Harvard Women's Health Watch

Managing osteoarthritis of the knee

There are many treatments short of surgical replacement.

If your knees have become painful, tender, or swollen, are stiff first thing in the morning, or are making crackling noises, the probable cause is osteoarthritis, which affects more than two-thirds of women over age 60. Osteoarthritis results from the breakdown of joint cartilage, the tough, slippery tissue that protects the ends of bones (see "Anatomy of knee osteoarthritis"). Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone. The goals of osteoarthritis treatment are to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.

About 5% of women in the United States over age 50 have had total knee replacement surgery, the recommended treatment when more conservative measures have failed and pain and disability are intolerable. The number of these procedures has more than doubled over the past decade, according to research presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). This is partly because knee replacement works—more than 80% of patients say they're satisfied with the results. But experts say it's also a sign that people aren't fully utilizing the many noninvasive strategies that evidence suggests should be tried first—above all, weight loss and exercise.

Weight loss: Lightening the load

Every step you take exposes your knee joints to a force equal to three to five times your body weight. If you have osteoarthritis, a weight gain or loss of just 5 pounds can cause a noticeable difference in the amount of pain you feel. One study of overweight or obese older adults who had knee osteoarthritis found that for every pound of weight they lost, the stress on their knees was reduced fourfold. Obesity not only puts added stress on the knees, it also spurs the production of inflammatory proteins that may hasten cartilage degeneration. Weight loss can help preserve cartilage and reduce symptoms.

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