Symptoms of knee osteoarthritis: from pain to warning signs

Mechanical pain and other symptoms of knee osteoarthritis

Mechanical pain is the primary symptom of knee osteoarthritis. It appears during physical activity (walking, climbing or descending stairs, prolonged standing) and subsides with rest. Its location varies depending on the affected compartment: the inner side of the knee, the outer side, or the front.

Morning stiffness is common, particularly upon waking or after a long period of inactivity. It generally subsides after a few minutes of walking (the "warm-up" effect) and rarely lasts more than 30 minutes in cases of knee osteoarthritis.

Knee swelling indicates a synovial effusion, which is an excess of joint fluid. It often occurs after significant physical exertion or at the end of the day. When it appears suddenly and is accompanied by local heat and intense nighttime pain, it is referred to as a congestive flare-up : an acute inflammatory episode that can occur in patients with known knee osteoarthritis.

Cracking sounds (crepitus during movement), locking or giving way (the knee briefly buckling when changing direction) are also reported by some patients.

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Symptoms vary depending on the knee compartment

Symptoms of knee osteoarthritis are not all the same. Their location and the circumstances in which they occur vary depending on the affected joint compartment.

Femorotibial osteoarthritis (medial or lateral):

• Pain on the inside or outside of the knee, often worsened by walking on uneven ground
• Knee giving way when changing direction or using stairs
• Possible progressive knee deformity: bow-legged (genu varum) for medial involvement, knock-kneed (genu valgum) for lateral involvement

Patellofemoral osteoarthritis (between the kneecap and the femur):

• Pain at the front of the knee, around or behind the kneecap
• Worsened by walking down stairs, prolonged sitting, or squatting
• Cracking sensations at the front of the knee during flexion

When symptoms warrant a doctor's visit

For patients with a known and monitored case of knee osteoarthritis, pain during exertion and mild swelling after long walks are typical. These symptoms should be managed through regular medical follow-ups.

Other signs require a more urgent consultation:

• Sudden swelling of the knee that is hot and painful, without any specific exertion
• Intense nighttime pain that differs from what is usually felt
• Fever accompanied by joint pain
• Sudden loss of mobility or persistent locking of the knee

These signs may suggest other conditions, such as infectious arthritis, a chondrocalcinosis flare-up (calcium deposits in the joint), or gout. They require a medical evaluation to determine the underlying cause.

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Symptoms of knee osteoarthritis vary depending on the affected compartment, the patient's profile, and the progression of the condition. When the clinical picture is unclear or the initial diagnosis raises questions, a second opinion can provide additional insight.

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