Knee osteoarthritis (OA) is a common condition that can cause pain, stiffness and difficulty with everyday activities. But having knee OA doesn’t necessarily mean your pain will get worse over time or that you’ll eventually need surgery.
The good news is that there are effective ways to manage knee OA, stay active and live well.
So, what does the best available evidence recommend?
1. Comprehensive assessment and diagnosis
Knee OA can often be diagnosed through a discussion about your symptoms, medical history and a physical examination.
Your healthcare professional should also consider how your symptoms affect your daily activities, work, exercise and overall wellbeing.
2. Appropriate use of imaging
You might be surprised to learn that you don’t usually need an X-ray or MRI to diagnose knee OA.
Changes seen on imaging don’t always match how much pain someone experiences. Some people have significant changes on X-ray with very little pain, while others have considerable pain with only minor changes.
If imaging is needed, an X-ray is usually the first choice.
3. Education and self-management
Learning about knee OA and how to manage it is an important part of treatment.
Your physiotherapist can help you understand your condition, discuss treatment options and develop a plan that suits your needs, preferences and goals.
This might include strategies for managing flare-ups, staying active and gradually returning to activities you enjoy.
4. Physical activity and exercise
Exercise is one of the most strongly recommended treatments for knee OA.
Both aerobic exercise (such as walking, cycling or swimming) and resistance training can help reduce pain, improve physical function and support your overall health.
Importantly, having knee OA doesn’t mean you need to avoid exercise. Exercise is generally safe and does not appear to accelerate the progression of knee OA.
The aim is to find activities you enjoy and can maintain consistently, while gradually building your capacity.
5. Weight management and nutrition
For people with knee OA who are living with excess body weight, weight loss can help reduce knee pain and improve function.
However, weight loss isn’t necessary or appropriate for everyone, and nutrition is about much more than managing your weight.
A healthcare professional, such as a dietitian, can help you develop an approach that suits your health needs, circumstances and preferences.
6. Medicines to manage pain and mobility
Medication can sometimes help manage pain and make it easier to stay active.
Your GP or pharmacist can discuss suitable options, including their potential benefits and risks.
Opioid medications are generally not recommended for knee OA because their risks typically outweigh their benefits.
7. Patient review
Managing knee OA isn’t necessarily a one-size-fits-all approach.
Your treatment should be reviewed and adjusted over time based on your symptoms, progress and changing goals.
If you’re continuing to experience significant pain and difficulty with everyday activities despite appropriate treatment, further assessment by a specialist may be helpful.
8. Surgery
Most people with knee OA should have the opportunity to try appropriate non-surgical treatments before considering surgery.
However, if knee OA continues to significantly affect your ability to carry out everyday activities despite these treatments, surgery may be an option. This could include knee replacement surgery or, for some people, joint-conserving surgery that aims to preserve the existing knee joint.
Your healthcare team can help you understand the potential benefits, risks and recovery process so you can make an informed decision.
Arthroscopic (keyhole) surgery isn’t recommended for uncomplicated knee OA because it generally provides little or no meaningful improvement in pain or function.
TL;DR:
· Knee OA doesn’t mean you need to stop doing the things you enjoy.
· For most people, the foundation of treatment is understanding your condition, staying physically active, exercising regularly and making changes that support your overall health.
· The goal isn’t necessarily to eliminate every bit of pain, but to help you move better, stay active and continue doing the things that matter to you.
Reference:
Australian Commission on Safety and Quality in Health Care (2024). Osteoarthritis of the Knee Clinical Care Standard.
