Osteoarthritis is the most common form of arthritis in the knee, and does not always cause pain or disability.
Osteoarthritis of the knee is a condition that impacts the entire joint, encompassing bone, cartilage, ligaments, and muscles. While it has been traditionally characterized as 'wear and tear,' current understanding suggests that osteoarthritis may actually be the outcome of a joint's heightened efforts to undergo self-repair.
In the knee joint, the ends of the bones where the thigh bone (femur) and the shin bone (tibia) meet are covered with ‘articular cartilage’.
The lining of the joint capsule may thicken and produce more fluid than normal, causing the joint swelling, pain and stiffness. Extra bone may form at the edge of the joint. These bony growths are called osteophytes and can sometimes restrict movement or rub against other tissues.
In some cases, osteoarthritis of the knee is caused by an earlier trauma or accident in or near the joint, such as after a ligament injury, torn meniscus or bone fracture.
What are the symptoms of knee osteoarthritis?
Osteoarthritis in the knee can be painful because of the joint’s weight-bearing role in standing, walking and exercising.
In addition to pain, which may develop slowly or quickly, the joint may swell or stiffen, making it difficult to bend or straighten the knee. There may be a feeling of weakness in the knee, resulting in a buckling sensation. Sometimes the knee joint may “lock” and not bend properly. Sometimes there may be a joint clicking or ‘crepitus’ sounds with movement.
Pain and swelling are often worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing, or kneeling. Early osteoarthritis symptoms can be self-managed through physical activity, exercise and weight loss if overweight. Pain flares and persistent pain symptoms may require support from your healthcare team.
What causes osteoarthritis in the knee?
In the case of osteoarthritis in the knee, obesity and/or a history of repeated knee trauma are common causes. Advanced osteoarthritis in the knee leads to misalignment of the leg joints. This is then described as being ‘knock-kneed’ also known as a valgus or ‘bow-legged’ varus position.
Should I see a doctor for knee osteoarthritis?
You should talk to your doctor or other health professional if your pain or other symptoms bother you. They will ask you about your symptoms and examine you. They may check for any serious medical problems that could be causing your pain, but these are rare. You should see your doctor if your pain does not settle down after a few weeks, or starts getting worse.
What can I do for my knee osteoarthritis?
Talk to your healthcare team. It is common to worry about the cause of your pain and how it will affect you. Talking to your doctor or another health professional about your worries can be helpful. You will usually find there is no serious cause and there are ways you can deal with it.
Learn about knee pain and play an active role in your treatment. Not all information you read or hear about is trustworthy, so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self-management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Australia office for details of these courses.
Learn ways to manage pain. Talk to your healthcare team about ways to relieve your pain. Some people have found massage and acupuncture helpful with knee pain, however this has not been proven by research.1,2 There are also medicines that can help with knee pain. It’s best to start with simple analgesics and measure their effect before trying others.
- Topical anti-inflammatory (NSAID) cream is a simple pain reliever that can relieve mild to moderate pain from osteoarthritis.
- Anti-inflammatory medicines (NSAIDs) may relieve symptoms of osteoarthritis. Always talk to your doctor or pharmacist before taking these medicines, as they are not suitable for all people.
- Stronger pain medicine, such as codeine or tramadol, is not recommended.
- A corticosteroid injection into the knee joint may relieve pain.
- Hyaluronan injections can be expensive and do not work for all people. Research has not proven that injecting hyaluronan into the joint can help with pain or protect the cartilage.3,4
- Creams containing anti-inflammatory medicines have been shown to reduce pain in knee osteoarthritis. Creams containing capsaicin (an ingredient in cayenne and chilli peppers) may also help relieve pain in knee osteoarthritis, although this has not been proven by research.1,2
Always talk to your doctor or pharmacist about your medicines, as even natural and over-the-counter medicines can have side effects.
Stay active. Your body is designed for movement and exercise and staying physically active is one of the most important treatments for osteoarthritis of the knee.
It helps to reduce pain and maintain your general health. To protect your sore joints, try low-impact activities, where there is less weight going through your knees. Examples of low-impact activities include cycling and walking.
You could also try:
- Water exercise: The buoyancy of the water takes pressure off your knees and you may find you can move more freely than you can on land. You could swim, do a hydrotherapy session with a physiotherapist or join a local warm water exercise class. See the Water exercise sheet for more information.
- Strengthening exercises: Physiotherapy exercises to strengthen the muscles around your knee can also help reduce pain from osteoarthritis.
- Tai chi: Studies show that tai chi can help reduce pain and stiffness for people with osteoarthritis.
See a physiotherapist or other health professional for advice about exercises to keep your knee moving. See the Working with your healthcare team information sheet for more information about seeing a physiotherapist.
Weight loss: Being overweight can lead to more pain and damage to hips and knees affected by osteoarthritis. Even modest weight loss (eg. five percent reduction in body weight) can noticeably reduce symptoms of knee osteoarthritis. You may find it useful to see a dietitian for advice about healthy eating and weight loss.
Aids or supports: Some people may find using a walking aid helps reduce pain. Always use the walking stick on the opposite side to your sore joint. Your physiotherapist may also suggest the following treatments to reduce pain from knee osteoarthritis, although the uses of braces and orthoses have not been proven by research.
- taping the kneecap (patella)
- knee braces
- orthoses (small wedges placed in your shoe to improve the alignment (position) of your knee when standing and walking).
See a physiotherapist for advice about any of these aids or supports.
Acknowledge your feelings and seek support. It is natural to feel scared, frustrated, sad and sometimes angry when you have pain. Be aware of these feelings and get help if necessary. You can learn skills to recognise and calm anxiety or strong emotions if you find they start to affect your daily life. See the Awareness of thoughts & emotions treatment.
There are many other treatments for knee pain that have not been well-proven. Some unproven treatments may still be useful, however further research is needed.
These treatments include:
- herbal medicines
- transcutaneous electrical nerve stimulation (TENS)
- low level laser therapy
- heat and cold (eg. hot water bottles, heat packs, ice packs).
- Your healthcare team can give you more advice and information about whether any of these or other treatments might be useful for you.
Other Resources
Podcasts: https://www.jointaction.info/
State/Territory Arthritis Offices
Your local Arthritis Office can provide further information to assist you and will have a range of education and support activities. Click here to find your local office.
Independent Living Centres (ILCs)
These centres provide information about products and services to help people remain independent and improve their quality of life. They are located in each capital city. See www.ilcaustralia.org.au or call the National ILC Infoline on 1300 885 886 to find your closest centre and more information. (In Queensland, the Independent Living Centre is called LifeTec).
Osteoarthritis Chronic Care Program
Osteoarthritis Chronic Care Program: A multidisciplinary pain management program for public patients with knee and hip osteoarthritis in the Hornsby area of Sydney. (NSW Health).
Osteoarthritis Chronic Care Program: A multidisciplinary pain management program for public patients on the elective joint replacement list at Royal North Shore Hospital and Ryde Hospital. (NSW Health)
Osteoarthritis Management Program: For people with knee and hip osteoarthritis to reduce joint pain and stiffness, conducted by Hunters Hill Private Hospital in Sydney.
https://aci.health.nsw.gov.au/statewide-programs/lbvc/osteoarthritis-chronic-care-program
https://www.health.nsw.gov.au/Value/lbvc/Pages/osteoarthritis.aspx
The below references have been used to develop this fact sheet with the most up-to-date evidence available.
References
- Gray B, Gibbs A, Bowden JL, et al. Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review. Osteoarthritis and Cartilage. 2024.
- Gibbs AJ, Gray B, Wallis JA, et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis and cartilage. 2023;31(10):1280-1292.
- Hunter DJ. Viscosupplementation for osteoarthritis of the knee. N Engl J Med. 2015;372(11):1040-1047.
- Yu SP, Hunter DJ. Intra-articular therapies for osteoarthritis. Expert Opinion on Pharmacotherapy. 2016;17(15):2057-2071.
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