Medial compartment
(inner side): The most common site of arthritis
Osteoarthritis is by far the most common type of knee arthritis. It affects an estimated 14 million Americans and is the leading reason for knee replacement surgery. Understanding what is happening inside the joint, and knowing the full range of treatment options, helps patients make informed decisions about their care.
How the Knee Is Structured
The knee has three compartments:
Lateral compartment
(outer side): Less commonly affected
Patellofemoral compartment
(behind the kneecap): Often involved to some degree
Arthritis can affect one, two, or all three compartments. The pattern of involvement determines which treatment options are appropriate. When arthritis is limited to one compartment, a partial knee replacement may be an option that preserves the healthy parts of the joint.
Symptoms of Knee Arthritis
Knee arthritis develops gradually, and symptoms worsen over time. You may notice:
Pain with activity:
Walking, climbing stairs (especially going down), standing from a seated position, or getting in and out of a car
Stiffness:
Especially after sitting for a period of time or first thing in the morning. Arthritic stiffness typically improves within 20 to 30 minutes of movement.
Swelling:
The knee may swell intermittently, particularly after increased activity
Crepitus:
A grinding, crunching, or crackling sensation when the knee bends, caused by rough cartilage surfaces moving against each other.
Loss of range of motion:
Difficulty fully bending or straightening the knee
Deformity:
Over time, bone loss and cartilage wear can cause the leg to bow inward (varus) or outward (valgus)
Pain at rest or at night:
In more advanced stages, pain may occur even without activity and can interfere with sleep.
Giving way:
A sense of instability or the knee "buckling," often caused by muscle weakness rather than ligament damage.
Diagnosing Knee Arthritis
Dr. Zalikha diagnoses knee arthritis with a combination of your symptom history, a physical examination, and standing X-rays.
Standing (weight-bearing) X-rays are important because they show the true joint space under load. X-rays taken while lying down can underestimate the severity of cartilage loss. Dr. Zalikha evaluates all three compartments and assesses overall knee alignment.
Key X-ray findings include:
Joint space narrowing:
The cartilage gap between the femur and tibia becomes thinner.
Bone spurs:
Extra bone growth at the edges of the joint.
Subchondral sclerosis:
Thickening of the bone beneath worn cartilage.
Bone-on-bone contact:
Complete loss of cartilage in one or more compartments.
MRI is not usually necessary to diagnose arthritis but may be ordered to evaluate meniscal tears, ligament integrity, or early cartilage damage not yet visible on X-ray.
Nonsurgical Treatment for Knee Arthritis
Dr. Zalikha starts with nonsurgical treatment for most patients with knee arthritis. Many people manage their symptoms successfully for years with a combination of conservative measures.
Physical Therapy:
Physical therapy is one of the most effective treatments for knee arthritis. Strengthening the quadriceps and hamstrings reduces stress on the joint and improves knee stability. A structured therapy program can significantly reduce pain and improve function, sometimes enough to delay surgery for years.
Weight Management:
The knee bears three to five times your body weight with each step. Losing even 10 to 15 pounds can produce noticeable improvement in knee pain. Weight optimization is one of the most impactful interventions for knee arthritis, and Dr. Zalikha discusses this openly with patients.
Medications:
Over-the-counter options include NSAIDs (ibuprofen, naproxen), acetaminophen, and topical anti-inflammatory gels applied directly to the knee. Prescription options are available when over-the-counter medications are insufficient or contraindicated.
Bracing:
An unloader brace shifts weight away from the arthritic compartment of the knee and onto the healthier side. This can be particularly effective for patients with single-compartment (medial or lateral) arthritis.
Activity Modification:
Transitioning from high-impact activities to low-impact options (swimming, cycling, elliptical training, walking on flat terrain) protects the knee while maintaining cardiovascular fitness and muscle strength.
Injections:
Knee injections are a core part of nonsurgical arthritis management:
Corticosteroid injections:
Fast-acting anti-inflammatory relief, typically lasting weeks to months.
Hyaluronic acid (gel) injections:
Restore lubrication and cushioning within the joint. May provide longer-term relief than cortisone.
PRP and biologic injections:
Use the body's own growth factors to promote healing. Evidence is evolving, and Dr. Zalikha provides honest guidance on expectations.
When Surgery Becomes the Right Option
Surgery is considered when nonsurgical treatment has been genuinely tried and is no longer controlling symptoms. The decision is based on how much arthritis is affecting your life, not just what the X-ray shows.
- Total Knee Replacement: Total knee replacement resurfaces all three compartments of the knee. It is the standard procedure for widespread arthritis. Dr. Zalikha performs total knee replacement with robotic-assisted technology for individualized implant positioning.
- Partial Knee Replacement: Partial knee replacement is an option when arthritis is confined to one compartment (usually the medial side) and the ligaments are intact. It preserves healthy bone and cartilage, allows for a smaller incision, and typically results in a faster recovery with a more natural-feeling knee.
- How Dr. Zalikha Helps You Decide: The choice between continuing conservative care, pursuing partial knee replacement, or proceeding with total knee replacement depends on: - The pattern and severity of arthritis on X-ray - Your symptoms, limitations, and goals - The condition of your ligaments and other knee structures - Your age, health, and activity level Dr. Zalikha reviews these factors with you and recommends the approach that best fits your situation. He does not push patients toward surgery. He makes sure patients have the information they need to make a confident decision.