Osteoarthritis of the Knee — Understanding Your Condition

What is osteoarthritis of the knee?

Osteoarthritis is the gradual wearing away of the cartilage that cushions the ends of the bones inside your knee joint. Cartilage has no blood supply and cannot repair itself once significantly damaged. As it wears down, bone begins to rub against bone — causing pain, stiffness, swelling, and progressive loss of function.

It is the most common form of arthritis and the leading reason patients come to see me at NHS Hospital Jalandhar. It is not a disease that happens overnight. It develops over years — quietly at first, then more insistently, until the knee begins to dictate what you can and cannot do with your day.

Who gets knee osteoarthritis — and why Punjab patients are particularly vulnerable

In my practice at NHS Hospital Jalandhar, I typically begin seeing knee osteoarthritis from the age of 50 onwards. However, the seeds of the condition are often sown much earlier — through years of physical loading, injury, or lifestyle factors that gradually wear the cartilage down.

The patients I see most commonly fall into these groups:

• Overweight and obese patients: Every kilogram of body weight places approximately 4 kilograms of force across the knee joint with each step. Over decades, excess weight accelerates cartilage loss significantly.
• Agricultural and labour workers: Years of squatting, kneeling, climbing, and carrying heavy loads place repetitive stress on the knee that accumulates over a working lifetime.
• Patients with previous knee injuries: A ligament tear, a meniscus injury, or a fracture around the knee in younger years dramatically increases the risk of early osteoarthritis in that joint.
• Sports injuries and heavy physical work: Any significant injury that disrupts the normal mechanics of the knee creates uneven loading that accelerates cartilage wear in specific areas.

What does knee osteoarthritis feel like?

The symptoms develop gradually and tend to follow a recognisable pattern:

• Pain that worsens with activity and improves with rest — in the early stages.
• Morning stiffness lasting 15–30 minutes after waking.
• A grinding or crunching sensation inside the knee with movement.
• Swelling around the knee — especially after prolonged activity.
• Difficulty climbing stairs, getting up from a chair, or squatting.
• Increasing difficulty walking distances that were once manageable.
• In advanced stages — pain that disturbs sleep and is present even at rest.

One pattern I see consistently in clinic is that patients delay seeking help for far too long. They tolerate pain for years, reducing their activity gradually, until they realise they have given up things they never intended to give up — the morning walk, the family trip, sitting comfortably at a wedding.

The right time to seek assessment is not when you can no longer walk. It is when the pain is beginning to change how you live.

How is knee osteoarthritis diagnosed?

Diagnosis is primarily clinical — meaning a thorough history and physical examination tells me most of what I need to know. I assess your gait, your range of movement, where exactly the pain is located, how the ligaments feel, and whether there is any deformity.

X-rays are the essential imaging investigation — they show the degree of joint space narrowing, the presence of bone spurs, and whether the deformity is affecting alignment. In selected cases I may request an MRI, but for most patients with established osteoarthritis, X-rays and clinical assessment together give a complete enough picture to guide treatment.

What are the non-surgical treatments for knee osteoarthritis?

My approach has always been to exhaust appropriate non-surgical options before recommending surgery. Not because surgery should be avoided — but because surgery should be the right answer for the right patient at the right time.

The non-surgical treatments I recommend, in sequence:

1. Physiotherapy and targeted exercise

Strengthening the muscles around the knee — particularly the quadriceps — reduces the load the joint has to bear and can significantly improve pain and function. This is not a cure, but it is a genuine treatment that delays progression and improves quality of life. It requires commitment and consistency.

2. Medications

Oral anti-inflammatory medications (NSAIDs) reduce pain and swelling and allow patients to remain more active. They are effective for mild to moderate symptoms. Long-term use in older patients requires monitoring for stomach, kidney, and cardiovascular effects — which I discuss openly with every patient.

3. Intra-articular injections

When physiotherapy and oral medications are insufficient, injections directly into the knee joint can provide meaningful relief:

• Corticosteroid injections: Reduce inflammation rapidly and can provide 3–6 months of significant pain relief in appropriate patients.
• PRP (Platelet Rich Plasma) injections: Use the patient's own blood components to reduce inflammation and potentially support cartilage health. Evidence is evolving but results in selected patients are encouraging.

Injections are a bridge — not a destination. They buy time and improve comfort, but they do not reverse the underlying cartilage damage.

When does surgery become the answer?

I make this decision with the patient — never for them. Surgery becomes the appropriate recommendation when a combination of factors converge:

• Pain is constant and significantly affects daily life and sleep.
• Walking distance has become severely restricted.
• All conservative treatments have been tried over at least 6 months and have failed to provide adequate relief.
• X-rays show significant joint space loss confirming structural disease that matches the clinical severity.

When all of these are present together, continuing to delay surgery does not protect the patient — it simply prolongs their suffering while the joint continues to deteriorate. The decision is never taken lightly. But when the right time has come, surgery offers a genuine return to function and quality of life that no injection or medication can provide.

What surgical options are available for knee osteoarthritis?

Depending on the extent of the cartilage damage, the following options are available:

• Partial Knee Replacement: When arthritis is confined to only one compartment of the knee, preserving the healthy bone, tissue, and ligaments.
• Total Knee Replacement: When all compartments of the knee are affected, requiring a complete resurfacing of the joint.
• Robotic-Assisted Surgery: Available at NHS Hospital Jalandhar using the CORI Surgical System. It delivers sub-millimetre precision for both partial and total knee replacements, allowing custom implant placement matched to your specific anatomy.

A message to patients who are waiting

I see this every week — patients who have been managing knee pain for five, seven, sometimes ten years before finally coming to clinic. They have given up walks, pilgrimages, playing with grandchildren, and sitting comfortably at family functions.

The knee does not get better with time. Arthritis is progressive. The question is not whether to address it — but when.

If your knee pain is affecting how you live, come for a consultation. The assessment will tell us exactly what stage you are at, what options are appropriate, and what realistic outcomes look like for your specific situation. That conversation costs nothing and changes everything.

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