Knee osteoarthritis
By The Treatment Registry editors
Degenerative joint disease of the knee, characterised by progressive cartilage loss, joint-space narrowing, and pain. The treatment ladder runs from lifestyle and medical management through intra-articular injections, joint-preserving surgery, and finally joint replacement. Modern guidelines have substantially reduced the role of arthroscopy in osteoarthritis without mechanical symptoms.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Weight management and physiotherapy
First-line for all symptomatic patients. Each kilogram lost reduces knee load substantially during walking; supervised exercise improves pain and function.
- Analgesia (paracetamol, NSAIDs)
Topical NSAIDs preferred for localised pain; systemic NSAIDs effective but with cardiovascular and gastrointestinal risk profiles to consider in older patients.
Procedural
- Intra-articular corticosteroid injection
Short-term symptomatic relief (weeks to months). Repeated injections over time are associated with cartilage loss and are not a long-term solution.
- Hyaluronic acid (viscosupplementation) injection
Limited and contested evidence; some patients report symptomatic improvement.
- Knee arthroscopy
Now of limited evidence in osteoarthritis without mechanical locking; current AAOS and NICE guidance has substantially reduced its routine indication.
Surgical
- Unicompartmental knee replacement
Partial replacement when osteoarthritis is confined to one compartment. Faster recovery and better range of motion than total replacement, but with higher revision rates in some series.
- Total knee replacement · View procedure page
Definitive surgical treatment for end-stage osteoarthritis. Modern implant survivorship at 15-20 years exceeds 90% in registry data.
- High tibial osteotomy
Realignment osteotomy to redistribute load away from the affected compartment. Selected younger active patients with isolated medial-compartment disease.