Pain that builds with activity and eases with rest — early on, at least.
Stiffness first thing in the morning or after sitting for a while, easing after ten to twenty minutes of moving.
Shrinking walking distance, often noticed as a change in what you are willing to plan.
Difficulty with stairs, particularly going down.
Grinding, creaking or crunching from the joint.
Swelling after activity or at the end of the day.
The leg gradually bowing outwards, or occasionally inwards.
Later, pain at night and at rest — the point at which most people seek help.
Why it happens
Age-related wear of the cartilage surface, the commonest cause by far.
Previous injury — a meniscus tear, an ACL tear, or a fracture involving the joint surface.
Previous removal of a meniscus, which concentrates load onto a smaller area.
Leg alignment: bow legs load the inner compartment, knock knees the outer.
Body weight — every extra kilogram is multiplied several times through the knee when walking.
Occupations involving heavy lifting, deep squatting or kneeling for years.
Inflammatory arthritis such as rheumatoid disease, which damages cartilage by a different mechanism.
A family tendency, which is real but far less important than weight, injury and alignment.
See someone sooner if…
The knee is hot, red and swollen and you feel unwell — this needs assessment for infection today.
Pain is waking you at night regularly.
The knee locks or gives way, which suggests a mechanical problem on top of the arthritis.
Your walking distance is falling quickly over weeks rather than years.
You are becoming less independent, or relying on painkillers daily.
What arthritis actually is
The ends of the bones in your knee are covered by cartilage — a smooth, slippery layer a few millimetres thick, with a lower coefficient of friction than ice on ice. It has no nerve supply, so you have never felt it. Arthritis is the gradual thinning and roughening of that layer.
The pain does not come from the cartilage itself. It comes from the bone underneath once it is no longer protected, from the inflamed joint lining, and from the joint capsule being stretched by swelling. That is why the amount of pain someone has correlates surprisingly poorly with how bad their X-ray looks — and why treatment aimed at the inflammation and the load can help even when the X-ray does not change.
What genuinely works before surgery
Ranked honestly, by how much difference each is likely to make. The first two outperform everything else, and they are the two people most often skip.
Treatment
How much it helps
Worth knowing
Strengthening the quadriceps and hips
Substantial — the best-evidenced treatment there is
Needs 12 weeks of consistent work before you judge it. Most people stop too early.
Losing weight
Substantial, if you carry extra
Each kilogram lost removes several kilograms of load per step. 5% of body weight is a meaningful target.
Simple painkillers and anti-inflammatories
Moderate
Useful for flares. Long-term daily use needs a discussion about stomach, kidney and heart risk.
Corticosteroid injection
Moderate, for 6–12 weeks
Best used to break a flare so you can do the strengthening. Repeated frequently, it is not good for cartilage.
Hyaluronic acid injection
Modest, and variable between patients
Some people get several months of useful relief; the evidence overall is mixed. Reasonable to try, not to rely on.
A brace or an insole
Modest to moderate in one-sided wear
An unloader brace can genuinely help inner-compartment arthritis, and is worth trying before surgery.
Walking aid used sensibly
Moderate
A stick in the opposite hand removes a real proportion of load. Pride costs more than the stick does.
Glucosamine and chondroitin
Little to none
Widely taken, poorly supported. Harmless, but not a substitute for strengthening.
Non-surgical treatments for knee arthritis, assessed frankly.
If you are under sixty, ask about keeping your knee
This is the part of the conversation that most often does not happen, and it matters. In most people arthritis does not affect the whole knee — it starts in one half, usually the inner side, driven by the shape of the leg. If your legs are slightly bow-shaped, you are concentrating your weight through the worn compartment thousands of times a day.
An osteotomy changes the angle of the bone so that load transfers to the healthy side of the knee. Nothing is replaced. For a 48-year-old who wants to keep working physically and keep running, that can buy ten to fifteen years of their own joint — and a replacement remains possible afterwards.
What does not help
Arthroscopic washout or 'cleaning' of an arthritic knee. This has been tested properly in large trials and performs no better than physiotherapy. It will not be offered here for arthritis without mechanical locking.
Complete rest. Cartilage depends on movement for its nutrition, and muscles waste quickly. Modifying activity helps; stopping does not.
Waiting for it to settle by itself. Arthritis does not reverse, but the pain and function are very much modifiable — which is worth acting on.
How it is assessed
Examination of movement, alignment, ligament stability and exactly where the tenderness is.
Weight-bearing X-rays, which show the true joint space under load — a lying-down X-ray can badly underestimate wear.
Full-length standing alignment films if joint preservation is being considered, so the correction can be planned in degrees.
MRI only where a mechanical problem such as a locking meniscus tear is suspected on top of the arthritis, since MRI is not needed to diagnose arthritis itself.
First, without surgery
What to try before an operation
This list comes first on purpose. For most people reading this page, it is the whole treatment — and where it is not, having genuinely worked through it makes the decision to operate a much clearer one.
A twelve-week progressive strengthening programme for the quadriceps, hamstrings and hip muscles — supervised at first, then continued independently.
Weight reduction where relevant, targeting an initial 5% of body weight.
Low-impact activity that keeps the joint moving: cycling, swimming, walking on level ground.
Anti-inflammatory medication for flares, used with a clear plan rather than indefinitely.
A corticosteroid injection to break a bad flare so rehabilitation becomes possible.
Hyaluronic acid injection as a reasonable trial where steroid has helped only briefly.
An unloader brace or lateral wedge insole for inner-compartment wear.
Practical changes at home: a higher chair, a raised toilet seat, a stool rather than a deep squat at floor level.
If surgery is needed
And when it genuinely is
Each option below says when it applies, not just what it is. If your situation does not match, that is a good reason to ask more questions.
Told he needed a knee replacement at 47. He kept his own knee.
“Two doctors had told me a replacement was the only option, and that I would have to give up the farm work. Here I was shown standing X-rays and told the wear was only on the inner side, and that my bow legs were the reason. The eight weeks on crutches were long. But I am back on the land and I still have my own knee.”
Bhavesh D., 47 · Farmer
Bardoli · 22 months after treatment
Outcome. High tibial osteotomy correcting the alignment away from the worn inner compartment. Off crutches at eight weeks, back to full agricultural work by seven months, no restriction on physical labour.
A consultation means your imaging on the screen, a plain explanation of what is actually wrong, and an honest opinion on whether you need surgery — including when the answer is no.