Knee pain in older adults: arthritis and other causes, what helps, walking aids, stairs and falls

Common in later lifeStrong evidence

About 1 in 4 people over 55 have a lasting spell of knee pain in a year, and about 1 in 10 have painful, disabling knee osteoarthritis, a review of UK community studies from the 1990s found. In 7,878 people aged 50 and over in North Staffordshire, most kinds of pain became less common with age, but pain in the hips, knees and feet didn't, and pain that got in the way of daily life rose with age.

The knee is the commonest joint for osteoarthritis worldwide, most common at ages 80 to 84, and osteoarthritis is commoner in women; higher body weight accounted for about a fifth of the burden in global estimates. Arthritis UK's 2026 report puts the number of people in the UK with knee osteoarthritis at 6.4 million (its knee page says over 5 million), with symptoms usually starting around 55.

Sources 1, 2, 3, 4, 5

Osteoarthritis comes first, and it isn't the knee wearing outStrong evidence

The NHS says joints meet a constant low level of everyday damage that the body usually repairs; osteoarthritis is when that repair falls behind, and it doesn't necessarily get worse over time and can sometimes improve. Arthritis UK describes the knee's repair becoming less effective, and says the changes in the joint don't always match the pain people have.

The National Institute for Health and Care Excellence (NICE) diagnoses osteoarthritis without an X-ray in people aged 45 or over with pain on activity and morning stiffness of 30 minutes or less. Knees are often most painful walking up or down hills or stairs, and may give way. Pain and X-rays often disagree: in one review, 15% to 76% of people with knee pain had osteoarthritis on X-ray, and 15% to 81% with X-ray changes had pain. Weaker thigh muscles went with a higher chance of knee osteoarthritis with symptoms across 5 cohorts (odds ratio 1.65), which is one reason strength work matters.

Sources 6, 5, 7, 8, 9, 10

The other common causes, and how common each isEmerging evidence

Worn (degenerative) meniscus tears showed on magnetic resonance imaging (MRI) in 19% of women in their 50s up to 56% of men aged 70 to 90 in a community sample, and 61% of people with a tear had had no knee pain, aching or stiffness in the previous month. An awkward twist getting up from a chair can be enough to tear an ageing meniscus, the American Academy of Orthopaedic Surgeons says, with catching, locking or swelling.

A Baker's cyst, a fluid-filled lump behind the knee, is commonest between 35 and 70 and usually comes from osteoarthritis, an injury, rheumatoid arthritis or gout; it was found on MRI in a third of people with painful knee osteoarthritis, and on ultrasound in about a quarter of people with knee pain.

Gout affected 2.49% of people registered with UK GPs in 2012, rising with age and levelling off after 80; it brings sudden, severe pain with hot, swollen, red skin over a joint, usually the big toe but sometimes the knee. Calcium crystal arthritis (pseudogout) is rare before 60, most often affects the knee, and an attack can look like gout or an infection; calcium deposits showed on knee X-rays in about 7% of UK adults over 40, rising steeply with age, though deposits on an X-ray aren't the same as attacks. NICE asks doctors to think of gout, calcium crystals and infection in any painful, red, swollen joint.

Sources 11, 12, 13, 14, 15, 16, 17, 18, 19, 20

The hip can be felt in the kneeMixed evidence

Studies disagree on how often. In 60 people waiting for a hip replacement, 47% had pain below the knee, but in 51 people whose pain was confirmed to come from the hip joint, only 2% felt it in the knee. In a series of 21 people referred with knee pain who turned out to have hip arthritis, about half had knee surgery first, and 14 of 17 had complete relief of the knee pain after a hip replacement. Groin or thigh pain, a stiff hip, and trouble putting on shoes and socks or getting in and out of a car point to the hip.

Case reports describe a broken hip in an older adult felt only as knee pain. The NHS broken hip page names pain in the hip, upper leg and groin, not the knee, so our line on knee pain after a fall is our suggestion from those reports: after a fall, knee pain with hip or groin pain, or trouble putting weight on the leg, gets checked as a possible broken hip.

Sources 21, 22, 23, 8, 24, 25, 26

Sudden, severe pain with no injury: an insufficiency fractureEmerging evidence

A small fracture under the joint surface (a subchondral insufficiency fracture, once called spontaneous osteonecrosis) causes sudden, often one-sided knee pain without an injury, out of proportion to the X-ray, mostly from about 60 and more often in women. It is uncommon (2.94% of 340 painful knees that had MRI in one review), early X-rays are often normal, and MRI shows it. Most early cases improve with protected weight-bearing, using crutches or a stick for some weeks, though some go on to need surgery; no trial has compared treatments.

Sources 27, 28

Knee pain and fallsStrong evidence

At least a third of people over 65 living at home fall each year. Knee osteoarthritis went with more falls across 21 studies (risk ratio 1.35), and pain with repeated falls across 7 studies (odds ratio 2.04). In knee osteoarthritis, poor balance, muscle weakness and other conditions predicted falls, while the evidence on knee pain itself was conflicting. The World Falls Guidelines call pain and arthritis risk factors for falling, and the NHS lists conditions that affect mobility or balance, such as arthritis, among the causes of falls.

Sources 29, 30, 31, 32, 33, 34

Infection, clots and inflammatory arthritis: the causes not to missStrong evidence

A joint infection brings sudden severe pain in one joint, hot, swollen or red skin, difficulty moving or putting weight on it, and usually a fever, although not everyone has one; it is more likely with rheumatoid arthritis, a weakened immune system, recent joint surgery, an artificial joint such as a knee replacement, or diabetes. A blood clot in a leg vein (deep vein thrombosis, DVT) brings throbbing pain and swelling in one leg, and is more likely over 60, after surgery, 3 or more days in bed, or a journey of over 4 hours; a burst Baker's cyst looks just like it. Morning stiffness that lasts much longer than 30 minutes, with swelling in several joints, can be an inflammatory arthritis such as rheumatoid arthritis.

Sources 35, 36, 15, 37, 6

When a scan or test helpsStrong evidence

Usually not for osteoarthritis: NICE diagnoses it from symptoms and doesn't routinely use imaging to diagnose it or to follow it up, and meniscus tears and other scan findings are common in knees that don't hurt. NICE's reasons to look further are a recent injury, long morning stiffness, symptoms getting rapidly worse or a change of shape, a hot swollen joint, or a worry about infection or cancer.

Tests answer specific questions: an X-ray after a fall or an injury when you can't take 4 steps or you're 55 or over (the Ottawa knee rule); an urgent X-ray of the hip when a broken hip is possible, and an X-ray of the hip when the hip may be the source; an ultrasound within 24 hours for a suspected clot, which also tells it from a burst Baker's cyst; fluid drawn from the joint for a suspected infection, or when gout or calcium crystals are uncertain; an MRI for sudden severe pain with a normal X-ray; and blood tests for suspected inflammatory arthritis.

Sources 7, 11, 38, 26, 23, 36, 15, 18, 27, 37

How it usually goesEmerging evidence

Osteoarthritis often comes in flares that settle, and it doesn't necessarily get worse; new knee pain, or a flare of a long-standing problem, usually begins to settle within 6 weeks, NHS inform says. Exercise helps over weeks: the Danish GLA:D programme runs for 6 weeks, and its gains held at a year.

An untreated gout attack usually lasts 1 to 2 weeks. A Baker's cyst can take a few months to a few years to settle, and a burst one a few weeks. Most early insufficiency fractures improve over weeks of protecting the knee, though some need surgery. No one can promise a timescale.

Sources 6, 39, 40, 17, 15, 28

Exercise is the main treatment, at any ageStrong evidence

NICE makes therapeutic exercise, and weight management where it applies, the core treatments for osteoarthritis, and says joint pain may rise when you start exercising while regular exercise still helps your joints. Across 139 trials of 12,468 people, exercise eased knee osteoarthritis pain by about 9 points out of 100 against a placebo or attention, and by 13 against usual care (low-certainty evidence), and improved function by 11 to 13 points (moderate certainty), with possibly more minor side effects. "Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness", the NHS says.

Programmes focused on the thigh muscles (the quadriceps), and supervised ones at least 3 times a week, did more in an analysis of 48 trials, and the benefit was similar whatever the X-ray showed.

Sources 7, 41, 42, 43

Exercise doesn't wear the knee outEmerging evidence

Exercise that loads the knee didn't seem to harm cartilage in 9 trials (low-quality evidence). In 1,212 people aged 50 and over with knee osteoarthritis, those who walked for exercise were less likely to develop new frequent knee pain (odds ratio 0.6), and across 17 studies, recreational runners had less hip and knee osteoarthritis (3.5%) than people who didn't run (10.2%). The NHS treatment page, which is past its review date, still warns that too much exercise too quickly, or the wrong sort, may damage your joints, without giving evidence; building up gradually covers that worry.

Sources 44, 45, 46, 42

Supervised programmes help, and older adults do them wellEmerging evidence

In Denmark's GLA:D programme (3 education sessions and 12 supervised exercise sessions over 6 weeks; the knee group's average age was 64), knee pain fell by about 14 points out of 100 and stayed down at a year, and fewer people took painkillers; there was no control group, so the true effect is probably smaller. In 76 people aged 60 to 77 with severe hip or knee osteoarthritis, a similar programme was done with pain kept to 5 out of 10 or less. Across 36 studies, older adults lost no more muscle function after unaccustomed exercise than younger adults, and reported less soreness.

Sources 40, 47, 48

Weight, if it appliesStrong evidence

For people living with overweight or obesity, NICE says weight loss will improve quality of life and physical function and reduce pain, that any amount of weight loss is likely to help, and that losing 10% of body weight is likely to help more than 5%. In 454 adults aged 55 and over, diet plus exercise (11.4% weight loss) eased pain more than either alone over 18 months, and across 4 trials, disability improved once more than about 5% had been lost. It is one treatment among several, alongside exercise, never a precondition for help.

Sources 7, 49, 50

Walking sticks, shoes and insolesEmerging evidence

NICE says consider walking aids such as sticks, crutches, frames and rollators. In 64 people with knee osteoarthritis, using a cane every day for 2 months eased pain and improved function a little; the NHS says hold a stick on the opposite side to the sore leg, so it takes some of your weight.

In 164 people with knee osteoarthritis, stable, supportive shoes eased walking pain more than flat, flexible ones over 6 months (by about 1 point out of 10), but special unloading shoes did no better than ordinary walking shoes, and wedged insoles did no better than flat ones over a year. The evidence on braces is inconclusive, and NICE doesn't routinely offer insoles, braces or supports unless the knee is unstable and exercise alone isn't enough.

Sources 7, 51, 42, 52, 53, 54, 55

Medicines: a gel firstStrong evidence

NICE says offer an anti-inflammatory gel for knee osteoarthritis first; consider an anti-inflammatory tablet if that isn't enough, at the lowest dose for the shortest time, with a medicine to protect the stomach and care with age, kidney and heart risks; don't routinely offer paracetamol or weak opioids; and don't offer glucosamine or strong opioids. The NHS adds that anti-inflammatory tablets may not suit people with asthma, a stomach ulcer or angina, or after a heart attack or stroke. Opioid painkillers raise the risk of falls, the World Falls Guidelines note.

Sources 7, 42, 33

Injections: short-term help at bestStrong evidence

NICE says consider a steroid injection when other treatments haven't helped or to support exercise, explaining that the relief lasts 2 to 10 weeks; Arthritis UK adds that it can only be repeated a few times, as the benefit may get shorter each time. NICE doesn't offer hyaluronic acid injections, and allows platelet-rich plasma injections only with special arrangements because the evidence is limited.

Sources 7, 56, 5

Keyhole surgery doesn't help a worn kneeStrong evidence

Removing part of a worn meniscus did no better than a placebo operation in 146 people aged 35 to 65, or than 12 weeks of supervised exercise at 2 years in 140 people. Across 9 trials, keyhole surgery gave a small benefit that faded within months, with rare but serious harms such as clots. A guideline panel makes a strong recommendation against keyhole surgery in nearly all worn knees, with or without catching or a sudden start, the possible exception being a knee that is truly locked, and NICE says don't offer washout or debridement for osteoarthritis. An older NICE procedure guidance from 2007 still allows washout with debridement, which conflicts with the current guideline.

Sources 57, 58, 59, 60, 7, 61, 5

A knee replacement: for knees that still hold you backStrong evidence

NICE suggests considering referral for a knee replacement when symptoms substantially affect your quality of life and non-surgical treatment hasn't worked, and says no one should be ruled out because of age, sex, smoking, other conditions, or overweight or obesity. In 100 people eligible for one, surgery plus non-surgical care did better at a year than non-surgical care alone, with more serious adverse events (24 against 6), and 37 of the 50 given non-surgical care hadn't had the operation a year later. Only about 1 in 10 people with knee osteoarthritis go on to have a replacement, Arthritis UK says; 134,652 were done in England, Wales and Northern Ireland in 2024, 98% of them for osteoarthritis.

Sources 7, 62, 5, 4

Strength and balance exercise prevents fallsStrong evidence

Across 108 trials of 23,407 people with an average age of 76, exercise cut the rate of falls by 23% and the number of people falling by 15% (high-certainty evidence). The World Falls Guidelines recommend balance-challenging and functional exercise, such as sit-to-stands and stepping, 3 or more times a week, made harder over at least 12 weeks and continued for longer effect.

The Otago home programme of leg strengthening and balance exercises cut falls and fall injuries by about a third in 1,016 people aged 65 to 97, and people aged 80 and over gained most in fewer injuries; across 7 trials, only 36.7% of those still taking part at a year were exercising 3 or more times a week. NICE asks for falls programmes that are progressive and tailored, and the NHS advises strength and balance activities at least twice a week; its own strength and balance exercise pages start with 5 slow sit-to-stands, side-stepping, heel-to-toe walking and one-leg stands next to a wall or a sturdy chair.

Sources 29, 33, 63, 64, 65, 34, 66, 67

A flare: the first 48 hours (written steps)

Our 3D figure can't show these. Each step names its source.

• 1. Reduce your activities but keep moving as much as your symptoms allow; raise the leg when you rest; move the knee gently for 10 to 20 seconds every hour while you're awake; and avoid long periods on your feet. After 48 hours, use the leg more (NHS inform).
• 2. Heat or ice, whichever helps, for no more than 20 minutes at a time and a few hours apart, and neither if you have problems with circulation or feeling in the leg (NHS inform).
• 3. In a gout attack, rest and raise the limb, use an ice pack wrapped in a towel for up to 20 minutes at a time, keep bedclothes off the joint at night and don't put pressure on it (the NHS).
• 4. With a Baker's cyst, rest the knee, use a wrapped ice pack for around 10 minutes at a time, and raise the leg (the NHS).

Sources 39, 17, 15

Walking and a walking stick (written steps)

These come from the NHS, an NHS trust and NICE, unless they say editorial.

• 1. Keep walking, little and often, on flatter routes during a flare (editorial); walking for exercise went with less new frequent knee pain in a large cohort. Build towards 150 minutes a week of moderate activity, which the NHS advises for people with osteoarthritis, with strength exercises on 2 or more days.
• 2. Hold a walking stick in the hand opposite the sore knee, so it takes some of your weight (the NHS). Set the handle at wrist height, wear supportive flat shoes, and replace a worn rubber tip (an NHS trust).
• 3. Walking with a stick, the trust's order is the stick forward a stride's length, then the sore leg, then the good leg. To stand up from a chair, push up from the chair arm, not the stick.
• 4. You can borrow some sticks and frames through the NHS; get the height checked, and ask a physiotherapist before using a stick on steps (the NHS). NICE says consider sticks, crutches, frames and rollators.

Sources 45, 6, 42, 71, 72, 7

Stairs, shoes and chairs (written steps)

Each step names its source.

• 1. On stairs, lead with your good leg going up and your sore leg coming down, and use the handrail (NHS inform and Arthritis UK). With a stick and a rail: good leg up first, then the sore leg and the stick; coming down, the stick first, then the sore leg, then the good leg (an NHS trust).
• 2. Rails on steps and grab rails in the bathroom help prevent falls (the NHS).
• 3. Shoes with shock-absorbing soles (the NHS) or thick soles with room for your toes (Arthritis UK); stable, supportive shoes eased walking pain more than flat, flexible ones in a trial. Shoes or slippers that fit well, don't slip off and grip (the NHS). Wedged insoles and special unloading shoes did no better than ordinary ones in trials.
• 4. Choose a firm chair that isn't too low, ideally with arms. Sit near the front, feet slightly back, lean forward and stand up slowly, using your hands on the chair if you need to (the Otago booklet). If a chair is too low, a cushion on the seat helps until you don't need it (Arthritis UK).

Sources 39, 5, 71, 34, 42, 52, 54, 53, 70, 73

If you fall, and around the home (written steps)

These come from the NHS falls page, unless they say otherwise.

• 1. If you fall, take a couple of minutes to check for pain or injury. If you feel able to get up, take your time: roll onto your side, push up onto your hands and knees, crawl to something stable such as a heavy chair, put one foot flat on the floor and stand up slowly, holding on.
• 2. If you can't get up, use a phone or personal alarm, or shout or bang for help; keep warm and keep moving gently while you wait. Don't try to lift someone else who has fallen.
• 3. Around the home: a non-slip mat in the bath or shower, a personal alarm or a mobile phone with you, less clutter and nothing to trip on such as loose wires or rugs, and help with tasks you find difficult, such as lifting or reaching. Your local council can do a free care needs assessment, including changes to make your home safer.
• 4. Have regular eye and hearing checks, and ask a GP or pharmacist if your medicines could be affecting your balance; opioid painkillers raise the risk of falls (the World Falls Guidelines).
• 5. Practising getting down to the floor and back up is the plan's last stage, and in some areas you can refer yourself to a falls service after a fall.

Sources 34, 33

Weight, if it applies

For people living with overweight or obesity, NICE says any weight loss is likely to help, and 10% is likely to help more than 5%. It sits alongside exercise as a core treatment, not a test you have to pass first; our weight loss exercise page covers how activity fits in.

Source 7