Why Patients Delay or Decline Knee Replacement Surgery

It's not uncommon for patients to initially postpone but eventually undergo knee replacement surgery. Certainly, many patients have the procedure done. Every year in the United States alone, more than 600,000 knee replacements are performed. So why the apprehension about something that is supposed to improve a patient's physical function and relieve pain that interferes with daily living activities?

Doctor operating on leg in operating room
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Patients Go Through Stages Before Accepting Knee Replacement Surgery

Patients' pre-op and post-op experiences with knee replacement surgery were analyzed in a study from Kent State University. The researchers identified four stages that patients went through on their way to accepting that they needed knee replacement surgery. The four stages are:

  • putting up and putting off
  • waiting and worrying
  • letting go and letting in
  • hurting and hoping

Putting Up and Putting Off Knee Replacement Surgery

Putting up and putting off is the first stage a patient goes through once they are informed they need knee replacement surgery. Patients initially hope that knee replacement surgery isn't really needed — something else will work or it will get better on its own. With this line of thinking, the patient chooses to put up with the bad knee and put off the surgery. They view surgery as a last resort treatment option, but they don't believe they have reached that last resort.

Waiting and Worrying

The second stage, waiting and worrying, begins once a patient decides to have knee replacement surgery. Typically, patients going through stage two had put off having the surgery for years and have reached the point of wanting to get it done and over with. But there tends to be some worry involved with this stage. Although patients realize they must have the surgery, they worry that something will go wrong or won't turn out right. It's a bit of obsessive thinking or a level of anxiety that might be expected.

Letting Go and Letting In

Stage three may be the most important of all. Patients evolve to this stage by realizing they must give up some independence, relinquish some control (that's the letting go part) and accept help and encouragement from others (that's the letting in part). A patient must be inspired to reach for the goal – a successful knee replacement – and understand how it will improve and enhance their life. There is no better way than learning from those who have done it and can guide you through the process.

Hurting and Hoping

The fourth stage could also have been called "No Pain, No Gain". There is pain before surgery and there is pain during the recuperative period after surgery. Psychologically, the patient must get beyond the hurt, and focus completely on getting better. The ultimate goal is to return to activities they love and had to give up – and to just feel normal again.

What Must Happen to Progress to Getting Knee Replacement Surgery

Knee replacement surgery is needed if a patient is in pain that cannot be relieved by other more conservative treatments and if the pain and other symptoms interfere with daily living activities. Once that is the case the patient needs to move beyond stage one and stop putting off the inevitable.

During the process, a certain amount of anxiety is expected, but patients should recognize anxiety and apprehension for what it is and try to temper it. Patients can seek out others who have had successful knee replacement surgery and become empowered by their positive experience.

Most importantly, never lose sight of why you need a knee replacement and the expectation that life will improve after the surgery and recovery period. Positive thinking plays a big part in arthritis treatment, including joint replacement surgery. Once you learn all you can about knee replacement surgery and what to expect, engage in positive thinking, and draw inspiration and encouragement from others — you're where you need to be. No need to further delay or decline the surgery.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Total Knee Replacement OrthoInfo.

  2. Jacobson AF, Myerscough RP, Delambo K, et al. Patients' perspectives on total knee replacement. Am J Nurs. 2008;108(5):54-63. doi:10.1097/01.NAJ.0000318000.62786.fb

Additional Reading

By Carol Eustice
Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis."