In simple words: Knee Osteoarthritis (OA) is when the smooth cushion (cartilage) inside your knee gradually wears away. Without that cushion, bones start rubbing against each other — causing pain, swelling, and stiffness. It is not a life-threatening condition, but it does affect quality of life — and the good news is, most patients can be treated without surgery.
Understanding the Condition
What is Cartilage and Why Does It Matter?
Think of cartilage as the shock absorber of your knee — a smooth, slippery layer that sits between your thigh bone and shin bone. It allows your knee to bend, twist, and bear your weight without any pain.
In Osteoarthritis, this cartilage slowly breaks down. Once cartilage is gone, it does not grow back on its own. That's why early treatment matters — to slow the damage and preserve what remains.
Who Gets It?
OA is extremely common — especially in India. It mostly affects people over 45, women more than men, and those who are overweight. But it can also happen in younger people after a knee injury.
- Age: Cartilage wears with years of use
- Weight: Every extra kilo = 4 kg of extra load on the knee
- Old injury: ACL tear, fracture, or sports injury
- Sitting cross-legged or squatting regularly — very common in Indian daily life
- Family history — genetics plays a role
How Bad Is It?
The 4 Grades of Knee OA
Doctors use X-rays to grade OA from 1 to 4. This helps decide the right treatment.
1
Mild
Slight narrowing, early wear. Minimal symptoms.
2
Moderate
More wear, osteophytes (bone spurs) forming. Pain on activity.
3
Severe
Joint space significantly reduced. Pain even at rest.
4
End Stage
Bone-on-bone. Severe pain, deformity. Surgery often needed.
📋 Kellgren-Lawrence Grading Scale — used by orthopaedic surgeons worldwide
Recognise the Signs
Symptoms — What You May Feel
😖
Pain in the kneeWorse when climbing stairs, squatting, or after long walks. Gets better with rest.
🦿
Morning stiffnessKnee feels stiff when you wake up — usually improves within 30 minutes.
💧
SwellingKnee may look puffy, especially after activity. This is fluid (effusion) building up.
🔊
Cracking / grinding soundsA crunching or clicking sound when bending the knee — called crepitus.
📐
Bow-leg or knock-kneeIn advanced cases, the knee can become visibly bent or crooked.
🚶
Difficulty walkingTrouble walking longer distances or getting up from the floor or a low chair.
Treatment — Step by Step
How We Treat Knee OA — A Step-by-Step Approach
Treatment is personalised — based on your grade, age, weight, and lifestyle. We always start with the safest option and only move to the next step if needed.
Step 1 — Grades 1 & 2
Lifestyle & Medicines
- Weight loss — even 5 kg makes a big difference
- Physiotherapy — quad strengthening, stretching
- Pain medications — Paracetamol, anti-inflammatories
- Knee brace or support
- Avoid squatting, sitting cross-legged, climbing on knees
- Swimming and cycling — excellent low-impact exercise
Step 2 — Grades 2 & 3
Injections — Reduce Pain & Delay Surgery
- PRP (Platelet-Rich Plasma): Your own blood, concentrated and injected — reduces inflammation, repairs cartilage. Lasts 12–18 months.
- BMAC (Bone Marrow Aspirate Concentrate): Stem cell-rich concentrate from your own bone marrow — powerful regeneration for Grade 2–3.
- MFAT (Micro-Fragmented Adipose Tissue): Processed fat cells from your own body containing stem cells — reduces inflammation and supports healing.
- Stem Cell Therapy DGCI Approved — Allogeneic stem cells injected into the joint to slow cartilage breakdown and relieve pain long-term. Only DGCI approved products are used.
- Hyaluronic Acid (Gel injection): Lubricates and cushions the joint. Best combined with biologics for Grade 2–3 OA.
💉 OrthoRegen Approach — Avoid or Delay Surgery
Dr. Sumit Dubewar specialises in regenerative orthopaedics — using advanced techniques to preserve your natural knee as long as possible.
🩸
PRP Therapy
Your blood's healing proteins, concentrated and injected into the knee. Reduces inflammation and slows cartilage damage.
🧬
BMAC — Bone Marrow Stem Cells
Stem cell-rich concentrate from your own bone marrow — powerful regeneration, cartilage repair.
🫧
MFAT — Fat-Derived Stem Cells
Processed fat tissue from your own body — rich in regenerative stem cells, reduces inflammation.
✅ PRP, BMAC and MFAT use your own (autologous) biological material — no external approval required.
⚠️ Allogeneic (donor-derived) stem cell therapy is used only with DGCI Approved products as per Indian regulatory guidelines.
Step 3 — Grade 4 · Not Fit for Surgery
RFA — Palliative Pain Control Only
- Who it is for: Grade 4 OA patients who cannot undergo surgery due to heart disease, uncontrolled diabetes, high anaesthesia risk, or personal choice.
- What it does: Burns the nerve endings (genicular nerves) around the knee that carry pain signals — providing relief for 12–24 months.
- Critical warning: RFA does not heal the joint. Because pain is the body's warning signal, when it is removed, patients unknowingly overload the knee — which actually accelerates joint destruction. The OA continues to worsen silently.
- Bottom line: RFA is a last resort for pain relief in patients where no other treatment is possible — not a substitute for regenerative therapy or surgery.
Surgery — The Definitive Solution for Grade 4
- High Tibial Osteotomy (HTO): Bone realignment for younger patients with one-sided OA
- Partial Knee Replacement: Only the damaged part is replaced
- Total Knee Replacement (TKR): Full replacement — Grade 3–4. Lasts 15–20 years.
- Robotic TKR: Computer-assisted precision. Better alignment, quicker recovery.
Common Misconceptions
Myths vs. Facts
Myth"Rest is best. Don't exercise with knee pain."
FactThe right exercises actually strengthen the muscles around the knee and reduce pain. Complete rest weakens muscles and worsens OA. Walking, swimming, and cycling are safe.
Myth"OA means you will definitely need surgery."
FactMost patients — even with Grade 2 or 3 OA — can be managed very well with physiotherapy, weight loss, and injections. Surgery is the last option, not the first.
Myth"OA only happens to the elderly."
FactYoung athletes with old knee injuries, overweight individuals in their 30s, and people with genetic predisposition can all develop OA. We are seeing it increasingly in patients under 45.
Myth"The cracking sound means my knee is getting worse."
FactCrepitus (cracking) is common and not always dangerous. It happens due to irregular cartilage surfaces. The key indicator is whether it is accompanied by pain, not the sound itself.
Frequently Asked Questions
Your Questions, Answered
Can OA be reversed?
Cartilage damage cannot be fully reversed, but it can be slowed significantly. Regenerative treatments like PRP can help the remaining cartilage survive longer. The goal is to keep your knee functional and pain-free for as long as possible.
How long does a knee replacement last?
A modern total knee replacement typically lasts 15–20 years. Younger patients may need a revision after that. With robotic surgery and improved implant materials, longevity is improving significantly.
Is PRP covered by insurance?
PRP is generally not covered by standard health insurance in India as it falls under regenerative/elective procedures. However, the cost has come down significantly, and one PRP session often delays surgery by 1–2 years — making it very cost-effective.
Someone told me about RFA — is it a good option for my knee?
RFA (Radiofrequency Ablation) is reserved for a very specific group — Grade 4 OA patients who are medically unfit for surgery (due to heart conditions, uncontrolled diabetes, or very high anaesthesia risk). It works by burning the nerve endings that carry pain, giving relief for 12–24 months. However, because pain is your body's warning system, removing it means you can unknowingly continue to stress and damage an already severely destroyed joint — accelerating the destruction. It is a palliative option only, not a cure, and not suitable for patients who are candidates for regenerative therapy or surgery.
Can I sit cross-legged after treatment?
Sitting cross-legged puts significant stress on the knee joint and should be avoided, especially after Grade 2+ OA. Use a chair. After knee replacement, sitting cross-legged is generally not recommended at all.
How much weight loss actually helps?
Every 1 kg of body weight = approximately 4 kg of force on the knee while walking. Losing just 5 kg reduces knee load by 20 kg. Even modest weight loss has a dramatic impact on pain and slows OA progression.
Not Sure Which Stage You Are At?
Dr. Sumit Dubewar offers a detailed consultation — including X-ray review, grading, and a personalised treatment plan.
📅 Book a Consultation
ONE Healthcare Clinic · Tirumalagiri, Secunderabad · Also available at Apollo, Medicover & TX Hospital
👨⚕️
Dr. Sumit Dubewar
MBBS · DNB (Orthopaedics) · DABRM (USA) · MNAMS · FIJR · FIASM
Consultant Orthopaedic Surgeon · Reg. No: TSMC/FMR/25167
🦴 Joint Preservation & Regenerative Orthopaedics · Knee & Hip Replacement · Robotic Surgery · PRP · BMAC · MFAT