Knee Osteoarthritis: Stages, Causes, Treatment Options, and Prevention

Common Misunderstandings About Knee Osteoarthritis

A common misconception is that people with knee osteoarthritis should take calcium supplements because they believe the knee is made entirely of hard bone. In reality, the knee joint consists of more than bone.

A joint is formed where two bones meet, with cartilage covering the ends of the bones. This cartilage acts as a protective cushion that:

๐ Supports body weight

๐ Absorbs shock during movement

๐ Reduces friction within the joint

๐ Prevents the bones from rubbing directly against each other

As people age or repeatedly place excessive stress on their knees, the cartilage can gradually wear down. This may lead to joint stiffness, grinding or cracking sounds, pain, inflammation, swelling, and changes in the shape of the knee.

Knee osteoarthritis is therefore primarily a condition involving the gradual degeneration of joint cartilage. It does not affect only older adults. Younger people may also develop the condition depending on their lifestyle, body weight, previous injuries, muscle strength, and patterns of knee use.

Other contributing factors include:

๐ Previous knee injuries

๐ Excess body weight

๐ Repeated high-impact activity

๐ Frequent squatting or deep knee bending

๐ Weak muscles around the knee

๐ Inadequate exercise or joint care

Knee osteoarthritis is now being diagnosed more frequently among younger adults. Without appropriate care, it may progress to an advanced stage that requires surgery. Early assessment and treatment are therefore important.

The Four Stages of Knee Osteoarthritis

Stage 1: Early Osteoarthritis

During the early stage, patients may not experience clear pain. However, they may notice stiffness, reduced flexibility, or unusual sounds from the knee.

Symptoms may be more noticeable after:

๐ Sitting for a long time

๐ Kneeling

๐ Keeping the knee in one position

๐ Getting up after prolonged inactivity

The stiffness often improves after moving the knee for a while.

At this stage, there may be mild cartilage wear and inflammation of the joint lining, while the overall amount of cartilage remains relatively well preserved.

Treatment may focus on:

๐ Reducing inflammation

๐ Strengthening the muscles around the knee

๐ Controlling body weight

๐ Improving movement patterns

๐ Supporting cartilage and joint health

Because the damage is still limited, early treatment may help control symptoms and slow further degeneration.

Stage 2: Mild Osteoarthritis

At this stage, the cartilage may begin to develop cracks, and the space between the bones inside the knee may start to narrow.

Patients may experience:

๐ More frequent knee pain

๐ Longer-lasting stiffness

๐ Discomfort during walking or exercise

๐ Increased pain after prolonged activity

๐ Grinding or cracking sensations

Supplements alone may not provide sufficient improvement when cracks have already developed within the cartilage.

Hyaluronic acid injections may be used to improve lubrication within the joint and reduce friction. This can be compared with applying lubricant to a stiff hinge.

These injections may help relieve pain and improve movement, although they do not necessarily repair the underlying cartilage damage.

Growth-factor or platelet-rich plasma treatments may also be considered to support tissue repair and reduce inflammation, depending on the patient’s condition and the doctor’s assessment.

Stage 3: Moderate Osteoarthritis

Moderate osteoarthritis involves more noticeable cartilage loss, significant narrowing of the joint space, and the possible formation of bone spurs.

As the protective cartilage becomes thinner, the bones experience greater friction, resulting in clearer and more persistent symptoms.

Patients may experience:

๐ Moderate to severe knee pain

๐ Pain during walking or standing

๐ Joint swelling

๐ Reduced range of motion

๐ Difficulty climbing stairs

๐ Stiffness after rest

๐ Grinding within the knee

Pain medication or a knee support may be required to manage symptoms. Dietary supplements are generally less effective once a substantial amount of cartilage has been lost.

Hyaluronic acid or growth-factor injections may provide temporary relief, but repeat treatment may be required because relatively little healthy cartilage remains.

In selected cases, laboratory-cultured cell treatments may be considered to support cartilage repair. Physical therapy and exercises to strengthen the muscles around the knee are also essential parts of treatment.

Stage 4: Severe or End-Stage Osteoarthritis

At the severe stage, less than approximately 30% of the cartilage may remain. The joint space may become extremely narrow or completely closed, significantly restricting knee movement.

Symptoms may include:

๐ Severe and persistent pain

๐ Difficulty walking

๐ Inability to bend the knee normally

๐ Dependence on a walking stick or other support

๐ Difficulty kneeling, squatting, or sitting cross-legged

๐ Visible bowing or deformity of the knee

๐ Episodes of sudden pain caused by loose cartilage fragments

Surgery may be the most appropriate treatment at this stage.

Possible surgical options include:

๐ Arthroscopic removal of damaged or loose tissue

๐ Partial knee-joint replacement

๐ Total knee replacement

An orthopaedic specialist will recommend the most suitable procedure based on the extent of the damage, the patient’s symptoms, age, health, and activity level.

Causes and Risk Factors for Knee Osteoarthritis

Genetics

The knee joint consists mainly of cartilage and the synovial lining. These tissues contain several types of collagen, including collagen types II, IX, and XI.

Genetic abnormalities affecting these collagen structures may increase a person’s susceptibility to early cartilage degeneration and osteoarthritis.

Excess Body Weight

The knees support the body’s weight and remain active throughout standing, walking, running, and other daily movements.

Excess weight places additional pressure on the knee joints, causing them to work harder and increasing the risk of earlier cartilage wear.

Higher levels of body fat may also contribute to inflammation because fat cells can produce inflammatory substances that circulate throughout the body. These substances may worsen joint inflammation and accelerate osteoarthritis.

Controlling or reducing body weight can therefore help:

๐ Reduce pressure on the knees

๐ Decrease friction within the joint

๐ Relieve pain

๐ Slow further cartilage degeneration

๐ Improve mobility

Weak Muscles Around the Knee

The muscles surrounding the knee help support body weight and stabilise the joint.

When these muscles become weak, the knee loses an important source of support and must bear more pressure directly.

Strengthening the thigh and surrounding muscles helps:

๐ Stabilise the knee

๐ Reduce pressure on the joint

๐ Improve balance and movement

๐ Reduce the risk of further injury

๐ Support the joint’s recovery process

Accidents and Improper Knee Use

Previous injuries or repeated improper movements may increase the risk of osteoarthritis.

People at higher risk may include:

๐ Athletes with previous ligament or cartilage injuries

๐ People who have experienced direct trauma to the knee

๐ Those who frequently squat or kneel

๐ People whose work requires repeated deep knee bending

๐ Those who perform high-impact exercise without proper technique

Treatment and Preventive Care for Knee Osteoarthritis

1. Dietary Supplements

Undenatured Type II Collagen

Cartilage and joint structures contain several types of collagen. Type II collagen is the primary form found in joint cartilage.

Collagen is a protein that may change when exposed to heat or chemicals during manufacturing. Undenatured type II collagen is processed in a way that preserves its original structure and is commonly used in supplements intended to support joint health.

Other commonly discussed joint supplements include:

๐ Glucosamine

๐ Chondroitin

๐ Methylsulfonylmethane, or MSM

The effectiveness of supplements may vary between individuals and according to the stage of osteoarthritis. They should not replace medical treatment when significant cartilage damage is present.

2. Hyaluronic Acid Injections

Hyaluronic acid is a natural component of joint fluid. It helps lubricate the joint and absorb shock during movement.

Injecting hyaluronic acid into the knee may help:

๐ Improve joint lubrication

๐ Reduce friction

๐ Relieve pain

๐ Reduce stiffness

๐ Support smoother movement

This treatment is generally considered for people with early to moderate osteoarthritis.

A treatment course may involve one injection per week for approximately three to five weeks, depending on the product and the doctor’s recommendation.

3. Growth Factors or Platelet-Rich Plasma Therapy

Blood contains four main components:

๐ Plasma

๐ Red blood cells

๐ White blood cells

๐ Platelets

Platelets contain growth factors and signalling substances involved in tissue repair.

Platelet-rich plasma, or PRP, is prepared from the patient’s own blood and injected into the knee to support tissue recovery and reduce inflammation.

Potential benefits include:

๐ Supporting cartilage and tissue repair

๐ Reducing inflammation

๐ Improving joint function

๐ Relieving pain

๐ Accelerating the natural healing response

However, the concentration of platelets and growth factors in PRP can vary between patients. This means that treatment results may also differ.

Prepared growth-factor products may offer more consistent concentrations of selected factors. They may be considered for patients with mild to moderate osteoarthritis, depending on the product and medical assessment.

Some patients may require approximately three injections to achieve clearer improvement.

Possible temporary effects after injection include:

๐ Mild pain

๐ Tenderness

๐ Swelling

These symptoms usually improve within a few days.

4. Laboratory-Cultured Cell Therapy

Growth factors work by stimulating living cells. In advanced osteoarthritis, the number of healthy cartilage cells or local stem cells may be too low for growth-factor treatment alone to provide a sufficient response.

Laboratory-cultured cell therapy involves preparing suitable cells under controlled conditions and administering them into the knee with the aim of supporting damaged tissue.

Growth-factor treatment may subsequently be used to stimulate the administered cells and enhance the repair process.

However, cell therapy is not suitable for every patient or every stage of osteoarthritis. The treatment should be considered based on:

๐ The degree of cartilage loss

๐ The patient’s age and health

๐ The condition of the joint

๐ The source and quality of the cells

๐ Laboratory and manufacturing standards

๐ Available clinical evidence

Physical therapy and muscle-strengthening exercises remain important after treatment to reduce pressure on the joint and protect the repaired tissues.

5. Weight Reduction

Body weight is one of the most significant factors affecting pressure on the knee.

Reducing body weight by approximately 10% may substantially decrease the load placed on the knee during daily activities. This may help reduce pain, pressure, and friction within the joint.

People with osteoarthritis may find conventional exercise difficult because of pain or restricted movement.

Lower-impact options include:

๐ Swimming

๐ Walking in water

๐ Water aerobics

๐ Stationary cycling

๐ Exercises supervised by a physiotherapist

Water supports part of the body’s weight, allowing patients to exercise while placing less pressure on the knees.

Nutrition, metabolism, underlying hormonal conditions, and blood sugar control may also need to be assessed when weight loss is difficult.

6. Knee Braces and Supportive Devices

A knee brace provides additional support and helps stabilise the joint, functioning in a way similar to an external supporting muscle.

A suitable brace may help:

๐ Reduce pressure on the knee

๐ Improve joint stability

๐ Limit harmful movements

๐ Increase confidence while walking

The brace should fit securely without being excessively tight.

It is generally most useful during activities that place greater pressure on the knee, such as prolonged standing or walking. It should usually be removed during rest unless otherwise recommended, allowing the muscles to continue working naturally.

7. Knee-Strengthening Exercises

Strengthening the muscles around the knee helps improve joint support.

One simple exercise can be performed while sitting on a chair:

๐ Sit with your back supported.

๐ Straighten one leg in front of you.

๐ Tighten the thigh muscle and lift the leg slightly.

๐ Hold the position for as long as comfortably possible, gradually working towards 60 seconds.

๐ Lower the leg slowly.

๐ Repeat with the other leg.

Perform approximately 10-15 repetitions per leg, up to four times per day.

Once the exercise becomes easy, light ankle weights may be added under professional guidance.

8. Physical Therapy

Physical therapy may include several techniques designed to reduce inflammation, improve mobility, and strengthen the knee.

Treatment may involve:

๐ Stretching exercises

๐ Joint mobilisation

๐ Muscle-strengthening exercises

๐ Therapeutic ultrasound

๐ Laser therapy

๐ Shortwave deep-heat therapy

๐ Electrical muscle stimulation

The treatment plan should be designed according to the individual’s symptoms, stage of osteoarthritis, and physical ability.

9. Avoid Activities That Place Excessive Pressure on the Knee

Certain positions and movements can place additional stress on the knee joint.

Activities that should be limited or avoided include:

๐ Sitting cross-legged for long periods

๐ Deep squatting

๐ Prolonged kneeling

๐ Repeatedly bending the knees deeply

๐ Walking downstairs unnecessarily

Walking upstairs can help strengthen the muscles around the knee when performed carefully and without significant pain. However, walking downstairs places greater pressure on the knee and should be limited when symptoms are present.

Using a lift or escalator when going down may help reduce unnecessary joint stress.

Summary

Knee osteoarthritis is caused by the gradual degeneration of cartilage rather than a simple lack of calcium. The condition can affect both older and younger people, particularly those with excess body weight, weak knee muscles, previous injuries, or repeated improper knee use.

Treatment depends on the stage of the condition.

๐ Early osteoarthritis may be managed with weight control, exercise, physical therapy, and joint-supportive care.

๐ Mild to moderate osteoarthritis may require injections, rehabilitation, and more targeted treatment.

๐ Severe osteoarthritis may require surgery.

Early assessment, appropriate treatment, muscle strengthening, and reducing excessive pressure on the knee can help control symptoms and delay the progression of the condition.

 

Reference :

Medtopia Integrative Medical Center OA Knee

ArokaGO Providers Medtopia Integrative Medical Center