The Big Decision: Surgery or Injections?
When joint pain significantly impacts your quality of life, you face an important decision. Should you pursue joint replacement surgery—a proven but major procedure—or try injection treatments that may provide relief without surgery?
This guide helps you understand both options, their appropriate uses, and how to make an informed choice for your situation.
Understanding Your Options
Joint Replacement Surgery
Joint replacement (arthroplasty) removes the damaged joint surfaces and replaces them with artificial components (prostheses). Modern joint replacements are highly successful, with over 95% of patients reporting significant pain relief and improved function.
Types of joint replacement:
- Total knee replacement
- Partial knee replacement
- Total hip replacement
- Hip resurfacing
Injection Treatments
Several injection options can provide relief without surgery:
- Hyaluronic acid (gel) injections: Restore joint lubrication
- Corticosteroid injections: Reduce inflammation
- PRP injections: Use your body’s healing factors
- Stem cell injections: Emerging regenerative option
Head-to-Head Comparison
Effectiveness
Surgery:
- 90-95% of patients report significant improvement
- Pain relief is typically dramatic and lasting
- Enables return to most activities
- Most effective for severe, end-stage arthritis
Injections:
- 60-80% of patients report meaningful improvement
- Best results in mild-to-moderate arthritis
- May delay surgery by years
- Less effective for bone-on-bone arthritis
Recovery and Downtime
Surgery:
- Hospital stay: 1-3 days typically
- Walker/crutches: 2-6 weeks
- Return to driving: 4-6 weeks
- Return to work: 6-12 weeks (desk job); 3-6 months (physical job)
- Full recovery: 6-12 months
- Physical therapy: Required for months
Injections:
- Outpatient procedure (go home same day)
- Return to driving: Immediately
- Return to normal activities: 24-48 hours
- No physical therapy required (though often beneficial)
Risks and Complications
Surgery Risks:
- Blood clots (deep vein thrombosis): 1-2%
- Infection: 1-2%
- Implant loosening: 5-10% over 15-20 years
- Nerve or blood vessel damage: Rare
- Stiffness requiring manipulation: 1-2%
- Need for revision surgery: 5-10% lifetime
- Anesthesia complications: Rare but serious
- Medical complications (heart, lung): Risk increases with age/health
Injection Risks:
- Post-injection flare: 2-5%
- Infection: Less than 0.01%
- Allergic reaction: Rare
- No systemic risks
- No anesthesia required
Cost Comparison
Surgery:
- Hospital and surgeon fees: $30,000-$50,000+
- Anesthesia: $2,000-$5,000
- Physical therapy: $2,000-$5,000
- Lost wages during recovery: Variable
- With insurance: $3,000-$10,000 out-of-pocket typical
Injections:
- Hyaluronic acid series: $1,500-$3,000 per treatment cycle
- Cortisone injection: $100-$300 per injection
- With Medicare/insurance: Often minimal out-of-pocket
- No lost wages (minimal downtime)
Longevity of Results
Surgery:
- Knee replacements: 85-90% last 15-20 years
- Hip replacements: 90-95% last 20-25 years
- Revision surgery possible if needed
- Younger, more active patients may need earlier revision
Injections:
- Cortisone: 4-12 weeks
- Hyaluronic acid: 6-12 months
- Can be repeated as needed
- Allow you to “buy time” while new treatments develop
Who Should Consider Each Option?
Surgery May Be Right If You Have:
- Severe (Stage 4) arthritis with bone-on-bone contact
- Significant quality of life impact despite other treatments
- Failed injection treatments (tried and didn’t provide adequate relief)
- Good overall health for surgery and recovery
- Realistic expectations about recovery and outcomes
- Support system for recovery period
- Willingness and ability to complete rehabilitation
Injections May Be Right If You Have:
- Mild-to-moderate (Stage 2-3) arthritis
- Responded well to previous injections
- Medical conditions making surgery risky
- Desire to delay surgery (especially if younger)
- Need to remain active without extended recovery
- Concerns about surgical risks
- Insurance coverage for injection treatments
The “Try Injections First” Approach
Many orthopedic specialists recommend trying conservative treatments, including injections, before considering surgery. Here’s why:
Benefits of Delaying Surgery
- Technology improves: Joint replacement techniques and implants continue advancing
- Longer implant life: Delaying means fewer potential revision surgeries
- Natural healing time: Some patients improve with conservative care
- Risk avoidance: Every surgery avoided is risk avoided
- Financial savings: Injections cost far less than surgery
When Delaying Doesn’t Make Sense
- Severe bone-on-bone arthritis unlikely to respond to injections
- Significant joint deformity affecting function
- Previous injections provided no benefit
- Quality of life severely impacted despite treatments
- Waiting would worsen surgical outcomes
Real Patient Scenarios
Scenario 1: Good Candidate for Injections First
Patient: 58-year-old, moderate knee OA (Stage 2-3), active lifestyle, some morning stiffness, pain with stairs
Recommendation: Trial of hyaluronic acid injections
- May provide 6-12 months of relief
- Allows continued activity
- Delays surgery potentially 5-10 years
- Preserves surgical option for future
Scenario 2: Better Candidate for Surgery
Patient: 72-year-old, severe knee OA (Stage 4), bone-on-bone, failed 2 injection treatments, constant pain affecting sleep
Recommendation: Total knee replacement
- Injections unlikely to provide significant relief
- Quality of life significantly impacted
- Good surgical candidate
- Expected excellent outcome
Scenario 3: Poor Surgical Candidate
Patient: 80-year-old, severe hip OA, diabetes, heart disease, on blood thinners
Recommendation: Optimized injection therapy + pain management
- Surgical risks elevated
- Injections can provide meaningful relief
- Focus on quality of life without major surgery
- Reassess if conditions change
Questions to Ask Your Doctor
About Surgery:
- What are MY specific surgical risks based on my health?
- What type of replacement do you recommend and why?
- How many of these procedures do you perform yearly?
- What is your complication rate?
- What is the expected longevity of the implant?
- What will recovery realistically look like for me?
About Injections:
- What type of injection do you recommend and why?
- How likely is it to help my specific condition?
- Do you use imaging guidance for accuracy?
- How long should I expect relief to last?
- Can I repeat injections if they work?
- At what point should I reconsider surgery?
Making Your Decision
Consider these factors:
| Factor | Favors Injections | Favors Surgery |
|---|---|---|
| Arthritis stage | Mild to moderate | Severe/bone-on-bone |
| Previous injection response | Good | Poor or none |
| Overall health | Any | Good surgical candidate |
| Age | Younger (delay surgery) | Older with good health |
| Activity goals | Maintain current | Return to high activity |
| Recovery time | Can’t take time off | Can commit to rehab |
| Risk tolerance | Risk-averse | Accepts surgical risks |
The Bottom Line
There’s no one-size-fits-all answer. The best choice depends on:
- Your specific diagnosis and arthritis severity
- Your overall health and surgical risk
- Your goals and lifestyle
- Your response to previous treatments
- Your personal preferences and values
For many patients with mild-to-moderate arthritis, trying injections first makes sense. For those with severe, end-stage arthritis significantly impacting quality of life, surgery often provides the best outcome.
The most important step is having an honest conversation with your healthcare provider about YOUR specific situation.