Overview 

Degenerative joint disease is an umbrella term for conditions that gradually wear down the knee joint, causing pain and reduced mobility. The most familiar form is osteoarthritis (OA) — affecting roughly 1 in 5 UK adults over 45 and a leading cause of disability. Each year, it drives over 80,000 knee replacements across the UK.

OA is the leading cause of cartilage damage, but not the only one. Injury, infection, inflammatory conditions like rheumatoid arthritis, and several rarer conditions can also be to blame.

It's tempting to write OA off as simple "wear and tear" from ageing. There's a grain of truth here, but not the whole picture — if ageing alone caused OA, everyone would develop it eventually, and they don't. In fact, research shows the cartilage changes in OA are distinct from those of normal ageing.

What's really happening is an imbalance within the joint: enzymes that break down cartilage (MMPs) ramp up, while the body's natural "brakes" on them (TIMPs) lose effectiveness. The result is progressive cartilage breakdown.

What causes Osteoarthritis?

The exact causes remain unclear, but known risk factors include:

  • Higher body weight (BMI)
  • Occupation and activity levels
  • Age
  • Genetics
  • Sex (more common in women)
  • Ethnicity (lower rates observed in people of Afro-Caribbean descent)

Symptoms

The most common symptoms of knee osteoarthritis include:

  • Pain during walking, which can become severe enough to disrupt sleep
  • Swelling around the joint
  • Stiffness and reduced range of movement
  • Difficulty walking or staying active

Pain often leads people to use the affected joint less, which can cause the surrounding tissues to stiffen and further limit movement. Reduced activity also weakens the supporting muscles, placing additional strain on the joint — creating a cycle that can gradually make symptoms worse if left untreated.

Treatments  

OA treatment depends on symptom severity, disease stage, age, and activity level — ranging from conservative management to surgery.

Conservative Measures

The usual starting point is conservative management with:

  • Lifestyle & physiotherapy

    Weight loss and targeted exercise to strengthen the muscles around the joint are foundational. Dietitian input can help too.
  • Injections
    • Three main types: ‍
      • Steroids - Once the go-to for pain and swelling, but repeated use is now linked to faster cartilage breakdown and earlier joint replacement, so they're used more sparingly.‍
      • Hyaluronic acid - Cushions and lubricates the joint for symptom relief, though it doesn't slow arthritis progression.‍
      • PRP (platelet-rich plasma) - Uses growth factors to help preserve cartilage, reduce inflammation, and rebalance the enzymes that break it down.

Surgical Options

  • Joint preservation

    A modern approach focused on keeping the natural knee intact as long as possible — especially important for younger patients, since early replacement is best avoided.
  • Joint replacement

    Highly effective for older patients with wear across all three compartments and limited mobility. Implants typically last 15-20 years before needing revision, which gets trickier in younger, more active patients. For younger patients with single-compartment arthritis, preservation is usually the better route.

Frequently asked questions

Diagnosis usually begins with an X-ray, which helps identify the classic signs of joint degeneration, including:

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  • Narrowing of the joint space
  • Formation of bony growths (osteophytes)
  • Small cysts beneath the joint surface
  • Hardening of the bone (sclerosis)
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In some cases, an MRI scan may also be recommended to examine the joint in more detail and help guide the most appropriate treatment plan.
Once your results are reviewed, we'll discuss the findings with you and recommend the treatment approach best suited to your needs.

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Yes. Excess weight puts additional stress on weight-bearing joints like the knees and hips, and can accelerate cartilage breakdown. Weight loss can significantly reduce pain and slow progression.

Yes — in fact, it's usually recommended. Low-impact activities like swimming, walking, and cycling can strengthen muscles around joints, improve flexibility, and reduce pain, as long as they're tailored to the individual's condition.

It's most common in people over 50, but it can develop earlier, particularly after joint injuries or in people with genetic predisposition.

If you experience persistent joint pain, stiffness, swelling, or reduced range of motion that affects daily activities, it's a good idea to book an appointment with a knee specialist for evaluation. 

Please use the link below to make an enquiry and we will be in touch to book an initial appointment with Mr Barkatali.

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