Knee Arthritis

What is knee arthritis?

Knee arthritis happens when the smooth covering of the bones inside the knee gradually becomes worn or damaged. As this progresses, the knee may become painful, stiff and less able to tolerate everyday activities.

Arthritis can develop gradually over many years, although previous injuries, ligament problems, meniscus damage and other conditions can also contribute to it.

What are the symptoms of knee arthritis?

You may experience:

• Pain while walking or standing

• Pain when climbing stairs

• Difficulty squatting or sitting on the floor

• Stiffness, particularly after rest

• Swelling

• Reduced walking distance

• Difficulty getting up from a chair

• Pain that interferes with sleep

• Increasing difficulty with everyday activities

How is knee arthritis diagnosed?

Diagnosis usually involves understanding your symptoms, examining the knee and taking X-rays.

The X-ray helps show how much the joint has changed, but the picture does not always match how much pain a person has. Some people with significant changes on an X-ray have relatively few symptoms, while others with less obvious changes may have considerable pain.

Your treatment should therefore be based on both your symptoms and the condition of your knee, rather than the X-ray alone.

Does everyone with knee arthritis need a knee replacement?

No. Having arthritis on an X-ray does not automatically mean that you need a knee replacement.

Many people can manage their symptoms for a long time with exercise, strengthening, weight management when appropriate, medicines and other non-surgical treatments.

Knee replacement is considered when pain and stiffness become significant enough to interfere with your daily life and other treatments are no longer providing enough relief.

What are the treatment options?

Treatment depends on how much the arthritis is affecting you.

It may include:

• Exercise and strengthening

• Physiotherapy

• Weight management where appropriate

• Changing activities that aggravate the pain

• Medicines for pain when appropriate

• Injections in selected patients

• Surgery when symptoms remain significantly limiting

Treatment does not always mean surgery. The aim is to control pain, maintain movement and function, and help you remain active for as long as possible.

What happens if I don't have surgery?

Knee arthritis does not necessarily require surgery. Many people are able to manage their symptoms without a knee replacement, sometimes for many years.

However, arthritis can gradually become more painful and restrict walking, work, sleep and other activities. If pain becomes severe and continues despite appropriate non-surgical treatment, continuing without surgery may mean accepting ongoing limitations in everyday life.

The decision to have a knee replacement should therefore be based on how much the problem is affecting you and whether other treatments are still providing enough relief.

When is knee replacement considered?

A knee replacement may be considered when:

• Knee pain is persistent or severe

• Walking or everyday activities have become difficult

• Pain affects sleep or quality of life

• The knee has become significantly stiff or deformed

• Appropriate non-surgical treatments no longer provide enough relief

• X-rays show changes that match the symptoms

There is no single X-ray measurement or age at which everyone should have a knee replacement. The decision is made by considering your symptoms, examination, X-rays, general health, activity level and expectations.

Do I need a knee replacement just because my X-ray shows severe arthritis?

Not necessarily. The decision to have a knee replacement should not be based on the X-ray alone. What matters most is how much pain and difficulty the knee is causing you and how much it is affecting your daily life.

If your symptoms are manageable, surgery may not be necessary even when the X-ray shows advanced arthritis. Conversely, significant symptoms together with appropriate X-ray findings may make knee replacement a reasonable option.

What type of knee replacement may be recommended?

Depending on how much of the knee is affected, you may be advised to have a total knee replacement (TKA), where the damaged parts of the whole knee are replaced, or a partial knee replacement (UKA), where only the affected part of the knee is replaced. The choice depends on the extent and location of arthritis, your symptoms, and the condition of the rest of your knee.

What can I expect after knee replacement?

When can I return to normal activities?

Recovery after knee replacement is gradual. Most patients begin walking soon after surgery and progressively increase their activity over the following weeks.

Many patients can manage basic daily activities within the first few weeks, but strength, movement and confidence continue to improve over several months. A more complete recovery commonly takes around 3–6 months, although some patients continue to improve beyond this period.

When can I return to work?

The timing depends on the type of work.

People with desk-based jobs may be able to return in around 4–6 weeks, depending on their recovery and ability to travel and sit comfortably. Jobs involving prolonged standing, walking, climbing or heavy physical work may require around 8–12 weeks or longer.

Your individual recovery and the demands of your job will determine when you are ready to return.

When can I return to sports?

Low-impact activities such as walking, cycling and swimming can usually be resumed progressively after recovery.

Higher-impact activities and sports involving repeated jumping, running or twisting place greater demands on the replacement knee and may not be advisable 

Will I be able to walk normally after knee replacement?

Yes. Most patients are able to walk independently and return to their usual daily activities after recovering from knee replacement. The main aim of the surgery is to relieve pain and improve the function of the knee.

Walking usually begins soon after surgery, with support initially if needed. As pain and swelling settle and the muscles regain strength, most patients gradually become more confident and independent with walking. Over the following weeks and months, walking distance and stamina continue to improve.

Many patients are able to walk comfortably for longer distances, climb stairs and return to activities that had become difficult because of arthritis. The final level of recovery varies from person to person, but a successful knee replacement can make a substantial difference to mobility and quality of life.

When should I see an orthopaedic surgeon?

You should consider seeing an orthopaedic surgeon if knee pain or stiffness is beginning to interfere with your walking, work, sleep, exercise or everyday activities.

You do not need to wait until the pain becomes unbearable. An early assessment can help identify the cause of the pain, discuss non-surgical options and understand whether the arthritis is likely to progress.

If you already have arthritis and your symptoms are progressively limiting your daily life despite appropriate treatment, an orthopaedic assessment can help determine whether continuing non-surgical treatment or considering knee replacement would be more appropriate.