MANAGEMENT
Non-Surgical Treatment — Start Here
The evidence consistently shows that exercise and load management are the most effective first-line treatments for knee OA — more effective than many medications, and without the side effects. A structured physiotherapy programme, weight optimisation, and activity modification should be explored fully before surgical referral.
FIRST-LINE TREATMENT
- Strengthen muscles around the knee — especially quadriceps and glutes
- Improve joint movement and maintain full range
- Weight optimisation to reduce joint load
- Activity modification — build up slowly and avoid flare-ups
- Regular low-impact exercise: walking, cycling, swimming
- Physiotherapy guidance early — it changes outcomes
- Assistive devices — braces, shoe inserts, walking aids where appropriate
Injections — including corticosteroid, hyaluronic acid, and PRP — can provide short to medium term relief in some patients and may create a window for rehabilitation to progress. See Destination 15 for a full guide to knee injection options.
SURGICAL OPTIONS
When Surgery is Considered
Surgery may be appropriate when pain significantly affects daily life, non-operative treatments are no longer effective, and mobility is severely limited. The two main surgical options are:
Unicompartmental replacement — also known as partial knee replacement — replaces only the damaged compartment, leaving the healthy parts of the knee intact. It is suited to patients whose OA is isolated to one area, typically the medial (inner) compartment. It involves a smaller incision, preserves more natural knee structure, and generally allows faster recovery. Mr Gupté performs unicompartmental replacement using the MAKO robotic system for enhanced precision.
Total knee replacement is recommended when OA affects multiple compartments, or when significant deformity or ligament damage is present. The procedure removes damaged cartilage, reshapes the bone surfaces, and inserts smooth metal implants with a polyethylene spacer. Mr Gupté performs total knee replacement using the MAKO robotic platform, which improves accuracy of implant positioning.
The choice between unicompartmental and total replacement is made individually, based on the extent of arthritis, the integrity of the ligaments, and the patient’s goals and expectations.
WHEN SURGERY IS INDICATED
- Pain significantly affects daily life and sleep
- Non-operative treatments fully explored and no longer effective
- Mobility is severely limited
- Multiple compartment involvement or significant deformity
‘Movement is medicine. Gentle, regular activity nourishes the joint and slows progression. Stiffness is the enemy — not movement.’
YOUR SELF-CHECK: Can you walk for 10 minutes without significant pain? If yes, gentle daily walking is one of the most evidence-based things you can do for knee OA today. Start with 10 minutes and build gradually. If no, speak to your clinician before starting an exercise programme.
EVIDENCE BASE
What the Research Shows
REFERENCES — CLINICAL REFERENCES
- NICE Guidelines NG226 (2022) — Exercise and weight management are core first-line treatments for knee OA. Pharmacological and surgical options are adjuncts.
- Fransen et al. (Cochrane Review, 2015) — Land-based exercise significantly reduces pain and improves function in knee OA.
- Skou et al. (NEJM, 2022) — Supervised exercise and education as effective as total knee replacement for many patients with moderate OA at two years.
- British Knee Society Position Statement (2023) — Structured non-operative pathway recommended before surgical referral in all suitable patients. Mr Gupté is an executive member of BASK, the society that co-developed this guidance.
- Vivek K, Kamal R, Perera E, Gupte CM et al. (2024) — Vitamin D deficiency leads to poorer health outcomes and greater length of stay after total knee arthroplasty, and supplementation improves outcomes: a systematic review and meta-analysis. JBJS Reviews. Important SportsHealing/Imperial research demonstrating that optimising Vitamin D status before knee replacement surgery significantly improves outcomes — directly relevant to the pre-surgical pathway.
- Ahmed I, Metcalfe AJ, Baker P, Gupte CM et al. (Bone and Joint Journal, 2024) — Research priorities of members of the British Association for Surgery of the Knee. Identifies OA management and non-surgical alternatives as a top research priority for UK knee surgery; reflects Mr Gupté’s leadership of BASK research direction.
- Gill SS, Sugand K, Gupte CM (2025) — Why do orthopaedic surgeons get sued? An analysis of £2.2 billion in claims against NHS England. Archives of Orthopaedic and Trauma Surgery. Co-authored analysis including knee surgery litigation; highlights the importance of informed consent and documentation in OA surgical decision-making.
