What is knee osteoarthritis?
Osteoarthritis (OA) is the most common form of arthritis. It is a slow, age-related condition where the articular cartilage — the smooth covering at the ends of bones inside the knee — gradually thins and wears down. Over time, the joint loses some of its cushioning, the protective synovial fluid changes in quality, and inflammation can set in.
OA is sometimes called wear-and-tear arthritis, but that is an oversimplification. It is actually an active, multifactorial process involving cartilage cells, the bone underneath, the joint lining, and supporting muscles.
Common symptoms of knee OA
- Pain while walking, especially on uneven ground
- Pain when climbing or descending stairs
- Morning stiffness that improves after some movement
- Clicking or grinding sensations (crepitus)
- Swelling around the kneecap
- Difficulty squatting, sitting cross-legged, or kneeling
- Fatigue in the legs after standing for long
- A feeling of giving way in advanced cases
- Loss of full range of motion
What causes osteoarthritis?
- Age — risk increases significantly after 40
- Genetics & family history
- Excess body weight — every extra kilo adds 3–4 kg of load across the knee while walking
- Female gender — slightly higher risk after menopause
- Past injuries — old fractures, ligament tears, meniscal tears
- Repetitive overuse — high-impact sports, heavy manual work
- Knee alignment — bow legs (varus) or knock-knees (valgus)
- Muscle weakness — weak quadriceps, hamstrings, or hip stabilisers
- Metabolic factors — diabetes and other systemic conditions
How OA is graded — the Kellgren–Lawrence (KL) classification
Doctors use a 0–4 grading system based on X-ray findings:
- Grade 0: Normal — no signs of OA on X-ray
- Grade 1 (Doubtful): Possible joint space narrowing; very mild changes
- Grade 2 (Mild): Definite small bone spurs (osteophytes); possible joint space narrowing
- Grade 3 (Moderate): Multiple osteophytes, definite joint space narrowing, some bony changes
- Grade 4 (Severe / End-stage): Large osteophytes, marked joint space narrowing, deformity, bone-on-bone changes
Grade is one piece of the picture — it must be interpreted alongside your symptoms, function, and lifestyle. Some Grade 2 patients have severe pain; some Grade 3 patients walk comfortably with the right plan.
Treatment ladder — from foundation care to surgery
Modern OA care is best understood as a ladder, not a single intervention. Most patients climb only as high as needed.
Step 1 — Foundation care (everyone)
- Patient education
- Activity modification & sensible pacing
- Physiotherapy and structured exercise
- Weight management
- Footwear and gait advice
Step 2 — Medications (as needed)
- Paracetamol for symptomatic relief
- Short-term NSAIDs when appropriate, with stomach/kidney/heart safety in mind
- Topical anti-inflammatories
- Selected supplements (limited but real role in some patients)
Step 3 — Targeted injections
- Hyaluronic acid injections — joint lubrication & cushioning support
- GFC therapy — concentrated regenerative growth factors
- Corticosteroid injection — targeted, short-term inflammation control in selected scenarios
- All injections, where indicated, performed under ultrasound guidance
Step 4 — Combination & repeat protocols
- HA + GFC layered care for moderate OA
- Periodic top-up injections
- Continued physiotherapy
Step 5 — Surgical referral, when truly indicated
- Arthroscopic procedures (selected cases)
- Osteotomy for alignment correction
- Partial knee replacement
- Total knee replacement
Living well with knee OA — practical day-to-day tips
- Move every hour — long static sitting stiffens the joint
- Warm up before walks — a few gentle leg swings and quad activations
- Climb stairs the smart way — leading with the stronger leg up, weaker leg down
- Manage flares — short rest, ice, modified activity, then gradual return
- Strengthen consistently — 3 short sessions per week beats one long session
- Sleep well — poor sleep amplifies pain perception
- Track triggers — note which activities reliably worsen or improve your knee
When does knee OA need surgery?
- Pain is severe, persistent, and present at rest or at night
- Function is severely impaired despite a good non-surgical trial
- Imaging shows advanced changes (Grade 3–4) with deformity
- There is a structural problem like a large displaced meniscal tear or locked knee
- Quality of life is significantly affected
Even then, you deserve a clear explanation of which operation is being recommended and why. Trusted joint-replacement surgeons are involved when patients reach this point — and you will be told honestly when you are not there yet.
Service area — South Bengaluru
Knee OA evaluation and treatment are offered at Raghava Multispeciality Hospital, Attibele and Health Nest Hospital, HSR Layout. Bring your X-ray or MRI; it will be reviewed and explained in plain language during your consultation. Patients travel from Attibele, Anekal, Bommasandra, Chandapura, Hosur Road, Electronic City, HSR Layout, Koramangala, BTM Layout, Sarjapur Road, and Bellandur.
Frequently asked questions
What is knee osteoarthritis?
It is a chronic condition where the cartilage cushioning the knee joint slowly wears down, leading to pain, stiffness, and reduced movement.
Is knee OA the same as arthritis?
OA is the most common type of arthritis. There are other types like rheumatoid arthritis, gout, and post-infectious arthritis, which are managed differently.
Can knee OA be reversed?
No. OA cannot be reversed, and lost cartilage cannot be fully regrown. However, modern care can significantly reduce pain, improve function, and slow progression.
How is knee OA diagnosed?
By a combination of symptoms, examination, and X-ray. MRI may be added in select cases.
What are the grades of knee OA?
Grade 0–4 on the Kellgren–Lawrence system. Grade 0 is normal, Grade 4 is severe end-stage OA.
What is the best treatment for knee OA?
There is no single best treatment. The best care is a personalised, layered plan combining lifestyle changes, physiotherapy, and — where indicated — HA, GFC, or other targeted injections.
Can OA be treated without surgery?
Most patients with mild-to-moderate OA can be managed without surgery. Severe end-stage OA may eventually need surgical care.
Are HA injections better than GFC for OA?
They serve different purposes. HA improves lubrication; GFC supports the biological environment of the joint. Many patients benefit from a combination.
Is exercise safe with knee OA?
Yes — and it's essential. The right kind of exercise (low-impact strength + flexibility) protects the knee. Avoid deep squats and high-impact running during flares.
Does walking worsen knee OA?
Sensible, paced walking generally helps. Walking too fast, too far, or on hard surfaces during flares can aggravate symptoms.
Will losing weight really reduce my knee pain?
Yes — significantly. Even a 5–10% weight reduction can produce meaningful improvement in many patients.
Is bone-on-bone the same as needing surgery?
Not always. Even bone-on-bone OA can sometimes be managed conservatively for a meaningful period, especially when symptoms and function still allow daily life.
Can OA affect both knees?
Yes. Bilateral knee OA is common, especially in older adults. Both knees can be assessed and treated.
Service area
Patients are seen at Raghava Multispeciality Hospital, Attibele (Sarjapura–Attibele Road) and Health Nest Hospital, HSR Layout. The clinics serve Attibele, Anekal, Bommasandra, Chandapura, Hosur Road, HSR Layout, Bellandur, Sarjapur Road, Electronic City, and surrounding areas of South Bengaluru.
Medical disclaimer
This information is for educational purposes only and does not replace a clinical examination. Treatment outcomes vary based on the severity of your condition, age, weight, lifestyle, and other medical factors. Severe joint degeneration may still require surgical management. A physical examination and imaging review by Dr. Nitin N Sunku are required before any therapy is recommended.