Mri shows loss of cartilage from severe arthritis and bone ontop of bone is very painful i can't bare weight on my legs will i need knee surgery?

Not good: If you have bone on bone at the knee joint (femorotibial joint) at age 32, it's not good. Weight loss (unless you're underweight) helps because every 1 lb lost takes 4 lb of pressure off the knee. Braces may help stability. Rx and/or cortisone injections or hyaluronic acid injections may make things livable. Surgery sounds inevitable but you may be able to delay.

Knee pain: Please check the answers to all the similar questions you asked. Obviously max out on conservative before tka.

Very possible: Other disorders must be evaluated however, if indeed the diagnosis is osteoarthritis with preofound loss of cartilage, i would first recommend a trial of intra-articulay hyaluronic acid therapy which is injected into the knee as a lubricant weekl for 3 doses.

Possible surgery: I prescribe therapy, nsaids, weight loss (if necessary) and possible bracing and steroid shots first. If you fail this, then surgery may be needed.