Knee osteoarthritis

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Knee osteoarthritis is the name given to age-related arthritis which causes the knee joint to become painful and stiff.

The process of osteoarthritis involves wearing or thinning of the smooth cartilage joint surfaces as well as stiffening to the soft tissue surrounding the joint. These aspects combine to produce swelling, inflammation and pain.

Several factors normally combine to cause symptoms of osteoarthritis:

  • Previous joint damage
  • Increased bodyweight
  • Age (risk increases with age)
  • Family history (genetics)
  • Poor lower limb alignment (termed biomechanics)

General exercise such as walking, cycling and playing sport does not increase the risk of developing or increase the rate of deterioration of knee osteoarthritis.

How is knee osteoarthritis treated?


Non-surgical management

In the majority of cases, the symptoms of knee osteoarthritis can be managed effectively by non-invasive measures as described below. The most effective are exercises and weight loss for those who are overweight.

Weight loss
You can use a BMI calculator which will tell you if it might be advisable for you to try to lose some weight.

Losing weight reduces the load which weighs down on your joints as you move about. Evidence shows that weight loss can result in significantly better mobility; there is also some evidence to suggest that weight loss alone may actually help to reduce pain. However, in combination with exercise, the results can be staggering.

There is lots of support and advice available. For example, you can find some excellent ideas, including recipes and advice on making healthy food choices, on the NHS Change 4 Life website, where there is also information about healthy activities near you.

NHS recommended guidelines for healthier families

ESCAPE Pain Programme
ESCAPE-pain is a rehabilitation programme for people with chronic joint pain of the knees and/or hips. It links self-management and coping strategies with exercise specific for each person. It helps people understand their condition, teaches them simple things they can help themselves with, and takes them through a progressive exercise programme so they can cope with pain better. To find out more please click here.

Regular exercises to maintain flexibility and strength to the affected knee joint.

Using painkillers when needed
Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Versus Arthritis website with information about the various drug options.

APOS Therapy trial
For patients with advanced osteoarthritis who want to avoid surgery, APOS Therapy may provide a treatment option. It is based around a shoe-like biomechanical device which can help to distribute the forces more evenly through the joint and aid in strengthening the joint.

If you are suitable for this therapy your clinician will discuss a referral when you are seen in the MSK service. Please note this service is only currently available for Bedfordshire patients.

Corticosteroid injection therapy
For individuals with mild to moderate knee OA who continue to suffer disabling symptoms in spite a course of non-surgical management (outlined above) or for patients who are unable to commence a supervised exercise program due to pain levels, a corticosteroid injection may be offered. You can read more about local corticosteroid injections here.

Surgical management

Total knee replacement (TKR) surgery is an effective option for patients with advanced stage knee osteoarthritis who:

  • Have trialled a course of non-surgical management without success
  • Have consistent, disabling pain significantly limiting mobility or affecting sleep pattern
  • Have a satisfactory Body Mass Index (BMI) or if BMI >35 have made lifestyle changes to lose excess bodyweight

You may be asked to complete a questionnaire called an Oxford Knee score. This can help the clinician assess the impact of your symptoms which can be useful in assessing suitability for surgery.