Knee osteoarthritis

• Pain with walking, stairs or transfers.
• Stiffness after rest.
• Gradual limitation of some activities.
• Episodes of swelling or symptom flares in some people.

Symptom severity does not always match X-ray changes.

NICE recommends clinical diagnosis without imaging in people aged 45 or over with activity-related pain and no morning stiffness or stiffness lasting no more than 30 minutes. Imaging is not routinely required unless there are atypical features or concern about another diagnosis.

No. NICE recommends tailored therapeutic exercise, including local strengthening and aerobic fitness. Discomfort can initially increase, but regular and consistent exercise can improve pain, function and quality of life over time.

• Lower-limb strengthening.
• Mobility work when needed.
• Walking or suitable aerobic activity.
• Functional tasks such as sit-to-stand, stairs and balance.

For people with osteoarthritis who are living with overweight or obesity, weight loss can help reduce pain and improve physical function and quality of life. Any amount of weight loss is likely to be beneficial, with greater benefits generally associated with greater weight loss. Losing 10% of body weight is likely to provide more benefit than losing 5%. An appropriate and achievable weight-loss goal can be agreed, with support provided as needed.

Braces, insoles and other supports are not routinely recommended. They may be considered in selected situations when there is joint instability or abnormal biomechanical loading, when therapeutic exercise is ineffective or unsuitable without the addition of an aid or device, and when that aid or device is likely to improve movement and function.

Referral may be considered when pain, stiffness, reduced function or deformity substantially affect quality of life and non-surgical management is ineffective or unsuitable. The decision is not based on imaging alone.

See rehabilitation after total knee arthroplasty

Main sources

• NICE NG226 — Osteoarthritis in over 16s