Knee Osteoarthritis

Knee osteoarthritis is a chronic, degenerative condition where the cartilage that cushions the bones in your knee gradually breaks down.

What is Knee Osteoarthritis?

Knee osteoarthritis is a chronic, degenerative condition where the cartilage that cushions the bones in your knee gradually breaks down. This cartilage normally allows for smooth, pain-free joint movement, but when it wears away, the bones start to rub against each other, leading to pain, swelling, stiffness, and reduced mobility.

The condition tends to worsen over time and may eventually interfere with simple activities like walking, climbing stairs, or standing for extended periods. While common with ageing, it can also develop earlier due to joint injuries, overuse, or excess body weight.

Knee osteoarthritis is typically classified into four stages, based on the degree of joint damage:

Stage 1 (Early) — minor wear-and-tear in the knee joint, often without noticeable symptoms. X-rays may show small bone spurs, but the joint space remains normal.
Stage 2 (Mild) — more noticeable joint changes, including cartilage thinning and occasional discomfort after long periods of activity. Some stiffness may occur in the morning or after rest.
Stage 3 (Moderate) — clear loss of cartilage, joint space narrowing, and frequent pain during daily activities. Inflammation and swelling are more common.
Stage 4 (Severe) — most or all of the cartilage is gone. Bone-on-bone contact causes chronic pain, significant stiffness, and limited mobility. Joint deformity may also be present.

What causes Knee Osteoarthritis?

Knee osteoarthritis arises from the gradual breakdown of the structures that keep the knee joint stable, cushioned, and functional. At the centre of this process is the degeneration of articular cartilage, the smooth tissue that covers the ends of the bones and allows for easy, pain-free movement.

As this cartilage wears down, the bones begin to rub directly against each other, leading to inflammation, stiffness, and pain. But the disease process goes beyond just cartilage loss. It involves multiple components of the knee joint, including:

Synovial inflammation — the lining of the joint, called the synovium, can become inflamed and produce less synovial fluid. This fluid is essential for lubricating and nourishing the joint.

Subchondral bone changes — the bone beneath the cartilage becomes thicker and harder, sometimes forming cysts or developing microcracks that contribute to joint pain.

Osteophyte formation — as the joint attempts to repair itself, the body may form bony growths called osteophytes (bone spurs), which can restrict movement and irritate surrounding tissues.

Meniscal degeneration — the menisci, which help absorb shock within the knee, may fray or tear, further destabilising the joint.

Muscle imbalance and altered joint loading — changes in the way a person walks or uses their leg muscles can place uneven pressure on the knee, accelerating joint wear.

Although the progression of knee osteoarthritis is typically slow, these internal changes create a cycle of mechanical stress and inflammation that worsens over time. Left unaddressed, the condition can lead to reduced mobility, chronic pain, and significant loss of quality of life.

What are the symptoms of Knee Osteoarthritis?

Knee osteoarthritis develops gradually, and symptoms often worsen over time. In the early stages, discomfort may be mild and occasional, but as the condition progresses, it can interfere with daily activities and significantly affect mobility and quality of life.

Common symptoms include:

Pain in the knee — this is usually the earliest and most noticeable symptom. The pain often worsens with activity and improves with rest. Over time, it may become more constant, even occurring during sleep.

Stiffness — many individuals experience stiffness in the knee, particularly in the morning or after long periods of sitting or inactivity. This stiffness usually eases after gentle movement.
Swelling — inflammation within the joint can cause swelling and a sensation of warmth around the knee. Swelling may fluctuate depending on activity levels.
Reduced range of motion — as the joint becomes less flexible, it may become difficult to fully bend or straighten the knee, making everyday movements like climbing stairs or squatting more challenging.
Grinding or clicking sensations — also known as crepitus, some people report a grinding, crackling, or popping sound when moving the knee. This is due to irregularities in the joint surface caused by cartilage wear.
Weakness or instability — the knee may feel weak, as though it could give way during walking or standing, especially on uneven ground.
Joint deformity — in advanced cases, the shape of the knee may appear altered, with visible changes in alignment such as bowing of the legs.

It is important to note that the severity of symptoms does not always match the extent of joint damage. Some people with mild cartilage loss may experience significant pain, while others with advanced osteoarthritis may have relatively manageable symptoms.

What complications can arise from Knee Osteoarthritis?

If left unmanaged, knee osteoarthritis can lead to several complications that affect both joint function and overall quality of life. As the condition progresses, you may experience:

Persistent pain — what begins as occasional discomfort can become constant, even at rest or during sleep.
Limited mobility — stiffness and joint damage may make it difficult to walk, climb stairs, or carry out daily activities independently.
Muscle weakness — reduced movement can cause the surrounding muscles to weaken, leading to further instability and imbalance.
Joint deformity — in advanced cases, the knee may appear misshapen due to bone changes and loss of alignment.

Who is at risk of Knee Osteoarthritis in Singapore?

Knee osteoarthritis can affect anyone, but certain individuals are more prone to developing it due to lifestyle, health, and occupational factors. In Singapore, the following groups may be at increased risk:

Older adults — ageing is the most significant risk factor. As cartilage naturally wears down over time, older adults are more likely to experience joint degeneration.
Women — women, especially after menopause, are at higher risk due to hormonal changes and joint structure differences.
People who are overweight — extra body weight increases pressure on the knees and accelerates cartilage breakdown. Obesity also contributes to systemic inflammation.
Those with previous knee injuries — individuals who have had ligament tears, meniscal injuries, or fractures are more likely to develop osteoarthritis later in life.
Workers in physically demanding jobs — jobs that involve frequent kneeling, lifting, or squatting, such as cleaning, construction, and manual labour, put repetitive stress on the knees.
Individuals with a family history — genetics can influence cartilage strength and joint resilience. A family history of osteoarthritis may increase personal risk.
Sedentary individuals — a lack of physical activity weakens the muscles that support the knee, increasing stress on the joint. This is common in desk-based professions.
People with medical conditions — chronic conditions like diabetes, gout, or rheumatoid arthritis may increase joint inflammation and contribute to early joint damage.

How is Knee Osteoarthritis diagnosed?

When it comes to diagnosing the condition, orthopaedics often take a thorough and patient-centred approach. Generally, the process entails the following:

Detailed medical history — we begin by asking about your symptoms, when they started, and how they affect your daily activities. Past injuries, family history, and lifestyle habits also offer important clues.
Physical examination — your doctor will examine the knee for signs of swelling, tenderness, range of motion limitations, and any unusual sounds or sensations during movement.
X-rays — imaging helps us assess the extent of cartilage loss, narrowing of the joint space, formation of bone spurs (osteophytes), and any alignment issues.
MRI scan (if needed) — while not always necessary, an MRI can give a more detailed view of soft tissues such as cartilage, tendons, and the menisci, especially in early or complex cases.
Joint aspiration (in selected cases) — in certain situations, we may draw fluid from the knee joint to rule out infection, gout, or other inflammatory conditions.

What are the treatment options for Knee Osteoarthritis in Singapore?

Treatment for knee osteoarthritis can include lifestyle changes, medications, physical therapy, injections, and surgery when necessary. At our clinic, we offer the following options tailored to your condition and needs:

Lifestyle changes — simple adjustments like maintaining a healthy weight, switching to low-impact exercises (such as swimming or cycling), and using proper footwear can significantly reduce joint stress.
Physiotherapy — targeted exercises to strengthen the muscles around the knee, improve flexibility, and restore balance can ease pain and improve function over time.
Oral medications — paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and reduce inflammation.
Topical creams or patches — these can provide localised pain relief without the systemic effects of oral medications.
Joint injections — corticosteroid injections can help reduce inflammation during flare-ups, while hyaluronic acid injections may improve joint lubrication in selected patients.
Pain management procedures — we offer pain management options, including nerve blocks and image-guided procedures, especially for patients who are not ready for surgery but need longer-lasting relief.
Assistive devices — using a knee brace, walking stick, or orthotic inserts may help offload pressure on the affected joint and improve daily mobility.
Surgery (if necessary) — in severe cases where conservative treatments are no longer effective, surgical options such as knee replacement may be considered. We work closely with orthopaedic specialists to ensure a coordinated care plan.

Summary

Knee osteoarthritis is a common condition that can lead to chronic pain, stiffness, and reduced mobility. At Apicare Pain Clinic, we offer a full spectrum of treatment options — from conservative approaches like pain and weight management, to comprehensive procedures such as hyaluronic acid injections and image-guided procedures, when needed.

Each treatment plan is tailored to the severity of your symptoms and your personal goals to improve joint function, reduce pain, and help you stay active. If you are experiencing persistent knee pain, stiffness, or reduced mobility, schedule a consultation with us for a personalised assessment and treatment plan tailored to your lifestyle and needs.