KNEE OSTEOARTHRITIS
Knee Osteoarthritis in Madison, WI
When knee arthritis starts changing how you move and live, start with answers.
Knee osteoarthritis can make walking, stairs, exercise, work, travel, and everyday activities harder than they used to be.
But an arthritis diagnosis or an X-ray does not tell the entire story.
The important questions are:
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What is happening in your knee?
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How is it affecting your movement and function?
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Which options make sense for you now?
At Arc of Life Medical Center in Madison, Wisconsin, we evaluate before we recommend. We identify the findings that matter, explain what they mean, determine which options fit and which do not, and recommend a personalized path around what you want to get back to doing.
Personalized care. Honest guidance. A clear path forward.
What Is Knee Osteoarthritis?
Knee osteoarthritis is a joint condition in which tissues within the knee change over time.
Although cartilage is an important part of osteoarthritis, the condition can also involve the bone, joint lining, meniscus, ligaments, and other tissues around the joint.
These changes can contribute to pain, stiffness, swelling, reduced motion, weakness, and difficulty using the knee.
Osteoarthritis affects people differently. Some people have relatively mild symptoms, while others experience significant changes in mobility and everyday function.
Knee osteoarthritis is more than an X-ray finding. Understanding how the condition is affecting you is an important part of determining what should happen next.
Common Symptoms of Knee Osteoarthritis
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Pain with walking or weight-bearing
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Knee stiffness
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Stiffness after sitting or resting
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Swelling
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Reduced ability to bend or straighten the knee
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Pain going up or down stairs
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Pain getting up from a chair
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Difficulty squatting or kneeling
Symptoms can develop gradually and may change from day to day. Common symptoms include:
The symptoms you experience—and what they are preventing you from doing—matter just as much as the name of the condition.
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Grinding, crunching, or creaking
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Tenderness around the knee
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Weakness
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Buckling or giving way
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Reduced walking tolerance
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Pain after increased activity
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Pain that can interfere with sleep
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Loss of confidence using the knee
Where Can Knee Arthritis Occur?
The knee has more than one joint compartment. Osteoarthritis can affect one area or several areas at the same time. Medial Compartment Osteoarthritis- The medial compartment is the inside portion of the knee between the femur and tibia. Arthritis in this area can cause pain along the inside of the knee, stiffness, swelling, and difficulty with walking or weight-bearing. Lateral Compartment Osteoarthritis- The lateral compartment is the outside portion of the knee. Arthritis here can cause outer-knee pain, stiffness, swelling, and changes in how forces move through the knee while standing or walking. Patellofemoral Osteoarthritis- The patellofemoral joint is where the kneecap moves against the femur. Patellofemoral arthritis commonly causes pain around or behind the kneecap and can make stairs, squatting, kneeling, prolonged sitting, and rising from a chair uncomfortable. Tricompartmental Osteoarthritis- Tricompartmental osteoarthritis means arthritic changes are present in all three major compartments of the knee: -Medial compartment -Lateral compartment -Patellofemoral compartment The location and extent of arthritis are important findings, but they still need to be considered alongside your symptoms, examination, function, goals, and overall health.
What Causes or Contributes to Knee Osteoarthritis?
Knee osteoarthritis usually does not have one single cause.
Several factors can influence how the condition develops or progresses, including:
Age
Osteoarthritis becomes more common as people get older, although arthritis is not simply an inevitable consequence of aging.
Previous Knee Injury
A previous meniscus tear, ligament injury, fracture, cartilage injury, or other significant knee trauma can increase the likelihood of osteoarthritis later in life.
Previous Knee Surgery
Some previous injuries and surgical procedures can alter how forces move through the knee over time.
Joint Alignment and Structure
The shape and alignment of the knee can influence how load is distributed across different parts of the joint.
Body Weight
Greater body weight increases the load placed across the knee during walking, stairs, and other weight-bearing activities. Excess body fat creates inflammation and can further degenerate joints.
Repetitive Joint Loading
Years of repeated kneeling, squatting, heavy lifting, or other demanding activities can contribute to joint stress in some people.
Genetics and Family History
Inherited factors can influence the likelihood of developing osteoarthritis.
Other Joint Conditions
Previous joint infection, gout, inflammatory conditions, or other knee problems can sometimes contribute to later joint changes.
The goal of an evaluation is not to promise that there is one hidden “root cause.”
The goal is to understand what is driving your current problem and which findings matter for the decisions you need to make now.
Knee Arthritis Is About More Than Pain
A pain score tells us something.
It does not tell us everything.
Knee arthritis becomes especially meaningful when it starts changing the way you live.
You may notice that you:
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Take stairs differently
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Avoid longer walks
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Use the railing more
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Stop kneeling or squatting
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Sit out activities you used to enjoy
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Think twice before traveling
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Avoid uneven ground
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Cut back on exercise
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Have difficulty getting out of low chairs
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Stop golfing, hiking, biking, or playing sports
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Need more recovery time after activity
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Feel less confident carrying things
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Worry that the knee might give way
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Plan your day around how much walking will be required
These adaptations can happen gradually.
You may not realize how much the knee has changed your life until you stop and compare what you do now with what you used to do.
Progress should not be measured only by how much your knee hurts. It should also be measured by what you can do, how confidently you can do it, and whether the improvement lasts.
How We Evaluate Knee Osteoarthritis
Answers Before Treatment
An arthritis diagnosis does not automatically tell us which treatment you need.
We start with the person, the problem, and the findings.
1. Listen
We want to understand:
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Why are you having the knee evaluated now?
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What has changed?
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What activities have become harder?
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What have you already tried?
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What are you worried about?
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What do you want to be able to do again?
2. Discover
Your examination can assess:
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Knee range of motion
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Swelling
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Areas of tenderness
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Joint alignment
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Knee stability
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Strength
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Kneecap movement
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Walking mechanics
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Balance and control
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Functional movements
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Related hip, leg, or movement findings when appropriate
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Diagnosic Imaging: Ultrasound & X-Rays
We also review previous imaging, treatment, injuries, medical history, and other factors that affect the decision.
3. Educate
We explain:
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What the examination shows
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What your imaging shows
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Which findings appear clinically important
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What remains uncertain
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How the findings relate to your current function
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What reasonable paths exist from here
4. Personalize
Some options fit.
Some do not.
The recommendation should reflect your findings, severity, health history, activity level, goals, previous care, preferences, and what you want to protect or regain.
5. Restore
When care is appropriate, the plan can combine the right tools in the right sequence rather than treating each service as a separate answer.
6. Thrive
We reassess progress by looking at meaningful function—not only a pain score.
Good care should make progress visible.
What Can Knee X-Rays Tell Us?
X-rays are commonly used when evaluating knee osteoarthritis.
They can help show:
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Loss of joint space
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Bone spurs, or osteophytes
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Changes in the bone beneath the joint surface
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Areas of increased bone density or sclerosis
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Bone cysts
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Knee alignment
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Which compartments are affected
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The extent of visible degenerative change
Weight-bearing X-rays can be particularly useful because they show the knee while it is carrying load.
What Can't an X-Ray Tell Us?
An X-ray is important information.
It is not the entire answer.
An X-ray does not tell us:
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Exactly how much pain you experience
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How far you can walk
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Whether you can climb stairs comfortably
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How strong or stable the knee feels
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How confident you are using it
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What activities matter most to you
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Whether a particular treatment is right for you
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Whether you should automatically have surgery
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X-rays also do not directly show every soft-tissue structure in the knee.
MRI or Ultrasound Studies can provide additional information about structures such as cartilage, menisci, ligaments, and other soft tissues, but not every arthritic knee needs an MRI or Ultrasound Study.
The imaging decision should answer a specific clinical question and help guide what happens next.
What Does “Bone-on-Bone” Knee Arthritis Mean?
“Bone-on-bone” is a common phrase used to describe advanced loss of joint space on an X-ray.
It tells us that significant structural changes are present.
It does not, by itself, determine what you should do next.
Two people with similar-looking X-rays can have different:
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Pain levels
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Strength
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Mobility
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Walking tolerance
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Activity goals
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Health factors
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Treatment history
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Expectations
The better question is not simply:
“How bad does the X-ray look?”
It is:
“What do the imaging, examination, symptoms, function, and goals tell us together?”
Treatment Options for Knee Osteoarthritis
There is no single best treatment for every arthritic knee. Treatment should match the person and the findings.
Depending on your situation, reasonable options can include:
Education and Activity Modification
Understanding what is aggravating the knee, what activities are safe, and how to manage loading can help you remain active instead of simply avoiding movement.
Exercise and Rehabilitation
Exercise is a core treatment for knee osteoarthritis.
A program can address:
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Strength
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Range of motion
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Mobility
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Balance
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Coordination
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Walking tolerance
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Functional movement
The goal is not simply to “strengthen the knee.” It is to improve the capabilities that matter in your life.
Weight Management When Appropriate
For people with knee osteoarthritis who are overweight or obese, sustained weight loss can improve pain and function and reduce load across the knee.
Knee Bracing
A knee brace can be useful for selected patients.
For example, an unloading brace may be considered when arthritis is concentrated in one compartment and changing how forces move through the knee could improve comfort or function.
A brace should match the condition rather than simply be given to everyone with knee pain.
Hyaluronic Acid / Viscosupplementation
Hyaluronic acid injections are used for knee osteoarthritis in some clinical settings.
Current AAOS guidelines do not recommend routine use for symptomatic knee osteoarthritis because average benefits across studies have been limited.
That does not mean every patient's circumstances are identical. It means the evidence, alternatives, goals, cost, and expectations should be discussed before deciding whether the option makes sense.
Platelet-Rich Plasma — PRP
PRP is prepared from a patient's own blood and concentrates platelets before injection into the knee.
AAOS states that PRP may reduce pain and improve function in symptomatic knee osteoarthritis.
A2M, Alpha 2 Macroglobulin
A2M protects cartilage from proteins known to cause degeneration in joints which leads to osteoarthritis. A2M molecules are naturally and evenly found throughout the body. Unfortunately, they are not naturally concentrated in the joints to prevent arthritis. We concentrate A2M and inject it directly into your affected joints, the A2M concentrate can help slow the progression of arthritis.
Regenerative Therapies
Regenerative and biologic therapies may be considered for selected patients as part of a broader treatment plan. These treatments are intended to support the body’s natural healing and recovery processes and may be used alongside rehabilitation, bracing, activity modification, and other conservative care. Recommendations are based on the individual’s diagnosis, examination findings, health history, goals, and the available clinical evidence. Not every therapy is appropriate for every patient, and outcomes vary.
Manual and Musculoskeletal Care
Manual therapy or other musculoskeletal care can be used as an adjunct when mobility, surrounding tissues, movement patterns, or related joint findings are contributing to functional limitations.
It is one possible tool within a larger plan—not a treatment that rebuilds lost knee cartilage.
Laser / Photobiomodulation
Laser therapy can be considered as an adjunct in selected patients.
This noninvasive treatment uses specific wavelengths of light to stimulate cellular repair, improve circulation, and accelerate the body’s healing process.
Focused Shock Wave Therapy
Focused extracorporeal shock wave therapy, or focused ESWT, uses concentrated acoustic pressure waves that can be directed into specific tissues around the knee without injections or surgery.
Research suggests that shock wave therapy can reduce pain and improve physical function in some people with knee osteoarthritis. The American Academy of Orthopaedic Surgeons states that extracorporeal shock wave therapy may be used to improve pain and function in knee osteoarthritis, although the strength of the recommendation remains limited because more high-quality, long-term research is needed.
Focused shock wave therapy differs from radial pressure-wave therapy. Focused shock waves concentrate energy at a defined depth within tissue, while radial waves disperse energy more broadly near the surface.
In a randomized study comparing focused and radial shock wave therapy for knee osteoarthritis, both groups improved, but patients receiving focused shock wave therapy experienced greater improvements in pain, WOMAC scores, and walking performance during short-term follow-up.
At Arc of Life Medical Center, focused shock wave therapy can be considered as one tool within a personalized knee osteoarthritis plan when the examination, goals, and clinical findings support its use.
Orthopedic Consultation
Sometimes the right treatment is not something we provide.
If the findings indicate that an orthopedic opinion or surgical evaluation is the better next step, we will tell you.
The goal is not to keep every patient from surgery. The goal is to help you make the right decision about your knee.
When Does a Knee Replacement Consultation Make Sense?
Knee replacement is not automatically the first step after an arthritis diagnosis.
It also should not be treated as a failure when it becomes the appropriate option.
An orthopedic consultation becomes especially reasonable when:
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Pain remains significant despite appropriate nonsurgical care
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Walking and everyday activities remain substantially limited
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Stiffness or loss of motion significantly affects function
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Symptoms interfere with sleep or quality of life
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Structural arthritis is advanced
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The knee has substantial deformity
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The limitations are no longer acceptable to you
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Nonsurgical options no longer provide enough benefit
Partial knee replacement may be an option in certain patients when arthritis is limited to one compartment.
Total knee replacement can become appropriate when disease and symptoms are more extensive.
Good guidance includes knowing when to continue conservative care, when to change direction, and when another specialist is the better path.
Can Knee Osteoarthritis Improve?
The structural changes seen with osteoarthritis are not something we promise to reverse.
But that does not mean nothing can improve.
Many people can improve:
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Pain
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Strength
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Mobility
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Walking tolerance
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Function
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Confidence
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Ability to participate in meaningful activities
The goal is to determine what improvement is realistic for you and choose a path that matches your condition and goals.
Frequently Asked Questions About Knee Osteoarthritis
Is knee osteoarthritis just “wear and tear”?
No. Osteoarthritis involves biological and structural changes in multiple tissues within the joint. Age and mechanical loading matter, but the condition is more complex than simply “wearing out” a knee.
What are the first signs of knee osteoarthritis?
Common early symptoms include activity-related pain, stiffness after rest, swelling, reduced motion, and increasing difficulty with activities such as stairs, walking, squatting, or getting up from a chair.
Where does knee arthritis usually hurt?
It depends on which part of the knee is affected. Pain can be felt along the inside of the knee, outside of the knee, around or behind the kneecap, or more generally throughout the joint.
Why does knee arthritis hurt more on stairs?
Stairs increase the forces and muscular demands placed across the knee. Patellofemoral arthritis can be particularly noticeable during stairs, squatting, and rising from a chair.
Why is my knee stiff after sitting?
Short-lived stiffness after rest or inactivity is common with osteoarthritis. Moving the knee again often reduces some of that stiffness.
Why does my arthritic knee swell?
Osteoarthritis can irritate tissues within the joint and lead to increased joint fluid. Significant or sudden swelling can have other causes and should be evaluated when the presentation is unusual.
Does knee arthritis always get worse?
Osteoarthritis can change over time, but the course and symptoms vary considerably between people. We should not assume that every patient will decline at the same rate or inevitably lose function.
Does “bone-on-bone” mean I need a knee replacement?
No. Advanced joint-space loss is an important structural finding, but surgery decisions also depend on symptoms, function, health status, goals, prior care, and how much the problem is affecting your life.
Do I need an MRI for knee osteoarthritis?
Usually not as the first imaging test for chronic knee pain. X-rays are commonly used first. MRI becomes more useful when another internal knee problem is suspected or when additional information would change the clinical decision.
Is exercise safe with knee osteoarthritis?
Appropriately selected exercise is recommended for knee osteoarthritis and can improve pain and function. The program should match your current abilities and be adjusted when symptoms or another condition require it.
Should I stop walking if my knee is arthritic?
Not automatically. Remaining active is generally important, but the amount and type of activity may need to be adjusted based on your symptoms and findings.
Can a knee brace help arthritis?
Yes, in selected patients. Bracing can improve pain and function for some people, especially when the type of brace matches the location and mechanics of the arthritis.
How do I know which knee treatment is right for me?
Start with the condition, not the procedure.
Your symptoms, examination, imaging, health history, goals, previous treatment, evidence, alternatives, risks, and preferences should determine which path makes sense.
When should I consider a surgical opinion?
A surgical consultation becomes reasonable when significant pain and functional limitations continue despite appropriate nonsurgical care or when the examination and imaging suggest that surgery may offer the clearest path forward.
What happens at an Arc of Life knee evaluation?
We begin by understanding why you are seeking help now, what the knee has changed, and what you want to get back to doing.
We examine the knee, movement, and function and review or obtain appropriate imaging when needed.
Then we explain the findings, determine which options fit and which do not, and give you a clear recommendation.
The evaluation is not a commitment to treatment.
Why Arc of Life for Knee Osteoarthritis?
Knee arthritis care should not begin with choosing an injection, brace, exercise program, or surgery.
It should begin with understanding the problem.
At Arc of Life Medical Center, rehabilitation, bracing, medical care, manual care, laser therapy, injections, imaging, orthobiologic procedures, and specialist referral are tools.
They are not predetermined answers.
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We evaluate before we recommend.
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We explain what the findings mean.
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We determine which options fit and which do not.
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We coordinate the appropriate path.
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And we measure whether that path is producing meaningful progress.
Listen. Discover. Educate. Personalize. Restore. Thrive.
Personalized care. Honest guidance. A clear path forward.
Ready to Get Clear About Your Knee?
If knee arthritis is changing how you walk, climb stairs, exercise, work, travel, or participate in the life you want to live, you do not have to guess what comes next.
Start with an evaluation.
We will evaluate what is driving the problem, explain the findings, determine which options fit and which do not, and recommend a clear path forward.
Medical References
National Institute of Arthritis and Musculoskeletal and Skin Diseases — Osteoarthritis
Overview of osteoarthritis, joint changes, symptoms, risk factors, diagnosis, and treatment.
American Academy of Orthopaedic Surgeons — Management of Osteoarthritis of the Knee (Non-Arthroplasty), Clinical Practice Guideline
Evidence-based recommendations for exercise, education, weight management, bracing, medications, injections, PRP, and other nonsurgical treatments.
American College of Rheumatology / Arthritis Foundation — Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
Evidence-based recommendations for nonpharmacologic and pharmacologic osteoarthritis care.
American College of Radiology — Appropriateness Criteria: Chronic Knee Pain
Guidance regarding X-rays, MRI, and other imaging for chronic knee pain.
American Academy of Orthopaedic Surgeons — Surgical Management of Osteoarthritis of the Knee
Evidence-based guidance regarding surgical management and knee replacement.
McAlindon TE, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis. JAMA. 2017;317(19):1967–1975. View JAMA study
Ibad HA, et al. Longitudinal MRI-defined Cartilage Loss and Radiographic Joint Space Narrowing Following Intra-Articular Corticosteroid Injection for Knee Osteoarthritis: A Systematic Review and Meta-analysis. Osteoarthritis Imaging. 2023. View PubMed record
American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Clinical Practice Guideline. AAOS states that corticosteroids can provide short-term relief, but the recommendation was downgraded because of potential risk of accelerating OA.
Kao DS, Zhang SW, Vap AR. A Systematic Review on the Effect of Common Medications on Platelet Count and Function: Which Medications Should Be Stopped Before Getting a Platelet-Rich Plasma Injection? Orthopaedic Journal of Sports Medicine. 2022.
Frey C, Yeh PC, Jayaram P. Effects of Antiplatelet and Nonsteroidal Anti-inflammatory Medications on Platelet-Rich Plasma: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2020.
Merkely G, et al. Do Nonsteroidal Anti-Inflammatory Drugs Have a Deleterious Effect on Cartilage Repair? A Systematic Review. Cartilage.
Constantinescu DS, et al. Nonsteroidal Anti-Inflammatory Drugs and Their Effect on Musculoskeletal Soft-Tissue Healing: A Scoping Review.
Medical Review
Written by: Arc of Life Medical Center
Clinically reviewed by:
Kaili A. Richey, DC, DIBCN
Last reviewed:
09/10/2026
Next evidence review:
12/01/2026
This page provides general educational information. It does not diagnose an individual condition or replace an examination, diagnosis, or individualized medical advice from a qualified healthcare professional.