No cartilage in knees, bone on bone, and knee caps are misaligned. do i need total knee replacement surgery?

Possibly: Your x-rays suggest you have severe arthritis. A total knee replacement, which would correct this problem, is one of the most successful operations orthoapedic surgeons perform. Whether or not you need surgery depends on the severity of your symptoms and your consideration of the risks and benefits of the procedure. Visit with a board-certified orthopaedic surgeon to learn more.

Total knee surgery: Possibly, however the decision to perform a total knee replacement doesn't just depend on xray findings of "bone on bone" arthritis. Many non-surgical options are available to improve symptoms of knee arthritis in an effort to delay surgery such as: medications, injections, braces, activity modification, and physical therapy.