Osteoarthritis (OA) is divided into five stages.
Stage 0 is assigned to a normal, healthy knee. The highest stage, Stage 4, is assigned to severe OA. OA that has become this advanced is likely to cause significant pain and disrupt joint movement and function.
Read on to learn about each stage and how it’s treated.
Stage 0 OA is classified as “normal” knee health. The knee joint shows no signs of OA and the joint functions without any impairment or pain.
No treatment is needed for stage 0 OA.
A person with stage 1 OA is showing very minor bone spur growth.
Bone spurs are bony growths that often develop where bones meet each other in the joint. There might be minor loss of cartilage but not enough to compromise the joint space.
Someone with stage 1 OA will usually not experience any pain or discomfort as a result of the very minor wear on the components of the joint.
Without outward symptoms of OA to address, most doctors won’t require you to undergo any treatments for stage 1 OA.
However, if you have a predisposition to OA or are at an increased risk, your doctor may recommend you begin an exercise routine to help relieve any minor symptoms of OA and to try to slow the progression of the arthritis.
Exercise and osteoarthritis
In recent clinical guidelines, the American College of Rheumatology (ACR) and the Arthritis Foundation (AF) strongly recommend regular exercise and tai chi for all people with knee osteoarthritis (OA).
They don’t endorse specific types of exercise. A variety of options, from walking to swimming, are considered beneficial.
However, they do note that supervised exercise (as in physical therapy or a fitness class) produces better outcomes than unsupervised exercise.
The ACR and the AF also conditionally recommend balance exercises and yoga. The evidence in favor of these methods isn’t as robust.
Stage 2 OA of the knee is considered a mild stage of the condition.
X-rays of knee joints in this stage will reveal greater bone spur growth, but the cartilage is usually still at a healthy size. In other words, the space between the bones is normal, and the bones aren’t rubbing or scraping one another.
At this stage, synovial fluid is also typically still present at sufficient levels for normal joint motion.
However, this is the stage where people may first begin experiencing symptoms, such as:
- pain after a long day of walking or running
- greater stiffness in the joint when it’s not used for several hours
- tenderness when kneeling or bending
Talk with your doctor about the signs and symptoms of OA. They may be able to detect and diagnose the condition at this early stage. If so, you can develop a plan to prevent the condition from progressing.
Several different therapies can help relieve the pain and discomfort caused by this mild stage of OA. These therapies are mainly nonpharmacological, which means you don’t need to take medication for symptom relief.
If you’re overweight, losing weight through diet and exercise can help relieve minor symptoms and improve your quality of life. Even people who aren’t overweight will benefit from exercise.
Low-impact aerobics and strength training can help strengthen the muscles around the joint, which increases stability and may decrease the likelihood of additional joint damage.
Protect your joint from exertion by avoiding kneeling, squatting, or jumping.
Braces and wraps can help stabilize your knee.
Over-the-counter (OTC) pain relievers
Some people may require medications for mild pain relief. These are usually used in conjunction with nonpharmacological therapies.
For example, if you need to take acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, you should also try exercise, weight loss, and protecting your knee from unnecessary stress.
Long-term therapy with these medications may cause other problems. Taking larger doses of acetaminophen may cause liver damage. NSAIDs can cause stomach ulcers, cardiovascular problems, and kidney and liver damage.
Remedies for stages 2 and 3 osteoarthritis of the knee
Simple, over-the-counter (OTC) remedies are available to help address these stages of osteoarthritis. Shop for them online:
Stage 3 OA is classified as moderate OA. In this stage, the cartilage between bones shows obvious damage, and the space between the bones begins to narrow.
People with stage 3 OA of the knee are likely to experience frequent pain when walking, running, bending, or kneeling.
They may also experience joint stiffness after sitting for long periods of time or when waking up in the morning. Joint swelling may be present after extended periods of motion as well.
If nonpharmacological therapies or OTC pain relievers don’t work or no longer provide the pain relief they once did, your doctor may also recommend a class of medications known as glucocorticoids.
Glucocorticoids are types of corticosteroid drugs. Corticosteroids include cortisone, a hormone which has been shown to relieve OA pain when injected into the affected joint.
Cortisone is available as a pharmaceutical drug, but it’s also produced naturally by your body.
The Food and Drug Administration (FDA) has approved the glucocorticoid triamcinolone acetonide (Zilretta) exclusively for the treatment of knee OA.
Other glucocorticoids that may be prescribed for knee OA include hydrocortisone (Solu-Cortef) and prednisolone.
The effects of a corticosteroid injection may wear off in about 2 or 3 months, after which the injections may be repeated.
However, you and your doctor should look at the use of corticosteroid injections carefully. Research shows long-term use can actually worsen joint damage.
OTC pain relievers and lifestyle remedies
If you have stage 3 OA, you should continue with nonpharmacological therapies such as exercise and weight loss.
People with stage 3 OA will also continue to receive NSAIDs or acetaminophen.
If your OA medications are causing side effects, you should speak with your doctor about switching to a different one. Also, topical forms of NSAIDs and capsaicin (pepper extract) can be tried.
Prescription pain medication
If NSAIDs or acetaminophen are no longer effective at all, prescription pain medication, or tramadol (Ultram), can help relieve the increased pain common in stage 3 OA.
Tramadol is an opioid, and it’s available as an oral solution, capsule, or tablet.
In clinical guidelines from the American College of Rheumatology (ACR) and the Arthritis Foundation (AF), experts conditionally recommend tramadol over other opioids for people with knee OA.
Narcotic medications such as opioids aren’t recommended for long-term use due to the risk of increased tolerance and possible dependence.
Side effects of these medications include:
Stage 4 OA is considered severe. People in stage 4 OA of the knee experience great pain and discomfort when they walk or move the joint.
That’s because the joint space between bones is dramatically reduced.
The cartilage is almost completely gone, leaving the joint stiff and possibly immobile. The synovial fluid is decreased dramatically, and it no longer helps reduce the friction among the moving parts of a joint.
Available treatments for Stage 4 OA include surgery.
Bone realignment surgery
Bone realignment surgery, or osteotomy, is one option for people with severe OA of the knee. During this surgery, a surgeon cuts the bone above or below the knee to shorten it, lengthen it, or change its alignment.
This surgery shifts the weight of your body away from the points of the bone where the greatest bone spur growth and bone damage have occurred. This surgery is typically performed on younger people.
Total knee replacement (TKR)
Total knee replacement (TKR), or arthroplasty, is available for severe, persistent pain and decreased function for people with severe OA of the knee.
During this procedure, a surgeon removes the damaged joint and replaces it with a plastic and metal device.
Side effects of this surgery include infections at the incision site and blood clots. It takes several weeks or months and extensive occupational and physical therapy to recover from this procedure.
It’s possible that replacing your arthritic knee won’t be the end of your OA knee problems. You may need additional surgeries or even another knee replacement during your lifetime.
However, the newer knees may last for decades.
A wide range of treatments, from OTC medications to knee replacement surgery, are available to help relieve knee pain caused by OA.
If you’re experiencing symptoms such as stiffness or discomfort, speak with your doctor to determine whether OA is the culprit. They’ll help you find the treatment that’s right for you.