A degenerative knee joint is a state of the joint as a whole system that may cause pain when it is used, stiffness after being still, occasional swelling, and reduced function. Treatment aims to make the symptoms and the participation in life better. It does not make a degenerated joint come back to normal or guarantee that surgery will not be needed in the future.

Confirm the cause before treating the knee joint

Knee pain does not always mean a degenerative knee joint. Injury of the meniscus or the ligaments, problems of the kneecap joint, the tendons or the bursae around the joint, gout or calcium crystals, inflammatory arthritis from the immune system, infection, bleeding into the joint, and symptoms referred from the hip or the back all require different approaches to care.

A knee joint that is hot, red, swollen, and very painful together with fever or feeling unwell must receive an urgent assessment in order to rule out infection. Urgent care should be received after a severe accident when the joint is deformed, weight cannot be borne, or it is locked so that it cannot be straightened, as well as when there is numbness, or a cold pale foot. If the calf is abnormally swollen together with breathlessness or chest pain, an emergency assessment must be received in order to rule out a state of blood clots.

A degenerative knee joint with characteristics that follow the usual pattern can usually be diagnosed from the history and the examination without imaging as a routine. An X-ray may be useful when the symptoms are atypical or change quickly, and when surgery must be planned. Magnetic resonance imaging is usually used when another problem is suspected and the result will change the plan of treatment.

A degenerative knee joint does not proceed in fixed stages

The cartilage, the bone, the lining of the joint, the muscles, and other tissue all play a part. The symptoms may improve or flare up, and an X-ray that looks severe may come with few symptoms, while an image that has changed little may come with a great deal of pain. There is not yet a particular period that has been proved in which treatment at the level of the cells will stop the degeneration.

The plan of treatment should hold to the symptoms, the function, sleep, work, the goals for activity, accompanying diseases, and the wishes of the patient, not to a fixed division into stages. It should be assessed again when the symptoms change abnormally or when the previous plan does not help in doing meaningful activities.

The treatments that the guidelines support most

Knowledge, therapeutic exercise, and activity

Understanding a degenerative knee joint and setting realistic goals together is the important heart of it. Strengthening the muscles, aerobic exercise, training balance or the control of movement, and training in water adjusted according to capability may reduce pain and increase function. Symptoms may increase temporarily when training begins, but the level should be adjusted so that it can be managed, instead of stopping movement altogether.

Managing weight where suitable

For those who are overweight or obese, losing weight, even only partly, may help with pain, function, and quality of life. The goals should be safe, actually achievable, and not blaming. Sleep, mental health, and other chronic diseases also have an effect on the pain and on the readiness to do activities.

Medicine is a helper, not the whole plan

A non-steroidal anti-inflammatory medicine of the kind applied externally is usually considered first. The oral kind may be considered when the applied medicine is not suitable or is not enough, after assessing the risks to the stomach, the kidneys, the heart, blood pressure, interactions between medicines, and the necessity of a medicine to protect the stomach. The lowest dose that works should be used for the shortest period that is suitable.

Paracetamol, opioids, and food supplements are not a long-term answer to be used as a routine. Strong painkillers may cause drowsiness, falls, constipation, dependence on the medicine, and overdose. Medicine should help you go back to doing activities and to rehabilitation, not be used in place of these.

What injections into the knee joint can and cannot do

Corticosteroids may relieve the symptoms in the short term when other medicines are not suitable, or in order to help you come back to therapeutic exercise, but they do not create new cartilage. The risks of infection, temporarily high blood sugar, and the effects of repeated injection must be discussed
Hyaluronic acid gives a benefit that on average is inconsistent. Important guidelines do not recommend using it as a routine, so it should not be claimed that any particular molecular weight will certainly work, will remain in the joint as long as guaranteed, or is superior to other products
Plasma with a high concentration of platelets may help the symptoms in some groups of patients, but the methods of preparation and the results of the studies differ. It has not yet been proved that it creates new cartilage or reliably postpones joint replacement
Prolotherapy and products sold as concentrated growth factor have less certain evidence and should not be used in place of care according to the guidelines. A dose or a branded protocol name does not prove clinical effectiveness
Stem cell products, exosomes, and other restorative products may still be experimental or not approved for a degenerative knee joint, depending on the product and the jurisdiction. These products carry risks of infection, immune reactions, contamination, and other risks, so they should not be advertised as a cure

Ultrasound may help place the needle more precisely, but precision does not prove that the substance injected is effective. Informed consent should cover the alternatives, the length of time of relief that can be expected, the uncertainties, the costs, and the harms that may arise. If after the injection the pain increases quickly, the joint is hot, red and swollen, or there is fever, an assessment must be received immediately.

Devices and treatments that are received passively have a secondary role

A walking aid adjusted suitably may increase safety and reduce the load on the joint. A knee brace, an insole, or supportive taping may help selected patients when there is instability or abnormal load-bearing, but they do not have to be used as a routine, and claims that they can align the joint permanently are misleading.

Heat or cold may help give temporary comfort, and manual therapy may be used together with exercise. Laser, shock waves, therapeutic ultrasound, electrical or magnetic stimulation, dry needling, and similar devices should not be described as creating cartilage, treating the root cause, or guaranteeing long-term recovery. The evidence is still limited, or the guidelines do not recommend using them as a routine.

Surgery is not a failure, and should not be postponed with treatment that does not work

A person sitting on a sofa and holding a painful knee joint

There should be a referral for an assessment for joint replacement when pain, stiffness, reduced function, or deformity greatly affects the quality of life, and suitable care without surgery does not help enough or is not suitable. The symptoms and the goals are important alongside the images. Age, weight, smoking, or accompanying diseases should not automatically block the assessment, although the risks must still be reduced and the health prepared.

Partial or total joint replacement depends on the pattern of the disease, the alignment of the joint, the working of the ligaments, health, and the wishes of the patient. Arthroscopic washout or trimming the surface of the joint is not a normal treatment for a degenerative knee joint alone. A knee that is truly locked, or other structural disease, must be assessed separately.

Shared decision-making should compare the benefits and the risks of continuing care without surgery against the surgical alternative. Repeating injections or devices that have no evidence merely because the patient still hesitates about surgery may increase the costs and the risks without helping them decide better.