3100 Quakerbridge Road, Hamilton, NJ 08619 and discover the latest advances in knee and hip replacement surgery and learn how a team of specialists help prepare patients for a successful joint replacement. All registered for this program will receive a “healthy dinner.” Space is limited and available on a first come first serve basis. Register online at or call 609-584-5900 and dial “1” to reach Health Connections.

For more information about state-of-the-art orthopedic treatments offered through the Orthopedic and Spine Institute at Robert Wood Johnson University Hospital Hamilton, call 609.689.7031 or visit