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What is knee osteoarthritis (gonarthrosis)?
Knee osteoarthritis (gonarthrosis) is a degenerative-dystrophic disease in which the cartilage tissue of the knee joint is destroyed, leading to pain, limited mobility, and deformity. Read more about the stages of the disease in our article on the 4 stages of gonarthrosis.
This is the most common osteoarthritis disease. According to WHO data, about 10% of men and 13% of women over 60 suffer from gonarthrosis. In Germany, more than 190,000 knee joint replacement surgeries are performed annually — this is one of the most common orthopedic procedures.
Stages of gonarthrosis (Kellgren-Lawrence):
- Grade I — doubtful radiographic signs, minimal osteophytes
- Grade II — moderate joint space narrowing, definite osteophytes
- Grade III — significant joint space narrowing, subchondral sclerosis, multiple osteophytes
- Grade IV — marked joint space narrowing, large osteophytes, deformation of bone contours
Types of involvement:
- Medial — involvement of the medial compartment (most common)
- Lateral — involvement of the lateral compartment
- Patellofemoral — involvement of the patella
- Total — involvement of all compartments
Facts about knee osteoarthritis (gonarthrosis)
- ICD-10: M17
- Prevalence: 10-13% of population over 60 years
- Gender: women affected 1.5-2 times more often
- Joint replacement: 190,000+ surgeries/year in Germany
- Obesity: increases risk 4-5 times
Symptoms of knee osteoarthritis (gonarthrosis)
Early signs
- Pain when climbing stairs
- Morning stiffness (up to 30 minutes)
- Crunching (crepitus) in the knee
- Discomfort after prolonged sitting
- Intermittent joint swelling
Progression
- Constant pain while walking
- Limited flexion/extension
- Joint instability
- Varus or valgus deformity
- Synovitis (joint effusion)
Late Stages
- Pain at rest and at night
- Marked leg deformity (O- or X-shaped)
- Inability to fully extend
- Quadriceps muscle atrophy
- Need for cane or crutches
Knee osteoarthritis (gonarthrosis): treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Load management, weight loss | Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain | Well studied, recommended |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Moderate evidence |
| Hyaluronic acid | Reduces pain for a few months in some patients | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Moderate evidence |
| BMAC / MFAT | Cell preparations from bone marrow or fat; more expensive, no proven advantage over PRP | Little data |
| Knee replacement | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In osteoarthritis, regenerative injections can reduce pain and improve function for a period of several months to a year. PRP in knee osteoarthritis is the best studied: in a number of trials it reduced pain more than hyaluronic acid, but not in all of them. Restoration of damaged cartilage has not been shown. Cell-based methods (BMAC, MFAT) are less well studied and more expensive. Exercise and weight control remain the basis of treatment — injections add to them rather than replace them.
When surgery is discussed. Surgery is discussed when marked pain and restricted movement do not improve after 3–6 months of conservative treatment, and in advanced stages with deformity.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell knee osteoarthritis from similar conditions
In knee osteoarthritis the knee hurts with load, stairs and getting up from a chair, morning stiffness is short — up to 30 minutes — and over time grinding and loss of extension appear. Rheumatoid arthritis affects both knees and small joints with stiffness over an hour; gout or pseudogout causes sudden swelling and redness. A meniscus tear causes locking and joint-line pain. A standing X-ray shows the stage; MRI is not always needed.
What you can do yourself
Regular exercise for the thigh and gluteal muscles is the best-proven way to reduce pain. Losing 5–10% of body weight noticeably offloads the knee. Walking, cycling and swimming are better than complete rest; a cane in the opposite hand reduces load during flare-ups.
Outlook and timelines
Knee osteoarthritis progresses slowly and unevenly; in many people pain is controlled for years with exercise and painkillers. Corticosteroid injections help during flare-ups for weeks, and hyaluronic acid and PRP help some patients in early stages. With severe pain and joint destruction, knee replacement is discussed.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Bennell KL et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA, 2021.
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently Asked Questions About Knee Osteoarthritis Treatment
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request