Knee Osteoarthritis

Knee osteoarthritis is the gradual wear of the cartilage that cushions the ends of the bones in the knee. It causes pain, stiffness, swelling and difficulty with walking, stairs and sport. Arthritis does not mean you have to stop being active, and many treatments can help at every stage. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, offers the full range of care for knee arthritis, from exercise programs and injections to joint-preserving surgery and partial or total knee replacement.

Symptoms

• Pain with activity, stairs, squatting or after sitting
• Stiffness, especially in the morning or after rest
• Swelling
• Grinding, catching or clicking
• Loss of motion or a change in the alignment of the leg (bow-legged or knock-kneed)

Diagnosis

Dr. Dold examines the knee and reviews standing X-rays, which show the joint space, bone spurs and the alignment of the leg. An MRI is sometimes used, for example when a meniscus tear or a focal cartilage injury is suspected. The pattern and severity of the arthritis, together with your age, activity level and goals, guide the treatment plan.

First-line treatment: exercise and weight management

Major guidelines strongly recommend exercise and, for patients who are overweight, weight loss for knee osteoarthritis.¹ A meta-analysis of randomized trials found that strengthening and aerobic exercise both reduced arthritis pain, with non-weight-bearing strengthening giving the largest short-term benefit.² In the IDEA randomized trial, adults who combined diet and exercise lost an average of about 11% of their body weight and had less pain and better function after 18 months than those who exercised alone.³ Other helpful measures include activity modification, a cane, bracing and anti-inflammatory medicines when appropriate.¹

Injection options

Dr. Dold offers several injections for knee arthritis and reviews the evidence for each with you:

• Cortisone can relieve pain quickly, but in a 2-year randomized trial, injections every 3 months led to greater cartilage loss than saline without better pain relief.⁴
• Hyaluronic acid (gel) is a lubricating injection; the AAOS guideline does not recommend it for routine use, although some patients report benefit.⁵
• Platelet-rich plasma (PRP): the AAOS guideline says PRP may reduce pain and improve function,⁵ while the American College of Rheumatology recommends against it.¹ Dr. Dold was first author of a 2014 systematic review of PRP for cartilage damage and arthritis.⁶
• Bone marrow aspirate concentrate (BMAC), made from your own bone marrow, is another non-steroid option.

PRP and BMAC are not FDA-approved to treat any specific orthopedic condition and are usually not covered by insurance. See Biologics and regenerative medicine for the full research on each.

Joint-preserving surgery

For younger, active patients, preserving the natural knee is often the goal:

• Knee osteotomy realigns the leg to shift weight away from the worn side. In a review of patients with advanced arthritis on the inner side of the knee, about 75% of high tibial osteotomies were still in place without a knee replacement at 10 years, with good patient-reported results.⁷
• CartiHeal™ Agili-C™ is an FDA-approved implant for cartilage defects, including knees with mild to moderate arthritis.
• Cartilage repair and transplantation can restore focal areas of damaged cartilage.

Partial and total knee replacement

When arthritis is advanced and other treatments no longer control pain, knee replacement is a reliable option. Dr. Dold performs both partial and total knee replacement.

• Partial (unicompartmental) knee replacement resurfaces only the worn part of the knee. A meta-analysis found shorter hospital stays and, in registry and cohort data, better function scores than total knee replacement, with no difference in pain.⁸
• Total knee replacement resurfaces the whole joint. A 2023 review found that, on average, about 10% of patients were dissatisfied after total knee replacement, most often because of complications, unmet expectations, persistent pain or stiffness.⁹ Good preparation and realistic expectations matter.

See Knee Replacement: 62 Questions Patients Ask for more.

What the research shows

Knee arthritis is among the most studied conditions in medicine. Here is what recent trials add.

Physical therapy, weight and medicine

Two randomized trials found physical therapy gave less pain and better function at 1 year than cortisone injections. For people with obesity, weight-loss medicine has also reduced knee pain in a large trial, alongside diet and exercise.

Injections: what the trials show

PRP results are mixed. Several meta-analyses of placebo-controlled trials find meaningful improvement in pain and function for up to a year, while one well-designed trial found no benefit over saline. For cell-based injections, including BMAC, a large randomized trial found none was better than a cortisone injection at 1 year. Dr. Dold reviews this evidence candidly so you can decide whether an injection is worth trying.

Arthroscopy is not a treatment for arthritis

Placebo-controlled trials and Cochrane reviews show that arthroscopic “clean-out” surgery and partial meniscectomy provide little or no lasting benefit for degenerative knees, and one trial linked partial meniscectomy to slightly more arthritis at 5 years. Arthroscopy is reserved for specific mechanical problems.

Other options

Radiofrequency ablation of the knee’s sensory nerves has relieved pain longer than cortisone in a trial. Genicular artery embolization has mixed sham-controlled results. For younger patients with arthritis on one side of the knee, a high tibial osteotomy relieved pain more than an unloader brace in a 2025 trial. When replacement is needed, partial knee replacement offers some advantages over total replacement for suitable patients, with a somewhat higher revision rate.

Why see Dr. Dold

• Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
• Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
• Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
• Published research on knee ligament and meniscus surgery, including The Posteromedial Corner of the Knee (JAAOS, 2017) and transtibial meniscal root repair (KSSTA, 2017)
• Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
• D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Research cited on this page

1. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220-233. PubMed
2. Tanaka R, Ozawa J, Kito N, et al. Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2013;27(12):1059-1071. PubMed
3. Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273. PubMed
4. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975. PubMed
5. Brophy RH, Fillingham YA. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition. J Am Acad Orthop Surg. 2022;30(9):e721-e729. PubMed
6. Dold AP, Zywiel MG, Taylor DW, Dwyer T, Theodoropoulos J. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med. 2014;24(1):31-43. PubMed
7. Dal Fabbro G, Grassi A, Agostinone P, et al. High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review. Arch Orthop Trauma Surg. 2024;144(9):3977-3988. PubMed
8. Wilson HA, Middleton R, Abram SGF, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ. 2019;364:l352. PubMed
9. DeFrance MJ, Scuderi GR. Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty. 2023;38(3):594-599. PubMed
10. Deyle GD, Allen CS, Allison SC, et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 2020;382(15):1420-1429. PubMed
    In a randomized trial (NEJM 2020), physical therapy led to less pain and disability at 1 year than cortisone injections.
11. Lee M, Jing C, Lee K. Physical therapy vs. glucocorticoid injection in patients with meniscal tears and knee osteoarthritis: a multi-center, randomized, controlled trial. BMC Med. 2025;23(1):277. PubMed
    A 2025 randomized trial also found physiotherapy improved pain, quality of life and balance more than cortisone injections over 1 year.
12. Bliddal H, Bays H, Czernichow S, et al. Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis. N Engl J Med. 2024;391(17):1573-1583. PubMed
    In the STEP 9 trial, weekly semaglutide in adults with obesity and knee arthritis led to more weight loss and less knee pain than placebo.
13. Bennell KL, Paterson KL, Metcalf BR, et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021;326(20):2021-2030. PubMed
    A randomized trial in mild to moderate knee arthritis found PRP was no better than saline placebo for symptoms or cartilage at 12 months.
14. Bensa A, Previtali D, Sangiorgio A, et al. PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2025;53(3):745-754. PubMed
    A 2025 meta-analysis of placebo-controlled trials found PRP gave clinically relevant improvement in function up to 12 months and in pain at 3 and 6 months.
15. Jawanda H, Khan ZA, Warrier AA, et al. Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Arthroscopy. 2024;40(5):1623-1636.e1. PubMed
    A network meta-analysis found PRP improved pain and function compared with placebo at 6 months or more.
16. Mautner K, Gottschalk M, Boden SD, et al. Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nat Med. 2023;29(12):3120-3126. PubMed
    A large randomized trial found bone marrow, fat-derived and umbilical cell injections were no better than one another or a cortisone injection at 1 year.
17. Belk JW, Lim JJ, Keeter C, et al. Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis. Arthroscopy. 2023;39(7):1714-1734. PubMed
    A meta-analysis found PRP and BMAC gave better outcomes than hyaluronic acid.
18. Dubin J, Leucht P, Murray M, et al. American Academy of Orthopaedic Surgeons Technology Overview Summary: Platelet-Rich Plasma (PRP) for Knee Osteoarthritis. J Am Acad Orthop Surg. 2024;32(7):296-301. PubMed
    The AAOS evidence review summarized PRP compared with placebo, medications, cortisone and exercise for knee arthritis.
19. O’Connor D, Johnston RV, Brignardello-Petersen R, et al. Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database Syst Rev. 2022;3(3):CD014328. PubMed
    A Cochrane review found arthroscopic surgery for degenerative knee disease provides little or no clinically important benefit.
20. Thorlund JB, Juhl CB, Roos EM, et al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747. PubMed
    Any benefit from arthroscopy for the degenerative knee was small, short-lived and accompanied by risks.
21. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020;54(22):1332-1339. PubMed
    A placebo-surgery trial found partial meniscectomy for degenerative tears gave no benefit and slightly increased arthritis at 5 years.
22. Berg B, Roos EM, Englund M, et al. Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial. Br J Sports Med. 2025;59(2):91-98. PubMed
    At 10 years, partial meniscectomy and exercise therapy had similar arthritis progression for degenerative meniscus tears.
23. Davis T, Loudermilk E, DePalma M, et al. Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis. Reg Anesth Pain Med. 2018;43(1):84-91. PubMed
    Cooled radiofrequency ablation of the knee nerves gave longer pain relief than a cortisone injection in a randomized trial.
24. Bagla S, Piechowiak R, Sajan A, et al. Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol. 2022;33(1):2-10.e2. PubMed
    In one sham-controlled trial, genicular artery embolization reduced pain and disability more than sham.
25. van Zadelhoff TA, Bos PK, Moelker A, et al. Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial. BMJ Open. 2024;14(10):e087047. PubMed
    Another sham-controlled trial found genicular artery embolization was no better than sham, so evidence is mixed.
26. Stam M, Verschueren J, Van Outeren MV, et al. Unloader brace or high tibial osteotomy in the treatment of the young patient with medial knee osteoarthritis: a randomized controlled trial. Acta Orthop. 2025;96:102-109. PubMed
    A 2025 randomized trial found high tibial osteotomy reduced knee pain more than an unloader brace at 12 months.
27. Kirkley A, Webster-Bogaert S, Litchfield R, et al. The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am. 1999;81(4):539-48. PubMed
    An early randomized trial found an unloader brace helped people with bow-legged arthritis more than a neoprene sleeve.
28. Brouwer RW, Huizinga MR, Duivenvoorden T, et al. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev. 2014;2014(12):CD004019. PubMed
    A Cochrane review found valgus high tibial osteotomy reduces pain and improves function in medial knee arthritis.
29. Palmer JS, Monk AP, Hopewell S, et al. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev. 2019;7(7):CD012128. PubMed
    A Cochrane review found no placebo-controlled trials of surgery for mild to moderate knee arthritis.

CartiHeal and Agili-C are trademarks of Smith+Nephew. Dr. Dold is a consultant for Smith+Nephew.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.