A common cause of knee pain is osteoarthritis (OA) Osteoarthritis is a condition which can cause joint pain with varying degrees of functional limitation and effect on quality of life. It is common, affecting people all over the world and at least 8 million people in the UK.
Anyone can develop OA, the larger weight-bearing joints are most commonly affected – hips and knees. It develops in previously healthy joints, normally in people over 45. It can also develop in younger people after a fracture or similar injury.
It is twice as common in women as men, and more likely in people who are overweight.
Most patients with knee pain, including osteoarthritis, will be referred for a course of physiotherapy as the first step.
Surgery is for people who have severe symptoms and have tried other treatments without success.
Please note that knee arthroscopy for patients with osteoarthritis (keyhole surgery) is not routinely available on the NHS, unless there is a clear history of mechanical locking.
This is because alternative, more effective and less risky treatments, such as exercise programmes, losing weight (if necessary) and managing pain have been shown to result in more positive outcomes for patients. Please read the associated policy here.
Selfcare and more information
Managing my knee pain
There are various ways of managing knee arthritis without surgery, the main goals being:
- reducing pain
- increasing joint mobility
- preventing further joint damage
Many people find that self-help measures are enough to help them manage their symptoms, but your physiotherapist will be able to suggest other treatments if you need them. There isn't likely to be one single thing that will help reduce pain, or increase mobility, but by trying a variety of things that work for you improvements can be made.
Click here for a list of exercises that may help your knee pain.
Deciding what to do about Osteoarthritis of the knee
This is a helpful tool to support you when deciding how best to manage your knee pain. Use it on your own, or with help from a clinician, this will take you quickly through the different options.
Click on the boxes below to read more.
5 main options if you have osteoarthritis of the knee
The choices are:
Lifestyle changes. Such as losing weight if needed and doing more exercise and specific mobility exercises for the affected joint.
Physiotherapy. This means having physiotherapy and may also involve treatment. It may include using walking aids like canes or special insoles. Patients with knee pain, including osteoarthritis, will generally be referred for a course of physiotherapy as the first step prior to considering surgery.
Physio or occupational therapy usually requires a referral from your practice but in some cases you can self-refer. It is hoped that self-referral will be rolled out across Devon in the future.
Exercise (no matter what type) has been found to be the most effective treatment for arthritis; it is effective at improving pain, mobility, controlling weight as well as helping with other medical conditions such as diabetes and heart disease and psychological disorders such as anxiety and depression.
Drug treatment to manage pain including over the counter tablets from your local pharmacy, tablets prescribed by your GP, injections into the joint by a GP or specialist physio and self-help support.
Complementary therapies including TENS, acupuncture, and the nutritional supplements chondroitin and glucosamine.
Surgery including total or partial knee replacement and osteotomy. Surgery is usually reserved for people with severe symptoms who have tried other treatments first. Keyhole surgery (arthroscopy) is not effective in the treatment of knee arthritis and is not routinely available on the NHS, please read the associated policy here .
How will this help my pain?
Losing even a small amount of weight, if you are overweight, can lessen your pain. Taking regular exercise can reduce pain for some people with knee arthritis although the effect may be small.
Physical management can improve your pain. We know that strengthening exercises for your knee, wearing special shoe inserts, taping up the knee, and wearing a knee brace all help improve knee pain.
Treatment to manage pain
There are many types of medicine that can reduce the pain of osteoarthritis. However, medication does not work for everyone. Pain medications, such as paracetamol and NSAIDs, can help reduce pain for most people.
The amount of pain relief varies according to the type of medicine and the dose. Steroid injections reduce pain, especially during ‘flare ups’, but the effects can be variable, sometimes lasting months but often only weeks. Self-help support programmes, such as cognitive behavioral therapy (CBT) may help you to manage pain better.
We don’t know whether most forms of complementary treatments help with pain. Acupuncture may help some people. Glucosamine Sulphate may also help relieve pain.
Surgery is usually for people who have severe symptoms and have tried other treatments without success. Many people find their pain is much better after knee replacement, but it may not get rid of your symptoms altogether. Keyhole surgery (arthroscopy) is not effective in the treatment of knee arthritis and is not routinely available on the NHS, please read the associated policy here .
How will my mobility be affected?
You may be able to walk further and faster, climb stairs more easily, and move your joint more freely.
A course of physical management may help you walk further and faster. We know that knee exercises to strengthen the joint and wearing a knee brace can help you walk further
Treatment to manage pain
Some pain medicines, including NSAIDs, reduce inflammation and may make it easier for you to move your knee joint. Self-help support programmes may help you keep more active.
We don't know if the different types of complementary treatments of such as acupuncture and nutritional supplements can help.
Most people find they can get around much better after a knee replacement, once they have recovered from the operation. The replacement knee has some limitations in range of movement and if the knee is stiff before the surgery, the bend may be similar after the surgery. Patients often find kneeling difficult after knee replacement surgery.
Will my arthritis get worse?
If you are overweight, losing some of this weight will help relieve some of the strain on your joints. This can help avoid further damage to the knee. Taking regular exercise may also protect your knee arthritis from getting worse.
Physiotherapy can often help to ease pain and improve mobility but it does not prevent arthritis from getting worse. But exercises that strengthen the muscle around the knee may help protect the joint from damage.
Treatment to manage pain
NSAIDs, corticosteroid injections and self-help support also help to ease pain, but will not stop your arthritis getting worse. Effective pain management may stop your pain from getting worse.
Complementary treatments such as acupuncture and nutritional supplements are not likely to slow or stop arthritis from getting worse.
Surgery is generally for people who have severe symptoms and have tried other treatments without success. Knee replacement replaces the damaged joint surface. This removes the part of the joint affected. The new joint may wear out and may eventually need to be re-done.
How will it affect my quality of life?
Regular exercise may help you feel better about the overall quality of your life. We don't know if weight loss helps you feel better about your quality of life.
Physical management such as using a walking cane. knee taping and wearing a knee brace may help you walk further, but may not improve your overall quality of life.
Treatment to manage pain
Medication can be effective at relieving pain. This can have a big impact on quality of life. Self-help support programmes may help improve quality of life.
We don't know if complementary treatments such as acupuncture and nutritional supplements can improve your quality of life.
Knee replacement can improve quality of life for people with knee osteoarthritis. We know that for every ten people who have knee replacement surgery, eight people will be satisfied with their surgery.
Are there any side effects or complications?
Generally, taking enough exercise, and eating a healthy diet is safe.
These are generally safe treatments with few risks. Physiotherapy exercises may hurt at first but this naturally improves over time. Some people find knee braces uncomfortable.
Treatment to manage pain
Pain medicines can cause effects. NSAIDs carry a risk of stomach bleeds. Some painkillers can cause constipation. People who take painkillers for a long time can become dependent on them. This means they get withdrawal symptoms when they try to stop taking them and this can be a big problem.
Complementary treatments, such as acupuncture and nutritional supplements can have side effects. Herbal medicines may react badly with other medicines. Acupuncture can cause infections if the needles used are not sterile.
If you are overweight, or you smoke, you are more likely to develop complications after surgery and your surgery may be less successful. You may want to discuss this with your health professional getting support to lose weight or to stop smoking prior to considering surgery.
Surgery can cause complications including blood clots, infections, bleeding and there is a risk of death, which is higher if you have many serious other medical conditions.
There is a risk of medical complications such as heart attacks and strokes, and some people have a bad reaction to anaesthetics.
The first few months after surgery can be painful and it is likely that you will still need to take pain killers for up to a couple of months after surgery while things settle.
We know that for every ten patients who undergo knee replacement surgery, eight out of ten will be satisfied with their surgery.
Knee replacements can also wear out with time, especially if you are under 60 years old when you have your surgery. Approximately one in twenty knee replacements need re-do surgery within ten years.
How much time will I spend in hospital or receiving treatment?
You won't need to spend time in hospital or recovering from treatment if you make changes to your lifestyle.
You may need to go to hospital to have physiotherapy and occupational therapy sessions. But you won't need to stay in hospital. You will need to attend a number of sessions.
Treatment to manage pain
You can buy simple painkillers, such as paracetamol, from your pharmacy. Your GP may also prescribe pain medication. You are unlikely to need to go to hospital to get pain medications. You might need to take medicines every day to manage your pain. Self-help support programmes vary in length.
Often, complementary therapists recommend a course of treatment. These can vary in length and be expensive.
You will need to stay in hospital for two to three days after knee replacement surgery. Patients undergoing partial knee replacements often go home the following day. For the first three to six weeks after the operation you will need a walking aid, such as crutches, to help support you.
Most people are able to return to work by about 3 months after knee replacement surgery.
What are the pro’s and con’s of each option?
People with knee osteoarthritis are not all equally affected by their problem. For some it’s a minor inconvenience to getting on with life. For others it has a huge impact as an individual.
How much you are affected will influence what treatment you choose.
Generally the more intensive or invasive the treatment the more severe and frequent the side effects.
Not all arthritis gets worse and many people manage to get by with simple treatment.
How do I get support to help me make a decision that is right for me?
People using this type of information say they understand the health problem and treatment choices more clearly, and why one treatment is better for them than another. They also say they can talk more confidently about their reasons for liking or not liking an option with health professionals, friends and family.
Find some useful links in the 'Support for managing my knee pain' section of this page.
Videos about my knee pain
23 and 1/2 hours: What is the single best thing we can do for our health?
Dr Mike, Reframe Health Lab | published 2 December 2011
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.
What support is available?
Support for managing my knee pain
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