Q&A with Dr. Howard Luks: Arthritis and Joint Replacement

Q&A with Dr. Howard Luks: Arthritis and Joint Replacement

Dr. Howard Luks is an orthopedic surgeon in Westchester County, New York with over 20 years of experience and the author of Longevity Simplified.

His approach is notably conservative and fitness-forward. He is one of those rare surgeons who will tell you, clearly and without hesitation, that staying active is almost always the right call, even with arthritis, even with alarming imaging findings, and even if you are bone on bone.

Members submitted questions in advance and Dr. Luks answered them directly. Here is a summary of the most important points from that conversation.

What Your MRI Actually Means (and What It Doesn’t)

One of the most common fears people have is receiving an MRI report filled with terms like “meniscus tear” or “degenerative changes” and assuming those findings explain their pain and require surgery.

Dr. Luks pushes back on this strongly. None of us have normal joint MRIs by middle age. The word “tear” implies an acute injury, but most meniscus findings are more like an old pair of jeans that have slowly worn through. They are age-appropriate changes, not evidence of something you did wrong or something that must be surgically repaired.

It is worth knowing that many of these changes, including meniscus findings and rotator cuff changes, are common in people with no pain at all. They do not automatically indicate injury or a need for intervention. Many people live fully active lives with these findings present on imaging and never experience symptoms from them.

Pain is multifactorial. What shows up on an image is very often not the direct cause of your pain. A surgical recommendation made solely on the basis of imaging, without accounting for your symptoms, function, and quality of life, is worth questioning.

You have every right to ask: is this finding actually causing my pain? Have we exhausted conservative options? Do I need surgery, or is there a path that doesn’t involve it?

If you are in an appointment and feel like you are not getting clear answers, advocate for yourself. Ask the questions. Seek a second opinion if needed. Find a surgeon who truly listens to you.

Does Exercise Make Arthritis Worse?

No. This comes through clearly and repeatedly in Dr. Luks’ perspective. Being told to stop exercising is one of the worst things that can happen to someone with a joint condition, and it is unfortunately very common advice.

“Exercise is the risk you take to avoid the dangers of sitting still.”

– Dr. Howard Luks

The risks of inactivity, including muscle loss, increased inflammation, worsening joint health, and deteriorating quality of life, far outweigh any risk from exercise.

Even with severe arthritis. Even if you are bone on bone. Resistance training, staying active, and continuing to push and pull heavy things is not going to make your arthritis worse. Your body is resilient. Give it the movement it needs and it will adapt.

Not all pain implies harm. Some discomfort during or after activity is normal and does not mean damage is occurring. Learning to read your pain, rather than fear it, is a meaningful part of managing arthritis well.

When Is Joint Replacement the Right Choice?

Dr. Luks does not view joint replacement as a failure or a last resort. He describes it as the final common pathway: a genuinely effective option when it is the right time for the right person.

The key is that the decision should be driven by your quality of life, not by what an X-ray looks like.

He describes a pattern he sees often: you will wake up one day and simply know you are done. You have tried everything. You can no longer do the things that matter to you. That clarity tends to be the natural moment the decision becomes obvious.

Until that point, conservative management, staying strong, and continuing to move are the right approach.

Is it ever too late for joint replacement? No. Age alone is not a barrier. Dr. Luks performed knee replacement surgery on a 94-year-old patient who went on to live independently on his farm for another six and a half years.

Overall health matters far more than age. The bigger risk in waiting is becoming so sedentary that you lose the muscle mass needed to recover well afterward.

How to Prepare for Surgery (Prehab)

If surgery is on the horizon, the single most important thing you can do is prehabilitation: getting as strong as possible before the procedure.

The stronger you go in, the faster and more complete your recovery will be. Dr. Luks will sometimes delay surgery specifically to require a patient to complete prehab first, because willingness to commit to prehab tells him a great deal about whether that person will commit to rehabilitation afterward.

Steps to take before joint replacement surgery:

What to Expect During Recovery

Hip replacements tend to recover faster than knee replacements. For knees, expect a 6 to 12 month process.

The first few days often feel surprisingly good thanks to nerve blocks, which can create a false sense that recovery will be easy. When those wear off, things get harder. This is normal. It gets a little better every week, but only if you put in the work.

Recovery is an active process. You will be doing stretches and exercises throughout the day, not just during scheduled physical therapy visits. The physical therapist is important, but you are more important. A good outcome is a team effort, and you are the most critical member of that team.

What about activities after replacement? Dr. Luks does not restrict patients from most activities. People run, play singles tennis, play pickleball, golf, swim, and kneel after joint replacement.

These joints are strong, built to last 20 to 25 years, and you are not going to wear one out by being active. The belief that a replaced joint needs to be protected by doing less is not supported by the evidence.

The Mental and Emotional Side

Chronic joint pain does not only affect your body. When pain limits what you can do, the ripple effects on mood, relationships, and social connection can be significant.

Dr. Luks sees patients who stop going out, cancel plans with friends, and become more isolated. He notes that this spiral can actually affect how well someone recovers from surgery. Staying as active as possible and maintaining your social life, even imperfectly, matters more than most people realize.

He also noted that women in particular tend to put everyone else’s needs first when considering surgery, often waiting longer than necessary out of a sense of obligation to family or household. If it is time to prioritize your health and your mobility, that is not selfish. It is necessary.

Watch the Full Conversation

Want to hear everything directly from Dr. Luks? Watch the full Q&A session below.

Key Takeaways