Knee Osteoarthritis
A common cause of knee pain linked to changes in joint cartilage and surrounding structures
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Knee osteoarthritis is one of the most commonly discussed causes of knee pain, particularly in middle-aged and older adults. The term refers to a group of gradual structural changes that can occur within the knee joint over time, affecting structures such as the articular cartilage, underlying bone, and surrounding soft tissues.
The knee is the largest joint in the body and is responsible for transmitting substantial forces during everyday activities such as walking, climbing stairs, and standing from a seated position. Because the joint is exposed to repeated mechanical loading throughout life, it is normal for small structural changes to develop within the joint as people get older.
Importantly, these changes are very common and often occur without causing pain. Many people have signs of osteoarthritis visible on X-rays or MRI scans but experience little or no symptoms. For this reason, the presence of osteoarthritis on imaging does not necessarily mean that it is the main cause of a person’s knee pain.
Although osteoarthritis is often described as “wear and tear”, the process is more complex than simple joint degeneration. The condition involves changes affecting several structures within the knee, including cartilage, bone, ligaments, and the surrounding soft tissues.
In many cases these structural changes form part of normal joint ageing and may not cause significant problems. Symptoms are more likely to occur when the changes within the joint begin to affect how the knee functions during everyday activities.
Understanding this distinction is important, as knee pain is not always directly explained by the degree of osteoarthritis seen on a scan.
This page explains:
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Understanding the knee joint
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What happens in knee osteoarthritis?
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What does knee osteoarthritis feel like?
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Why knee osteoarthritis develops
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Bone health and structural resilience
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Where is knee osteoarthritis pain usually felt?
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How knee osteoarthritis is diagnosed
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Are scans needed?
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Rehabilitation and management
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How long does knee osteoarthritis last?
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Conditions that can mimic knee osteoarthritis
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Managing flare-ups of knee osteoarthritis
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Common misconceptions about knee arthritis
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When surgery may be considered
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Summary
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Knee Osteoarthritis FAQ's
Understanding the knee joint
The knee joint is a complex structure that must balance mobility with stability while transmitting large forces through the lower limb.
The joint is formed where the femur (thigh bone) meets the tibia (shin bone). At the front of the joint sits the patella (kneecap), which improves the mechanical efficiency of the quadriceps muscles when the knee straightens. The ends of the bones are covered by articular cartilage, a smooth and resilient tissue that allows the joint surfaces to glide against each other with very little friction. This cartilage helps distribute forces across the joint during movement.
Several additional structures help support normal knee function:
• the menisci, which act as shock absorbers and help distribute load
Several additional structures help support normal knee function:
• the ligaments, which provide stability and control movement
• the joint capsule and synovial lining, which produce lubricating fluid
• surrounding muscles such as the quadriceps and hamstrings, which help control movement
Together these structures allow the knee to tolerate substantial mechanical loads during everyday activities such as walking, stair climbing, squatting, and rising from a seated position.
Because the knee is involved in almost every weight-bearing activity, even relatively small changes in joint structure or muscle function can influence how forces are distributed within the joint.
What happens in knee osteoarthritis?
Knee osteoarthritis involves gradual changes affecting several structures within the joint rather than a single isolated problem. One of the most recognised features of osteoarthritis is a change in the articular cartilage that covers the ends of the bones. Over time this cartilage may become thinner or less resilient, reducing its ability to distribute mechanical forces across the joint.
However, osteoarthritis does not affect cartilage alone. Changes may also occur in several other joint structures, including:
• thickening of the joint capsule
• increased bone formation at the joint margins (osteophytes)
• changes in the bone beneath the cartilage
• irritation of the synovial lining that produces joint fluid
Because multiple tissues within the joint can be involved, the symptoms experienced by patients may arise from several sources rather than a single structure.
Importantly, these structural changes develop gradually over many years, and many people have visible osteoarthritic changes without experiencing significant symptoms.
What does knee osteoarthritis feel like?
Knee osteoarthritis commonly produces pain, stiffness, and reduced joint movement. Symptoms often develop gradually and may fluctuate depending on activity levels. Many people notice discomfort during activities that place greater mechanical load on the knee joint.
Typical symptoms may include:
• pain during walking or prolonged standing
• discomfort when climbing or descending stairs
• stiffness after periods of rest
• reduced ability to fully bend or straighten the knee
• swelling within the joint
Some people may also notice sensations such as clicking, grinding, or catching within the knee during movement. These sensations are often related to changes in joint surfaces or surrounding soft tissues but it is also to highlight that these features such as clicking and grinding also occur in non painful joints, so they are not always a problem.
It is also common for symptoms to vary from day to day. Periods of increased activity may temporarily aggravate symptoms, while periods of reduced loading may allow the knee to settle.
Why knee osteoarthritis develops
Knee osteoarthritis usually develops through a combination of mechanical, biological, and sometimes injury-related influences affecting the joint over time.
Throughout life the knee joint is exposed to repeated mechanical forces during everyday activities such as walking, climbing stairs, squatting, and standing from a seated position. Under normal circumstances the joint structures are able to tolerate and adapt to these stresses.
However, when the balance between mechanical loading and the joint’s ability to adapt becomes disrupted, gradual structural changes may begin to develop within the joint.
In many cases osteoarthritis does not arise from a single cause but instead develops when several contributing factors interact over time.
Age-related changes
Ageing is one of the most commonly recognised influences in osteoarthritis. Over time the cartilage within joints may become less resilient and the surrounding tissues may adapt more slowly to mechanical stress. These changes can make the joint more sensitive to loading, particularly when combined with other risk factors.
Importantly, many people develop structural changes associated with osteoarthritis as they get older without necessarily experiencing pain.
Previous injury or trauma
Previous injury to the knee joint can increase the likelihood of developing osteoarthritis later in life. Injuries affecting important stabilising structures within the knee may alter how forces are distributed across the joint surfaces.
Examples of injuries that may influence long-term joint health include:
• meniscal tears
• ligament injuries, particularly ACL injuries
• fractures involving the knee joint
• repeated sports-related injuries
These injuries may change the way the knee moves or loads during activity. Over time this altered joint mechanics can increase stress on certain parts of the joint. This process is often described as post-traumatic osteoarthritis.
You may also find it helpful to read:
• Meniscal Tears
• Ligament Injuries Explained
Joint alignment and biomechanics
The way forces pass through the knee joint can influence how stress is distributed across the joint surfaces. Variations in limb alignment or movement patterns may increase loading in certain areas of the knee. Over time this uneven distribution of forces may contribute to structural changes within the joint.
Factors that may influence joint loading include:
• knee alignment
• hip muscle strength
• foot and ankle mechanics
• walking or running patterns
Because the knee functions as part of a larger mechanical system, factors affecting the hip, ankle, and foot may also influence knee loading.
Muscle strength and joint stability
Muscle strength plays an important role in protecting the knee joint. The muscles surrounding the knee — particularly the quadriceps and hip muscles — help control movement and absorb forces during activity.
If these muscles are weak or unable to support the joint effectively, the mechanical stress transmitted through the joint surfaces may increase. For this reason, strengthening exercises often form an important part of rehabilitation programmes for knee osteoarthritis.
Body weight and joint loading
Because the knee is a weight-bearing joint, body weight can influence the forces transmitted through the joint during movement.
Even relatively small increases in body weight may increase the mechanical load placed on the knee during activities such as walking or climbing stairs. However, it is important to recognise that osteoarthritis also occurs in people with normal body weight, which again highlights the multifactorial nature of the condition.
A combination of factors
In most cases knee osteoarthritis develops when multiple influences combine over time. Age-related tissue changes, previous injuries, muscle strength, joint alignment, and activity levels can all interact to influence how the knee joint responds to mechanical stress.
Understanding these factors can help guide rehabilitation strategies aimed at improving joint function and reducing symptoms.
Bone health and structural resilience
The strength and quality of the underlying bone can also influence how the knee joint responds to mechanical stress.
Beneath the articular cartilage lies a layer of bone known as the subchondral bone, which helps support and distribute forces across the joint during weight-bearing activities. Changes in the strength or structure of this bone can influence how mechanical loads are transmitted through the joint.
In some individuals, reduced bone density or other factors affecting bone health may alter the way the joint responds to repeated loading.
Factors that may affect bone health include:
• osteopenia or osteoporosis
• long-term corticosteroid use
• reduced physical activity
• certain hormonal or metabolic conditions
• nutritional deficiencies affecting bone metabolism
When bone quality is reduced, the underlying bone may become more sensitive to mechanical stress. In some situations this can contribute to bone marrow changes or stress-related reactions within the joint. Although these changes are not the same as osteoarthritis, they may sometimes occur alongside degenerative joint changes and can contribute to symptoms.
For this reason, clinicians may occasionally consider overall bone health when assessing persistent knee pain, particularly in individuals with known risk factors for reduced bone density.
Where is knee osteoarthritis pain usually felt?
Knee osteoarthritis does not affect the entire joint uniformly. Instead, different compartments of the knee may be affected to varying degrees.
The knee joint is often divided into three main compartments:
• the medial tibiofemoral compartment (inner side of the knee)
• the lateral tibiofemoral compartment (outer side of the knee)
• the patellofemoral joint, where the kneecap moves over the femur
Osteoarthritis may affect one or more of these compartments, and the location of symptoms often reflects which part of the joint is primarily involved.
Medial compartment osteoarthritis
The medial compartment is the most commonly affected area of the knee in osteoarthritis. This part of the joint lies between the inner side of the femur and tibia. During normal walking and standing, a slightly greater proportion of body weight is typically transmitted through this side of the knee.
Over many years this loading pattern may contribute to structural changes within the medial compartment. People with medial compartment osteoarthritis often report:
• pain along the inner side of the knee
• tenderness along the medial joint line
• discomfort during walking or prolonged standing
• stiffness after periods of rest
In some individuals, gradual changes in joint structure may also influence knee alignment, which can further increase loading on the medial compartment.
Patellofemoral osteoarthritis
In some individuals osteoarthritis primarily affects the patellofemoral joint at the front of the knee. This joint is formed where the patella (kneecap) moves over the groove at the front of the femur during knee movement.
Patellofemoral osteoarthritis often produces symptoms that feel different from medial compartment arthritis. People commonly describe pain around or behind the kneecap rather than along the inner side of the knee.
Typical symptoms may include:
• pain at the front of the knee
• discomfort when climbing or descending stairs
• pain during squatting or kneeling
• difficulty rising from a seated position
These activities place increased compressive forces on the patellofemoral joint, which may aggravate symptoms in this area.
You may also find it helpful to read:
• Patellofemoral Pain Syndrome (future page)
Lateral compartment osteoarthritis
Less commonly, osteoarthritis may primarily affect the outer side of the knee joint. This involves the lateral tibiofemoral compartment, where the outer portion of the femur and tibia meet.
Symptoms may include:
• pain along the outer side of the knee
• discomfort during weight-bearing activity
• tenderness along the lateral joint line
Although this pattern is less common, it may occur in individuals with certain alignment patterns or previous injuries affecting the knee.
Why compartment involvement matters
Understanding which part of the knee joint is primarily involved can help guide clinical assessment and rehabilitation strategies.
For example, strengthening specific muscle groups, modifying activity patterns, or addressing biomechanical factors affecting the lower limb may influence how forces are distributed across the knee joint.
Because the knee functions as part of the entire lower limb, factors affecting the hip, ankle, and foot can also influence how stress is transmitted through the knee during movement.
How knee osteoarthritis is diagnosed
Diagnosis of knee osteoarthritis is usually based on a combination of clinical assessment, symptom history, and, in some cases, imaging findings. A clinician will normally begin by discussing the patient’s symptoms in detail. Understanding how the pain behaves during different activities often provides important clues about whether osteoarthritis is likely to be contributing to the problem.
During the clinical assessment, several aspects of knee function are usually evaluated. These commonly include:
• the location and behaviour of knee pain
• the presence of stiffness, particularly after rest
• the range of movement within the joint
• swelling or fluid within the knee
• muscle strength around the joint
• the way the knee moves during walking or other activities
Because the knee functions as part of a larger mechanical system, clinicians will often also consider how the hip, ankle, and foot contribute to movement. Problems affecting these areas can sometimes influence the stresses placed on the knee joint.
In many cases, the pattern of symptoms combined with the findings of the physical examination provides sufficient information to suggest osteoarthritis as a likely contributor to the symptoms.
However, it is important to remember that knee pain can arise from several different conditions. The clinical examination therefore plays an important role in distinguishing osteoarthritis from other possible causes of knee pain.
Are scans needed?
Imaging may sometimes be used to support the diagnosis of knee osteoarthritis, but it is not always necessary. The most commonly used investigation is a plain X-ray, which can reveal structural changes within the joint.
Typical X-ray findings associated with osteoarthritis may include:
• narrowing of the joint space
• bony growths known as osteophytes
• changes in the bone beneath the cartilage
These changes reflect alterations in the joint structure that have developed gradually over time.
More detailed imaging such as MRI scans may sometimes be used when clinicians need to assess additional structures within the knee joint. MRI scans can provide detailed images of cartilage, ligaments, menisci, and other soft tissues.
However, one of the most important things to understand about imaging is that structural changes seen on scans do not always explain the symptoms experienced by the patient.
Many people have visible osteoarthritic changes on imaging despite experiencing little or no pain. Conversely, some individuals may experience significant knee pain even though only mild structural changes are visible on a scan.
For this reason, imaging findings are usually interpreted alongside the patient’s symptoms and clinical examination rather than being used in isolation.
You can read more about these investigations here:
Rehabilitation and management
Exercise-based rehabilitation plays a central role in the management of knee osteoarthritis. The muscles surrounding the knee help stabilise the joint and absorb forces during movement. When these muscles are strong and functioning well, they can reduce the mechanical stress placed on the joint surfaces.
For this reason, rehabilitation programmes for knee osteoarthritis often focus on improving muscle strength and joint function.
Common components of rehabilitation programmes include:
• strengthening the quadriceps muscles at the front of the thigh
• strengthening the hip muscles, which influence knee mechanics
• improving knee joint mobility
• gradually increasing tolerance to everyday activities
Exercise also helps maintain joint movement and can improve how forces are distributed across the knee during weight-bearing activities. Importantly, many people experience improvement in their symptoms with appropriate exercise and activity management, even when structural changes within the joint remain present.
Because each individual’s symptoms and activity levels are different, rehabilitation programmes are usually tailored to the person rather than following a single standard approach.
How long does knee osteoarthritis last?
Osteoarthritis is generally considered a long-term condition, but the symptoms associated with it can often be managed effectively. Unlike some injuries that resolve completely within a defined period, osteoarthritis represents gradual structural changes within the joint that develop over many years.
However, this does not mean that symptoms inevitably worsen over time. Many people experience periods where the knee feels relatively comfortable, followed by occasional periods where symptoms become more noticeable.
These fluctuations often relate to changes in activity levels, joint loading, or temporary irritation within the joint.
Maintaining muscle strength, managing activity levels appropriately, and maintaining general joint health can often help reduce the impact of symptoms on everyday life.
For many people, learning how their knee responds to different activities allows them to remain active while minimising the likelihood of flare-ups.
Conditions that can mimic knee osteoarthritis
Not all knee pain is caused by osteoarthritis, and several other conditions can produce similar symptoms. For this reason, careful clinical assessment is important when evaluating knee pain. Some conditions that may produce symptoms similar to knee osteoarthritis include:
• Meniscal tears, which can cause joint line pain or mechanical symptoms
• Patellofemoral pain syndrome, which often produces pain around the front of the knee
• Ligament injuries, which may lead to instability or altered joint mechanics
• Inflammatory joint conditions, which may produce swelling and stiffness
Because these conditions may present with overlapping symptoms, clinicians use a combination of symptom history, physical examination, and sometimes imaging to determine the most likely cause of the problem.
You may find it helpful to read more about related conditions here:
• Meniscal Tears
• Ligament Injuries Explained
• Patellofemoral pain syndrome
Managing flare-ups of knee osteoarthritis
Many people with knee osteoarthritis experience occasional flare-ups where symptoms temporarily worsen. During these periods the knee may become more painful, stiff, or swollen than usual. Flare-ups can sometimes occur without an obvious trigger, but they are often associated with changes in joint loading or activity levels.
For example, symptoms may increase after:
• longer periods of walking than usual
• climbing large numbers of stairs
• prolonged kneeling or squatting
• returning to activity after a period of rest
• minor twists or irritations within the joint
These changes can temporarily irritate the joint structures, leading to increased pain or swelling.
Importantly, a flare-up does not necessarily mean that the joint has become permanently worse. In many cases it simply reflects a temporary increase in joint irritation.
Why flare-ups occur
Several tissues within the knee joint can contribute to flare-ups. These may include:
• irritation of the synovial lining, which produces joint fluid
• temporary swelling within the joint
• increased sensitivity of surrounding soft tissues
• changes in how forces are distributed across the joint
Because osteoarthritis involves several joint structures rather than a single tissue, symptoms may fluctuate depending on how these structures respond to activity.
Managing activity during a flare-up
When symptoms increase, it is often helpful to temporarily reduce activities that place high stress on the knee joint. This may involve modifying activities such as long walks, repeated stair climbing, or deep squatting. However, completely avoiding movement is usually not recommended. Gentle movement of the joint can help maintain mobility and prevent excessive stiffness.
Many people find it helpful to maintain light activity such as:
• gentle walking
• controlled knee movement exercises
• low-impact activities that do not aggravate symptoms
Gradually returning to normal activity as symptoms settle is usually the most effective approach.
Supporting the knee during recovery
During flare-ups, some people find it helpful to use simple strategies that help settle symptoms while maintaining mobility.
These may include:
• temporarily reducing high-load activities
• gentle mobility exercises
• maintaining muscle activity around the knee
• pacing activity levels to avoid overloading the joint
The aim is usually to allow irritated tissues to settle while maintaining enough movement to prevent stiffness and loss of function.
Returning to normal activity
As symptoms begin to improve, activities can usually be reintroduced gradually. Increasing activity levels too quickly after a flare-up can sometimes trigger further irritation, so a gradual return to normal loading is often helpful. Over time, learning how the knee responds to different activities can help individuals find a balance between maintaining activity and avoiding excessive joint irritation.
When to seek further assessment
Although flare-ups are common in osteoarthritis, it may be helpful to seek assessment if:
• symptoms become progressively worse
• the knee becomes significantly swollen
• movement becomes severely restricted
• symptoms do not settle after a period of modified activity
A clinician can assess whether the symptoms are consistent with osteoarthritis or whether another condition may be contributing to the problem.
Common misconceptions about knee arthritis
Knee osteoarthritis is often misunderstood, and several common beliefs about the condition are not entirely accurate.
Because the word “arthritis” can sound serious, many people assume that once osteoarthritis is diagnosed the knee will inevitably deteriorate and require surgery. In reality, the condition often behaves in a much more variable way.
Understanding some of the common misconceptions surrounding osteoarthritis can help people make more informed decisions about their activity levels and treatment options.
“Arthritis means the joint is worn out”
Although osteoarthritis is often described as “wear and tear”, this description oversimplifies a much more complex process. Many people develop structural changes within their joints as they get older, and these changes may be visible on imaging scans even when the joint is functioning well pain free.
In many cases these changes represent normal joint ageing rather than severe joint damage.
“Bone-on-bone means the knee cannot improve”
People are often told that their knee is “bone on bone” after an X-ray. While this description may reflect narrowing of the joint space on imaging, it does not necessarily mean that symptoms cannot improve.
Many individuals with significant changes visible on X-rays are still able to remain active and manage their symptoms effectively through rehabilitation and activity management.
Symptoms often depend as much on muscle strength, joint mechanics, and overall activity levels as they do on the degree of structural change within the joint.
“Exercise will wear the knee out”
Some people worry that using the knee too much will accelerate arthritis. However, appropriate exercise is widely recognised as one of the most effective ways to manage symptoms associated with knee osteoarthritis.
Strengthening the muscles surrounding the knee helps support the joint and can improve how forces are distributed across the joint during movement.
For this reason, maintaining regular physical activity is usually encouraged rather than avoided.
“Arthritis always gets progressively worse”
Osteoarthritis is often assumed to follow a steady pattern of deterioration. In reality, symptoms frequently fluctuate over time. Many people experience periods where the knee feels relatively comfortable, followed by periods where symptoms temporarily increase.
With appropriate management strategies, many individuals are able to maintain good levels of activity for many years.
When surgery may be considered
Most people with knee osteoarthritis are able to manage their symptoms without surgery. Rehabilitation exercises, activity modification, and general joint health strategies often help improve function and reduce symptoms.
However, in some situations surgical treatment may be considered.
When conservative treatment is not enough
Surgery is usually considered only when:
• symptoms remain severe despite appropriate rehabilitation
• pain significantly limits everyday activities
• the knee joint has become severely restricted in movement
• other treatment options have not provided sufficient improvement
In these cases a specialist orthopaedic assessment may be recommended to discuss possible surgical options.
Types of surgical treatment
The most commonly performed surgical procedure for advanced knee osteoarthritis is knee replacement surgery, where damaged joint surfaces are replaced with artificial components designed to restore joint movement.
In some situations partial knee replacement may be possible if the arthritis is limited to a single compartment of the knee.
The aim of surgery is usually to reduce pain and improve function when other treatments have not been successful.
Surgery is usually a later option
Because surgery involves significant recovery and potential risks, it is generally considered after non-surgical management options have been explored.
For many individuals, appropriate rehabilitation, strengthening exercises, and activity management can provide substantial improvements in symptoms without the need for surgical intervention.
Summary
Knee osteoarthritis is a common condition involving gradual structural changes within the knee joint. These changes can affect several tissues within the joint, including the articular cartilage, underlying bone, joint capsule, and surrounding soft tissues. Because the knee is exposed to repeated mechanical forces throughout life, it is normal for some degree of joint change to occur as people get older.
Importantly, structural changes associated with osteoarthritis are extremely common and do not always cause pain.
Many individuals have visible arthritic changes on imaging despite experiencing little or no symptoms. For this reason, knee pain is not always directly explained by the degree of arthritis seen on a scan.
When symptoms do occur, they are often influenced by a combination of factors including joint loading, muscle strength, movement patterns, and previous injuries affecting the knee.
Exercise-based rehabilitation, strengthening of the surrounding muscles, and appropriate management of activity levels can often help improve knee function and reduce symptoms. Many people are able to remain active and manage their symptoms successfully without surgical intervention.
In some cases where symptoms remain severe despite appropriate management, surgical treatment such as knee replacement may be considered.
Understanding how osteoarthritis develops and how the knee responds to activity can help individuals make informed decisions about managing their symptoms and maintaining long-term joint health.
Educational Notice
This content is intended for educational guidance only and reflects current evidence and clinical reasoning at the time of publication. It does not replace individual assessment, diagnosis, or treatment provided by your healthcare practitioner. Management decisions should always be based on personalised clinical evaluation.
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Frequently Asked Questions About Knee Osteoarthritis
1) Is knee osteoarthritis the same as “wear and tear”?
The term “wear and tear” is often used to describe osteoarthritis, but the condition is more complex than simple joint deterioration.
Osteoarthritis involves gradual changes affecting several structures within the knee joint, including cartilage, bone, and surrounding soft tissues. Many of these changes develop naturally as people get older and do not always cause symptoms.
2) Is plantar fasciitis an inflammatory condition?
Not necessarily.
Many people have visible signs of osteoarthritis on X-rays or MRI scans despite having little or no knee pain. For this reason, clinicians usually interpret imaging findings alongside the patient’s symptoms and physical examination.
3) Where is knee osteoarthritis pain usually felt?
Pain is most commonly felt along the inner (medial) side of the knee, as this area of the joint often experiences greater mechanical loading during walking.
However, some people experience symptoms at the front of the knee, particularly if the patellofemoral joint is involved.
4) Can exercise make knee osteoarthritis worse?
Appropriate exercise is usually beneficial for people with knee osteoarthritis.
Strengthening the muscles around the knee helps improve joint stability and can reduce stress on the joint surfaces during movement. Exercise programmes are often an important part of managing symptoms.
5) Does knee osteoarthritis always get worse over time?
In the most yes, but how this related to pain is not always straightforwards.
Many people experience periods where symptoms improve and other times where the knee becomes more painful or stiff. With appropriate management strategies, many individuals are able to remain active and maintain good joint function for many years.
6) Can knee osteoarthritis improve without surgery?
Yes. Many people manage their symptoms successfully without surgical treatment.
Exercise-based rehabilitation, strengthening of the surrounding muscles, and managing activity levels can often help reduce pain and improve function.
7) Why does my knee sometimes flare up?
Flare-ups may occur when the joint structures become temporarily irritated.
This may happen after increased activity, prolonged loading of the joint, or minor irritation within the knee. These episodes are often temporary and may settle with appropriate activity modification.
8) When might surgery be considered?
Surgery is usually considered only when symptoms remain severe despite appropriate rehabilitation and other management strategies.
In these situations an orthopaedic specialist may assess whether procedures such as knee replacement surgery could help improve pain and function.
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