What You Need to Know About Knee Osteoarthritis

Maybe you used to hop out of bed and go for a run or a morning walk with the dog, but recently you’ve noticed that your knee doesn’t have the get-up-and-go that your mind does. It might be a little stiff and sore in the morning, and painful when you use it too much. If so, you might be experiencing the early stages of knee osteoarthritis (OA). 

Knee osteoarthritis happens when the cartilage in your knee joint wears down over time. That can lead to inflammation and cause pain, stiffness and swelling that make everyday activities harder. Treatments focus on reducing symptoms because there aren’t any therapies that can stop or reverse OA. Exercise, weight management and medication can help, and if it worsens too much, you might choose joint surgery for relief. 

What Causes Knee Osteoarthritis? 

• Age: OA is most common in older adults, although it can also develop in younger adults. 
• Sex: Women are more likely to have knee OA than men. 
• Obesity: Being overweight adds stress to your knees. Fat cells also make proteins that can cause damaging inflammation in and around your joints. 
• Injuries: Any knee injury, even old ones, can set the stage for knee OA. 
• Repeated Stress: Frequent stress on your knee from your job or playing sports can increase risk for OA. 
• Genetics: You can inherit a tendency to develop OA. 
• Bone Deformities: If you have crooked bones or joints that affect your knees, you are at higher risk. 

Can You Prevent Knee OA From Getting Worse? 

You can't reverse knee OA, but staying active and maintaining a healthy weight can significantly slow its progression. Losing just 1 pound relieves 4 pounds of stress on your knee joint. You can also protect your joint by strengthening the muscles around your knee, avoiding high-impact repetitive activities and preventing re-injury. 

What Does Knee Osteoarthritis Feel Like?

• Pain: Movement causes pain. Sometimes your knee will ache while sitting still. 
• Stiffness: Your knees may be stiff first thing in the morning or after sitting for a long time. 
• Loss of motion: Over time, you may lose the ability to bend and straighten your knee all the way. 
• Creaking and grating (crepitus): You may hear cracking noises or feel a grating sensation. 
• Instability: Your knee may “give out,” or buckle — or feel like it could. 
• Locking: The knee may lock or stick. 
• Swelling: Your knee may get puffy all around or on one side. 

When Should You See a Doctor? 

You can first try conservative measures to relieve pain, such as ice and heat, topical pain-relief gels or creams, over-the-counter pain relievers (in moderation) and maybe a knee brace. If those no longer help and you’re still having pain that’s affecting your activities, it’s time to see a doctor. 

What Are the Stages of Knee OA? 

Knee OA progression is often measured using a five-point scale that measures X-ray images of osteoarthritis progression: 

• Early on, before there is much damage to cartilage, you probably won’t notice many symptoms.  
• When cartilage thins a bit more, you’ll probably feel some pain and stiffness and may occasionally have a flare of pain.  
• As damage progresses over months and years and cartilage continues to wear down, you are likely to feel more pain, especially with activities like squatting or climbing stairs. Your knee may also feel more stiff after you’ve been sitting for a while or when you get up in the morning. 
• When cartilage is gone to the point that your bones are rubbing together, you will feel significant pain and are likely to be limited in your leg and knee movements, including walking, climbing stairs and getting up and down from a chair. 

How Is Knee Osteoarthritis Diagnosed?

Your doctor can usually diagnose knee OA with a physical exam and X-rays. No special tests are needed in most cases, but bloodwork might be drawn, or fluid removed from your knee to rule out other forms of arthritis.

To diagnose OA, your doctor will check for: 

• Swelling, warmth, redness or soreness in or around the joint. 
• Range of motion — how much you can move your knee. 
• Instability of the joint — how loose is the joint. 
• Pain from weight being placed on the knee. 
• Gait problems — how you walk. 
• Signs of previous injury. Your doctor may order X-rays of one or both knees. Cartilage does not show up on X-ray, but cartilage loss is seen because the space between the bones gets thinner and cartilage wears down. X-rays can show bone spurs (bony growths around the edges of the joint). 

Magnetic resonance imaging (MRI) might be used to get a picture of the knee that includes both bone and soft tissue. 

Osteoarthritis cannot be stopped or reversed. But treatments can reduce pain and help you move better.

Most people manage knee OA successfully with conservative treatment for years. Understanding what to try first can help you stay active, as only a percentage of people eventually need surgery.

What Can You Do Without Medication? 

These are the first-line, evidence-backed steps to start with. 

• Apply ice or heat to help ease stiffness, pain and swelling. 
• Lose excess weight to help reduce stress on the knees. 
• Keep moving with activities like swimming, biking or walking. 
• Exercise is the only non-surgical intervention strongly recommended by every OA guideline. Focus on low-impact cardio, quad strengthening, and range-of-motion work. Avoid deep squats and high-impact running. If you are in pain, start slowly. Work with a physical therapist to learn what types of activities to do and how to adapt them to your needs. 

What Medications Help? 

If lifestyle changes aren't enough, over-the-counter options can help. 

Oral medications that include acetaminophen  and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help ease pain — at the lowest dose for the shortest time possible to avoid stomach bleeding and ulcers. 

Gels or creams that contain an NSAID, like diclofenac, or anesthetic, like lidocaine and salicylates that can be rubbed on the knee. Other topicals contain numbing or other ingredients like capsaicin, menthol or camphor that may help. 

If you are no longer getting relief from more conservative measures, your doctor may prescribe physical therapy with a professional, a prescription medication or an injection or procedure. 

If fluid has built up around the knee, causing swelling, your doctor may use a syringe to draw off extra fluid. 

An injection of a corticosteroid (such as cortisone) can reduce inflammation and pain relief. Too many injections can break down cartilage, so your doctor will limit how often you get one. 

Lubrication injections with hyaluronic acid (viscosupplementation) help ease pain and improve mobility for some people. 

When Is Surgery an Option? 

If all other treatments are no longer enough to reduce pain and maintain your ability to get around, you might explore surgical options. 

Your doctor probably won't recommend arthroscopy for knee OA. However, you may get some relief by removing bone spurs and loose pieces of cartilage. 

Cartilage grafting might be an option for younger patients who have small areas of cartilage damage. Healthy cartilage is used to replace the cartilage of your bad knee.  

If only one side of your knee is damaged, your doctor may recommend an osteotomy. Either the tibia (shinbone) or femur (thighbone) is reshaped. This helps shift weight off the damaged side of the joint and can relieve pain and improve function. 

Total knee replacement (arthroplasty) may be recommended. Your surgeon removes the damaged cartilage and bone and then puts in new joint implants to restore the function of the knee.