Knee Arthritis: From Aching Joints to Renewed Mobility
Knee arthritis often begins gradually. You may notice intermittent aching, stiffness, or mild swelling around the joint, especially after walking long distances, standing for a long time, climbing stairs, or getting up from a chair. As the cartilage wears down, creaking or popping sounds can occur when you bend or straighten your knee. Over months to years, discomfort may progress to constant pain that interferes with sleep or occurs even at rest, and the knee may feel unstable or become bowlegged or knock‑kneed.
At the first signs of knee arthritis, rest and protect the joint by avoiding activities that cause pain. Apply ice packs for 15–20 minutes several times a day when swelling or soreness flares, and use moist heat to ease stiffness. Over‑the‑counter pain relievers such as ibuprofen, naproxen or acetaminophen can reduce discomfort when taken as directed. Wearing a supportive knee sleeve or brace, using cushioned shoes or orthotic inserts, and keeping the leg elevated can help reduce stress on the joint. Gentle stretching and low‑impact exercises like walking on level ground, stationary biking or swimming maintain mobility without overloading the knee, and gradually losing excess weight decreases pressure on the joint.
Make an appointment with an orthopedic specialist or rheumatologist if knee pain persists more than a couple of weeks despite rest and home care, or if swelling, warmth, redness or stiffness worsen. Seek medical attention sooner if you cannot bear weight on the affected leg, your knee locks or gives way, you have difficulty walking, or pain is accompanied by fever or a recent injury. Persistent night pain, deformity of the leg, or an inability to perform daily activities such as climbing stairs or getting out of a chair are additional reasons to see a doctor for evaluation and to rule out other conditions.
Most people manage knee arthritis with a combination of lifestyle changes, physical therapy and medications. Your doctor may recommend low‑impact exercise programs supervised by a physical therapist to strengthen the quadriceps, hamstrings and hip muscles, improve flexibility and correct mechanics. Losing even a small amount of weight lessens stress on the knee. Assistive devices such as canes, unloader braces or supportive knee sleeves can help take pressure off the damaged area. Oral or topical NSAIDs and acetaminophen provide pain relief; COX‑2 inhibitors offer an alternative for those sensitive to traditional NSAIDs. For inflammatory arthritis, disease‑modifying antirheumatic drugs may be prescribed. If pain persists, injections such as corticosteroids, platelet‑rich plasma or hyaluronic acid (“gel shots”) can provide temporary relief. Complementary therapies like acupuncture may offer additional comfort for some people.
Symptom relief from exercise, weight loss and medications typically appears within 6–12 weeks, but knee arthritis is a chronic condition requiring ongoing management. Physical therapy programs often last several months, and continuing home exercises helps maintain gains. Injections may be repeated every few months if effective. If pain and stiffness continue to limit your activities after several months of diligent conservative care, your doctor may discuss surgical options.
Surgery is considered when severe knee pain and functional limitations persist despite 3–6 months of comprehensive nonsurgical treatment. Indications include advanced cartilage loss on imaging, bone‑on‑bone contact, persistent swelling or deformity (bowlegged or knock‑kneed posture), significant mechanical symptoms such as locking or giving way due to degenerative meniscal tears, and progressive inability to walk, climb stairs or sleep due to pain. People with inflammatory arthritis may be candidates for surgery if joint damage progresses despite medication, and younger patients with misalignment or a focal cartilage defect might benefit from corrective procedures.
Surgical procedures range from minimally invasive to joint replacement. Arthroscopy may be used to remove loose fragments or repair a degenerative meniscal tear, though it rarely addresses arthritis itself. In younger patients with damage confined to one area, cartilage restoration procedures or an osteotomy can realign the bones and redistribute weight away from the damaged compartment. A synovectomy removes the inflamed joint lining in cases of rheumatoid arthritis. When arthritis involves a single compartment, a partial (unicompartmental) knee replacement can resurface only that section, while advanced disease affecting multiple compartments may require total knee replacement. Knee replacement involves removing damaged bone and cartilage and implanting metal and plastic components to restore function; it is performed either inpatient or as a short hospital stay and is typically followed by months of rehabilitation.
Knee arthritis is a lifelong condition, but with early intervention and adherence to treatment, many people maintain an active lifestyle and slow disease progression. Lifestyle modifications, exercise and weight management often provide long‑term symptom control, and periodic medications or injections can manage flares. For those who eventually need surgery, knee replacement has a high success rate: most patients experience significant pain relief and improved function, and about 90–95% of implants continue to work well after 10 years, with more than 80% lasting 20 years or longer. Outcomes are typically better in individuals who maintain a healthy weight, follow rehabilitation guidelines and avoid high‑impact activities.
Nonsurgical treatments have few serious risks; side effects may include stomach irritation or kidney problems from NSAIDs, or temporary pain and infection risk after injections. Major complications from knee replacement surgery are uncommon, occurring in fewer than 2% of patients. These include infection, blood clots, implant loosening, stiffness, or nerve injury. Revision surgery is relatively rare, with about 3–4% of patients needing another procedure within 10 years and around 10% within 20 years. Younger, more active individuals and those with underlying health conditions have slightly higher revision rates.
With conservative treatment, people often notice gradual improvement within a few weeks and continue to gain strength and flexibility over several months. After knee replacement surgery, physical therapy starts within 24 hours, and most patients transition from using a walker to a cane over the first 2–3 weeks. Early recovery emphasizes range of motion for six weeks, followed by strength training through 16 weeks. Many people return to desk work and light activities within 4–6 weeks and resume most daily activities by three to six months. However, full recovery—regaining endurance and confidence for low‑impact sports and heavy tasks—may take six months to a year. Ongoing exercises and weight management remain important for sustaining long‑term improvement.
A successful outcome involves substantial reduction or elimination of knee pain, improved mobility and stability, the ability to perform daily activities and participate in low‑impact exercises without significant limitations, and a better overall quality of life. Most patients achieve good to excellent results with diligent conservative management or, when needed, surgery. More than 90% of patients report significant pain relief and improved function after knee replacement, and 85–90% are satisfied with their results one year after surgery. Long‑term success depends on maintaining a healthy weight, following a customized exercise program, using assistive devices when necessary, and avoiding activities that overstress the joint to delay or prevent further degeneration.