Before a Knee or Hip Replacement, a Second Set of Eyes

Should I get a second opinion before a knee or hip replacement?

For a planned joint replacement, it is a reasonable and low-risk step. Knee and hip replacements are elective operations done to relieve pain and restore function, not emergencies — so there is almost always time to get a second opinion without any downside. The decision hinges on judgment calls: how bad the joint really is, whether you have tried enough first, and whether now is the right moment.

Knowing when to get a second opinion is easy here: any time major, permanent surgery is recommended and the situation is not urgent. Joint replacement is elective — which means there is almost always time for a second opinion, and rarely a downside. If anything, the elective nature is exactly why a second look tends to pay off.

Have the non-surgical options been tried first?

This is the single most useful question a second opinion can ask. For osteoarthritis — the usual reason for replacement — surgery generally comes at the end of a sequence of care, after gentler measures have been given a fair trial. A second orthopedic surgeon can tell you where you actually are in that sequence, and whether a step was skipped.

• Activity changes and physical therapy to strengthen the muscles that support the joint.
• Weight management, which reduces the load a knee or hip carries.
• Medication for pain and inflammation, used as directed by a clinician.
• Injections that can relieve symptoms and buy time for some people.

Trying non-surgical care first does not close the door on surgery later — it mainly makes sure the timing is right. None of these fixes advanced arthritis permanently, and for a severely damaged joint they may offer little. But when they have not been tried at all, a second opinion often surfaces that gap — in spine surgery, an adjacent field, second-opinion programs judged about 61% of surgical referrals inadequate and cut operations by up to about half 1Ref 1de Oliveira IO, Lenza M, de Vasconcelos RA, Antonioli E, Cendoroglo Neto M, Ferretti M (2019).Second opinion programs in spine surgeries: an attempt to reduce unnecessary care for low back pain patients.Cited for the programmatic finding that spine-surgery second-opinion programs judged about 61% of surgical referrals inadequate and reduced operations by up to about half, as an adjacent-orthopedic analogy..

When a knee or hip replacement is clearly the right call

Just as often, a second opinion confirms that surgery is the right choice — and there are clear situations where it is. Replacement is generally well justified when advanced arthritis shows on imaging, the pain limits everyday activities like walking or sleeping, and adequate non-surgical treatment has stopped helping. Severe joint damage from injury or deformity can also make replacement the clear answer.

The right frame is a sequence of care — a good second opinion flags surgery that is premature and endorses surgery that is overdue. When a joint is worn out and conservative measures have genuinely run their course, delaying a replacement mainly prolongs the pain and can make rehabilitation harder. A useful second opinion is honest in both directions, not reflexively for or against the operation.

How often surgery recommendations change on a second look

Direct data on joint-replacement second opinions is thin, but the wider evidence shows surgical recommendations shift often on review. In elective coronary stenting, only about half of non-emergency procedures met appropriateness criteria 2Ref 2Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, et al. (2011).Appropriateness of percutaneous coronary intervention.Cited for the finding that only about half of elective, non-emergency coronary stent procedures met appropriateness criteria, illustrating that elective-procedure recommendations carry real judgment. — a reminder that elective procedures carry real judgment. And in general internal medicine second opinions, a new treatment was started in 56% of patients even when the diagnosis was unchanged 3Ref 3Burger PM, Westerink J, Vrijsen BEL (2020).Outcomes of second opinions in general internal medicine.Cited for the finding that a general internal medicine second opinion started a new treatment in 56% of patients even when the diagnosis was unchanged..

For a joint, the diagnosis — arthritis — is rarely in doubt. What a second opinion changes is the plan: whether to operate now, later, or not yet, and whether to optimize first. A second opinion before back surgery, or before heart surgery, works the same way, changing the response to a condition more often than the condition itself.

Getting ready: preoperative optimization

If surgery is the right call, a second opinion is also a chance to prepare for the best possible result. Many orthopedic surgeons ask patients to address modifiable factors before an elective replacement — this is preoperative optimization, and it can include weight management, blood-sugar control for people with diabetes, and stopping smoking. These steps are meant to lower the risk of complications and support recovery.

Weight before joint replacement comes up often, because surgeons weigh a person's weight and BMI when estimating surgical risk and planning the operation. A second surgeon may set different optimization targets than the first, or explain the reasoning more fully. None of this is about gatekeeping; it is about walking into a permanent operation in the best shape to heal from it.

Does insurance cover a second opinion, and how do I get one?

Often, yes, and getting one is straightforward. Original Medicare (Part B) covers a second opinion before medically necessary, non-emergency surgery, and a third if the first two disagree, with the usual 20% cost-share 4Ref 4Centers for Medicare & Medicaid Services (2024).Second surgical opinions coverage.Cited for Medicare Part B coverage of a second (and third, if the first two differ) opinion for non-emergency surgery, with a 20% beneficiary cost-share.; joint replacement, as elective surgery, fits that benefit. A second opinion is also your right, and treating doctors are usually willing to help arrange one and send your records 5Ref 5MedlinePlus, U.S. National Library of Medicine (NIH) (2024).Your cancer diagnosis - Do you need a second opinion?.Cited for the patient's right to a second opinion, that doctors usually help arrange one, and the practice of transferring records and imaging for review..

A short second opinion records checklist for a joint keeps it simple: your X-rays or other imaging and the reports, notes on treatments already tried, your medication list, and the recommendation for surgery. Following a plain second opinion step-by-step process — decide, request records, choose a surgeon, book — is all it takes. Remote second opinion programs are an option too, with a typical remote second opinion workflow in which a specialist reviews your imaging and returns a written report; the actual images matter more than the summary.

Will my orthopedic surgeon be offended?

Almost never. Seeking a second opinion before elective surgery is a normal, expected part of care, and most doctors are willing to help arrange one and forward your records 5Ref 5MedlinePlus, U.S. National Library of Medicine (NIH) (2024).Your cancer diagnosis - Do you need a second opinion?.Cited for the patient's right to a second opinion, that doctors usually help arrange one, and the practice of transferring records and imaging for review.. Orthopedic surgeons see second opinions routinely, especially for planned joint replacements, and a good one treats the request as sensible due diligence before a permanent change.

A second opinion before a planned joint replacement is standard practice, not a slight to your surgeon. The worry that a doctor will be offended by a second opinion keeps some people from asking, but it is mostly unfounded. A simple, respectful framing — that you want to be confident before a major operation — almost always lands well. And if it does not, that reaction tells you something useful before you have committed to anything.