Most people arrive at a consultation with a scan and a question about the scan. What is the grade. How bad is it. Is it bone on bone.
I will look at it, carefully, and we will look at it together on the screen rather than me describing it to you. But not first.
Why not first
Because the correlation between what an X-ray shows and how much a person suffers is only moderate. It is one of the most consistently replicated findings in osteoarthritis research and one of the least intuitive.
I see people with radiographs that look alarming who walk several kilometres a day and have decided they can live with it. I see people with modest changes whose lives have narrowed to the length of their driveway. Both are real. Neither is explained by the film.
Cartilage has no nerve supply. Cartilage loss is not itself painful. The pain comes from the bone underneath, the joint lining, the capsule and the tissues around it, and those do not photograph.
What I ask instead
What have you stopped doing?
Not a pain score. Not how bad it is out of ten. What has the joint taken from you. The walk you no longer do. The stairs you plan your day around. The grandchild you cannot lift. The sleep you are losing. The trip you did not book.
That is the list the operation is measured against, and it is the list we return to afterwards. A joint replacement that produces a perfect radiograph and does not give you the walk back has not succeeded.
Then the imaging
Once I know what the joint has cost you, the imaging becomes genuinely useful. It tells me which compartments are involved, how the limb is aligned, what the bone quality is like, whether there is old injury or retained metalwork, and whether what I am seeing matches what you are describing.
That last point is the important one. When the imaging and the story disagree, the story is usually right and the diagnosis is usually somewhere else: the hip referring to the knee, the tendons rather than the joint, the back. Operating on a joint because its X-ray looks bad, when the pain is coming from elsewhere, is one of the more reliable ways to produce a disappointed patient.
What this means for you
Come with the films rather than only the report, and come with the list. The list is the thing I cannot get anywhere else, and it is the thing the decision actually turns on.
See your first knee appointment for what else is worth bringing.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.