Arthritis in Knee: 4 Stages of Osteoarthritis

Medically Reviewed on 8/27/2020

What is arthritis?

There are four stages of knee osteoarthritis.
There are four stages of knee osteoarthritis.

Painful joint swelling is called arthritis. Osteoarthritis is due to wear and tear of the joints over many years. Arthritis maye develop in any joint, including the fingers, hips and knees. Usually, patients with arthritis feel pain in their joints even after moderate movements. The cartilage (a rubbery tissue covering the ends of the bones) breaks down over time, leaving the bones without cushions. This causes the bones to rub against each other resulting in painful swelling. Arthritis is a very painful condition that does not have a cure. However, there are lots of treatment options available to curb the complications of arthritis. 

What are the four stages of osteoarthritis in the knees?

People who have immense osteoarthritis pain may only show mild changes on X-ray, so it is important to concentrate on the symptoms rather than just the X-ray. Below are the stages of osteoarthritis of the knee with appropriate treatment plans.

Stage 0 or Normal:

  • When the knee shows no signs of osteoarthritis, it is classified as stage 0. 
  • There is no treatment required for stage 0 osteoarthritis.

Stage 1 or Minor:

  • In this stage, patients may develop very minor wear and tear and bone spur growths at the end of the knee joints. 
  • Usually, patients may not feel pain or any discomfort.
  • This stage is usually diagnosed as an incidental finding or during a regular health checkup.
  • Physicians may not recommend any special treatment for stage 1. However, supplements such as glucosamine and chondroitin may be recommended. Lifestyle considerations such as regular exercise and weight loss may also prove to be helpful.

Stage 2 or Mild:

  • In stage 2, diagnostic images or X-rays of knee joints will show more bone spur growth, although the space between the bones appears normal.
  • Patients usually visit the doctor during this stage due to joint pain or discomfort. Typically, the area around the knee joints will feel stiff and uncomfortable, particularly when sitting for an extended period, after rising in the morning or after a workout. In this stage, the cartilage and soft tissues may remain healthy.
  • There are different nonpharmacologic therapies to help relieve the pain and discomfort caused in this mild stage. Many patients are recommended a strict regimen of exercise and strength training to increase joint stability. Additionally, braces, knee supports or shoe inserts may be used to protect the knee from stress.

Stage 3 or Moderate:

  • In this stage, there is obvious erosion of the cartilage surface between the bones and fibrillation narrows the gap between the bones. The bones develop spurs at the joints as they become rougher. There may be obvious joint swelling that causes frequent pain when walking, running, squatting, extending or kneeling. Along with joint stiffness after sitting for long periods of time or when waking up in the morning, there may be popping or snapping sounds when walking.
  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or pain-relief therapies may be prescribed. If these methods are not effective, the doctor may prescribe a stronger pain medicine, such as codeine and oxycodone.
  • Patients who have not responded positively to physical therapy, a weight loss program and use of NSAIDs may require visco-supplementation, which is intra-articular injections of hyaluronic acid into the knee joint. Moderate knee arthritis can be treated aggressively with three to five injections of hyaluronic acid over three to five weeks’ time. It may take several weeks for the treatment to start showing results, but pain relief typically lasts six months.

Stage 4 or Severe:

  • In stage 4, the joint space between the bones is considerably reduced, causing the cartilage to wear off and leaving the joint stiff. The breakdown of cartilage leads to a severe swelling response with decreased joint fluid that causes friction, greater pain and discomfort when walking or moving the joint.
  • Soft tissue destruction may be noted around the knees in this stage. The development of more spurs causes excruciating pain, which makes even daily activities difficult.
  • Treatment options include osteotomy or bone realignment surgery. The surgeon cuts the bone above or below the knee to shorten the length and help realign it to reduce stress on the knee joint. This surgery helps protect the knee by shifting the weight of the body away from the site of the bone spur growth and bone damage.
  • Total knee replacement or arthroplasty: During this surgical procedure, the damaged joint is removed and replaced with a plastic or metal prosthesis device. 
  • Recovery from surgery may take several weeks and requires patience and discipline with continuous physical and occupational therapy to regain full mobility.


Exercises for Knee Osteoarthritis and Joint Pain See Slideshow

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Medically Reviewed on 8/27/2020
Medscape Medical Reference

Illinois Bone & Joint Institute