Knee osteoarthritis

We want to help you to enjoy walking again

Osteoarthritis of the knee is a very common condition, usually presenting as pain and stiffness in the knee. Articular cartilage normally lines the femur, tibia and patella inside the healthy knee. Osteoarthritis represents inflammation of the joint due to the progressive loss of this important cushioning surface. As the cushion is lost, the normal forces passing through this weight-bearing joint are no longer absorbed and instead cause micro trauma to the underlying bone, thus causing inflammation which gives you an aching pain.

Our specialists at Schoen Clinic will guide you through all your options, both conservative treatments and evidence-based surgical procedures, to remove your symptoms as quickly and as effectively as possible.

Knee osteoarthritis – What is it exactly?

We are all born with a healthy amount of cartilage covering the ends of the bones that make up the knee. This surface cartilage can wear down over time. Specialists refer to this as primary osteoarthritis of the knee. Sometimes, diseases that cause inflammation inside joints can also erode the surfaces prematurely e.g. rheumatoid arthritis, gout and psoriasis.

In addition, previous damage to ligaments or cartilage injury can also lead to a premature “post traumatic” worn surface and cause pain and instability at a younger age than might be expected from the normal aging process.

Osteoarthritis of the knee symptoms

Osteoarthritis of the knee can present with either pain, stiffness, swelling or instability. The exact symptoms depend on the location of wear within the knee. The following symptoms are signs of osteoarthritis of the knee:
  • Pain during longer walks or when going up and downstairs.
  • Swelling in the knee capsule is often present.
  • Occasional pain at the back of the knee, due to a Bakers Cyst.
  • Sometimes the knee can become unstable too and keep giving way on certain movements.
  • In the early stage, the knee may be swollen and may hurt during activity.
  • If more advanced, it can even cause pain at rest. Eventually, you may hear grinding and crunching noises in the knees on movement.

Causes of osteoarthritic knee: How does it develop?

Primary Osteoarthritis is an age-related wearing of the knee joint leading to Pain, Deformity and Loss of function. Secondary Osteoarthritis is due to:
  • Inflammatory joint disease
  • Previous cartilage surgery/meniscectomy
  • Previous Ligament injury 
  • Previous Trauma to Knee 
  • Previous infection in knee

Diagnosis: How we determine that you suffer from knee osteoarthritis?

Our experts at Schoen Clinic will check whether you suffer from knee osteoarthritis through in-depth consultation and thorough examination.

We will establish whether your knee is swollen and test its range of movement. Usually, it is possible through gentle palpation to establish the areas of maximum sensitivity which also helps better understand the degree and distribution of any degenerative change.

X-ray imaging shows changes in the knee joint

Having taken a full history and examined you, we will carry out x-ray examinations during your appointment. We use a series of special views of the knee to assess different parts of the joint. These where possible with the full weight on the joint as this creates a more accurate image of the reality of the loss of protective cushion. If the “space” between the bones is seen to be reduced, this means that the articular cartilage has been eroded. In extreme cases, the two bones will be touching.

Additional examinations in special cases

On occasion, we may choose to add another layer of imaging in addition to the plain radiographs. An MRI can sometimes be useful to assess soft tissue problems, cartilage tears and loose bodies in the knee, that often co-exist with OA. On rare occasions, a blood sample may be required or a sample of the fluid taken from inside the knee. Analysis of these will help exclude infections of a systemic inflammatory arthritis.

We will make walking easy again

If you have been diagnosed with knee osteoarthritis, we work with you to choose the best-possible therapeutic approach for your specific case. In many cases, we can use conservative treatment to stop or delay the degenerative process in your knee. This way, your native knee may be preserved for longer. We believe in giving nature a helping hand to improve the situation rather than rushing in with what may be unnecessary surgery.


If the degenerative process is more advanced and conservative approaches simply are not working then we may then offer surgical procedures as a solution. Our team of experts will be happy to give detailed advice on the appropriate procedure and discuss the pros and cons of each option to agree on the best solution for each individual patient. This is achieved through a shared decision-making process between patient and clinician.

Conservative treatment of knee osteoarthritis

Non-operative or “ conservative” treatment is almost invariably the first port of call for knee arthritis. Whilst there are a huge range of so-called “breakthrough” therapies to be found for treating knee arthritis, very few, if any, have the necessary scientifically proven outcomes to justify the risks involved. For example, there are now numerous clinics, both in the UK and abroad offering “Stem cell” injections at great cost but sadly without the level of peer-reviewed publications to prove their worth. At Schoen Clinic we will never offer any treatments that we cannot justify.

Perhaps not surprisingly the basic principles of weight loss and physio led exercise with the occasional use of anti-inflammatory medications are the mainstay of non-operative treatment. There are, however, other complementary approaches such as lubricant injection that can help a proportion of patients but by no means all.

Joint replacement surgery

Knee replacement surgery has evolved tremendously in the last 40 years. At Schoen Clinic, our leading surgeons are experts in joint replacement surgery and have some of the best results on the UK National Joint Registry.


Although called a knee replacement, the procedure could also be referred to as a resurfacing of the worn part of the knee. Your surgeon will carefully discuss the type and make of the replacement surface and also the latest techniques on sizing and aligning your new knee with you at your consultation.


Prior to surgery, you will be thoroughly assessed by our dedicated pre-assessment team including a Consultant Anaesthetist, Nurse and Physiotherapist.


Surgery generally takes 30-60 minutes and is very successful. We use the latest rapid recovery techniques both during and after surgery to keep you comfortable and most patients will be encouraged to walk as soon as 3-4 hours after surgery.


Schoen Clinic London is the first and only elective orthopaedic hospital to have resident intensive care consultants looking after its patients 24 hours a day, seven days a week, on the routine surgical ward. This enables us to pick up any post-operative medical issues early and deal with them before complications occur. It also enables us to use advanced local anaesthetic techniques on the ward after Knee replacement surgery, which in turn helps patients manage their pain better and keep mobile during the first few days after joint replacement surgery.


You will usually be discharged home two or three days after your joint replacement surgery and will be expected to have outpatient physiotherapy to make a full recovery. Some people may choose to go directly to a specialist rehabilitation facility for inpatient physiotherapy and hydrotherapy.

Rapid Recovery - Fit and active

Rapid Recovery is an evidence-based approach that can help you to recover as soon as possible after your knee surgery. One of the key principles is that you are encouraged to be part of your own recovery at all stages of your ‘patient journey’.

By effectively planning all stages carefully before and after surgery, you can help to reduce the emotional and physical stress of your operation and then have the best chance to recover faster.

Research tells us that the earlier you get out of bed and start walking, eating and drinking after your operation, the shorter your recovery time will be, allowing you to get back to normal life and the things you enjoy as quickly as possible.

Before your knee surgery
Staying active prior to your surgery will help your recovery sooner. It will stop your muscles from becoming weaker and prepare you for the rehabilitation process. We call this stage pre-habilitation. Before your operation, we will conduct a full health assessment, establishing your general health and mobility. We will explain what happens in the hospital, discussing exercises you need to do before and after surgery, and your pain management plan in detail. We also explore your home circumstances during the consultation with you, so that we may be able to advise you on things you may need to put in place before you have your surgery. This will enable you to return home to a safe and comfortable environment after your knee replacement.

After your knee surgery
You will start your rehabilitation almost immediately after your operation, working with our very specialised physiotherapist, doctors and nurses. This is one of the real advantages of being a single specialty hospital, as you will not be on a mixed ward with the team looking after all types of surgical case. Instead, our team specialise in the recovery of just orthopaedic patients. They will prepare a post-operative plan for you to follow and tailor the goals of your rehabilitation to your needs, thus ensuring the best outcomes for you. Our goal is to get you back to your daily routines as quickly and easily as possible.

Having your individual therapy plan

At Schoen Clinic, your Consultant Orthopaedic Surgeon will work with leading Sports and Exercise medicine Physicians, Consultant Anaesthetists, Specialist Nurse Practitioners, Physiotherapists and Rehabilitation experts to formulate an individual plan to shape your recovery. This process starts at your first consultation with your Consultant Knee Surgeon and will enable you to recover quickly following your knee replacement.

Knee osteoarthritis: Our specialists

Our leading knee specialists work together as a multidisciplinary team for the benefit of every patient. They make sure you receive the right treatment and the right rehabilitation plan specific to your individual needs.

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Ian Bacarese-Hamilton

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - International

Head of Department - Leg Lengthening

Consultant Orthopaedic Surgeon & Trauma Surgeon
FRCS(Orth)
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Mr Sam Rajaratnam

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - Knee

Consultant Orthopaedic Surgeon
FRCS (Tr&Orth)

 

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Mr David Sweetnam

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - Knee

Consultant Orthopaedic Surgeon
MBBS FRCS FRCS (Orth)
DipSportsMed
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Mr Alastair Davidson

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon 
MBChB; FRCS(Eng); FRCS(Tr&Orth)

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Mr Dean Michael

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon - Hip

Consultant Orthopaedic Surgeon
FRCS (Eng), FRCS ( Tr&Orth)
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Mr Rhidian Morgan-Jones

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon
MB BCh, FRCS, MMedSci, FRCS (Trauma & Orthopaedics)
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Mr Manoj Sood

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon - Hip

Consultant Orthopaedic Surgeon
BSc.(Hons) MB. FRCS(Eng.) FRCS(Tr. & Orth.)
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Mr Paul Trikha

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon & Knee Specialist
FRCS (Tr&Orth) MBBS
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Mr Jonathan Walczak

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Knee

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon - Hip

Consultant Trauma & Orthopaedic Surgeon
MB BS Bsc FRCS (Eng) FRCS (Tr& Orth)
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Prof Mike Loosemore MBE

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant in Sport and Exercise Medicine
MBBS MSc PhD FFSEM(UK)
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Dr Julian Widdowson

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant Sport Exercise Medicine Physician
MBBS MRCGP DCH DRCOG MScSEM FFSEM
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Knee osteoarthritis: Our specialised hospital

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Authors, 09.06.2020