# Knee osteoarthritis

> Citation bundle for Knee osteoarthritis on The Treatment Registry.
> URL: https://thetreatmentregistry.com/conditions/knee-osteoarthritis
> Bundle URL: https://thetreatmentregistry.com/api/citations/conditions/knee-osteoarthritis

## Description

Degenerative joint disease of the knee, characterised by progressive cartilage loss, joint-space narrowing, and pain. The treatment ladder runs from lifestyle and medical management through intra-articular injections, joint-preserving surgery, and finally joint replacement. Modern guidelines have substantially reduced the role of arthroscopy in osteoarthritis without mechanical symptoms.

## Treatment ladder

### conservative

- **Weight management and physiotherapy** — First-line for all symptomatic patients. Each kilogram lost reduces knee load substantially during walking; supervised exercise improves pain and function.
- **Analgesia (paracetamol, NSAIDs)** — Topical NSAIDs preferred for localised pain; systemic NSAIDs effective but with cardiovascular and gastrointestinal risk profiles to consider in older patients.

### procedural

- **Intra-articular corticosteroid injection** — Short-term symptomatic relief (weeks to months). Repeated injections over time are associated with cartilage loss and are not a long-term solution.
- **Hyaluronic acid (viscosupplementation) injection** — Limited and contested evidence; some patients report symptomatic improvement.
- **Knee arthroscopy** — Now of limited evidence in osteoarthritis without mechanical locking; current AAOS and NICE guidance has substantially reduced its routine indication.

### surgical

- **Unicompartmental knee replacement** — Partial replacement when osteoarthritis is confined to one compartment. Faster recovery and better range of motion than total replacement, but with higher revision rates in some series.
- **Total knee replacement** — Definitive surgical treatment for end-stage osteoarthritis. Modern implant survivorship at 15-20 years exceeds 90% in registry data.
- **High tibial osteotomy** — Realignment osteotomy to redistribute load away from the affected compartment. Selected younger active patients with isolated medial-compartment disease.

## Related procedures

- https://thetreatmentregistry.com/procedures/knee-replacement

## Sources

- [AAOS — Surgical Management of Osteoarthritis of the Knee Clinical Practice Guideline](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/surgical-management-of-osteoarthritis-of-the-knee/) — American Academy of Orthopaedic Surgeons (accessed 2026-05-09)