Second Opinion Before (or After) Knee Replacement: When and How to Get One

Published June 2026.

If you have been told you need a knee replacement and something about it does not sit right — or you have already had one and the knee still is not right — a second opinion is a normal, reasonable step, not an act of disloyalty. A good one means an independent review of your records and imaging, a fresh evaluation, and a clear written assessment you can actually use.

Let me start with what patients seem most nervous about, because it is almost never the knee — it is the etiquette. People half-apologize before asking whether it would be all right to have someone else look at their case. It is not rude. It is one of the most sensible things you can do before handing your knee, and the next year of your life, to someone.

Knee replacement is an elective operation in almost every case. The timing, the surgeon, and the decision itself belong to you. Here is when one is most useful — before surgery and after — what a good one involves, and how to get it whether you live near Long Beach or across the country.

When Does a Second Opinion Make Sense Before Knee Replacement?

My rule is simple: if you are about to let someone replace your knee and any part of you is uncertain — about the diagnosis, the timing, or the plan — that uncertainty alone is enough to justify a second opinion.

You were told you need a replacement, but you are not sure

The standard benchmark is worth knowing. The American Academy of Orthopaedic Surgeons describes knee replacement as an option when severe pain and stiffness limit everyday activities — walking, stairs, getting in and out of chairs — and nonsurgical treatment has not substantially helped [1]. If you do not recognize yourself in that description, that is exactly the mismatch a second opinion exists to examine. And sometimes the answer is that surgery really is the right call and the first surgeon simply did not explain it well — a good outcome too: the operation does not change, but your confidence in it does.

You were told you are “bone on bone”

“Bone on bone” describes an X-ray. It does not, by itself, tell you what to do about it. I see patients with severe-looking X-rays who are still hiking, and patients with moderate changes who can barely sleep. The principle I come back to constantly is to treat the patient, not the X-ray. If the main argument you were given for surgery was the image — rather than your symptoms, your function, and what you have already tried — a second set of eyes is worth your time.

You were offered only one option

Surgery is sometimes genuinely the only sensible recommendation; a severely damaged joint in a patient who has exhausted conservative care does not need a menu. But most knees are not that far along. If no one discussed physical therapy, injections, activity changes, or the difference between a partial and a total knee replacement, you have not really had a treatment discussion — you have had a scheduling discussion.

You have questions about whether you are a good candidate

Age, weight, diabetes, prior infections, and other medical conditions all factor into both the risk of surgery and its timing. If your candidacy was waved through without discussion — or you were declined without explanation — an independent evaluation can clarify the assessment and what, if anything, you could change before surgery.

When Should You Get a Second Opinion After Knee Replacement?

Most knee replacements work, but not all of them: in a systematic review of prospective studies, roughly 10% to 34% of patients reported persistent long-term pain after knee replacement — about 20% in the best-quality studies [2].

That number deserves honest framing. Persistent pain is not the same as a failed surgery; many of those patients have well-fixed, well-positioned implants and pain that needs a different explanation. But it means being unhappy after a knee replacement is common enough that no one should feel awkward seeking another evaluation. Three situations stand out.

Your pain has outlasted every timeline you were given

Discomfort during the first months of recovery is expected. Pain that is still limiting you a year or two after surgery is not something to keep waiting out. I have written separately about knee replacement pain at two years — the short version: persistent pain has a finite list of causes, and a structured workup can usually narrow it.

You were told “nothing is wrong,” but the knee still is not right

This may be the most frustrating position a patient can occupy. A normal X-ray is reassuring, but it does not rule out everything: low-grade infection, rotational problems with implant position, instability that only appears under load, and referred pain from the hip or spine can all hide behind unremarkable films. A second opinion brings a fresh differential — and honestly, sometimes a thorough workup finds nothing surgical, which is itself useful: it redirects you toward treatments that can actually help.

Someone has recommended revision surgery

Revision is a bigger operation than the first replacement, and the bar for doing it should be higher. Knee replacements fail for identifiable reasons — implant loosening and wear, infection, instability, stiffness, and fracture around the implant [3] — and before anyone revises your knee, the specific reason yours is failing should be clearly established. If a revision has been recommended and the explanation feels vague, get an independent review first. See the warning signs of a failed knee replacement for what actually points to failure; for Orange County patients weighing exactly this question, we offer a dedicated revision second-opinion service for Newport Beach and Irvine.

What Does a Good Second Opinion Actually Look Like?

A real second opinion is an independent re-evaluation of your case — records, images, and examination — not a polite glance at the first surgeon’s report.

Three components separate a useful second opinion from a token one. First, a records review that happens before your visit. Second, an independent read of your actual images — the X-rays and MRI themselves, not just the radiologist’s summary; reasonable physicians can weigh the same image differently, and that difference is often the entire point. Third, a conclusion that is explained: why the surgeon agrees or disagrees, and what they would do instead.

One more thing: a second opinion that always disagrees would be as useless as one that always agrees. A meaningful share of my second-opinion visits end with me telling the patient their first surgeon’s plan is sound. That is not a wasted visit — confidence in a good plan has real value.

How Does a Virtual Second Opinion Work?

A virtual second opinion follows the same sequence as an in-person one: your records and imaging are reviewed before the appointment, the video visit is spent on discussion rather than paperwork, and you receive a written summary afterward.

Not everyone can travel for an in-person consultation, which is why I offer a virtual second opinion for patients anywhere with a hip or knee problem. Before the appointment, I review the records and imaging you provide — X-rays, MRI or CT studies, operative reports from prior surgery, relevant lab work — so our time together is spent on your case, not on reading your chart for the first time.

During the video consultation we go through your symptoms and history, review your imaging together so you can see what I see, and talk through my assessment of the diagnosis and the realistic options — including whether surgery is indicated at all and, if so, what approach I would recommend. Afterward you receive a written summary you can share with your local physician.

Two honest caveats. Some problems can be assessed confidently from imaging and history alone — bone-on-bone arthritis is a good example — while others genuinely require an in-person examination, and I will tell you plainly when that is the case. And it has a real cost: the consultation is $600, self-pay, not billed to insurance. If surgery is appropriate and you choose to proceed with me, that fee is applied toward pre-operative planning.

Will Your Surgeon Be Offended If You Get a Second Opinion?

No — and I will say it as plainly as I can: patients sometimes apologize to me for wanting a second opinion, and there is nothing to apologize for.

Second opinions are a routine part of how orthopedic surgery works. Surgeons request them for their own family members. We send each other difficult cases. When a patient tells me they want another surgeon to review my recommendation, my honest reaction is that I want them to go into surgery confident — an uncertain patient commits less fully to rehab, and rehab is half the result.

A few etiquette myths worth retiring. You do not need to hide it from your surgeon, and you do not need their permission. You are entitled to copies of your records and imaging — requesting them is routine office work, not a confrontation. And if a surgeon does react badly to another set of eyes on your case, that reaction is itself information.

What Should You Bring to a Second Opinion?

If you have already had surgery, the single most valuable document you can bring is the operative report — it tells the reviewing surgeon exactly what was done, which implants were used, and what the first surgeon found inside your knee.

The record drives the quality of the opinion, so gather as much as you can:

• Your actual imaging — X-rays, MRI, or CT on disc or by digital transfer, not just the written reports
• The operative report from any prior knee surgery, including arthroscopy
• Implant identification records — the stickers or card from your joint replacement — especially if revision is being discussed
• Physical therapy notes, which document your function over time far better than memory does
• Your injection and treatment history: what was tried, when, and whether it helped
• A current medication list and any relevant lab results

It is also worth arriving with your questions written down. The AAOS publishes a useful list of questions patients should ask before joint replacement — including whether you need surgery at all, what the risks of waiting are, and what the surgeon’s own experience with the procedure looks like [4]. Those questions are just as useful in a second-opinion visit as in a first one.

Where Can You Get a Knee Replacement Second Opinion — Locally or From Anywhere?

However you get one, get it from someone who regularly performs the operation being proposed — and if the question is revision, from a surgeon who actually does revisions.

I am a Stanford fellowship-trained joint replacement surgeon; my practice covers hip and knee replacement, including complex revision surgery, with robotic-assisted techniques where they help. I see second-opinion patients at our Long Beach office at 2760 Atlantic Ave and operate at MemorialCare Long Beach Medical Center, the Surgery Center of Long Beach, and DISC Sports & Spine Center in Marina del Rey. For Orange County patients facing a possible revision, the Newport Beach and Irvine revision second-opinion page explains that process; for patients farther away, the virtual second opinion service covers the same ground without travel.

Whichever way you do it — with me or with someone else — please do it. Replacing a knee, or re-operating on one, deserves at least as much scrutiny as decisions we agonize over for far smaller stakes.

Frequently Asked Questions About Knee Replacement Second Opinions

References

1. American Academy of Orthopaedic Surgeons (OrthoInfo). Total Knee Replacement. orthoinfo.aaos.org. AAOS
2. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435. PMID: 22357571. PubMed
3. American Academy of Orthopaedic Surgeons (OrthoInfo). Revision Total Knee Replacement. orthoinfo.aaos.org. AAOS
4. American Academy of Orthopaedic Surgeons (OrthoInfo). Total Hip and Knee Replacement: Questions Patients Should Ask Their Surgeon. orthoinfo.aaos.org. AAOS

Medical Disclaimer: This content is provided for general educational purposes and does not constitute medical advice. Treatment recommendations vary based on individual diagnosis, imaging findings, and health history. Please consult Dr. Zalikha or a qualified orthopedic physician for an evaluation specific to your condition.