“I was scheduled for surgery but decided to postpone it until after I finished this program. I have learned so much about surgery ‒ and my knee (and the rest of me) is feeling so much stronger that I am really glad I opted to hold off on the operation.”

Paul, a past Hinge Health participant, tells a story that countless others can relate to.

It’s true that some injuries and conditions are best addressed with surgery. But shortly after starting the Hinge Health program, Paul learned what thousands before him have: that surgery should never be your first option for reducing persistent pain. In order to understand why, let’s talk through a few things.

Surgery Is Not as Effective as We Once Thought 

We know a lot more about pain now than we used to. And the most recent research shows that surgery doesn’t always address the root cause of persistent pain.

One study suggests as many as one in three knee surgeries are inappropriate and unnecessary. [1] Another found that knee replacements result in minimal improvement to quality of life. [2] And the British Medical Journal now has a “strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease.” [3]

While these studies may or may not reflect your personal experience, they do show that a dramatic treatment like surgery doesn’t guarantee a dramatic change in pain.

Scans Don’t Show Pain 

Imaging has an important place in medicine. But it’s proven to be quite unreliable when dealing with persistent pain because scans don’t tell your whole pain story.

If you’ve ever had an MRI or a scan, you may be familiar with the uneasy feeling of waiting for your doctor to give you bad news. Maybe your thoughts and emotions about your pain were influenced by an ‘abnormality’ your doctor saw on that scan.

Your knees are no different than the rest of your body in the sense that changes are normal as you age. Cartilage becomes thinner over time, and the space between the bones in your knee will narrow. But surgery usually isn’t needed to fix these changes. They’re natural, just as it’s natural to develop wrinkles on your skin and gray hair on your head.

Two-thirds of Americans over 50 years old show a meniscus tear on an MRI but report no pain. [4] In fact, 90% of individuals over 50 years old with no pain will have some type of abnormality on an MRI, most commonly osteoarthritis changes or cartilage damage. [5]

You see, persistent pain is incredibly complex. An MRI may reveal that you are ‘bone on bone,’ but that doesn’t actually tell us why you have pain.

Control What You Can Control 

In the previous playlist, you learned about the many different factors that can contribute to your pain. Some treatment options, like exercise, address multiple factors in your backpack.* Other treatments only address physical contributors to pain. Surgery is a perfect example of this.

We now know that the best way to manage persistent pain is to focus on the pain contributors you can change.

You can’t control your genetics or previous injuries. But you can make changes to your exercise and movement routine. You can set goals to work toward better stress management and sleep. You can make an effort to learn more about persistent pain. And when you focus on changing those factors in your backpack, it’s possible to avoid surgery altogether.*

Regardless of whether you’ve already had surgery, believe it’s inevitable for you, are determined to avoid it, or are unsure of what to think, we want you to feel confident in having an empowered conversation with your doctor about what’s best for you.

What you see on a scan should not dictate whether or not you have surgery to treat your pain. And it’s almost always worth it to address pain with movement and exercise therapy before having surgery. You too could end your story like Paul, who says, “Now I’m confident that surgery is not in my future and movement truly is medicine.”

* We added a video and additional content to the article “Rethink Your Pain,” which you read in a previous playlist. In case you missed it, be sure to take a look at “Rethink Your Pain” in the Library of your Hinge Health app for important background information and context. 

Key Takeaways 

  1. Surgery should never be your first choice for reducing persistent knee pain.

  2. Pain is personal and multifaceted.

  3. By focusing on what you can control, you may be able to avoid surgery altogether.


  1. Riddle,DL, Jiranek WA, Hayes CW. Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatology. 2014;66(8): 2134-2143

  2. Ferket, B. S., Feldman, Z., Zhou, J., Oei, E. H., Bierma-Zeinstra, S. M. A., & Mazumdar, M. (2017). Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. Bmj. https://doi.org/10.1136/bmj.j1131

  3. Siemieniuk, R. A. C., Harris, I. A., Agoritsas, T., Poolman, R. W., Brignardello-Petersen, R., Velde, S. V. de, … Kristiansen, A. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 357, j1982. https://doi.org/10.1136/bmj.j1982

  4. Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., … Losina, E. (2013). Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 368(18), 1675–1684. https://doi.org/10.1056/NEJMoa1301408

  5. Ali Guermazi, Jingbo Niu, Daichi Hayashi, Frank W Roemer, Martin Englund, Tuhina Neogi, Piran Aliabadi, Christine E McLennan and David T Felson. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ: British Medical Journal, Vol. 345, No. 7874 (15 September 2012), p. 16

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