Knee osteoarthritis: how to live without pain before considering surgery

There is a phrase I hear often in the clinic: "The doctor told me I have osteoarthritis and that when I can no longer cope, they will fit me with a replacement." Between the diagnosis and surgery there is a huge space that often goes unexplored. That space is where I work.

What knee osteoarthritis actually is

Osteoarthritis is the progressive wear of the cartilage covering the bone ends in the knee joint. Without that cartilage as a shock absorber, the bones rub together, the joint becomes inflamed and pain appears — especially when going downstairs, getting up in the morning or after sitting for a long time.

It is not just a disease of older people. Post-traumatic osteoarthritis — following a meniscus or ligament injury, for example — can appear in your forties or fifties. And excess weight accelerates it considerably, because every extra kilogram multiplies the load on the joint.

First: knowing exactly what stage it is at

Not all osteoarthritis is the same. There are four grades of wear and the treatment changes considerably from one to the next. With musculoskeletal ultrasound during the appointment itself I can see the state of the cartilage, whether there is fluid inside the joint (effusion) and whether there are other associated problems — meniscus, tendons — contributing to the pain. That changes the treatment plan completely.

Options before surgery

The scientific evidence supports several options to reduce pain and slow the progression of osteoarthritis. These are the ones I use most frequently:

Intra-articular hyaluronic acid

Hyaluronic acid is a substance found naturally in the synovial fluid of the knee. With osteoarthritis, that fluid loses quality and the joint starts to grind. An ultrasound-guided injection of hyaluronic acid restores the viscosity, reduces inflammation and improves joint glide. Its effect typically lasts between six months and one year and can be repeated without problem.

PRP (platelet-rich plasma)

PRP is obtained from the patient's own blood: it is centrifuged, the platelets are concentrated and injected into the knee. The platelets release growth factors that modulate inflammation and have a regenerative effect on cartilage. It works particularly well in mild-to-moderate osteoarthritis and in relatively young patients with good cartilage reserve.

Ultrasound-guided anti-inflammatory injections

When there is an acute inflammatory flare-up with significant effusion, an ultrasound-guided corticosteroid injection can calm the joint quickly, allowing the patient to resume activity and start rehabilitation in better condition. It is not a long-term solution on its own, but it is sometimes the first necessary step to break the pain-inflammation-inactivity cycle.

Therapeutic exercise and weight management

This has the strongest evidence of all the treatments, and is the most underrated. The quadriceps muscle acts as a shock absorber for the knee: strengthening it significantly reduces the load on the cartilage. I coordinate the exercise programme with your physiotherapist so that it is progressive, safe and adapted to your situation.

When a knee replacement is necessary

When osteoarthritis is very advanced (grade IV, bones rubbing directly), pain completely limits daily life and conservative treatments have stopped providing relief, a knee replacement is a surgery with very good outcomes. That decision is made by the orthopaedic surgeon in coordination with rehabilitation. My role is to help delay reaching that point for as long as possible — and also to ensure the best possible recovery if surgery does become necessary.

Frequently asked questions

Is knee osteoarthritis curable? +

Osteoarthritis cannot be cured in the sense of regrowing lost cartilage, but it can be managed very well. Many people with advanced osteoarthritis lead a completely normal life with appropriate treatment, without needing surgery.

How long does hyaluronic acid last? +

It depends on the degree of osteoarthritis and the individual, but in general the relief lasts between six months and one year. It can be repeated without problem. The less cartilage loss there is, the better the results tend to be.

Does PRP work better than hyaluronic acid? +

There is no universal winner. PRP has an interesting regenerative component, especially in mild-to-moderate osteoarthritis and in younger patients. Hyaluronic acid acts more as a lubricant. In many cases I combine them depending on the individual situation.

When is a knee replacement necessary? +

When the wear is very severe (grade IV, bone on bone), pain completely limits daily life and conservative treatments have stopped working. That decision is made by the orthopaedic surgeon, but reaching that point can often be delayed by years with good rehabilitation follow-up.