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Understanding the Five Stages of Osteoarthritis of the Knee

Arthritis is today one of the most common ailments afflicting people of all ages. Arthritis commonly affects one or more joints of the body and is associated with pain, stiffness of the joints and swelling. While any joint of the body may get affected by arthritis, the disease particularly affects the knee first. Osteoarthritis is the most common form of arthritis that affects the knee.[1] Osteoarthritis of the knee can be divided into five specific stages, with stage 0 implying a healthy knee. Some medical communities tend to cover only four stages, skipping stage 0 and starting the diagnosis from stage 1 only. Understanding the five stages of osteoarthritis of the knee is important to understand how osteoarthritis of the knee develops and what you can do to control and treat its symptoms.[2]

What is Osteoarthritis?

Osteoarthritis (OA) is one of the most common forms of arthritis that affects the knee. Osteoarthritis is typically divided into five or four stages. While Stage 0 in osteoarthritis implies a strong and healthy knee, by the time the patient reaches stage 5 of osteoarthritis, a surgical intervention might be required to fix the knee.

Osteoarthritis of the knee not only affects the bone of the knee, but it also affects the cartilage and the synovium of the knee joint. While the cartilage is responsible for providing a smooth surface for allowing joint motion and also provides a cushion between bones, the synovium lines the joints and produces a lubrication fluid known as the synovial fluid. Synovial fluid also supplies oxygen and nutrients to the cartilage of the knee. When the knee gets affected by osteoarthritis, the cartilage and the synovium are no longer able to function properly, thus the knee joint is left without any protection and lubrication. This is the primary reason why bone damage occurs in osteoarthritis. When the knee gets affected by osteoarthritis, it causes pain and stiffness and the symptoms tend to worsen over a period of time.[3]

What are the 5 Stages of Osteoarthritis of the Knee?

What are the 5 Stages of Osteoarthritis of the Knee?

Most doctors assign stage 0 in osteoarthritis to a normal and healthy knee and stage 4 in osteoarthritis is assigned to severe osteoarthritis. At stage 4, osteoarthritis is already likely to be causing an immense amount of pain and has already started disrupting the knee joint movement.

Let us understand each stage of osteoarthritis individually.

Osteoarthritis-Stage 0:

Stage 0 of osteoarthritis of the knee is known to be a stage where your knee health is normal. At this stage of osteoarthritis, the knee joint functions without any pain or impairment and shows no symptom of having osteoarthritis either. No treatment is required at stage 0 of osteoarthritis.

Osteoarthritis-Stage 1:

An individual who has stage 1 of osteoarthritis of the knee starts showing a very minor level of bone spur growth. These are bony outgrowths that begin developing at places where the bones meet each other at the knee joint. A person having osteoarthritis stage-1 does not generally experience any discomfort or pain since there is very little wear and tear of the knee joint. Since there are no symptoms that a person experiences at this stage of osteoarthritis, doctors typically do not recommend any type of treatment for stage 1 osteoarthritis. However, if it’s known that you have a predisposition to osteoarthritis or if you are at an increased risk for getting osteoarthritis of the knee, then your doctor may start you on supplements such as chondroitin and glucosamine. You may also be recommended a specific exercise routine for getting relief from any minor knee osteoarthritis symptoms and to also slow down the progression of osteoarthritis.

Osteoarthritis-Stage 2:

Stage 2 of osteoarthritis of the knee is considered to be a mild stage of the disease. At this stage of osteoarthritis, when x-rays are undertaken, it shows greater bone spur outgrowth, though at this osteoarthritis stage, the knee cartilage is still found to be at a healthy stage. The space between the joint bones are found to be normal and there is no scraping or rubbing between the joint bones in stage 2 of osteoarthritis of the knee. Synovial fluid is also present at a level that is sufficient to allow for normal joint movement.

However, at stage 2 osteoarthritis of the knee, people begin to experience symptoms, such as greater stiffness in the joint when the knee is not moved for some time, pain after running or prolonged walking, and they may even experience tenderness while bending or kneeling. At stage-2 of osteoarthritis of the knee, treatment may be required for OA. If you start experiencing any possible symptoms of osteoarthritis, you must talk with your doctor and your doctor will then run the required tests to detect and diagnose your condition. If osteoarthritis of the knee gets diagnosed at this early stage, your doctor can develop a plan to prevent osteoarthritis from worsening further.

There are many different types of therapies available for stage-2 of osteoarthritis that can help provide relief from the discomfort and pain caused by stage 2 osteoarthritis of the knee. These are typically non-pharmacologic therapies, meaning that you do not need to take any medications for your condition. Regular exercises and a healthy diet can also help relieve your symptoms occurring from stage-2 osteoarthritis of the knee.

Osteoarthritis-Stage 3:

Stage 3 osteoarthritis of the knee is known to be moderate osteoarthritis. During this osteoarthritis stage, the cartilage between the knee joint starts showing significant damage and the space between the joint bones also begins to narrow. People who have stage-3 osteoarthritis of the knee start experiencing pain on a frequent basis, even while walking, bending, kneeling, or running. They also experience joint stiffness if they do not move the joint for too long and certain amount of swelling is also present on the joint after long periods of movement.

You may notice at stage-3 osteoarthritis of the knee that non-pharmacological therapies have stopped working now and do not provide much relief for your pain. This is where your doctor may recommend that you take cortisone injections, which is known to relieve the pain caused by osteoarthritis. The injection is injected near the knee joint. However, the effects of a cortisone injection only last for about two to three months in relieving symptoms of stage-3 osteoarthritis. Cortisone injections are also not recommended for using in the long term as steroid use over a period of time can damage the joint even more.[4] Over-the-counter pain relievers such as NSAIDs or acetaminophen can work, along with prescription pain relievers such as oxycodone and codeine for managing the symptoms of knee osteoarthritis stage-3.

Osteoarthritis- Stage 4:

The last stage, stage 4 osteoarthritis of the knee, is considered to be severe. Patients at this stage of osteoarthritis of the knee already experience a great deal of pain and discomfort while walking or trying to move the knee joint. The space between the knee joint has now dramatically reduced and the cartilage has also more or less disappeared completely, making the joint stiff and even immobile in some cases. The synovial fluid has also decreased drastically and is no longer able to reduce the friction between the joint.

If you have stage 4 osteoarthritis of the knee, osteotomy, or bone realignment surgery, is one of the more common options that doctors recommend. During this surgery, the surgeon cuts the bone from above or below the knee and either lengthen it, shorten it, or realign it, making it possible for the body to shift its weight away from the points of the knee bone where there is maximum damage caused by bone spur growth. Total knee replacement is usually the last option left for patients who are suffering from severe osteoarthritis of the knee or the last stage, which is the stage-4 of osteoarthritis of the knee. Due to the side effects and long recovery period involved in this surgery, many elderly people often decide to forego the procedure.[5]


It is possible for a person to not notice any of the early symptoms of osteoarthritis of the knee till the disease has already progressed to a moderate or severe level. It is also not necessary that every knee pain will be a resultant of osteoarthritis of the knee only. If you experience any osteoarthritis symptoms that persist over a period of 10 to 15 days, then it is recommended that you consult your doctor. Your doctor will examine your joints, test their mobility, and also check for damage, and then only will they be able to conclude if you are suffering from osteoarthritis of the knee, and if so, then to what stage your osteoarthritis has reached. It is not recommended that you start self-medicating yourself without getting a proper diagnosis of osteoarthritis from your doctor.


Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 18, 2023

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