Treatments for Knee Osteoarthritis
Understanding the Tiers of Treatment for Knee Osteoarthritis
Currently, there is no known way of ‘curing’ osteoarthritis or reversing the condition. But that doesn’t mean that there is nothing you can do!!
In fact, many people with osteoarthritis (even those in ‘advanced stages’) can make meaningful improvements in their symptoms and function and avoid the need for surgery.
This section is designed to give you a thorough understanding of the current treatment options that exist for people with osteoarthritis.
exercise & Physical activity
weight & lifestyle management
medication & other treatments
surgery
Tiers of Treatment for Osteoarthritis
The osteoarthritis treatment pyramid describes the tiered levels of treatment as recommended by clinical guidelines.
At the bottom of the pyramid are the core treatments to be offered to EVERYONE with osteoarthritis. These treatments are also called first-line treatments because they should be offered before anything else.
SOME people will need additional support on top of these treatments. We call these add-on treatments or second-line treatments and they include things like pain medications, injections, manual treatments, prescribed footwear etc. These types of treatments can help with short-term relief of pain when needed but are often more costly compared to core treatments.
A FEW people will need to go on to have surgery (e.g. joint replacement) after trying the first two tiers of treatment.
These treatments are very effective at reducing pain and improving function and quality of life.
They are:
Is the order of treatment important?
The ORDER of treatment is very important.
Research shows us that if you begin with the core treatments, you are much less likely to need the add-on treatments such as medication, and much less likely to need surgery. If you do end up needing surgery, it is important that you continue to engage with core treatments like exercise, to stay strong.
Listen to Matthew’s experience of treatments for osteoarthritis.
Want to know more about the recommended order of treatments?
Do most people improve after core treatments for osteoarthritis?
YES!!!
Most people with knee osteoarthritis can improve their pain and function by engaging in first-line care or core treatments. This is great as it is a cost-effective way to manage your symptoms.
If you are looking for some guidance, continue reading below and speak to your healthcare professional if you need some additional help.
Will it ever be 100%?
It is very difficult to determine what ‘100%’ is for everyone.
Core treatments of exercise and physical activity, self-management and weight management are known to improve pain, function and quality of life.
Although people can significantly improve symptoms and live happy, meaningful lives doing the things they enjoy, most people with knee osteoarthritis still have a remaining discomfort or have episodes where their symptoms flare-up. This is part of the lived experience of knee osteoarthritis, however over time it is possible to reduce the number of flare-ups you have, and also improve your recovery afterwards.
But what about with a knee replacement?
Some people believe that having a knee replacement means that you are taking out all of the ‘osteoarthritis’ and therefore your knee should feel ‘like new’. Unfortunately, this isn’t the case. Even people who undergo surgery can have pain and restrictions in function. See more information in the surgery section. Remember though that even if you have surgery – you will still need to engage in first-line treatments before and after your operation.
Whatever treatments you decide, it’s important to remember that your symptoms do not always get worse over time. There is plenty that you can do to help yourself and your condition.
Is there anything I should be avoiding?
It is common for people who have knee osteoarthritis to avoid things that cause pain. This tends to be due to the belief that pain equals damage – but this isn’t true! You can find out more about pain in the ‘understanding symptoms‘ page.
Our knees respond well to being used and loaded in different ways. Therefore, there is nothing that you should be ‘avoiding’, BUT – there may be a few things that you need to adapt, or build up slowly towards. For example, if you have avoided stairs for many weeks/years then it would be wise to build up your tolerance to stairs again slowly over a period of time.
If you happen to ‘over do it’ one day and get a temporary increase in your symptoms (also known as a flare-up), then click here to see what we (and other people with knee osteoarthritis) advise.
Core Treatments for Knee Osteoarthritis
1. Exercise & Physical Activity
The first recommended core treatment for knee osteoarthritis is exercise and physical activity.
Exercise and physical activity should be provided to all people with knee osteoarthritis regardless of age, pain levels, severity of the condition or co-morbidities.
Benefits of Exercise for Knee Osteoarthritis
Your joints move through their range
Nutrients are pumped in and out of the cartilage when you move your joints
You build stronger muscles
Your coordination improves (the ability to use the right muscles at the right time with the right amount of force)
Your overall health improves
This makes it easier to do everyday activities (putting on socks, climbing stairs, getting in and out of the car)
This promotes growth and reformation of the cartilage which boosts it’s strength.
This helps to protect the joint, making daily activities easier.
This will make it easier to control movements like walking on uneven ground.
Feel happier, healthier and with less pain!
When you have knee pain, it is reassuring to know that an initial increase in pain after exercise is normal. Research has found that the level of pain has little to do with worsening of knee osteoarthritis and it is safe to continue exercising as long as your symptoms are acceptable to you.
For more instructions on how to monitor your pain during exercise, videos of exercise programmes for knee osteoarthritis and more, please visit the “Exercise and Physical Activity” page using the link below. You will also find a link at the end of this page or in the floating menu.
2. weight & lifestyle management
The second recommended core treatment for knee osteoarthritis involves learning how to live well with the condition and taking steps to manage weight if needed.
If you are reading this website, you are actively taking steps to improve your knowledge on the condition you live with – well done!
Self-management is about identifying what you need to know or learn and being supported and empowered with the education to live well with a chronic condition. This may include keeping a healthy weight to reduce or control the amount of force going through the knee, and to control processes involved in inflammation in the body (including the knee joint). It may also include learning about how to manage pain and improve your activity levels and sleep.
For more information and tips on dealing with a pain flare-up, what is a healthy diet, tips on sleep and videos of expert and patient advice, please visit the “Weight and Lifestyle Management” page using the link below. You will also find a link in the top floating menu.
Medications & Other Treatments for Knee Osteoarthritis
Other treatments for knee osteoarthritis may also be called second line or adjunct treatments and are on the second tier of the treatment pyramid.
Most commonly, medications are used to help to manage the symptoms of osteoarthritis when needed but they should never replace the core recommended treatments.
Medications such as anti-inflammatory creams or pills may be important sometimes in your overall management (e.g., taking pain relief during a flare-up or before an activity you are not used to). However, always check with your GP or pharmacist if they are suitable for you. Paracetemol is no longer recommended for osteoarthritis. Injections are likely to only provide short-term relief (less than 6 weeks).
Second line treatments are sometimes more costly and some carry a degree of risk so you should discuss your options with a healthcare professional. Other examples of treatments may include using hot or cold therapy, assistive devices, massage or manual therapy, orthotics or prescribed footwear.
For more detailed information on each of these treatments, please visit the “Medications & Other Treatments” page using the link below. You will also find a link at the end of this page or in the floating menu.
Surgery for Knee Osteoarthritis
Surgery is considered a last resort for knee osteoarthritis so it sits on top of the treatment pyramid.
It can be very beneficial for people who have extensively tried the core recommended treatments first and are still experiencing pain that is having a negative effect on their life.
An important factor in your decision to get surgery are the risks, complications and recovery time associated with getting surgery. This should be a decision that is made between you, your orthopaedic consultant and anyone else important in your life.
It is also necessary to continue with exercise and other core treatments before and after surgery to maintain your leg strength and overall health.
For more detailed information on the different types of surgery and videos with expert advice, please visit the “Surgery” page using the link below. You will also find a link at the end of this page or in the floating menu.
Now you have had an overview of treatment options, let’s learn more about the first core recommended treatment: Exercise and Physical Activity.
The information in this website page was informed by the following sources/references:
Scientific Publications
- Blackburn, S., Research User Group, Rhodes, C., Higginbottom, A., & Dziedzic, K. (2016). The OARSI standardised definition of osteoarthritis: A lay version. Osteoarthritis and Cartilage, 24(S1), S192 -S192. https://doi.org/10.1016/j.joca.2016.01.379
- French HP, Galvin R, Horgan NF, Kenny RA. Prevalence and burden of osteoarthritis amongst older people in Ireland: findings from The Irish LongituDinal Study on Ageing (TILDA). Eur J Public Health. 2016 Feb;26(1):192-8. doi: 10.1093/eurpub/ckv109.
- French SD, Bennell KL, Nicolson PJ, Hodges PW, Dobson FL, Hinman RS. What do people with knee or hip osteoarthritis need to know? An international consensus list of essential statements for osteoarthritis. Arthritis care & research. 2015;67(6):809-816.
- Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Annals of physical and rehabilitation medicine. 2016;59(5-6):333-339.
Patient Websites/Resources
- TREK ‘My Knee’ education and self-management toolkit. La Trobe University. https://myknee.trekeducation.org/
- Versus Arthritis. https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/
Clinical Guidelines
- National Clinical Guideline Centre (UK). National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis in over 16s: diagnosis and management. NICE guideline [NG226]. Published: 19 October 2022. https://www.nice.org.uk/guidance/ng226