Physical therapy steroid injections and meds hvnt helped my knees mri shows loss of cartilage bone on bone due to severe arthritis do i nd surgery?

Knee surgery: If you've maximized conservative treatment, including gel injections, cortisone injections, weight control, nsaids, omega, pain meds, then check with orthopedic surgeon for possible tka, uni knee, or osteotomy.

Depends: You are quite young for surgery. If it is very severe arthritis then seek an orthopedic opinion. But another alternative to try first would be viscosupplementation, therapy, weight loss, glucosamine & chondroitin & bracing if yo have no tried these yet.

Sounds like: You might. Bring your data to an orthopedic surgeon who specializes in total knee replacements. He will help you make the right decision.

Surgery possible: Sounds like you have done pretty good conservative treatment. Depending upon location and extent of arthritis, surgery may help.