The 4 Stages of Knee Osteoarthritis - Brace Direct

The 4 Stages of Knee Osteoarthritis

As a person ages, the body begins declining in one or more areas. The knees are prone to deterioration, especially in athletes or individuals with demanding jobs. 

A common condition resulting from wear and tear is osteoarthritis (OA), and millions of people suffer from it every day. About 80% of adults 55 and older have a diagnosis of osteoarthritis. More than half are symptomatic.

What is Osteoarthritis?

Osteoarthritis is a form of arthritis that affects the cartilage of certain joints, mainly in the hips, knees, hands, and back. Also known as Degenerative Joint Disorder, osteoarthritis is a slowly progressive disease that occurs when the cartilage in the joints wears down and causes friction between bones. The rubbing can cause debilitating pain and swelling. 

Cartilage is the firm connective tissue that cushions the joints, much like a shock absorber, so that the ends of bones do not rub against each other. Overuse of cartilage leads to its deterioration over time. Due to the lack of blood flow, cartilage does not heal itself. Most of the damage will be permanent. 

Osteoarthritis comes in two different types: primary and secondary. Their causes are what classify them.  

  1. Primary: This is the wear-and-tear form of OA. The cartilage in the knee joint begins breaking down, mostly in joints that you use most often, such as the fingers, spine, hips, knees, and the great toes. Primary OA most often occurs in individuals above 50. 
  2. Secondary: This type of osteoarthritis affects younger individuals. It focuses on areas of previous injuries or other forms of arthritis, including rheumatoid arthritis, gout, or genetic joint predispositions. Sports injuries are common causes of secondary osteoarthritis. 

Is osteoarthritis an autoimmune disease? No, it is not. It has some possible causes and several factors that can put a person at risk for developing it. Two primary causes of OA are wear-and-tear and weakness of the joints, resulting from injury or other stress. 


OA is most common in the elderly, but it can occur at any age. Men under 45 and women over 50 are the most prone.


Osteoarthritis is partial to women, and those with arthritis are at higher risk for it. Symptoms can start as early as 40 and increase as women age. 

A woman’s anatomy plays a factor in the development of the disease. Women’s hips are wider than men’s, meaning the knees take a great deal of stress. Menopause increases a woman’s risk of developing OA due to hormonal imbalances. 


Postmenopausal women tend to gain weight, which puts more pressure on the joints, causing damage to the cartilage. Adipose (fat) tissue creates proteins that can cause the joints to swell. 


Chances of having osteoarthritis can increase if another family member suffers from it. Genetically, the risk of the disease is what passes down from one generation to another. Joint abnormalities that run in the family may be a contributor. 

Injury to the Joint

Any form of injury to the ligaments in the knee joint, whether old or new, can lead to osteoarthritis in the future. Improper body mechanics, such as twisting or lifting incorrectly, can compromise the healthy knee. 

Stress on the Joints

Sports and other events that cause repetitive movements of the knees can eventually lead to osteoarthritis. Athletes and others with an active lifestyle easily get knee injuries. 

Congenital Deformities

Sometimes birth defects can cause problems with the joints as a person ages. 

Metabolic Conditions

Diabetes and iron imbalances subject a person to developing OA.

What Are the Four Stages of Osteoarthritis?

Each stage of osteoarthritis becomes harder to treat as it progresses. Treatments vary on the severity of each phase.

Stage One – Minor

There is a small amount of wear-and-tear with little to no pain. Some cartilage may begin to thin, but the damage is minimal. Bone spurs may begin to form. 

Things to do during this phase include keeping an active lifestyle without overusing your knee and taking glucosamine/chondroitin supplements. A diet high in protein will help prevent damage. Your doctor may recommend some lifestyle changes or a special brace, depending on your symptoms. 

Stage Two – Mild

The bone spurs grow larger and cause pain, but there is not any tearing of tissues yet. Stiffness starts to set in during resting periods. You will probably start to feel stiff and sore after a period of inactivity or a rough workout. 

Low impact exercise can help with muscle strengthening.  Avoiding activities that require bending at the knee will protect against future damage. Your doctor may recommend using a brace to stabilize the joint. 

An example of a brace that many physicians use is an adjustable ROM Osteoarthritis knee brace by KOAlign. The KOAlign biomechanically unloads your medial or lateral knee allowing for you to ambulate without or reduced pain. Available by prescription only, that knee brace is ideal for those with mild to moderate OA and is adjustable by the patient. 

Stage Three – Moderate

There is a degradation of the cartilage in the joint and noticeable swelling. Bones start to rub together. Walking, sitting, or kneeling may cause the knee to pop. Treatments at this stage generally include mild analgesics, prescription-strength pain meds, such as Tramadol, or injections. You may need to wear a brace as well.

Corticosteroid injections help reduce the swelling. The steroid shots can last up to three months, and a repeat injection may be beneficial. 

Stage Four – Severe

The cartilage is almost gone while bone spurs grow even more. The synovial fluid in the knee provides a cushion between the bones. When it shifts, it leads to joint swelling and extreme pain. 

You may not be able to do everyday activities like walking, sitting, or climbing stairs without excruciating pain. Symptoms this bad will most likely lead to surgical intervention. 

Symptoms of Osteoarthritis

As osteoarthritis progresses, so do the symptoms. They usually start slow in one or two joints and get worse as time moves on. During the late stages, symptoms can be so debilitating that depression can set in. 


Pain comes with movement due to deterioration. It is usually worse with activity, but the intensity may depend on the severity of the disease. The pain can become bad enough to keep you awake at night. It can also peak in the early morning or late at night. 


Inflammation of the joint can happen any time there is damage to the soft tissue. Inflammation is a result of the immune system trying to heal the body. 


Like a sticky wheel on a shopping cart, your knee becomes stiff due to wear-and-tear. A lack of movement, such as sitting too long, can make it difficult to move around. 

Popping or Cracking

The loss of cartilage in the knee joint causes the bones to rub together. The friction between the ends of bones can lead to popping or crackling, also known as crepitus. 

Lack of Mobility

It may be harder to walk or sit due to the stiffness and pain of osteoarthritis. In the early stages of the disease, getting up and walking around can help relieve some of the stiffness. More severe cases may not make that possible. 

What is the Best Treatment for Osteoarthritis?

How to treat osteoarthritis depends on the severity of the damage. The best way to conquer the disease is to catch it early and prevent it, if possible. Losing weight is crucial because it releases some of the pressure off of your joints. 

Not only does that lessen the pain intensity, but it also slows down the disease’s progress. Anti-inflammatory medications may treat the pain and swelling, but they don’t slow down the  progress of the disease

Other treatments include topicals, steroid injections, physical and occupational therapy, nutritional supplements, low-impact exercise, and orthopedic braces, like the KOAlign Osteoarthritis Adjustable knee brace.

One form of treatment that people may overlook is diet. What you may not know is that certain foods contribute to inflammation.

Here are foods to limit or avoid completely to help defeat osteoarthritis: simple sugar, alcohol, salt, refined grains, dairy, saturated fats, MSG, and complex carbohydrates. One crucial food to consume for healing is protein. 

Surgery is usually the last resort after doctors have tried everything else or if the damage is too significant. Two common corrective procedures are bone realignment (osteotomy) and total knee replacement (TKA).


This is a bone realignment surgery that reconstructs the bone above or below the knee. It relieves some pressure from the areas of damage in the knee. 

Total Knee Replacement (TKA)

During a TKA, the surgeon replaces the damaged parts of the knee with artificial joints, consisting of plastic and/or metal.  

This should be a different article instead of an add on.

What is the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Osteoarthritis and Rheumatoid arthritis are both debilitating diseases once they reach the final stages, but they have several features that tell them apart. 

Rheumatoid Arthritis (OA)

Rheumatoid arthritis is an autoimmune disease, whereas osteoarthritis is not. With an autoimmune disease, the body attacks itself, thinking it is a foreign and harmful invader, causing systemic inflammation. 

In rheumatoid arthritis, the swelling affects multiple joints while at the same time inflicting the whole body, which makes it symmetrical. The knee may appear red. It usually requires specific medications to slow it down.  

Osteoarthritis (OA)

Osteoarthritis is an asymmetrical disease, meaning it does not always affect both sides of the body like RA. If it does, one side may seem worse than the other. 

It is a degenerative disease that focuses on particular joints, mainly the hands, hips, and knees. Unlike rheumatoid arthritis, osteoarthritis does not directly cause inflammation. If swelling occurs, it is a secondary result of damage. Muscles around the joint may become weak and sink in.