When do you recommend a tkr? i have torn cartilage & ligament(s), some osteoarthritis, but i'm only 32. avoiding ligament surgery, would be 2nd time.

For SEVERE Arthritis: Your injury sounds like the "terrible triad" from lacrosse, soccer, or football (torn meniscus/medial collateral ligament/anterior cruciate ligament), or something close. Knee replacements are for severe arthritis when the cartilage is nearly gone, not simply injured. New joints may only last 10 years, give or take, so a tkr at your age is really unheard of.

TKR is for pain: Knee replacement is indicated in the setting of painful advanced knee arthritis that has failed less invasive treatments (pt, nsaids, activity modification, ambulatory aids ie cane, steroid and ha injections). Your treatment options depend on symptoms and degree of arthritis in your knee. Tkrs have been successfully but uncommonly perfomed in your age group. See a knee specialist or two.

Last resort: A tkr is reasonable for advanced arhtrosis (worn out joint) after other treatments have failed. At 32 if your knee is unstable and you have torn ligaments and cartilage then revision of your ligament repair is a better idea than tkr. The question is why did the first reconstruction fail. See a surgeon who specializes in knee ligament repair and who has extensive experience in revision repairs.

Advanced arthritis: (1 of 2) if you have instability as a primary problem i would recommend ligament reconstruction. Now if arthritis or poor alignment of the knee exists as well then consider osteotomy in addition ot the ligament reconstruction to address arthritis/instability/alignment of the extremity. Discuss acl graft options with your surgeon as well.

Instability: When the knee really feels unstable, like if you feel like your knee will give way on the staircase, then you would want to seriously consider surgery. Or if the pain becomes truly unbearable despite analgesics.