Bilateral Knee Osteoarthritis | Symptoms, Treatments, And More!

Written By on May 13, 2022 — Medically Reviewed By Kris Ceniza (PT)

Bilateral knee osteoarthritis occurs when both knee joints have some degree of cartilage damage. It ranges from mild to severe, depending on genetics, lifestyle, and other factors.

It’s common in people who already have degenerative changes in one knee. Below, we’ll discuss why this is the case, plus how this type of arthritis is diagnosed and treated.

Here are the topics we’ll cover – tap on any of them to easily navigate through the article:

Causes of bilateral osteoarthritis of the knee

Most of the time, it’s a consequence of having knee osteoarthritis in one knee. Researchers aren’t sure why this happens, though. (1)

Some think this is because of changes in the walking pattern. See, people with knee pain due to osteoarthritis can make small changes in the way they walk to reduce symptoms. (1)

This increases the load on the healthy knee, thus wearing its tissues quicker.

Some studies have shown this to be true. But others haven’t found significant differences between the walking pattern in people with unilateral vs bilateral knee OA. (1, 2)

This has led researchers to believe that bilateral knee OA may be caused by more than just walking pattern changes.

So, this is where risk factors come in.

Apart from having it in one knee, the following can increase your risk of developing osteoarthritis on both joints (1, 3):

  • Being over 60 years old.
  • Having a BMI >25 – this is a major risk factor.
  • Participating in certain sports.
  • Not doing physical activity.
  • Having a genetic predisposition to degenerative arthritis.
  • Suffering from systemic diseases like rheumatoid arthritis or diabetes.

Learn more: Causes and risk factors of knee osteoarthritis

Symptoms of bilateral knee arthritis

The symptoms are similar to those in unilateral knee osteoarthritis, but they are present on both joints. These include (4):



  • Knee pain that worsens with movement and rest.
  • Joint stiffness, especially in the morning.
  • Crepitus – a grating sensation when you move the knee.
  • Restricted range of motion.
  • Varying degrees of knee swelling.
  • Knee locking.
  • Stability problems.

Yet, please remember that having these symptoms is not enough to know if you have bilateral knee OA. You must do further tests to diagnose this condition accurately.

Further reading: 10 knee OA symptoms (and how to treat them)

How to diagnose bilateral knee OA?

The process has the same steps as unilateral knee osteoarthritis.

First, your doctor will ask about your joint pain and medical history. This is to look out for typical symptoms of this condition and identify any risk factors.

Next comes the physical exam. Here, your healthcare provider will inspect your knee and do a series of movement tests.

But to make a precise diagnosis, your doctor needs to do a radiological assessment.

That’s why you’ll have to get some X-rays or a magnetic resonance imaging test done. If your images show any of the following, it’s likely you have osteoarthritis (4):

  • Narrowing of the joint space.
  • Bone spurs.
  • Subchondral sclerosis.
  • Subchondral cysts.

Also, your doctor may request some blood tests too. This is to rule out other health problems, like rheumatoid arthritis or gout.

Related: The diagnostic process of knee osteoarthritis

Treatments available for knee OA on both joints

The biggest challenge with this condition is that it’s irreversible. To date, no treatment can heal the cartilage to how it was before the degeneration started.

That’s why treatments focus on helping you live with this knee osteoarthritis and delay its progression. (5, 6)

With that said, the most common treatments for bilateral knee OA include (5, 6):

Home treatments

These are key to treat knee osteoarthritis successfully. Patients usually have their own set of preferred home treatments, which often include:

  • Applying a hot or cold compress to the affected joint.
  • Doing a self-massage on the area.
  • Having an exercise routine to relieve symptoms.

Check this out: 11 effective home treatments for knee arthritis.

Wearing knee braces

These garments can be very effective at reducing pain and swelling in osteoarthritis. Wearing one can also help you keep your independence, do your daily activities, and make life easier in general. (5, 6)

There’s an immense variety to choose from – sleeves, braces with hinges, unloader designs… Each one will help with specific symptoms, so there’s no shortage of options.


Knee Force Knee Sleeve

This will help: Our picks of the best braces for knee OA.

Physical therapy

If you already have a knee osteoarthritis diagnosis, your doctor likely suggested going to physio.

This is because we are healthcare professionals that not only help you with pain. We also:

  • Treat you with individualized strategies.
  • Help you delay the progression of knee osteoarthritis with specific exercises.
  • Teach you how to adapt your surroundings and lifestyle to aid your condition.
  • Give you tools to manage flare-ups.
  • Answer any questions you may have regarding your condition.

In summary, a good physio is the best ally you’ll ever have when it comes to knee osteoarthritis.

Medications

There are several drugs available for managing osteoarthritis symptoms.

The most popular are over-the-counter medications, like NSAIDs. These are effective at reducing knee pain and come in oral or topical forms.

Now, if you’re taking them without results, your doctor may suggest taking prescription pain relievers. Another option is injecting corticosteroids or hyaluronic acid into the affected joint.

Also, some people with mild to moderate symptoms choose to take dietary supplements for knee osteoarthritis instead. Like glucosamine, chondroitin, or turmeric.

Learn more: The 11 types of medicine for knee OA.

Surgery

This is the last resort. Orthopaedic surgeons recommend surgery after exhausting all the other conservative options.

Now, there are different types of surgery for osteoarthritis of the knee. The choice will depend on your symptoms, the severity of the disease, your lifestyle, and other factors. They include:

  • Arthroscopy debridement/lavage.
  • Cartilage repair.
  • Tibial osteotomy.
  • Partial knee replacement.
  • Total knee replacement.

After surgery, you’ll have to do physical therapy as well. This is to ensure you recover fully and to minimize complications after the procedure.

Further reading: When is surgery necessary for knee OA?

FAQs

Is knee osteoarthritis usually bilateral?

Not at first. It usually starts on one knee, but it can affect the other after some years. More so if you’re not undergoing any treatment. (1)

Is knee osteoarthritis curable?

No, there’s no way to rebuild the lost cartilage to pre-injury levels (yet). Currently, the treatment options focus on managing symptoms and delaying the progression of the disease.



This can help: 10 evidence-based treatments for knee osteoarthritis

What are the 4 stages of knee joint osteoarthritis?

Minor, mild, moderate, and severe. They are the best way to know the level of structural damage, but they don’t correlate with the severity of symptoms. (7)

Further reading: The 4 stages of knee OA (complete guide)

Conclusion: Bilateral knee OA

The major cause of bilateral knee degeneration is unilateral osteoarthritis. This can be due to lower leg mechanics, or risk factors like genetics, lack of physical activities, or suffering from other diseases.

Treatments are similar to those of knee OA in one leg – home treatments, wearing knee braces, injections, surgery… But, the toll on daily life may be higher for some.

That’s why it’s imperative to find coping strategies to help you live with knee osteoarthritis.

Resources

  1. Metcalfe, Andrew J et al. “Is knee osteoarthritis a symmetrical disease? Analysis of a 12-year prospective cohort study.” BMC musculoskeletal disorders vol. 13 153. 22 Aug. 2012, DOI: 10.1186/1471-2474-13-153
  2. Messier, S P et al. “Are unilateral and bilateral knee osteoarthritis patients unique subsets of knee osteoarthritis? A biomechanical perspective.” Osteoarthritis and cartilage vol. 24,5 (2016): 807-13. DOI: 10.1016/j.joca.2015.12.005
  3. Primorac, Dragan et al. “Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations.” Genes vol. 11,8 854. 26 Jul. 2020, DOI: 10.3390/genes11080854
  4. Zhang, W et al. “EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis.” Annals of the rheumatic diseases vol. 69,3 (2010): 483-9. DOI: 10.1136/ard.2009.113100
  5. American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline (3rd Edition). Retrieved on April 2022 from: https://www.aaos.org/oak3cpg
  6. “Guideline for the management of knee and hip osteoarthritis.” The Royal Australian College of General Practitioners. Retrieved on April 2022 from: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf
  7. Culvenor, Adam G et al. “Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.” British journal of sports medicine vol. 53,20 (2019): 1268-1278. DOI: 10.1136/bjsports-2018-099257
  8. “Osteoarthritis.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved on April 2022 from: https://www.niams.nih.gov/health-topics/osteoarthritis
  9. “Osteoarthritis of the Knee.” Arthritis Foundation. Retrieved on April 2022 from: https://www.arthritis.org/diseases/more-about/osteoarthritis-of-the-knee
Author
Mich Torres (PT)
Mitch is a physical therapist, personal trainer, and nutrition coach. Fascinated with the knee joint, Mitch poured that passion into writing about knee pain and how to overcome it with movement. His goal is to teach you how to apply this knowledge into your daily life, so you can keep knee pain away for good.