• education
• weight loss
• exercise
• simple analgesia
• injectable therapies
• GLA:D program
• walking aids
Whilst not all of these treatments are appropriate for everybody, it is important to have a discussion with your doctor, nurse practitioner, or physiotherapist about which of these treatments may be appropriate for you.
Education
Education about your knee arthritis and the options available to treat it is the most important first step. Ultimately, you are the person who is going to be most motivated to get the right treatment, and it is essential that you understand your options.
Arthritis is a disease characterized by exacerbations and remissions. This means that sometimes the pain will be quite severe. Sometimes it will be more manageable. The goal of non-operative treatment is not necessarily to eradicate your pain completely, but more to help manage your pain so that the exacerbations become less frequent and less severe and ultimately restore you to a quality of life that is acceptable to you.
Reading the content of this website is a great first step in your education, and there are many other resources available to you, some of which are listed here. The more informed you are, the more likely you are to pursue the correct treatment for you.
Of course, if there are things that you don't understand, this is where it's important to discuss them with your health practitioner.
Arthritis AustraliaUnderstanding and managing arthritisVisit resource
Australian Orthopaedic AssociationAustralian orthopaedic patient informationVisit resource
AAOS OrthoInfoDetailed information about orthopaedic conditions and proceduresVisit resource
Healthdirect AustraliaIndependent Australian health informationVisit resource
Weight loss
Being overweight can impact all areas of your health, including worsening your knee arthritis.
The knee carries several times body weight with each step, so weight has a direct mechanical effect on symptoms. Weight loss is associated with symptom improvement in published studies, and where it is achievable it is one of the more effective things available.
It also matters for surgery later. Higher body weight is associated with higher rates of complication after joint replacement, including wound problems and infection, so weight reduction before an operation changes the risk profile of that operation. This is something Professor Rodda will discuss with you directly if surgery becomes part of the conversation, rather than leaving it unaddressed.
For many people weight loss is genuinely difficult, and the advice to lose weight is often given without support to do it. If it is relevant to you, it is worth discussing with your GP what practical help is available, rather than treating it as something to manage alone.
There are also many resources available to help with your weight loss. Some of those are listed here.
Exercise
Exercise is the most effective non-surgical treatment for knee arthritis, and it is recommended as first-line management in Australian and international clinical guidelines.
Appropriate exercise does not accelerate cartilage loss, so the goal is to keep the joint moving and the surrounding muscles strong. High-impact activity may increase pain in an arthritic knee, so running and jumping are often reduced in favour of controlled strengthening work, but the joint is not being damaged by sensible exercise.
Most people notice little in the first couple of weeks and meaningful change by six to twelve weeks. Stopping early is the most common reason exercise therapy does not work.
Low-impact exercise is probably the most important thing you can do to help manage your arthritis. On the Sunshine Coast, swimming and cycling are some of the best forms of exercise you can do. Whatever exercise you choose, it should be enjoyable and social so you are more likely to stick with it.
Medication
There are various medications that can be used to help manage your arthritis. These can all have potential side effects, so you should always involve your general practitioner in these decisions.
Panadol Osteo is commonly prescribed and is safe for most people with osteoarthritis. Panadol Osteo is the same medication as Panadol but is prepared in a way so that patients only need to take it 3 times a day instead of 4 times a day. This makes it more convenient for people with chronic pain, such as osteoarthritis. This is just a trade name for paracetamol. Often we recommend patients take Panadol Osteo two tablets three times a day.
Anti-inflammatory medication (NSAIDs) works in a different way to paracetamol. As a result, these can be taken as well as, not instead of, paracetamol. Broadly speaking, there are two types of anti-inflammatory medications:
- There are ones you get over the counter, like Brufen.
- There are ones that need to be prescribed, such as Mobic and Celebrex.
These medications do have potentially serious side effects. As a result, you should always contact your GP or Nurse Practitioner to discuss if they're appropriate for you. In general, these should be taken for a short time only during an exacerbation. Sometimes the prescribed anti-inflammatories can be taken for a longer period of time, but this needs to be with strict oversight from your medical practitioner.
Opioid medication Opioid medications are very strong and addictive painkillers. They generally should not be used for chronic pain, such as occurs with osteoarthritis. These can cause problems such as tolerance, dependence, falls, and cognitive effects, particularly in older adults. There is also a significant interplay between chronic pain, depression, and opiate abuse. If you are requiring opiates to manage your pain, this may be an indication to consider surgery.
Natural remedies including glucosamine, chondroitin, fish oil and turmeric, are widely used. Current clinical guidelines generally do not recommend them for knee osteoarthritis, as trial evidence has been inconsistent and the better-designed studies have mostly not shown benefit over placebo. They are low risk for most people, and some individuals find them helpful, there is no strong reason to stop taking them if that is your experience, but they should not be relied on as primary management.
Injections
Corticosteroid, hyaluronic acid, platelet-rich plasma and stem cell injections all have a role, or a claimed role, in managing knee arthritis without surgery. The evidence varies considerably between them.
GLA:D program
GLA:D, Good Life with osteoArthritis: Denmark, is a structured, evidence-based education and exercise programme for hip and knee arthritis, delivered in small groups over several weeks. It combines education about the condition with supervised, progressive exercise, and outcomes are tracked as part of the programme.
The programme was developed in Denmark and is now delivered internationally. It has been shown to reduce pain and improve function in people with hip and knee osteoarthritis, and is recommended as a first-line non-surgical treatment in clinical guidelines.
We refer patients into GLA:D through Fortius Allied Health on the Sunshine Coast.
Fortius Allied HealthGLA:D programme provider on the Sunshine CoastVisit website
Walking aids
A walking stick used on the opposite side to your sore knee can reduce the load passing through the joint and help with stability, particularly during a flare when pain is limiting your ability to get around.
It does not mean you are giving up on other treatments. It is a practical tool to keep you mobile and active while you work through exercise, weight management and other measures.
Your physiotherapist can help you choose the right aid and make sure it is set at the correct height. Using one incorrectly can cause compensatory pain elsewhere, so it is worth getting advice rather than picking one up on your own.
When to consider surgery
When you have tried a reasonable trial of non-surgical management and the pain is still severe, having a major impact on your quality of life and causing the interruption to your sleep, then this may be a time to consider surgical intervention.
Please take this questionnaire to help determine if surgery may be appropriate for you.
Questions to ask
- Would the GLA:D programme be appropriate for me?
- Is weight something we should discuss as part of my plan?
- Which of these have I not yet properly tried?
- Is there anything about my knee specifically that makes non-surgical management less likely to work?
- If I keep managing it this way, what should I expect over the next few years?
Common questions
What is GLA:D?
GLA:D, Good Life with osteoArthritis: Denmark, is a structured, evidence-based education and exercise programme for hip and knee arthritis, delivered in small groups over several weeks. It combines education about the condition with supervised, progressive exercise, and outcomes are tracked as part of the programme. We refer patients into GLA:D through Fortius Allied Health.
Does losing weight help knee arthritis?
The knee carries several times body weight with each step, so reducing weight reduces the load passing through the joint. Weight loss is associated with symptom improvement in published studies. It also matters for any future surgery, as higher body weight is associated with higher complication rates after joint replacement.
Can exercise make knee arthritis worse?
Appropriate exercise does not accelerate knee osteoarthritis and is recommended as first-line treatment in clinical guidelines. Structured programmes such as GLA:D target the strength and control around the joint specifically. High-impact activity may increase pain in an arthritic knee, so the type and intensity of exercise is usually adjusted rather than avoided altogether.
Should I take anti-inflammatories or paracetamol for knee arthritis?
Both have a role and are generally managed by your GP. Paracetamol is often the starting point, though its effect is modest. Anti-inflammatories are usually more effective but carry risks that increase with age and other health conditions, so they are typically used at the lowest effective dose for the shortest useful period.
Are opioids appropriate for knee arthritis?
Current guidelines do not recommend opioids for routine or long-term management of osteoarthritis, as the benefit is modest and the risks, including dependence and falls, particularly in older adults, are significant. Where they are used, it is generally short-term, for flares, and managed by your GP. A regular need for opioid pain relief is often a sign that it is time to discuss surgical options.
Do glucosamine and other supplements help arthritis?
Clinical guidelines generally do not recommend glucosamine, chondroitin or similar supplements for knee osteoarthritis, as trial evidence has been inconsistent. They are low risk for most people, and some find them helpful, but they should not be relied on as the main way of managing the condition.
Common questions.
Will exercise wear my knee out faster?
No. Appropriate exercise does not accelerate cartilage loss and it is the intervention with the most consistent evidence of benefit. Discomfort during and shortly after is expected; pain that persists to the next day means the load needs adjusting, not stopping.
How much weight loss actually makes a difference?
Because load through the knee is several times body weight, even a modest reduction produces a considerably larger reduction in joint force. Guidelines generally cite around 5 to 10 percent of body weight as clinically meaningful.
Is it better to take paracetamol or anti-inflammatories?
Guidelines favour non-steroidal anti-inflammatories, because the evidence for paracetamol in osteoarthritis is weak. NSAIDs carry stomach, kidney and cardiovascular risks that rise with age, so this should be decided and reviewed with your GP. Topical NSAIDs are a reasonable option for the knee.
Should I use a walking stick?
If walking distance is limited, yes, and hold it in the hand opposite the painful knee. It reduces load through that knee meaningfully. Most people resist the idea and most who try it find it helps more than they expected.
Am I leaving it too late if I wait?
Generally no. Waiting does not usually make a knee replacement technically harder or the outcome worse. The exception is if you become so inactive that you lose general fitness and muscle, because that does make rehabilitation harder.
Should I have keyhole surgery first?
No. Arthroscopy for degenerative knee disease has been shown in randomised trials, including against placebo surgery, to give no meaningful benefit. It is not a step on the way to a knee replacement.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.