Understanding Knee Arthritis

Knee arthritis is one of the most common causes of knee pain and stiffness, affecting thousands of Australians every year.  It can make everyday activities such as walking, climbing stairs, gardening or getting out of a chair increasingly difficult.  While many people think arthritis is simply a normal part of ageing, effective treatment options are available to reduce pain, improve function and help people stay active.

This guide explains what knee arthritis is, the symptoms to look out for, and the treatment options available, from exercise and weight management through to knee replacement surgery when required.

At a glance

✔ What knee arthritis is and why it develops

✔ The most common symptoms and warning signs

✔ Who is most likely to be affected

✔ How knee arthritis is diagnosed 

✔ Non-surgical treatment options

✔ When knee replacement surgery may be appropriate

✔ Frequently asked questions

The knee joint is covered by a smooth layer of cartilage that allows the bones to glide against each other with very little friction.  In knee arthritis, this cartilage becomes damaged and gradually wears away.

As the arthritis progresses, the joint may develop:

• Thinning or loss of cartilage

• Inflammation of the joint lining

• Bone spurs (osteophytes)

• Narrowing of the joint space

• Stiffness and reduced movement

The most common type is osteoarthritis, sometimes called wear-and-tear arthritis.  Other forms include rheumatoid arthritis, post-traumatic arthritis (after a previous injury), and inflammatory arthritis.

People often notice symptoms gradually over months or years.

Typical symptoms include:

• Pain during walking or weight-bearing activities

• Stiffness, particularly first thing in the morning

• Difficulty climbing stairs

• Swelling around the knee

• Grinding or clicking sensations

• Reduced ability to bend or straighten the knee

• Loss of confidence walking on uneven ground

Many patients tell me the first sign was avoiding activities they previously enjoyed.  Rather than sudden severe pain, arthritis often presents as gradually doing less because the knee becomes increasingly uncomfortable.

Knee arthritis becomes more common with age, but it can affect adults of all ages.

Risk factors include:

• Increasing age

• Previous knee injury (ACL tear, meniscal injury or fracture)

• Being overweight

• Family history of arthritis

• Physically demanding occupations

• Inflammatory conditions such as rheumatoid arthritis

Diagnosis usually involves a combination of:

Clinical assessment

Your surgeon will ask about:

• Location of pain

• Walking distance

• Stiffness

• Swelling

• Previous injuries

• Activities that are becoming difficult

Examination

The knee is assessed for:

• Swelling

• Range of motion

• Tenderness

• Alignment (bow-legged or knock-kneed)

• Ligament stability

X-rays

Weight-bearing X-rays are the most important investigation and often show:

• Joint space narrowing

• Bone spurs

• Changes in alignment

• Severity of arthritis

Consider an orthopaedic assessment if:

• Pain persists for more than 6–12 weeks

• You regularly need pain medication

• Walking distance is becoming limited

• Sleep is disturbed by knee pain

• The knee repeatedly swells or gives way

• You are avoiding work, exercise or social activities because of the knee.

Non-surgical treatment

Most patients begin with conservative management.

Effective options include:

• Exercise and physiotherapy – strengthening the quadriceps, gluteal and core muscles.

• Weight management – even modest weight loss can reduce the load through the knee.

• Activity modification – choosing lower-impact activities such as cycling, swimming or walking on flatter ground.

• Simple pain relief – as recommended by your doctor.

• Bracing – in selected patients with arthritis affecting one side of the knee.

• Injections – corticosteroid or other injections may provide temporary symptom relief for some people.

Surgical treatment

Surgery is considered when non-surgical measures no longer provide adequate relief.

Options may include:

• Partial Knee Replacement – when arthritis is limited to one compartment of the knee.

• Total Knee Replacement – when arthritis affects most or all of the joint.

• Occasionally, other procedures depending on the pattern of arthritis and the patient's age and activity level.

The goal of knee replacement is not simply to improve an X-ray.  It is to reduce pain, restore function and help people return to the activities that matter most to them.

Can knee arthritis improve without surgery?

Yes.  Many people achieve significant improvement with strengthening exercises, weight management, physiotherapy and appropriate pain management.

Does walking make arthritis worse?

Usually not.  Regular, comfortable walking is generally beneficial.  Severe pain during or after walking should be discussed with your healthcare team.

How do I know if I need a knee replacement?

The decision is usually based on pain, loss of function and reduced quality of life rather than the X-ray alone.  Many patients choose surgery when they can no longer do the activities that are important to them despite appropriate non-surgical treatment.

Is knee replacement successful?

Yes.  Modern knee replacement surgery is one of the most successful orthopaedic procedures for relieving arthritis pain and improving function.

Can I still exercise with knee arthritis?

Absolutely.  Cycling, swimming, walking, strength training and many other low-impact activities are encouraged and often form an important part of treatment.

Disclaimer: This article provides general information only and should not replace personalised advice from your orthopaedic surgeon, GP or physiotherapist.  Treatment recommendations should always be tailored to your individual circumstances.