Knee Osteoarthritis Overview

Knee osteoarthritis—often called “wear and tear” arthritis—is especially common in middle-aged and older adults. As the joint surface becomes rough, patients notice pain, swelling, and stiffness, sometimes accompanied by a gradual drift toward bow-legged or knock-kneed alignment. Other forms of arthritis affecting the knee include post-traumatic arthritis (after fractures, ligament injuries, or meniscus tears) and inflammatory arthritis, such as rheumatoid arthritis.

Symptoms

The discomfort usually creeps in slowly, though it can sometimes appear abruptly.

  • Morning stiffness or stiffness after rest

  • Pain and swelling that worsen with walking, climbing stairs, or kneeling

  • A sense of weakness, buckling, or “locking” of the knee

  • Weather-related worsening

  • Severe cases may disturb sleep or limit one’s ability to straighten or bend the knee fully

Investigations

After examining the knee, doctors typically request standing (weight-bearing) X-rays—AP and lateral views—to avoid missing the diagnosis. Additional imaging may include tunnel-view X-rays or an MRI scan, especially when symptoms involve sensations like clicking or locking.

Treatment Goals

The primary aim is simple yet vital: reduce pain, improve function, and enhance overall quality of life. Treatment decisions are best made collaboratively between patient and physician.

Nonsurgical Treatment Options

Lifestyle Modifications

  • Losing weight to reduce load on the knee

  • Switching from high-impact activities (running, jumping) to low-impact ones (cycling, swimming)

  • Reducing stair climbing or other aggravating activities

Weight loss alone often brings significant relief, particularly in walking.

Exercise

Targeted exercises improve flexibility, range of motion, and muscle strength. Physical therapy plays a key role in restoring function and reducing pain. A therapist or doctor can design a personalized program.

Supportive Devices

Helpful options include:

  • Canes

  • Energy-absorbing shoes or inserts

  • Knee sleeves or braces

Braces are particularly effective when arthritis affects only one side of the knee.

  • Unloader braces shift pressure away from damaged areas

  • Support braces stabilize the joint as a whole
    Many studies show better walking endurance and reduced pain with their use.

Other Non-operative Methods

  • Heat or ice applications

  • Water-based exercises

  • Elastic bandages or liniments

  • Medications like NSAIDs, glucosamine, chondroitin

  • Steroid injections

  • Viscosupplementation with hyaluronic acid

Surgical Treatment

Surgery is considered when:

  • Pain disrupts daily activities and persists despite conservative care

  • Stiffness, swelling, and mobility loss are significant

  • X-rays clearly show arthritis

The primary goal of knee replacement surgery—partial or total—is to relieve pain and restore mobility.

  • Partial (unicondylar) knee replacement: used when only one compartment is worn

  • Patellofemoral replacement: for kneecap–thigh bone joint degeneration

  • Total knee replacement: for widespread arthritis

In select cases, arthroscopy or osteotomy may reduce symptoms by smoothing the joint or realigning the limb.