Waiting for a Knee Replacement: Making the Months on the List Count

Waiting for a knee replacement is hard, but the months on the list are also the best chance you will get to make the operation and the recovery easier. In England the maximum waiting time for non-urgent, consultant led treatment is 18 weeks from when the hospital receives your referral¹, though plenty of people wait longer. What you do in that time, from building strength to telling your GP when things change, can make a real difference to how you come out the other side.

I sat on my hands while I waited. I had finally said yes to a replacement after years of putting it off, and then I simply stopped: no exercise, because I reasoned the knee was being replaced anyway, and no fuss, because I did not want to be a nuisance. Both were mistakes. My leg was weaker on the day than it needed to be, and I paid for that on the ward. This guide, checked by a consultant orthopaedic surgeon, is what I would do with the wait if I had it again.

How the waiting list works

In England, the NHS sets a maximum waiting time of 18 weeks for non-urgent, consultant led treatment. The clock starts when the hospital or service receives your referral letter, or when you book your first appointment through the NHS e-Referral Service¹. It is a maximum, not a promise, and orthopaedic surgery is one of the specialities where people often wait longer.

There are exceptions to the 18 week right. It does not apply if you choose to wait longer, if delaying treatment is in your best clinical interests, or if treatment turns out not to be needed¹. If you are asked to lose weight or get another condition under control before surgery, for example, that can change the timetable.

Two things are worth knowing early:

• You can check waiting times. The My Planned Care website shows waiting times at your hospital¹, which can help you plan and gives you something concrete to ask about.
• You can choose where to be treated. The NHS advises that waiting times vary between hospitals and that you should consider this when choosing one¹. Ask your GP about your options at the referral stage, when choice is easiest to use.

If your operation is cancelled at the last minute for non clinical reasons and that leads to a longer wait, you have the right to ask the hospital or your integrated care board to move you to a different provider¹.

If your knee gets worse while you wait

Tell someone. This is the part I got most wrong. A knee that was bad enough for a referral can deteriorate further over months, and the people managing your care cannot act on a change they do not know about. Go back to your GP or contact the hospital team if the knee gets clearly worse.

Be specific, because specifics are what count clinically:

• Distance: how far you can walk now compared with when you were referred.
• Sleep: how many nights a week pain wakes you, and for how long.
• Falls and giving way: any falls, near falls or the knee buckling.
• Daily life: what you have had to stop doing, from shopping to work to caring for someone.
• Pain relief: what you are taking and whether it still helps.

Your GP may be able to review your pain relief, refer you for physiotherapy, or in some cases discuss an injection to get you through a bad patch. Our guide to corticosteroid injections for knee pain explains what one can and cannot do, including why surgeons generally prefer a gap between an injection and the operation. Your surgeon would far rather hear about a deteriorating knee than have you arrive on the day unable to manage the stairs at home.

Build strength: the most useful thing you can do

Versus Arthritis puts it plainly: the stronger the muscles around your knee are before surgery, the quicker your recovery is likely to be, and exercises that involve raising your foot against gravity are best². NICE recommends exercise for everyone with knee osteoarthritis as a core treatment³, so this is not only an investment in the recovery. It usually makes the knee easier to live with during the wait as well.

The priority is the thigh muscles. Straight leg raises, sit to stands from a firm chair and small step ups are the backbone of most programmes, alongside a low impact activity you will keep doing, such as walking, cycling or swimming. Our guide to exercise for knee arthritis covers how much is enough and how much pain is acceptable, and many hospitals run prehabilitation classes or will refer you to a physiotherapist if you ask.

Do not let the thought that the knee is being replaced anyway talk you out of it, as it did me. The knee is being replaced. The muscles are not, and they have to do all the work afterwards.

Weight and general health

If you are carrying extra weight, the wait is the obvious time to start losing some. NICE notes that any weight loss is likely to help with knee osteoarthritis, and that losing 10% of body weight is likely to be better than losing 5%³. Steady loss over months is what you want, not a crash diet in the fortnight before the operation, which can leave you weaker and short of the protein you need to heal. Our article on losing weight before knee surgery goes into the detail, including why some surgeons set a weight target before they will operate.

Versus Arthritis also advises getting your general health as good as it can be before the operation, and having a dental check up with any problems dealt with well before surgery². If you smoke, stopping before the operation helps your wound heal and lowers the risk of complications; your GP or a local stop smoking service can help. If you have diabetes, high blood pressure or another long term condition, ask for a review during the wait so it is well controlled when your date comes. Problems like these are a common reason for operations being postponed at the pre operative assessment.

Get the practical things done early

The weeks after a knee replacement are not the time to be organising things, and the wait is long enough to sort most of them. The list I wish I had worked through:

• Home: clear the walkways, sort a firm chair with arms at the right height, think about how you will manage the stairs and the bath.
• Help: line up who will drive you, shop for you and be around for the first couple of weeks. Walking aids are usually needed for 2 to 6 weeks.
• Work: talk to your employer early about time off and a phased return.
• Equipment: an ice pack, a grabber and a raised toilet seat are cheap and useful, and the hospital may lend some.
• Questions: write down what you want to ask at the pre operative assessment.

Our guide to preparing for knee replacement surgery has the full checklist, and the hospital bag checklist covers the last week.

Paying privately

Some people decide the wait is costing them too much and pay for the operation themselves. In the UK, self pay prices for a knee replacement are broadly £12,000 to £16,000. If you are considering it, check exactly what a quote covers (consultations, the stay, physiotherapy, follow up and what happens if there is a complication), and remember that private and NHS surgery use the same types of implant and broadly the same techniques. Our guide to how much a knee replacement costs breaks the figures down.

There is no wrong answer here. Paying is a reasonable choice for some, and staying on the list and using the time well is a reasonable choice for others. What I would not do again is spend the wait doing nothing. A wait used well is not wasted time. It is the first part of your recovery, and the part you have the most control over.