Knee Osteoarthritis: A Patient’s Guide

X-ray image of two knees showing bones and joint structure.

Table of Contents

Knee osteoarthritis occurs when the protective cartilage in the knee joint gradually wears down, leading to bone-on-bone contact. This progressive condition affects the entire joint, including bones, cartilage, ligaments, and muscles. As the joint deteriorates, individuals may experience pain, stiffness, and reduced mobility, making activities like walking, climbing stairs, or standing up more challenging.

This guide explores the symptoms, causes, diagnosis, and treatment options for knee osteoarthritis, providing insights into how to manage the condition effectively.

Recognising the Symptoms of Knee Osteoarthritis

Knee osteoarthritis develops gradually, with symptoms worsening over time. Common signs include:

Pain During Movement: Pain occurs during walking, climbing stairs, or other weight-bearing activities. It often worsens with prolonged use and improves with rest.

Morning Stiffness: The knee feels stiff after waking up or sitting for long periods. This usually resolves within 30 minutes of movement.

Reduced Range of Motion: The knee becomes less flexible, making it difficult to fully bend or straighten. This can affect daily tasks such as getting in and out of a car.

Joint Swelling: Swelling may occur, especially after physical activity or towards the end of the day, causing tightness and discomfort.

Clicking or Crunching Sounds: Movement may be accompanied by clicking or a grinding sensation due to rough cartilage surfaces rubbing against each other.

What Causes Knee Osteoarthritis?

Multiple factors contribute to the development and progression of knee osteoarthritis, affecting joint health over time. Common causes include:

Age: The risk increases with age due to natural joint wear. Most cases occur in people over 50.

Previous Knee Injuries: Past injuries, such as meniscus tears, ligament damage, or fractures, can lead to osteoarthritis later in life.

Excess Weight: Additional body weight places extra strain on the knee. Each extra kilogram adds roughly four times the force on the knee during walking.

Genetics: Some individuals inherit a predisposition to osteoarthritis. Genetic factors can affect cartilage structure and durability.

Occupational Factors: Jobs that involve frequent kneeling, squatting, or heavy lifting can increase joint stress and contribute to cartilage breakdown.

Types of Knee Osteoarthritis

Osteoarthritis affects different parts of the knee joint, leading to varied symptoms and progression patterns.

Medial Compartment Osteoarthritis

Affects the inner side of the knee. Since this area bears most of the body’s weight, wear can lead to a bow-legged appearance, increasing stress on the inner knee.

Lateral Compartment Osteoarthritis

Affects the outer side of the knee. It is less common but can develop due to injuries or anatomical factors, sometimes leading to a knock-kneed stance.

Patellofemoral Osteoarthritis

Occurs between the kneecap (patella) and thighbone (femur). It often causes discomfort during activities that involve bending the knee, such as climbing stairs or standing up from a seated position. In some cases, kneecap alignment issues contribute to worsening symptoms.

How Knee Osteoarthritis Is Diagnosed

Accurate diagnosis helps determine the severity of the condition and the most suitable treatment approach. Several methods are used to confirm osteoarthritis and assess joint damage.

Physical Examination: The doctor evaluates knee movement, stability, and alignment. This includes checking for swelling, tenderness, and crepitus (crackling sounds) while moving the joint. Walking patterns and muscle strength around the knee are also assessed.

X-rays: Weight-bearing X-rays show joint space narrowing, bone spurs (osteophytes), and alignment changes. These images help track disease progression.

MRI Scanning: An MRI provides detailed images of soft tissues, including cartilage, menisci, and ligaments. It is useful for evaluating complex cases or planning surgery and can detect early cartilage changes that may not appear on X-rays.

Blood Tests: While osteoarthritis cannot be diagnosed through blood tests, these can help rule out other conditions like rheumatoid arthritis or gout by measuring inflammation markers.

Treatment Options for Knee Osteoarthritis

Management of knee osteoarthritis focuses on relieving symptoms, maintaining function, and slowing progression.

Non-Surgical Approaches

Exercise and Physical Therapy

Low-impact exercises strengthen the muscles around the knee and improve flexibility. A physiotherapist can tailor exercises to individual needs and guide proper movement to reduce joint strain.

Weight Management

Reducing excess weight helps decrease stress on the knee joint. A structured plan combining nutrition and exercise supports long-term joint health.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) help manage pain and inflammation. Topical treatments, such as creams and gels, provide localised relief with fewer systemic side effects.

Injections: Corticosteroid injections help reduce inflammation and provide temporary pain relief. Hyaluronic acid injections supplement the joint’s natural lubrication, which may improve comfort for several months.

Surgical Treatment

Arthroscopy

A minimally invasive procedure in which a surgeon makes small incisions to insert a camera and specialised instruments into the knee joint. This allows for the removal of loose cartilage, smoothing of rough joint surfaces, and addressing minor structural issues. Arthroscopy is typically used for symptom relief in selected cases rather than as a long-term solution for advanced osteoarthritis.

Osteotomy

A surgical procedure that involves reshaping the tibia or femur to shift weight away from the damaged part of the knee joint. By redistributing stress to healthier areas, this approach can help relieve pain and delay the need for joint replacement, particularly in younger or more active patients.

Joint Replacement

When osteoarthritis has severely damaged the knee joint, a partial or total knee replacement may be recommended. This procedure involves removing worn-out joint surfaces and replacing them with artificial components designed to restore movement and reduce pain. Joint replacement is typically considered when other treatments no longer provide sufficient relief.

Managing Knee Osteoarthritis

Ongoing management helps maintain mobility and slow progression. Regular exercise, including low-impact activities such as swimming or cycling, keeps the knee flexible and strengthens surrounding muscles. Using proper techniques when moving or lifting can minimise unnecessary joint strain.

Supportive footwear improves stability, and assistive devices like braces or walking aids may reduce pressure on the knee. Maintaining a healthy weight further reduces excess stress on the joints, helping to manage symptoms more effectively.

Conclusion

Knee osteoarthritis is a progressive condition, but with the right approach, symptoms can be managed to maintain mobility and quality of life. Early intervention, lifestyle adjustments, and appropriate treatment can help slow progression and reduce discomfort.

If you are experiencing persistent knee pain or stiffness, schedule a consultation to explore your treatment options.

Dr. Ambrose Yung

Specialist Orthopaedic Hip & Knee Surgeon

Dr Ambrose Yung Wai Yin is a Senior Orthopaedic Hip & Knee Surgeon with over 20 years of experience in the field of orthopaedics.

Areas of Expertise:

Knee Surgery: Complex procedures like revision knee arthroplasty, partial knee replacement, and primary total knee replacement.
Minimally Invasive Surgery: Shoulder, ankle, and knee surgeries with minimal scarring and quicker recovery times.
Limb Reconstruction: Specialized in both upper and lower limb reconstruction.

Computer-guided Knee Replacement: Dr. Yung trained at the prestigious Oxford University Hospital in the UK, where he specialized in computer-guided partial and total knee replacements.

Dr. Chee Kin Ghee

Specialist Hand & Orthopaedic Surgeon

Dr Chee Kin Ghee is a specialist hand surgeon with over 20 years of experience in hand and orthopaedic surgery.

His clinical expertise includes treatments for complex hand, wrist, and upper limbs injuries, wrist and finger joint replacement, minimally invasive hand and wrist surgery, and nerve compression release surgery

Dr Chee was awarded a 1-year fellowship (HMDP by MOH) & trained at world-renowned Wrightington Hospital Upper Limb Unit, UK.
He was trained in the management of complex upper limb conditions, including complex joint replacement of the shoulder, elbow, wrist, and hand, as well as modern minimally invasive upper limb surgery.

Dr. Low Mun Hon

Dr Low Mun Hon has over 20 years of experience managing trauma and orthopaedic clinical care. Prior to this, he has been in private practise as a practitioner at Singapore Sports & Orthopaedic Clinic (SSOC).

Dr. Low graduated from Monash University Medical School (Melbourne). Thereafter, he pursued his internship at The Alfred Hospital in Melbourne.

He subsequently continued his practice of medicine at Singapore General Hospital (SGH). During this period, he was awarded the membership of the Royal College of Physicians and Surgeons at Glasgow in 2008 & Master of Medicine in Orthopaedic Surgery (National University of Singapore) in the same year.
Dr Low had previously worked as an orthopaedic trainee at various local teaching hospitals i.e. Ng Teng Fong General Hospital (NTFGH), Tan Tock Seng Hospital (TTSH), KK Women’s and Children’s Hospital (KK Hospital) and Singapore General Hospital (SGH).

Justin Lim Xuan Li

Physiotherapist

Justin is a skilled and experienced physiotherapist who specializes in the treatment of neuro-musculoskeletal conditions (nerve, muscle and joint).

Over the years, he honed his clinical skills across all sectors of healthcare, allowing him to attain mastery of the sophisticated human body and address complex problems effectively, allowing him to successfully address complex neuro-musculoskeletal conditions at an accelerated pace.

Justin graduated from Trinity College Dublin and started his career in National Healthcare Group Polyclinics. His skills quickly gained recognition and was appointed as a clinical educator for physiotherapy students and even tasked to develop Clinical Practice Guidelines.
Subsequently, he continued his practice in community care settings such as Thye Hwa Kwan Rehabilitation Centres and Saint Andrew Community Hospital, where he focused on developing his skills for geriatric rehabilitation and improving quality of care in rehabilitation centres. He then moved on to private practice in Parkway East Hospital, specializing in post operative and outpatient rehabilitation.

Chan Jing Cheng (JC)

Physiotherapist

JC has over 12 years of experience in treating Chronic pain, Orthopaedic and Geriatric conditions.

He had worked at various Private Hospitals, Singapore General Hospital, NTUC Health Elder Care and Lions Home for the Elders.
He is passionate about solving complex musculoskeletal disorders and helping clients relief pain from trauma and illness.
He has a special interest in the Shoulder, Spine, Hip and Knee joint conditions.
He has helped thousands of clients go through rehabilitation smoothly and achieved higher satisfaction after orthopaedic surgery.

Zita Sham

Physiotherapist

Zita graduated with a Diploma in Physiotherapy from Nanyang Polytechnic (Singapore) in 2014 and started working in Ng Teng Fong General Hospital to serve her sponsorship bond.

Later in 2015, she pursued a Bachelor’s Degree in Physiotherapy from Trinity College Dublin, which was provided in Singapore Institute of Technology.

After completion of her studies, Zita worked in the Day Rehabilitation Centre in Jurong Community Hospital for 6 years, where she focused on community rehabilitation for a variety of patients. Patients that were mainly seen consisted of post-operative, geriatric and neurological conditions.
Zita also has a passion in musculoskeletal and sports physiotherapy and is looking to pursue that. She is also keen to provide home-based physiotherapy to reach out to those in need of her expertise.

Joanna Lim

Hand Occupational Therapy

Joanna’s primary specialization and passion is in hand therapy and upper limb rehabilitation, having more than 10 years of experience in this field.

Joanna obtained her Diploma in Occupational Therapy (Merit) from Nanyang Polytechnic in 2006. Under the MOH Health Science Scholarship, she graduated from La Trobe University, Australia, with a Bachelor’s degree in Occupational Therapy (1st class Honors) the following year. Upon graduation, she worked in Changi General Hospital and Sengkang General Hospital.

She has worked with hand and orthopedic surgeons in both inpatient and outpatient settings, providing quality therapy services for clients with a variety of hand and upper limb conditions, including fractures, sprains/strains, tendon injuries, nerve injuries, repetitive strain disorders and complex trauma injuries.
During her tenures at CGH and SKGH, Joanna was a Senior Occupational Therapist and held the role of Hand Therapy and Upper Limb Rehabilitation Unit Leader. She was in charge of clinical supervision and management of staff, manpower planning, and daily operations of the unit.