The core non-surgical treatments for knee osteoarthritis are education, appropriate physical activity, a tailored strengthening program, and weight-management support when relevant. Medicines can help selected people manage symptoms, but they support movement and function rather than reversing osteoarthritis.
Australia's 2024 Osteoarthritis of the Knee Clinical Care Standard recommends starting with a person-centred assessment and a coordinated non-surgical plan. It does not recommend several widely marketed injections and medicines, including platelet-rich plasma (PRP), hyaluronan, stem-cell treatments, medicinal cannabis, gabapentin or pregabalin for knee osteoarthritis.
This article provides general information and does not replace advice from your GP, pharmacist, physiotherapist or specialist. Medicines and exercise need to be matched to your health, risks and goals.
The short answer: what should a knee osteoarthritis plan include?
- A clinical assessment that considers pain, function, health conditions and personal goals.
- Clear information about osteoarthritis and what you can do to manage it.
- Regular physical activity and specific exercise that is progressed over time.
- Nutrition and weight-management support tailored to the individual.
- Short-term symptom relief where appropriate and medically safe.
- Review of progress, barriers, sleep and psychological wellbeing.
- Surgical assessment only when symptoms remain severe after suitable non-surgical care.
Does knee osteoarthritis always need an X-ray or MRI?
No. Australian guidance says knee osteoarthritis can often be diagnosed from a detailed history and physical examination. Routine imaging is not required when the clinical diagnosis is clear.
An X-ray may be useful when the diagnosis is uncertain, another condition is suspected, symptoms change unexpectedly or surgery is being considered. MRI is not a routine first test for typical knee osteoarthritis. A scan result also does not measure pain or disability by itself: treatment should respond to the person, not only the image.
1. Understand the condition and set useful goals
Education is part of treatment. Knee osteoarthritis is a long-term condition, but pain and function can improve. A useful plan focuses on activities that matter to you, such as walking to the shops, managing stairs, sleeping better or returning to a particular form of exercise.
Ask your clinician to explain:
- the likely cause of your symptoms
- which activities are safe to continue
- how to respond to a temporary pain flare
- what progress should look like
- when the diagnosis or treatment plan should be reviewed
2. Keep physically active
Physical activity is a first-line treatment, not something reserved for mild disease. The aim is to find a level you can sustain and build gradually. Walking, cycling, water-based activity and other low-impact options may be useful, but the best choice is one that fits your symptoms, confidence, health and preferences.
Some discomfort during or after activity does not automatically mean the joint is being damaged. However, a program should be adjusted if pain escalates sharply, function deteriorates or symptoms do not settle as expected. A physiotherapist or accredited exercise physiologist can help with pacing and progression.
3. Use a tailored strengthening program
Exercise for knee osteoarthritis commonly targets thigh, hip and calf strength as well as balance, movement control and aerobic fitness. The program should become appropriately challenging over time; repeating very easy exercises indefinitely may not improve strength.
A tailored program is especially useful when you:
- are unsure how to exercise safely
- have pain in more than one joint
- have had falls or feel unsteady
- also live with heart, lung or metabolic conditions
- have stopped activity because of fear of pain
- need to prepare for or recover from surgery
The Australian standard recommends reviewing whether the exercise plan is being completed, whether it is helping and what barriers are getting in the way. Supervision can be increased when a person needs help with technique, motivation or progression.
4. Get weight-management and nutrition support when relevant
Body weight can influence knee load and symptoms, but weight discussions should be respectful and practical. The standard recommends offering tailored support based on the person's priorities and preferences, alongside advice on nutritious eating for muscle, bone and general health.
Weight management is not a reason to delay all other care. Exercise, symptom management and functional goals can proceed at the same time. A GP or dietitian can help create a realistic plan and account for diabetes, heart disease, medicines, previous dieting experiences and other health needs.
5. Discuss medicines based on benefits and risks
Medicine decisions should consider kidney, heart and gastrointestinal health, other medicines, allergies and age. Do not start, stop or combine medicines based only on a general article.
The 2024 Australian standard describes the following options:
- Topical anti-inflammatory medicine or capsaicin: may be trialled as an addition to other strategies for short-term self-management.
- Oral non-steroidal anti-inflammatory drugs (NSAIDs): may be considered after an individual risk assessment, using the lowest effective dose for the shortest appropriate time.
- Paracetamol: is generally less effective than NSAIDs but may be considered when NSAID-related harm is a concern.
- Corticosteroid joint injection: may provide short-term relief for selected people, but repeated or long-term use is not supported.
- Duloxetine: may be considered as an additional option in selected cases; its use for knee osteoarthritis is off-label and supported by limited evidence.
Your GP or pharmacist can help assess interactions and whether any option is appropriate. Medicines should support participation in movement and daily life, not replace the rest of the treatment plan.
6. Consider supports for specific functional problems
Some people benefit from a walking aid, footwear review, activity modification or a brace. These are not automatic treatments for everyone. The useful question is whether the support improves safety or helps you complete a meaningful activity.
An allied health professional can check fit and technique. A poorly adjusted walking aid or brace can create new difficulties, so avoid selecting one solely from an online advertisement.
7. Address sleep, mood and persistent pain
Ongoing pain can affect sleep, confidence, work, relationships and mood. Those effects are part of the clinical picture, not a failure to cope. A coordinated plan may include sleep strategies, pacing, psychological support or a pain-management service alongside exercise and medical care.
Tell your GP if pain is affecting your mental health or if you are avoiding most activity because you fear damage. Addressing these barriers can improve participation in treatment.
Which knee osteoarthritis treatments are not recommended?
The Australian Commission on Safety and Quality in Health Care advises clinicians not to offer the following for knee osteoarthritis:
- platelet-rich plasma (PRP) injections
- hyaluronan injections
- stem-cell treatments, including adipocyte cell suspensions or mesenchymal stem cells
- medicinal cannabis
- gabapentin or pregabalin
- opioid analgesics for routine knee osteoarthritis care
- complementary products such as glucosamine, chondroitin and fish oil as osteoarthritis treatments
The standard states that the injection products above have not shown benefit and can involve significant expense. Opioids generally carry harms that outweigh their benefits for knee osteoarthritis, with only limited exceptional circumstances considered by a clinician.
Arthroscopic knee surgery is also not recommended for uncomplicated knee osteoarthritis. It may still be considered for a different diagnosis or specific mechanical problem, which is why an individual assessment matters.
When should surgery be considered?
Knee replacement is generally considered when pain and loss of function remain substantial despite an appropriate trial of non-surgical management, and when the likely benefits and risks make sense for that person. The Australian standard calls for optimal non-surgical care, including an exercise and physical-activity program, before referral for joint replacement assessment.
If you are unsure whether your next appointment should be with a rheumatologist or surgeon, read the guide to choosing an arthritis specialist in Perth.
An orthopaedic consultation should cover:
- whether symptoms and examination findings fit knee osteoarthritis
- which non-surgical options have been tried and whether they were delivered adequately
- how much pain and function affect quality of life
- expected benefits and important risks of surgery
- recovery, rehabilitation and support at home
- what may happen if surgery is delayed or declined
You can use the Perth knee surgeon directory to compare relevant profiles when your GP recommends a surgical opinion. For a wider search, view knee surgeons across Australia.
A practical first-appointment checklist
- Write down when the pain began and what makes it better or worse.
- List the activities you can no longer do or now do differently.
- Bring a current medicine list, including supplements.
- Bring existing reports or images, but do not arrange new scans unless advised.
- Describe exercise or physiotherapy already attempted, including duration and progression.
- Choose one or two functional goals to discuss.
Frequently asked questions
Can knee osteoarthritis improve without surgery?
Yes. Many people improve pain and function through exercise, physical activity, weight-management support where relevant, and carefully selected symptom relief. Osteoarthritis may remain visible on an X-ray even when a person is functioning better.
Is walking good for knee osteoarthritis?
Walking can be a useful form of physical activity when the amount and pace are appropriate. If symptoms repeatedly flare, a physiotherapist can help adjust distance, frequency, terrain and complementary strengthening.
Do PRP injections work for knee osteoarthritis?
Australia's 2024 clinical care standard does not recommend PRP for knee osteoarthritis, stating that evidence does not show benefit and that treatment can involve significant expense.
Do I need an MRI before seeing a knee specialist?
Usually not for a typical osteoarthritis assessment. Your GP or specialist can decide whether imaging would change the diagnosis or treatment plan. When imaging is clinically warranted, an X-ray is generally the first-line test.
When is knee replacement appropriate?
It may be appropriate when substantial pain and functional limits continue despite suitable non-surgical treatment, and after an informed discussion of benefits, risks, recovery and alternatives with an orthopaedic surgeon.