Understanding Knee Arthritis

If you have been told there is arthritis in your knee, this page explains what that means, what people commonly experience, and what the treatment options are — so that when we meet, you already have the background and we can spend the time on your situation rather than the basics.

It takes about six minutes to read. There is a short list of questions near the end worth thinking about beforehand.

What knee arthritis actually is

The ends of the bones in your knee are covered in cartilage — a smooth, slippery layer that lets the joint glide and cushions it as you move. It is remarkably tough, but it does not repair itself well once damaged, and over the years it can wear thin.

As that cushioning thins, the joint no longer moves as smoothly. In more advanced arthritis the protective layer can wear away entirely in places, leaving bone moving against bone. That is what produces the pain, the stiffness, and the grinding or creaking many people describe.

It is very common. Arthritis shows up on the X-rays of more than half of people over 65 — though not everyone with changes on a scan has symptoms, and how a knee looks on imaging does not always match how much trouble it is causing.

What people usually notice

Everyone’s experience differs, but these are the things patients most often describe:

• Pain when walking, particularly on stairs, slopes or uneven ground
• Difficulty getting up from a low chair, the car, or the floor
• Stiffness first thing in the morning, or after sitting for a while
• Swelling, which may come and go
• Grinding, clicking or a creaking sensation in the joint
• Pain at night, or trouble finding a comfortable position to sleep
• The knee feeling unreliable, or occasionally giving way
• Doing less than you used to — shorter walks, avoiding stairs, giving up things you enjoyed

Most people find it comes in waves. There are stretches where the knee is manageable, and flare-ups where it is considerably worse for days or weeks before settling again. That pattern is normal and does not mean something has gone wrong.

The part that often matters most is not the pain itself, but what the pain stops you doing. That is worth thinking about before we meet.

Treatment that does not involve surgery

Each of these is covered in more depth, against what the Australian clinical guideline actually recommends, in Treating Knee Arthritis Without Surgery.

Most people start here, and for many the combination below keeps things manageable for years. These approaches work best together rather than one at a time.

Weight management

Roughly three to four times your body weight passes through your knee with every step, so even a modest reduction takes a surprising amount of load off the joint. It is one of the most effective things available — and it is not about appearance, it is about the mechanics of what the knee is carrying.

Exercise, particularly land-based programs

This is the one that surprises people. When a joint hurts, the instinct is to rest it — but strong muscles around the knee take load off the joint and support it. Structured walking, cycling and strengthening work for the thigh and buttock muscles are among the best-evidenced treatments there are. Some discomfort while you build up is expected and is not a sign of damage.

Physiotherapy

A physiotherapist can build a program around your particular knee, check that you are doing the exercises in a way that helps, and progress you sensibly. It is more effective than exercising without guidance, especially early on.

Pain relief for flare-ups

Simple pain medication and anti-inflammatories can settle a bad patch and let you keep moving — which matters, because resting a sore knee for weeks tends to make things worse rather than better. What is safe for you depends on your other health conditions and medications, so it is worth a conversation with your GP or pharmacist rather than a guess.

Injections

A corticosteroid injection into the joint can calm a flare-up and give useful relief. It is worth being clear about what it does, though: the effect is usually measured in weeks to a few months, and it does not change the underlying arthritis. Injections are a way of buying comfortable time — helpful, but not a lasting solution.

When surgery comes into the conversation

Knee replacement is generally considered when arthritis is advanced and the measures above are no longer keeping symptoms under control — when pain limits the things that matter to you, disturbs your sleep, or narrows your life more than you are willing to accept.

The operation resurfaces the worn parts of the joint. The damaged surfaces are removed and replaced with metal components, with a smooth plastic bearing between them taking the place of the worn cartilage. Depending on how much of the knee is affected, this may involve the whole joint or only the damaged part of it — a partial knee replacement.

“Total knee replacement is one of the most rewarding operations I do. But it is a significant operation with a real recovery, and it is not the right answer for everyone or at every stage. That is a conversation, not a foregone conclusion.” — Dr Rhys Clark

For most people it is very effective at relieving arthritis pain. It is also a substantial procedure: a hospital stay, then weeks of rehabilitation and exercise to regain movement and strength. The result depends partly on the surgery and partly on the work done afterwards. Most people are returning to normal activities over the following months rather than weeks.

Worth thinking about before your appointment

These are the questions most useful to have considered. There is no need to write anything down unless you would find it helpful.

• What have you stopped doing because of your knee?
• How far can you comfortably walk now, compared with a year or two ago?
• Is the pain waking you at night, or making it hard to get to sleep?
• What have you already tried — exercise, physiotherapy, medication, injections — and what difference did each make?
• What would you most like to be able to do again?
• What questions or worries do you have about surgery?

Write your questions down

I am more than happy to answer any questions you have — that is what the appointment is for. But people very often think of them afterwards, on the drive home rather than in the room. Write them down before you come in and bring the list with you.

Appointments can be made on (08) 6332 6365 or through the contact page.