If you're weighing a knee or hip replacement in Charleston or Mount Pleasant, South Carolina, four decisions should shape your treatment options:

When joint replacement becomes the right step

Knee and hip arthritis can often be managed without surgery. The American Academy of Orthopaedic Surgeons identifies several nonsurgical treatments to relieve pain, including activity changes, physical therapy, over-the-counter anti-inflammatory medication and an assistive device such as a cane or a knee sleeve. Novant Health physicians address these treatment options and other common concerns in their list of myths about knee replacement surgery.

Once you've made an appointment to explore treatment options, the next step is evaluation. Surgeons look at more than how much your joint hurts. They also consider whether you have pain that wakes you at night, stiffness after sitting, swelling after ordinary activities and a decrease in how far you can walk comfortably. An exam and an X-ray show how far arthritis has progressed, and together they set the timing of treatment.

Timing is critical and determines how long you can put off knee replacement surgery. Having surgery before trying nonsurgical treatments can mean replacing a joint before it’s necessary. However, if you wait until walking, sleeping, standing and completing everyday activities are painful or impossible, you may have less muscle and a stiffer joint when it comes time for surgery, which adds work to the recovery.

"I'd rather see somebody early. If people wait a year or two and then say, 'OK, I can't take it anymore,' they show up weaker and stiffer than they had to be, and they're looking at more work on the back end. We work with our patients to determine the best plan for their current and future needs," said Dr. William Estes, an orthopedic surgeon at Novant Health Orthopedics & Sports Medicine Institute.

An evaluation isn't a commitment to surgery. Instead, it allows a surgeon to establish which joint is involved and how far the arthritis has progressed. It also sets the stage for the next several months of care.

What board certification and fellowship training tell you about a joint replacement surgeon

Board certification and fellowship training are two credentials you can check when choosing a surgeon. The American Board of Orthopaedic Surgery requires surgeons to complete a five-year accredited orthopedic residency and pass written and oral exams. The oral exam includes a review of cases the surgeon has performed. Board certification lasts 10 years and must be maintained through continuing education and a new list of cases.

A fellowship is an additional year of training after residency focused on a single subspecialty. For knee and hip replacement surgeons, that area is called adult reconstruction, which the American Medical Association's specialty directory describes as the reconstructive treatment of musculoskeletal disease. The American Association of Hip and Knee Surgeons sets common training standards for adult reconstruction fellowships through its recognition program.

Board certification shows a surgeon met a national standard across orthopedics, while fellowship training shows which joints a surgeon received additional specialized training to treat. The knee, hip and joint physicians at Novant Health Orthopedics & Sports Medicine Institute publish both board certifications and fellowship training on each surgeon's personal page. Every orthopedic surgeon who performs joint replacement at Novant Health Orthopedics & Sports Medicine Institute is board-certified, and each surgeon's profile on NovantHealth.org lists their board certification and fellowship training.

How to understand hospital recognition for orthopedic care

Independent recognition measures a hospital's quality. Here's what it means.

• Specialty recognition evaluates one area of care instead of a hospital's overall reputation. Novant Health East Cooper Medical Center is named on Newsweek's 2026 Best Hospitals for Specialized Orthopedic Care list. Hospital quality metrics from the Centers for Medicare and Medicaid Services and Leapfrog carry the most weight, accounting for 45% of the score. A national survey of medical professionals accounts for 33.5%, followed by patient experience at 15% and patient-reported outcome measures at up to 6.5%. East Cooper Medical Center also appears on Newsweek's 2026 America's Best-in-State Hospitals list.
• Safety recognition addresses how well a hospital prevents infections and avoidable complications. The Leapfrog Group grades hospitals twice a year on up to 32 patient safety measures, including hospital practices and patient outcomes. East Cooper Medical Center received Certified Zero Harm Awards in 2024 and 2025 from the South Carolina Hospital Association for avoiding specific hospital-acquired infections for an extended period.
• System-level recognition looks beyond an individual hospital to the health system behind it. Becker's Hospital Review included Novant Health among its 100 Hospitals with Great Orthopedic Programs in 2023, 2024 and 2025.

When comparing hospitals, look at what each recognition measures and whether a hospital or health system has earned it consistently over time. Different awards may tell you different things about orthopedic care, patient safety and the organization as a whole.

Why choosing a surgeon should come before choosing a hospital

For a planned knee or hip replacement, the surgeon you choose typically determines where the operation happens, because surgeons operate at the hospitals where they're approved to perform surgery.

If you have a complex medical history, a prior joint infection, significant bone loss or an earlier joint replacement that has worn out, ask the surgeon how often they treat cases like yours and who else would be involved in your care. Surgery to repair or replace a previous joint replacement is called revision surgery, and surgeons at Novant Health Orthopedics & Sports Medicine Institute perform both knee and hip revisions.

Novant Health Orthopedics & Sports Medicine Institute brings together orthopedic specialists across the Charleston area and the Lowcountry, with clinics in Mount Pleasant, Summerville and Goose Creek, so patients can get orthopedic care closer to home. The institute's surgeons perform joint replacement at Novant Health East Cooper Medical Center in Mount Pleasant, which carries national recognition for orthopedic care inside a nonprofit system that operates three hospitals and more than 60 physician clinics across South Carolina.

What to discuss in a joint replacement consultation

The following five topics should be covered during your joint replacement consultation.

• Candidacy and timing. Ask whether your surgeon recommends nonsurgical care or replacement for your joint, and what would change if you wait another year.
• The operation itself. Partial knee replacement, total knee replacement, total hip replacement and revision surgery aren’t one-size-fits-all procedures, so have the surgeon walk you through which joint replacement surgery services fit your joint and why.
• Fellowship training for your joint. Find out whether the surgeon has fellowship training in joint replacement.
• Technology. Robotic-arm assisted joint replacement is a surgical planning and positioning technology that can improve precision. Ask how it might be used in your surgery.
• The recovery plan. Get specifics on where rehabilitation happens, how often, who coordinates the handoff from the surgical team and what progress should look like at two weeks, six weeks and three months.

You can read more in a Novant Health article about considering knee replacement, in which a physician answers many of the same questions a consultation covers.

How robotic-arm assisted joint replacement works

Robotic-arm assisted joint replacement is a planning and positioning tool that the surgeon controls. Before robotic-assisted joint replacement, images (usually from a CT scan) are used to create a three-dimensional plan for the joint. During surgery, the surgeon removes damaged bone and cartilage and places the implant, while the robotic instruments provide feedback. The surgeon makes every decision, using that feedback to follow the plan built from the scan.

Robotic-assisted joint replacement usually requires additional imaging before surgery. It also involves placing small navigation pins, which carry a small risk of complications at the pin sites. The AAOS recommends choosing a well-trained and highly experienced orthopedic surgeon — another reason to ask about a surgeon’s credentials.

Novant Health physicians have explained why they choose robotic-assisted joint replacement procedures and how they use the technology in the operating room.

Planning for your recovery from joint replacement surgery

Plans made before surgery shape the weeks after it, and the AAOS guidance on preparing for joint replacement surgery covers everything from who drives you home to which rooms need rearranging, where physical therapy will happen and what to move within reach on the ground floor.

Some surgical teams recommend strengthening exercises before surgery, because stronger muscles around a joint can help with recovery afterward. Learn more from Novant Health experts about how to prepare with these pre-hab tips before orthopedic surgery. You can also read about what to expect during hip and knee replacement recovery, and specifically hip replacement surgery and recovery.

Rehabilitation is another factor to consider when choosing where to have joint replacement surgery. Newsweek named East Cooper Medical Center one of America's Best Physical Rehabilitation Centers in 2025.

"Recovery starts before surgery. The prep you do and the rehab you choose matter as much as the operation itself," said Estes.

The orthopedic surgeons who perform joint replacement at Novant Health Orthopedics & Sports Medicine Institute in the Charleston area

The table below highlights eight orthopedic surgeons at Novant Health Orthopedics & Sports Medicine Institute in the Charleston area, listing each surgeon's specialty, fellowship training and board certification.

If knee or hip pain has started getting in the way of everyday activities, it might be time to see a surgeon. Understanding a surgeon's training and a hospital's track record can help you choose the right care and get more out of your first appointment.

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