Osteoarthritis

• Surgery is discussed at stage III osteoarthritis if treatment without surgery has not helped.
• Treatment starts with exercise therapy, weight loss and painkillers.
• The operation takes 1–2 hours; you stand up with support on the first day.
• In Russia it can be free under OMS or a VMP quota; the wait depends on the region.

Joint replacement and osteoarthritis

Joint replacement swaps the worn surfaces of a joint for artificial ones. Doctors call the artificial joint an endoprosthesis; on this site we say implant. It is most often used for severe osteoarthritis of the knee and hip.

Osteoarthritis is the gradual breakdown of cartilage. Doctors also call it arthrosis. Cartilage covers the ends of the bones and lets them glide without friction. When it wears away, bone rubs on bone. The joint hurts, swells and loses movement.

Not everyone with a painful knee or hip needs surgery. It is discussed when pain seriously limits your life and treatment without surgery no longer helps[1, 2]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20242Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →. In 2019 Russia performed 147,061 primary joint replacements. Of these, 83,311 were hips and 63,750 were knees[3]3Эпидемиология эндопротезирования тазобедренного и коленного суставов и перипротезной инфекции в Российской Федерации — Травматология и ортопедия России, 27(3):84–93, 2021To the list of sources →.

Unfamiliar words are explained in the patient glossary.

How a joint is built

The knee and hip carry more load than any other joints. The hip is a ball in a socket: the head of the thigh bone turns in a cup in the pelvis. The knee is a hinge of the thigh bone, shin bone and kneecap. The bone ends are covered with cartilage. A capsule filled with fluid surrounds the joint and nourishes the cartilage.

Cartilage has no blood supply and barely repairs itself. As it wears, the bone beneath it hardens. Bony spurs called osteophytes grow at the edges. The joint space narrows, the joint lining becomes inflamed and movement starts to hurt.

Main causes of joint damage[1, 2]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20242Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →:

• Primary osteoarthritis: cartilage wears with age.
• Excess weight adds load on the knee and hip with every step.
• Injuries: fractures, ligament and meniscus tears. Osteoarthritis can start years later.
• Dysplasia: a hip socket that did not form properly at birth, so the load is spread unevenly.
• Avascular necrosis: part of the head of the thigh bone dies when its blood supply is cut off.
• Rheumatoid arthritis and other inflammatory diseases that destroy cartilage.

Stages of osteoarthritis

The stage is graded from an X-ray. Russia uses two scales: Kosinskaya (three stages) and Kellgren–Lawrence (grades 0 to IV)[1]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →. The stage decides whether you are offered treatment without surgery or joint replacement.

Surgery is usually discussed at Kosinskaya stage III (Kellgren–Lawrence III–IV) if treatment without surgery has not helped[1]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →. At stages I–II the joint is usually treated without surgery.

Grading scales

· 2 min

Stage: Kosinskaya / Kellgren–Lawrence	What the X-ray shows	What you feel
— / 0	No changes	Usually no complaints
I / I–II	Joint space slightly narrowed, a few osteophytes	Pain after activity that eases with rest
II / III	Joint space narrowed 2–3 times, many osteophytes, hardened bone	Pain when walking and at rest, limping, stiffness, grinding
III / IV	Joint space almost gone, bones deformed, cysts	Constant pain, severely limited movement, a shortened leg

The stages follow the Ministry of Health guidelines[1, 2]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20242Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →. The scales do not match exactly, so the correspondence is approximate.

Symptoms

Osteoarthritis develops over years, and the first signs are easy to put down to tiredness. See an orthopaedic surgeon if you notice[2]2Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →:

• Start-up pain: the first steps after sleep or long sitting hurt, then ease.
• Morning stiffness that clears within half an hour.
• Pain on load: on stairs, getting up from a chair, after a long walk.
• Grinding and clicking in the joint when it moves.
• Limited movement: putting on socks, tying shoelaces or sitting on a low chair is hard.
• A limp and a feeling that the leg is shorter. This happens when the hip is affected.
• Night pain that disturbs sleep. A doctor should assess it: it occurs in osteoarthritis and in other conditions.

None of these alone means you need surgery. It is a reason to see a doctor and discuss whether you need an X-ray.

Diagnosis

A doctor makes the diagnosis at an appointment. Three steps are usually enough[1, 2]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20242Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →:

1. Examination. The doctor checks your gait, range of movement, leg length, muscle strength and tenderness.
2. X-ray in two views, standing, with weight on the leg. The stage is graded from it.
3. Questionnaires such as WOMAC or the Oxford Hip/Knee Score. They ask about pain and daily activities. They show how much the disease limits you and let you compare before and after treatment.

Treatment without surgery

Under the 2024 Ministry of Health guidelines, treatment starts without surgery[1, 2]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20242Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →. For many people this is enough for years. Its goal is less pain and better movement. There is no proof that it slows osteoarthritis down[13]13Osteoarthritis in over 16s: diagnosis and management (NG226) — NICE, 2022To the list of sources →.

A plan usually includes:

• Exercise therapy: the main method. Exercise 2–3 times a week strengthens the muscles around the joint and reduces pain. The effect appears within a few weeks and lasts as long as you keep going[2]2Клинические рекомендации «Гонартроз» — Минздрав России, 2024To the list of sources →.
• Weight loss. The target is a body mass index below 25[1]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →. Even moderate weight loss reduces knee and hip pain.
• Painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen relieve pain and inflammation. They can harm the stomach, heart and kidneys. So a doctor sets the dose and how long you take them[1]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →.

Indications for surgery

There is no set age or moment for surgery. You and your surgeon weigh pain, limitations and risks together[1, 4]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20244Total Knee Replacement — AAOS OrthoInfo, 2024To the list of sources →. There are no strict age or weight limits either[4]4Total Knee Replacement — AAOS OrthoInfo, 2024To the list of sources →. Age and weight do affect the risks and the choice of implant.

How long to try treatment without surgery is your doctor’s call. There is no need to repeat a course that did not help[12]12ACR/AAHKS guideline for the optimal timing of elective hip or knee arthroplasty — American College of Rheumatology / AAHKS, 2023To the list of sources →.

Surgery is usually not rushed if:

• the X-ray shows stage I–II and you have not yet tried exercise and weight loss;
• pain is moderate and well controlled;
• you have an active infection, including tooth decay or unhealed wounds;
• you have severe heart or lung disease that is not under control;
• you smoke: smoking impairs healing, so the surgeon will probably ask you to stop first.

Before seeing the surgeon, get a recent X-ray and a list of your medicines. Ask yourself what exactly you can no longer do because of the joint.

Types of operation

There are four types of operation. The table below shows when each is used.

Total replacement is the most common and best-studied option[4]4Total Knee Replacement — AAOS OrthoInfo, 2024To the list of sources →. Partial knee implants last less well: at 25 years about 70 % are still working, against 82 % of total ones[6]6How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up — The Lancet, 393(10172):655–663, 2019To the list of sources →. Partial hip replacement is used mainly for hip fractures in older people. Revision, a repeat operation, is longer and more complex than the first, and the infection risk is higher[7]7Periprosthetic joint infection after 1.66 million primary and revision arthroplasties (2015–2023) — PMC, 2025To the list of sources →.

A robot helps place the implant more precisely. In the RACER-Knee trial patients felt no difference from standard surgery at 12 months. The robotic operation cost more[8]8Robotic-arm assisted versus conventional total knee replacement (RACER-Knee): a randomised controlled trial — The Lancet, 2026To the list of sources →. What is proven about robots is covered on the robotic joint replacement page.

The road from first symptoms to full recovery takes months or years. Timings are approximate: they depend on the joint, the clinic and your health.

Timings and figures follow the Ministry of Health guidelines, OrthoInfo, the NHS and arthroplasty registries[1, 4, 5, 9, 6, 10]1Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20244Total Knee Replacement — AAOS OrthoInfo, 20245Knee replacement — NHS, 20249Hip replacement — NHS, 20246How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up — The Lancet, 393(10172):655–663, 201910How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up — The Lancet, 393(10172):647–654, 2019To the list of sources →. Details for each joint are on the knee and hip pages.

Payment

In Russia joint replacement can be free under OMS or a VMP quota[11]11Травматология и ортопедия по квоте (ВМП): как получить — gosmed.ru, 2025To the list of sources →. OMS is compulsory health insurance; a VMP quota pays for high-tech care. You need a referral on form 057/u and an extract from your records. Implant choice and waiting times depend on the region and the hospital. The route and documents are on the free surgery page.