Carol Played Through the Pain for Two Years. Then She Got New Knees
Carol Simmons didn’t plan to become the most talked-about player at her Tuesday morning round-robin.
She planned to quit.
At 67, after two years of grinding knee pain, two cortisone shots that bought her maybe six weeks of relief each, and a tournament she spent the entire back half of limping through, Carol had a quiet conversation with herself on the drive home. She loved pickleball more than almost anything in her life. And pickleball was slowly taking her apart.
Her orthopedic surgeon had mentioned total knee replacement the previous winter. Carol had nodded politely and changed the subject.
The Question She Kept Avoiding
What Carol had — bone-on-bone osteoarthritis in her left knee — is more common in pickleball players than most people realize. The sport’s lateral cuts, kitchen lunges, and constant low-position bending load the knee joint in ways that accelerate wear, especially in players who came to the game later in life with existing mileage on their joints.
But the condition itself wasn’t the hard part. The hard part was the eighteen months before she finally took her surgeon seriously — the bargaining, the ibuprofen, the YouTube stretches at midnight, the compression sleeve she wore to bed and pretended didn’t exist in the morning.
“I kept thinking I just needed to strengthen something,” Carol says. “My quad, my hip flexors, whatever. I did everything. And my knee kept getting worse.”
For many players, chronic knee pain does respond to conservative treatment — VMO strengthening, glute and hip work, technique adjustments, weight loss, better shoes. If you haven’t gone down that road thoroughly, go down it first. A good sports physio will tell you honestly whether you’re dealing with something manageable or something structural. The distinction matters enormously.
For Carol, the answer was structural. And no amount of squats was going to fix that.
Could She Have Avoided It?
Probably not at that point — but possibly earlier. This is the honest answer most surgeons will give you if you ask directly.
Osteoarthritis doesn’t reverse. What you can do, if you catch it early enough, is slow the progression. Keeping your weight in a healthy range reduces joint load significantly — every pound lost takes roughly four pounds of pressure off your knees. Strengthening the muscles around the knee creates a kind of muscular armor that absorbs force the joint would otherwise take alone. Technique matters too: players who bend their knees properly in the ready position and avoid over-striding put less torque on the joint over thousands of repetitions.
If Carol had known ten years ago what she knows now, she might have bought herself more time. But some people are simply going to need this surgery. The genetics, the prior sports history, the accumulated load — it adds up, and no lifestyle intervention undoes bone-on-bone damage once it’s there.
The more useful question, once you’re in that territory, is whether to act sooner or keep waiting. Carol waited too long. She’ll tell you that herself.
The Decision
She agreed to surgery in October. On the table in January. The fear most players have about total knee replacement is the recovery — the months out, the lost fitness, the feeling that you’re gambling your active life on an outcome you can’t control.
What Carol found was that the fear was bigger than the reality.
By week three she was walking without a cane. By week six she was doing light footwork drills in her driveway. Her physical therapist, who works with a lot of pickleball players, told her something she held onto: the patients who recover fastest are the ones who were active before surgery and treat rehab like a sport.
At twelve weeks, she was cleared for light play. She showed up to Tuesday morning round-robin with a brace and no expectations. Her partner Sandra, who had watched her deteriorate for two years, burst into tears at the sight of her.
What It Costs
This part deserves a straight answer because it’s what people actually want to know and nobody wants to say it plainly.
In the United States, total knee replacement runs roughly $30,000 to $50,000 without insurance. With Medicare or private insurance covering the majority, most patients’ out-of-pocket costs land somewhere between $1,500 and $6,000 depending on their plan, deductible, and whether the surgery is done in a hospital or outpatient facility. Outpatient TKR — increasingly common for healthy, active patients — tends to run cheaper and has comparable outcomes for the right candidates.
Physical therapy is a separate cost. Budget for it. The patients who skip or shortchange PT because it’s not fully covered are the ones who take longer to recover and sometimes don’t get back to sport at all. It’s not optional.
Carol’s total out-of-pocket, including PT through week sixteen, was just under $4,000. She’s mentioned that number to several players at her club who were avoiding the conversation because they assumed they couldn’t afford it. Most of them could.
Was It Worth It?
Here’s what nobody told Carol before she went in — and what she now tells everyone else.
Pain changes your game in ways you stop noticing because it happens slowly. You stop lunging for certain shots. You avoid lateral movement on one side. You don’t bend into the ready position the way you used to. The compensation becomes your game, and after a while you think that’s just how you play. Remove the pain, and you get your real game back — sometimes for the first time in years.
Carol’s serve return, always the weakest part of her game, improved noticeably in her first month back. She could finally load properly on her left side. Her coach noticed before she did.
She doesn’t wear the brace anymore. Last month she signed up for a tournament for the first time in three years.
“I should have done it sooner,” she says. “I kept waiting for a reason to go ahead. I didn’t realize the reason was already two years behind me.” New knees. New game. Same Carol — just finally playing like herself again.