Health condition · Clinically reviewed
Osteoarthritis (hip & knee), what actually works, and when to consider surgery.
Joint wear that becomes symptomatic in many people over 50. Exercise, weight and simple analgesia carry most of the load — with injections and joint replacement when needed.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BOA or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK guidance on conservative care, injections and joint replacement.
Key facts
Hip & knee OA at a glance.
The essentials, in plain English — what osteoarthritis of the hip and knee is, why it hurts, and what the evidence says actually helps.
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Definition
Osteoarthritis is a mechanical and inflammatory joint disease — not simply cartilage wearing away.
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How common
Very common with age — the majority of adults over 50 have some radiographic change, with a large minority becoming symptomatic.
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Not "just" wear
Low-grade inflammation is real and contributes to pain and stiffness — it is not purely mechanical.
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Exercise wins
Structured exercise is the highest-evidence intervention — better than any single drug for pain and function.
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Weight matters
Losing 5–10% of body weight (if BMI > 25) meaningfully reduces knee and hip load and symptom scores.
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Surgery works
Total hip and knee replacement is transformative when done well — one of the most successful operations in medicine.
Why this guide matters
Movement, not rest, is the treatment.
Osteoarthritis of the hip and knee gets better with the right load, not with avoiding it — this guide shows what that looks like in practice.
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Exercise beats any single drug
Structured strengthening and load management have the strongest evidence for reducing pain and improving function.
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Weight is a huge lever
Losing 5–10% of body weight (if BMI > 25) meaningfully reduces joint load and symptom scores.
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Surgery when it is right, not before
Joint replacement is genuinely transformative — but only when conservative measures have been given a real chance first.
How the diagnosis is made
From painful joint to a clear plan.
The steps a UK GP will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Symptoms, examination and X-ray
Phase 2 · Confirming
MRI and bloods to rule out alternatives
Phase 3 · Managing
Physio, then specialist if needed
- 01
Recognising
Symptom pattern & function
Which joints, when it hurts, what you can and cannot do — the story is more telling than any single test.
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Recognising
Clinical examination
Range of movement, crepitus, effusion, gait and specific joint tests point to hip vs knee vs referred pain.
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Recognising
Weight-bearing X-ray
The standard first-line imaging — joint space narrowing, osteophytes and subchondral change show up here.
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Confirming
MRI if uncertain or younger
Useful if the diagnosis is unclear, if the patient is under 50, or to rule out other soft-tissue causes.
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Confirming
Bloods to rule out RA / gout
CRP, rheumatoid factor, CCP antibody and urate — to make sure it is not inflammatory or crystal arthritis.
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Managing
Physiotherapy assessment
The single most useful intervention — tailored strengthening, load management and function goals.
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Managing
Orthopaedic consultation
For severe or refractory disease — to discuss injections and, when appropriate, joint replacement.
Typical timeline: 2–6 weeks from first appointment to a settled plan.
Symptoms
What hip & knee OA actually feels like.
The pattern is more telling than any single symptom — worse with use, short morning stiffness, and gradual loss of function.
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Joint pain on use
The classic pattern — worse with activity and weight-bearing, better with rest.
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Morning stiffness (short)
Usually under 30 minutes — much longer suggests inflammatory arthritis instead.
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Loss of range of motion
Progressive stiffness — putting on socks, getting out of a low chair or climbing stairs gets harder.
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Functional limitation
Walking distance shortens, sleep is disturbed, and specific tasks (stairs, kneeling) become the sore spots.
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Deep aching
A dull, deep ache in the groin (hip) or around the knee — often worse at the end of the day.
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Effusion
A boggy swelling — especially at the knee after activity — can be recurrent in advanced disease.
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Gel phenomenon
Stiffness after sitting still that eases within a few minutes of getting moving again.
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Red flag
Hot swollen joint with fever — same-day A&E to exclude septic arthritis.
Treatment
How hip & knee OA is treated in the UK.
A staged approach — exercise and weight first, then simple analgesia and injections, with joint replacement reserved for severe disease.
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Structured exercise + physio
The highest-evidence single treatment — tailored strengthening and load management, kept up long-term.
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5–10% weight loss (BMI > 25)
Reduces mechanical load and symptom scores meaningfully — every kilogram counts at the knee.
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Paracetamol + topical NSAID
First-line pain relief — topical ibuprofen or diclofenac is often as effective as oral, with fewer side effects.
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Oral NSAID (short course)
For flares — short, defined courses with a gastric protector if used regularly, not indefinitely.
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Intra-articular steroid injection
Short-term relief for painful flares of hip or knee OA — useful to unlock rehabilitation.
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Hyaluronic acid injection (knee)
Selected patients with knee OA — modest evidence but can extend the interval before surgery.
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PRP injection (specialist)
Platelet-rich plasma — an option in specialist hands for mild-to-moderate knee OA; evidence still evolving.
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Total joint replacement
For severe disease that no longer responds to conservative care — genuinely transformative when done well.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or orthopaedic team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).
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British Orthopaedic Association. Standards and clinical guidance.
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Versus Arthritis. Patient information and support.
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European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
Red flags
When a painful joint becomes an emergency.
Most osteoarthritis is chronic and can be managed patiently. These are the situations where waiting is the wrong call.
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Hot swollen joint with fever
Possible septic arthritis — same-day A&E, do not wait.
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Locking joint
A mechanically locking knee suggests a loose body or unstable meniscal tear — orthopaedic review.
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Rapid deterioration
A joint that collapses over weeks — think avascular necrosis or rapidly destructive OA. Prompt imaging.
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Unexplained weight loss
With joint pain — investigate systemic causes before assuming OA.
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Post-injection infection
Increasing pain, redness or fever days after an injection — same-day review.
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Post-replacement complication
New pain, swelling, warmth or wound problems after a hip or knee replacement — contact your surgical team.
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Neurological signs from the spine
Referred pain from lumbar spine with weakness, numbness or bladder change needs urgent assessment.
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Very young patient with severe OA
Under 40 with severe joint damage — look for a specific underlying cause.
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Suspected inflammatory arthritis
Prolonged morning stiffness, symmetrical small-joint involvement — refer to rheumatology, not orthopaedics.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — movement, a flare plan, weight and regular reviews.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Movement
Keep the joint moving
Cartilage and periarticular muscle both do better with load than with rest — tailored activity is protective.
- 02 Flares
Have a flare plan
Short course of oral NSAIDs, a few days of relative rest, then straight back into rehab exercises.
- 03 Nutrition
Weight and diet
A Mediterranean-style diet plus a modest calorie deficit — 5–10% weight loss is a huge lever if BMI > 25.
- 04 Reviews
Reassess yearly
Symptoms, function and treatment plan reviewed at least annually — earlier if function changes.
Frequently asked
Everything we get asked about hip & knee OA.
Quick answers on exercise, weight, injections, joint replacement and when to seek help.
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Is osteoarthritis just wear and tear?
No. Osteoarthritis is both mechanical and inflammatory — low-grade joint inflammation contributes to pain and stiffness. Framing it as inevitable wear is unhelpful and outdated.
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Will exercise make my osteoarthritis worse?
No — structured exercise is the single most effective treatment for hip and knee OA. Tailored strengthening and load management reduce pain and improve function, even in painful joints.
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How much weight loss actually helps?
For anyone with a BMI over 25, losing 5–10% of body weight meaningfully reduces knee and hip load and symptom scores. Every kilogram counts, especially at the knee.
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When should I consider a joint injection?
Steroid injections are useful for painful flares that stop you engaging with rehabilitation. They give short-term relief — the aim is to unlock exercise, not to be a long-term solution.
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When is joint replacement the right answer?
When conservative treatment — exercise, weight, pain relief and injections — no longer controls pain or function, and imaging fits the clinical picture. Hip and knee replacement are among the most successful operations in medicine.
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What is the red flag I should not ignore?
A hot, swollen joint with fever — go to A&E the same day to exclude septic arthritis. Rapid deterioration, locking or post-operative infection also need prompt review.