Knee pain (Osteoarthritis)
Pain in the knee is common and can be caused by a variety of conditions including trauma, infection, acute inflammatory conditions such as gout and rheumatoid arthritis or osteoarthritis.
As part of normal life, joints are exposed to a constant low level of damage. In most cases, the body repairs the damage itself with few or no significant symptoms i.e., ‘tear, flare and repair’.
Damage to the cartilage discs within the knee (“menisci”) can be caused by minor trauma or simple age-related degeneration. This may cause swelling and instability within the knee and occasionally locking of the joint but in most cases where there is no clear history of major trauma the symptoms will settle with conservative management although this may take several months.
In osteoarthritis, the protective cartilage on the ends of the affected bones breaks down, causing pain, swelling and problems moving the joint. The effect on a person’s function and quality of life with osteoarthritis is extremely variable but often progressive.
Osteoarthritis can also develop in younger people after a fracture or similar injury or in joints which have been damaged by other conditions such as rheumatoid arthritis or gout.
Osteoarthritis is twice as common in women as men, and more likely in people who are overweight.
Selfcare and more information
Managing my condition
Knee pain caused by osteoarthritis or minor injury can usually be managed with conservative treatment including rest, analgesia and physiotherapy.
If the knee is swollen, then initial treatment can be summarised by the acronym PRICE:
- Protection
- Rest
- Ice
- Compression
- Elevation
You may find over the counter painkillers like paracetamol or ibuprofen (gel, cream or tablets) helpful. If you have any other medical conditions or are taking prescribed medication, then you should ask a pharmacist about suitable painkillers.
After a few days, you can try simple exercises to help improve things further and to decrease the chance of pain returning.
The aims of any treatment for knee osteoarthritis are to reduce your pain, improve movement and to try to prevent further joint damage.
Some recommended knee exercises can be found at the following links:
Many people find that self-help is enough to help them manage their symptoms. A physiotherapist will be able to suggest other treatments if you need them.
You should seek early medical advice if:
- The pain is severe or getting worse or you are unable to bear weight on the affected leg
- Your knee pain came on suddenly following significant injury
- The knee is very swollen with redness over the joint
- You also have a fever or feel unwell
- Unexplained, increasing or sudden onset severe pain in a previously replaced joint
- The pain is also in other joints
Deciding what to do about Osteoarthritis of the knee
Lifestyle changes
If you are overweight, then losing weight through dietary changes can be very helpful to relieve some of the strain on your joints. This may help to reduce further damage to your knee joint.
Exercising can also aid weight loss. If you exercise regularly and gradually increase your exercise then you may be able to walk further and faster, climb stairs more easily and move your joint more freely.
These changes can help you feel more in control of your arthritis and benefit your overall health including other medical conditions such as diabetes and heart disease and psychological disorders such as anxiety and depression. They will also help your recovery if you do eventually have surgery as obesity is linked to an increased risk of surgical complications.
Specific mobility and strengthening exercises for the affected joint are also helpful.
Generally, doing enough exercise and eating a healthy diet is safe. Lifestyle changes do require daily commitment, but you won’t need to spend time in hospital.
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Physiotherapy
In Devon, there are different ways of accessing physiotherapy.
Physiotherapists often recommend specific exercises which you will be taught during your session. Even if you are normally quite active, it is worth committing to these exercises as they are designed to strengthen and stretch specific muscles. It may include using walking aids including walking sticks and crutches, wearing a knee brace, taping your knee or using special insoles. Sometimes physiotherapists use massage or manipulation. Taping or wearing a knee brace should usually only be done under the supervision of a physiotherapist as there is a risk that, done in the wrong way, these measures can lead to weakness of muscles around the joint.
Physiotherapy can be uncomfortable at first, but this should ease. It can improve your mobility and quality of life as well as helping you to remain independent.
You will probably need to attend several sessions. It is important that you spend time continuing the exercises in between your therapy sessions so that you can progress to further exercises at your next appointment. It is also beneficial to continue the exercises after you have been discharged from physiotherapy.
In Devon, anyone who needs an orthopaedic referral for knee osteoarthritis will usually need to have undergone a course of physiotherapy.
The reasons are:
- You may benefit sufficiently from physiotherapy, so a referral is no longer needed
- The physiotherapist can make a detailed assessment of the severity of your condition and discuss with you how much you are likely to benefit from surgery
If surgery is needed, then physiotherapy helps to improve the outcome by ensuring that the muscles surrounding the joint are working well prior to the operation
However, it is recognised that NHS physiotherapy may not be available in some areas, and this will be considered when referrals are assessed.
In Torbay and South Devon, the physiotherapy service will assess your condition, arrange X-rays or scans and refer you to an orthopaedic specialist if needed without involving your GP.
In other areas, your GP or First Contact Physiotherapist at the surgery will make the referral if needed, following a course of physiotherapy. An X-ray is required prior to referral.
Pain management
Pain is a complex problem and how we experience pain can be affected by our feelings and emotions. Further information on understanding pain and how to manage it can be found via the following links:
You can buy simple painkillers such as paracetamol and ibuprofen. Your GP can prescribe painkillers. It is usually best to avoid opioid painkillers such as codeine and tramadol for ongoing pain because they tend to be addictive. There is a risk of getting used to them and needing increasing doses (tolerance). They can cause drowsiness which will affect ability to drive as well as other activities and can contribute to a higher risk of falls.
In some cases, your GP or physiotherapist may advise a steroid injection, especially during “flare-ups”. The beneficial effects sometimes last months, although often only weeks.
Your GP or physiotherapist may suggest a programme such as cognitive behavioural therapy (CBT) to help you manage your pain. Programmes vary in length, but all require a commitment by you both during and between the sessions. They are often delivered through a specialist pain clinic.
Easing your pain can help you move around more easily including walking further and faster as well as climbing stairs more easily. Changing the way in which you think about your pain can help you to keep more active.
Complementary therapies
Some people say that they find complementary therapies help their pain and mobility. These include TENS, acupuncture and the nutritional supplements chondroitin and glucosamine. Complementary treatments are not likely to slow or stop arthritis from getting worse. You need to access these treatments privately as the lack of evidence of effectiveness means they are not available on the NHS.
Herbal medicines may interact adversely with other medication. There is a risk of infection from acupuncture.
Surgery
Surgery is reserved for people who have severe symptoms and have tried other treatments without success. Knee replacement replaces the damaged joint surface. Knee replacement can improve pain and quality of life for people with knee osteoarthritis. Keyhole surgery (arthroscopy) is not effective in the treatment of knee arthritis and is not routinely available on the NHS.
We know that for every ten people who have knee replacement surgery, eight people will be satisfied with their surgery, but it may not get rid of all your symptoms. If the knee is stiff before surgery, the bend may be similar after surgery. Patients often find kneeling difficult after knee replacement surgery. Knee replacements can wear out with time and about one in twenty need re-do surgery within ten years.
Surgery is usually safe and effective, but the operations are major with some risk of complications. Therefore, other treatments should be tried first, including physiotherapy for at least twelve weeks.
Please click here to access a decision aid which you may find helpful if you are trying to weigh up the pros and cons of surgery.
If you are overweight or you smoke, then you are more likely to develop complications after surgery. Therefore, lifestyle changes are recommended prior to surgery.
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Most people go home two to three days after a total knee replacement or the day after a partial knee replacement. For the first three to six weeks after the operation you will need a walking aid, such as crutches, to help support you. You will be advised about doing specific exercises to help you recover well and it is important that you follow this advice.
Most people can return to work by about 3 months after knee replacement surgery. It does depend on how much physical activity is involved in your work.
For further information on knee replacement surgery and recovery please see:
Useful information about knee pain
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.