Knee arthritis: understanding your treatment choices

A practical guide to assessment, exercise, medicines, injections and when joint replacement may be considered.

Written by Mr Muhammad Umar, Consultant Trauma & Orthopaedic Surgeon.
Reviewed: 21 September 2026

Osteoarthritis is a long-term condition in which the joint changes over time. Pain, stiffness, swelling and reduced confidence in the knee can affect walking, stairs, sleep, work and leisure. An X-ray can help in some circumstances, but treatment decisions should be based on your symptoms, function, examination and goals rather than an image alone.

The main point: knee arthritis does not have one treatment that suits everyone. Care usually progresses from education, tailored exercise and symptom control towards injections or surgery when appropriate.

Start with the treatments that support the joint

Exercise and strength

Tailored strengthening and general aerobic exercise are central treatments. Some discomfort can occur when you begin, but regular, progressive exercise can improve pain and function over time. Supervised physiotherapy may help you start safely and build confidence.

Weight and daily load

If you are living with overweight or obesity, supported weight loss can reduce symptoms and improve function. Any sustainable reduction may help. Footwear, walking aids, activity pacing and changes at work or home can also reduce strain.

Medicines for symptom relief

Medicines do not reverse arthritis. Their role is to make symptoms more manageable, often so that you can remain active. NICE recommends a topical anti-inflammatory medicine for knee osteoarthritis. Oral anti-inflammatory medicines may be considered when suitable, but they can affect the stomach, kidneys and cardiovascular system and should be discussed with a clinician or pharmacist. Strong opioids and glucosamine are not recommended for routine osteoarthritis care.

Where injections fit

A corticosteroid injection may offer short-term relief when other medicines are unsuitable or have not helped, or to make therapeutic exercise more achievable. NICE advises explaining that benefit is usually short term. Hyaluronic acid, PRP and hydrogel injections have different evidence, availability and funding positions; suitability and realistic expectations require an individual discussion.

Read the detailed guide to knee injections, including steroid, viscosupplement, PRP and Arthrosamid® hydrogel →

Does arthroscopy treat arthritis?

Keyhole surgery is not a routine treatment for the pain of osteoarthritis. It may have a role for a specific mechanical problem after assessment, but it does not remove or cure arthritis. Symptoms such as true locking require careful evaluation.

Read when knee arthroscopy may and may not help →

When to discuss knee replacement

Referral for joint replacement may be appropriate when pain, stiffness, loss of function or deformity substantially affects quality of life and well-supported non-surgical treatment has been ineffective or unsuitable. NICE recommends using clinical assessment rather than a numerical severity score. Age, sex, smoking, other health conditions or body mass index should not by themselves exclude someone from referral, although these factors may affect preparation and individual risk.

A consultation should answer three questions: Is arthritis the main cause of your symptoms? Which options match your priorities and health? What are the likely benefits, limits and risks of each option?

Seek prompt medical advice if

the knee becomes suddenly hot, very swollen or red, especially with fever or feeling unwell
you cannot bear weight after an injury
the knee is locked and you cannot straighten it
pain or swelling is rapidly worsening, or you develop calf swelling or breathlessness

Reliable sources

NEXT STEP

Discuss your knee symptoms and priorities.

Your assessment can bring the available choices into a clear, individual plan.

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