By In-house Team, Circle Health Group

Osteoarthritis (OA) of the knee

Osteoarthritis of the knee causes symptoms such as pain, stiffness and difficulty mobilising

What is osteoarthritis of the knee?

Osteoarthritis (OA) is a common condition that causes inflammation of the joints. There are many types of arthritis including rheumatoid arthritis, reactive arthritis and gout. All types of arthritis are characterised by joint inflammation, but they have different causes.

Osteoarthritis is the most common type of arthritis in the UK and occurs due to wear and tear on your joints as you age. The condition is more common in women and usually affects people over the age of 50. Osteoarthritis is a degenerative condition meaning it develops slowly and often gets worse over time. It can affect almost any joint in your body but is most common in your hips, knees and the small joints in your hands.

Anatomy of the knee joint

Your knee joint is the largest joint in your body. It is a hinge joint that connects your upper leg to your lower leg and allows you to bend and straighten your leg. It also helps support your body weight, maintain stability and act as a shock absorber. Your knee joint is made up of three parts; the lower end of your thigh bone, the patella (kneecap), and the upper ends of your shin bone (tibia). The ends of these bones are covered with a smooth slippery substance called cartilage that protects and cushions your knee joint as you move. The meniscuses are two rubbery pieces of cartilage positioned between your thigh bone and shinbone that act as ‘shock absorbers,’ helping to cushion your joint and keep it stable.

Your knee joint is surrounded by a thin membrane (synovial membrane) that produces fluid (synovial fluid) to lubricate the cartilage, reduce friction and make movement easier.

Knee osteoarthritis

With knee osteoarthritis, the protective cartilage breaks down and becomes thinner causing bone to rub on bone and leading to inflammation, pain, stiffness and swelling in your knee joint and surrounding soft tissues. It can also lead to the formation of bone spurs (osteophytes), extra growths of bone, that can make pain and stiffness worse.

Osteoarthritis knee symptoms

The main symptom of knee osteoarthritis is pain in your knee. This can range from mild and intermittent to severe and constant. You might have pain when you stand, move around, or after rest, such as when you wake up in the morning. If your knee osteoarthritis is severe, you may have pain all the time.

Other symptoms of knee osteoarthritis include:

Stiffness in your knee joint, especially in the morning or after rest
Swelling around your knee
A cracking, grating or grinding noise when you move your knee
Your knee may feel as if it might buckle or ‘give way’
Locking or sticking of your knee joint
Difficulty moving your knee

How does knee osteoarthritis affect daily life?

Knee osteoarthritis can affect your daily life when pain and stiffness make it difficult to carry out certain tasks and activities. Long-term pain and reduced mobility can also affect your mental health and overall well-being.

Knee osteoarthritis may affect your daily life by leading to:

Reduced independence

Difficulty performing certain tasks and activities such as walking, domestic chores, climbing stairs, dressing and bathing may mean you need help with things you once did alone and reduce your independence. Knee osteoarthritis can also affect your ability to enjoy hobbies like gardening and walking.

Social isolation

Difficulty getting around due to pain and stiffness may mean you are more likely to stay at home which can lead to social isolation. It can also be difficult to use public transport, or access places without ramps or lifts.

Economic and financial effects

Depending on the job you do, knee osteoarthritis symptoms such as pain, stiffness and reduced mobility can make it difficult for you to work, leading to financial difficulties.

Difficulty sleeping

Long-term pain and stiffness can lead to difficulty falling or staying asleep which can make pain worse and lead to fatigue and low mood.

Effects on mental health

Reduced independence, social isolation, long-term pain, sleep disturbances and money worries can have a serious impact on your mental health and may lead to low mood, depression and anxiety.

Stages of knee osteoarthritis

Knee osteoarthritis is a degenerative condition that usually gets worse over time. The condition has four main stages: minor, mild, moderate, and severe which occur as the cartilage in your knee joint continues to break down and the joint space narrows, leading to increased pain and stiffness and reduced mobility.

Stage 1: Minor knee osteoarthritis

In the first stage of knee osteoarthritis, there is minimal damage to the cartilage. You may have no symptoms at all at this stage or may experience mild pain in your knee that comes and goes. Pain is often worse after activity or at the end of the day.

Stage 2: Mild knee osteoarthritis

As damage to the cartilage worsens, this is now visible on X-rays along with the beginnings of bone spur formation. You may have symptoms such as pain and stiffness, especially in the morning, or after periods of rest.

Stage 3: Moderate knee osteoarthritis

The cartilage has now significantly broken down and the joint space has narrowed. You may experience symptoms such as pain and stiffness more often, especially during activities where you move your knee like walking, squatting, and kneeling. You may also have difficulty moving your knee.

Stage 4: Severe knee osteoarthritis

In the most severe stage of knee osteoarthritis, the cartilage has worn away to the point where bone is grinding on bone. In this stage, you will likely have symptoms all or most of the time, and moving around may be difficult.

When to see a specialist for osteoarthritis of the knee

See your consultant for osteoarthritis of the knee if you have persistent symptoms such as pain, swelling, stiffness and difficulty moving that affect your ability to carry out day-to-day activities. Early diagnosis and treatment can help improve your symptoms and slow the progression of the disease.

How is knee osteoarthritis diagnosed?

At your initial appointment, your consultant will start by asking about your symptoms including what your symptoms are, when they started and how they impact your day-to-day life. They will perform a physical examination of your knee to check for pain, tenderness, swelling and reduced range of motion. They may ask you to stand and walk.

Your consultant may order tests such as a blood test to rule out any underlying medical conditions that could be causing your symptoms. They may also order scans such as an X-ray, CT scan or MRI to further examine your bones, joints and soft tissues.

Osteoarthritis knee treatment

There is currently no cure for osteoarthritis of the knee, but the condition can be managed with a combination of treatments to reduce your symptoms and slow the progression of the disease.

Treatment for knee osteoarthritis includes medication, physiotherapy, lifestyle changes, and in some cases, surgery to replace your damaged knee joint.

Osteoarthritis knee pain relief

Managing pain is one of the main aims of treatment for knee osteoarthritis and usually involves a combination of treatments such as medication, lifestyle changes, activity modification and physiotherapy.

Medication

Medications for knee osteoarthritis include painkillers and drugs to reduce inflammation in your knee joint. This may include:

Over-the-counter medicines: May include painkillers like paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Topical gels or creams
Stronger prescription painkillers
Steroid injections: This is an injection directly into your knee joint that provides short-term pain relief by reducing inflammation

Lifestyle changes

Making changes to your lifestyle can help to reduce pressure on your knees and improve your symptoms. Lifestyle changes include avoiding or limiting activities that make your knee pain worse, losing weight if you need to, and taking regular low-impact exercise.

Activity modification

Activity modification is when you avoid or limit activities that make your knee pain worse and rest your knee between activities. Assistive devices such as walking aids, knee braces and shoe orthotics can also help support your knee, reduce pressure on your knee joint and make some activities easier.

Losing weight

Being overweight or obese increases pressure on your knees and can make your symptoms worse. Losing weight and keeping your weight within healthy limits can help reduce pain and inflammation, improve your mobility and function and slow the progression of knee osteoarthritis. If you are struggling to lose weight, our private weight loss clinic can offer support and advice with safe, effective weight loss.

Physiotherapy

Knee physiotherapy involves special exercises and other treatments to improve your symptoms and manage pain by strengthening your knee muscles, improving your flexibility and increasing your range of motion. Your experienced physiotherapist will work with you to create an individual treatment plan tailored to your needs.

This may include:

Exercises: Your physiotherapist will teach you exercises to do during your sessions and at home
Transcutaneous Electrical Nerve Stimulation (TENS): Uses a low-voltage electrical current to relieve pain
ESWT (extracorporeal shockwave therapy)
Acupuncture
Steroid injection therapy
Heat/cold therapy: Applying heat or cold packs can help relieve pain and reduce swelling and stiffness
Phits 3D printed insoles
Alter G treadmill

Other treatments for knee osteoarthritis

Other non-surgical treatments for knee osteoarthritis include:

Arthrosamid® joint injections
Hyaluronic acid injections(HA)
Platelet-Rich Plasma (PRP) Injections

Knee surgery for osteoarthritis

If your knee osteoarthritis is severe, or your symptoms have not improved with other treatments, your consultant may recommend an operation called knee replacement surgery. This is surgery to remove all or part of your damaged knee joint and replace it with an artificial one called a prosthesis.

Osteoarthritis knee exercises

Regular low-impact exercise is an important part of knee osteoarthritis treatment and helps to strengthen the muscles around your knee, improve your flexibility and range of motion and reduce pain.

Talk to your consultant or physiotherapist before starting any new exercise programme and follow their instructions carefully so that you don’t make your knee osteoarthritis worse.

When starting exercises for knee osteoarthritis, always:

Start slowly and build up your activity level gradually
Warm up before exercising and cool down fully afterwards
Stop if you feel pain
Ensure you use the correct form (posture) when exercising to prevent injury

Some exercises you can do at home for knee osteoarthritis include:

Straight leg raises (floor)

Lie on the floor or bed
Bend one leg at the knee, keeping your other leg straight
Lift your foot on the straight leg a few inches off the floor or bed
Hold for five seconds
Repeat five times with each leg

Straight leg raises (chair)

Sit on a chair, keeping your back straight
Straighten one leg and raise it off the ground
Hold for 10 seconds and slowly lower your leg back down
Repeat 10 times with each leg

Knee muscle stretch

Lie on your back with a rolled-up towel under the ankle of one leg
Bend your other leg at the knee
Push the back of your knee of your straight leg towards the floor
Hold for five seconds
Repeat at least five times with each leg

Knee bends

Lying on your back, gently bend your knee up towards your chest as far as is comfortable
Hold for a few seconds, and then slowly straighten your leg
Repeat at least five times with each leg

Leg stretch

Sit on the floor with your legs straight out in front of you
Slowly, bend your knee up towards your chest, sliding your foot along the floor, until you feel a stretch
Hold for five seconds
Straighten your leg as far as you can and hold this position for five seconds

Step-ups

Stand in front of a flight of stairs, holding the banister for support if you need to
Step onto the bottom step with your right foot
Step up with your left foot and step down with your right foot
Repeat with each leg as many times as you can

Mini squats

Hold onto a chair or counter for support
Squat down as far as is comfortable, keeping your back straight
Repeat as many times as you can

Sit/Stands

Sit on a chair
Stand up and then sit back down slowly, without using your hands for support
Repeat as many times as you can

Osteoarthritis knee FAQs

We answer some of your most frequently asked questions about knee osteoarthritis.

Knee osteoarthritis dos and don’ts

When you have knee osteoarthritis, there are some simple dos and don’ts you can implement into your daily life to reduce your symptoms and make your condition more manageable.

Do:

Follow the advice of your consultant and/or physiotherapist carefully. Ask questions if you’re not sure about anything
Lose weight if you need to, and maintain a healthy weight
Follow a healthy, nutritious diet such as the Mediterranean diet with plenty of fruits, vegetables and healthy fats
Consider supplements such as glucosamine and collagen. Talk to your consultant before starting any supplements
Take regular low-impact exercise, such as walking, swimming, gentle cycling, Tai Chi, or yoga
Walk on level ground and avoid uneven or rough terrain
Wear the correct footwear that cushions and supports your feet and absorbs impact
Listen to your body and rest if you feel pain
Take a warm bath, or apply heat packs to your knee to reduce pain
Apply ice packs to your knee to reduce swelling
Consider assistive devices such as walking aids and knee braces

Don’t:

Put pressure on your knee by engaging in high-impact exercise (such as running and jumping), lifting heavy objects, climbing a lot of stairs, or squatting
Ignore or ‘push through’ pain
Make sudden movements that jerk or twist your knee
Stay inactive for long periods

Is walking good for osteoarthritis of the knee?

Walking is generally beneficial for knee osteoarthritis as it is a low-impact exercise that helps strengthen the muscles around your knee, improve flexibility and reduce pain and stiffness. It is also great for your overall health!

As with any exercise, it’s important to check with your consultant before starting a new regime, start slowly, increase the amount of walking gradually and stop if you feel pain. Consider using a cane or walking stick to reduce pressure on your knee joint and walk on a flat, even surface.

Do knee braces help knee osteoarthritis?

Knee braces can help with the symptoms of knee osteoarthritis by supporting your knee joint, improving stability and reducing pain and swelling. Talk to your consultant or physiotherapist about whether a knee brace would be beneficial for you.

Osteoarthritis knee in summary

Knee osteoarthritis is a common condition that affects an estimated 5.4 million people in the UK. It causes symptoms such as pain, stiffness and reduced mobility that can significantly impact your health, well-being and quality of life. While there is no cure for knee osteoarthritis, the condition can be managed effectively with a range of treatments including medication, physiotherapy and in some cases, surgery.

At Circle Health Group, our network of experienced consultants are experts in treating knee osteoarthritis and offer bespoke treatment plans tailored to your individual needs.

Clinical sources and further reading

Osteoarthritis overview, NHS
Osteoarthritis (OA) of the knee, Versus Arthritis
Knee Osteoarthritis, National Library of Medicine
Arthritis of the Knee, OrthoInfo