Why "It Depends" may be the best thing to hear from a surgeon.

Today I want to talk a little bit about treatment options. Sometimes the best answer you can get from a physician—or from a surgeon, in my case—is actually, “it depends.”

And why is that? Because it means there are multiple possible options. If there were only one option, you would simply be presented with that single solution. But most conditions, especially in orthopaedics, allow for several different approaches.

I see many patients who come to me for a second opinion. Often they have seen another surgeon who gave them just one answer. For example, someone may come in with knee arthritis and say, “The other surgeon told me I need a knee replacement.” Or they were told, “You will need a knee replacement eventually, but you’re not ready yet—so just wait until you’re older and the pain becomes unbearable.”

In many situations, my answer is different. My answer is usually, it depends.

That’s because the right treatment depends on several factors: how much pain you have, how much damage is present in the knee, and exactly where that damage is located.

If someone truly has severe arthritis throughout the entire knee—what we call “bone-on-bone” arthritis everywhere—then a total knee replacement may indeed be the best solution if the pain is significant enough. But if the pain is manageable, there are still many non-surgical options we can try first. These might include injections such as hyaluronic acid, PRP, or occasionally cortisone for flare-ups. Physical therapy, bracing, and oral supplements like turmeric, glucosamine, vitamin E, or fish oil can sometimes help as well. Even medications like Advil or Aleve may provide relief.

But many patients I see don’t actually have bone-on-bone arthritis everywhere. Sometimes the arthritis is limited to just one part of the knee—for example, the medial compartment, which is the inside part of the joint.

In those cases, the answer shouldn’t automatically be a total knee replacement. Instead, the treatment options may range from doing very little to considering several different interventions.

If symptoms are mild, sometimes the best approach is simply to listen to your body and continue your normal activities without aggressive treatment.

If symptoms are more bothersome, we might consider supplements or medications, injections, or supportive treatments such as a medial unloading brace.

And sometimes surgery becomes an option—but even then, there are several possibilities depending on the specific situation. In certain cases, we may consider cartilage repair if the problem is more of a focal cartilage defect. In other cases, especially if someone is bow-legged and placing excessive pressure on the inside of the knee, a procedure called a high tibial osteotomy may be appropriate to realign the leg and unload that compartment.

There are also newer technologies such as the MISHA implant—an implanted shock absorber designed to reduce pressure in the medial compartment of the knee.

And in some patients, a partial knee replacement—also called a unicompartmental knee replacement—may be the best surgical solution if the arthritis is limited to just one area.

So as you can see, there are many possible approaches. The right one depends on your individual situation—how much pain you have, how much damage is present, and what your goals are.

To determine that, we rely on good imaging studies such as X-rays, alignment views, and MRI scans, along with a careful physical examination. Then we can sit down together, review the findings, and decide which treatment option—or options—make the most sense for you.