Knee osteoarthritis is the most common form of osteoarthritis and affects millions of people worldwide. The pain and restricted mobility can significantly affect the quality of life. But what treatment methods are there? In this comprehensive comparison, we present all treatment options – from conservative to surgical.
What is knee osteoarthritis?
Knee osteoarthritis (gonarthrosis) is a degenerative joint disease in which the cartilage in the knee joint gradually breaks down. This leads to pain, stiffness, swelling and limited mobility.
Stages of knee osteoarthritis
- Stage 1: Slight cartilage damage, hardly any symptoms
- Stage 2: Significant cartilage loss, initial pain upon exertion
- Stage 3: Advanced cartilage loss, pain even at rest
- Stage 4: Cartilage almost completely broken down, bone rubs on bone
Conservative treatment methods
1. Hyaluronic acid injections
Hyaluronic acid injections are one of the most effective conservative treatments for knee osteoarthritis. The hyaluronic acid is injected directly into the knee joint and acts as synovial fluid.
Advantages:
- Long-lasting pain relief (3-12 months)
- Improved mobility
- Well tolerated
- May delay surgery
Available preparations:
- Ostenil: Proven classic, 3-5 injections
- Durolane: Single injection, effect up to 6 months
- Synvisc One: Single injection with Hylan polymer
- Hya-ject: Price-performance winner
- Go on: Knee osteoarthritis specialist
Duration of action: 3-12 months depending on the preparation
Costs: Variable, often self-paying service
💡 Find out more: Hyaluronic acid injections comparison | All joint injections
2. Physiotherapy and exercise therapy
Targeted exercises strengthen the muscles around the knee and relieve pressure on the joint.
Advantages:
- Strengthening the muscles
- Improve mobility
- Pain reduction
- No side effects
Recommended exercises: Quadriceps training, leg press, cycling, swimming
3. Drug therapy
Painkillers (NSAIDs):
- Ibuprofen, diclofenac, naproxen
- Have a pain-relieving and anti-inflammatory effect
- Only suitable for short-term use
- Possible side effects: gastrointestinal complaints
Cortisone injections:
- Strongly anti-inflammatory
- Fast pain relief
- Only for acute inflammation
- Not suitable for long-term use
4. Weight loss
Excess weight puts considerable strain on the knee joints. Every kilogram less relieves the knee by 3-4 times.
Advantages:
- Significant relief of the joints
- Pain reduction
- Slowing the progression of the disease
- Improving overall health
5. Orthopedic aids
Deposits: Correct misalignments and relieve pressure on the knee
Bandages: Stabilize the joint and reduce pain
Walking sticks: Relieve the affected knee when walking
6. Cold and heat therapy
Cold therapy: For acute inflammation and swelling
Heat therapy: For chronic pain to relax the muscles
Minimally invasive procedures
Arthroscopy (joint examination)
During arthroscopy, instruments are inserted into the knee joint through small incisions.
Possible measures:
- Removal of pieces of cartilage
- Smoothing rough cartilage surfaces
- Removal of inflamed joint mucosa
Advantages: Minimally invasive, quick recovery
Disadvantages: The effect is often only temporary, not in advanced osteoarthritis
Cartilage transplant
In younger patients with localized cartilage damage, cartilage transplantation may be considered.
Methods:
- Autologous chondrocyte transplantation (ACT)
- Osteochondral transplantation
Advantages: Can regenerate cartilage
Disadvantages: Complex, only with limited damage
Surgical treatment methods
Adjustment osteotomy
If there are misalignments (X or O legs), the bone is cut and fixed in the corrected position.
Advantages:
- Correction of the misalignment
- Relief of the damaged joint area
- May delay knee replacement
Suitable for: Younger patients with deformity and unilateral osteoarthritis
Knee prosthesis (knee TEP)
If osteoarthritis is advanced, an artificial knee joint is often the only solution.
Types:
- Partial prosthesis (unicompartmental prosthesis): Only one section of the joint is replaced
- Total denture: Complete joint replacement
Advantages:
- Significant pain reduction
- Restoration of mobility
- High success rate
- Shelf life 15-20+ years
Disadvantages:
- Major surgery with risks
- Long rehabilitation
- Not suitable for all activities
Alternative and complementary therapies
PRP (Platelet Rich Plasma)
Autologous blood therapy with concentrated platelets. Should stimulate healing processes.
Study situation: Mixed, further research needed
Stem cell therapy
Experimental therapy for cartilage regeneration. Not yet established.
Acupuncture
Can relieve pain and is covered by some health insurance companies.
Dietary supplements
Glucosamine and Chondroitin: Study situation inconsistent
Omega-3 fatty acids: Anti-inflammatory effect
Vitamin D: Important for bone health
Treatment according to osteoarthritis stage
Stage 1-2 (Early Osteoarthritis)
Recommended treatments:
- Physiotherapy and exercise
- Weight reduction if you are overweight
- Hyaluronic acid injections
- Orthopedic aids
- Painkillers if needed
Stage 3 (advanced osteoarthritis)
Recommended treatments:
- Hyaluronic acid injections
- Cortisone injections for inflammation
- Intensive physiotherapy
- Pain medication
- If necessary, arthroscopy
- If necessary, adjustment osteotomy
Stage 4 (Severe Osteoarthritis)
Recommended treatments:
- Knee prosthesis (usually the only permanent solution)
- Until the operation: pain therapy, physiotherapy
Comparison: Which method is the best?
| Method | Duration of action | invasiveness | Costs | Suitable for |
|---|---|---|---|---|
| Hyaluronic acid | 3-12 months | Minimal | Means | Stage 1-3 |
| Physiotherapy | Permanent | None | Low | All stadiums |
| Painkillers | Short | None | Low | All stadiums |
| Cortisone | weeks | Minimal | Low | Acute inflammation |
| Arthroscopy | months | Means | High | Stage 2-3 |
| Osteotomy | years | High | Very high | Young patient, deformity |
| Knee prosthesis | 15-20+ years | Very high | Very high | Stage 4 |
Coverage of costs by health insurance companies
Statutory health insurance companies cover:
- Physiotherapy (with prescription)
- Painkillers (partial)
- Operations (arthroscopy, prosthesis)
- Orthopedic aids (partial)
Often self-pay service:
- Hyaluronic acid injections (except for some private health insurance companies)
- PRP therapy
- Acupuncture (partially taken over)
Prevention: Prevent knee osteoarthritis
- Maintain normal weight
- Regular, joint-friendly exercise (swimming, cycling)
- Strengthen muscles
- Avoid overloads
- Treat injuries properly
- Correct misalignments
Conclusion: Find the right treatment
The best treatment for knee osteoarthritis depends on the stage of the disease, age, activity level and individual goals.
Early stages: Conservative therapies such as hyaluronic acid injections, physical therapy and weight loss are often very successful.
Advanced stages: Combination of different methods, possibly surgical procedures.
Severe osteoarthritis: Knee prosthesis is usually the only permanent solution.
Consult your orthopedist for advice on which treatment is best for you.
Further information: