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Bilateral Knee Osteoarthritis

12th March 2021

Osteoarthritis is an increasingly common cause of disability in those over the age of 55 years, all over the world. It has been anticipated that in the next nine years, a total of 67 million Americans over the age of 18 years may be affected by Osteoarthritis.

Out of the most common types of Osteoarthritis, knee osteoarthritis is the most prevalent having affected almost 250 million people all over the world. (1).

Out of the most common types of Osteoarthritis, knee osteoarthritis is the most prevalent having affected almost 250 million people all over the world. Out of the most common types of Osteoarthritis, knee osteoarthritis is the most prevalent having affected almost 250 million people all over the world.

What is Bilateral Knee Osteoarthritis?

Bilateral Knee Osteoarthritis is a degenerative joint disease affecting both the knees as a result of the everyday wear and tear and gradual loss of articular cartilage.

The common symptoms associated with this type of Osteoarthritis include:

  • Pain in both the knees which worsens with activity
  • Stiffening of both the knees
  • Swelling of both the Knees
  • Pain in both the knees after prolonged sitting

Stages of Bilateral Knee Osteoarthritis

1. Minor Osteoarthritis of the Knees

This stage is characterized by the formation of minute osteophytes in the knee area, which may, in turn, cause damage to the associated cartilage. However, no apparent narrowing of the space may be visible on the x-rays indicating the breaking down of cartilage just yet. Other than the joint appearing completely normal on the cartilage, the patient may also not be able to feel any changes in their joint or complain of any pain.

2. Mild Osteoarthritis of the Knees

Unlike minor Osteoarthritis, those suffering from Mild Osteoarthritis may start to notice changes in their knee joints. Moreover, the radiographic images will also start to show certain changes in the joint due to the visible appearance of the osteophytes and thinning of the cartilage. Even though the bones' space will still appear normal on the x-rays, the meeting point of the bones with the tissues will start to show visible hardening. This hardening can be seen by the thicker amount of bone present in this region with a denser appearance. These changes will lead to the individual experiencing some stiffness of the joint and pain on movement, which may worsen when the person is sitting for long periods of time.

3. Moderate Osteoarthritis of the Knees

Moderate Osteoarthritis of the knees involves a more significant amount of damage to the cartilages, narrowing of the space between the bones, and considerable cartilage loss. The patient may also experience a greater amount of pain and discomfort, which starts to interfere with their daily activities like running, walking, bending, and kneeling. With further progress of the Osteoarthritis, signs of inflammation also begin to become visible, and the cartilage continues to thin to the point that it eventually breaks down. In contrast to the cartilages, the bones of the knee start to thicken and grow outward, forming visible lumps on the surface. Due to the excess synovial fluid production due to inflammation, swelling may also start to form on both the affected knees. This condition is also known as Synovitis, which is also referred to as water on the knees.

4. Severe Osteoarthritis of the Knees

Stage 4 Osteoarthritis is the most advanced stage of Osteoarthritis and can be easily recognised by the severity of the symptoms. It is associate with the breakdown of the cartilage due to the continuous narrowing of the space between the two bones. The reduction in the amount of synovial fluid also leads to extreme friction between the bones on movement, which may be felt by the patient as sudden pain on movement. The x-ray evaluation of the knees will show a presence of bone-on-bone contact as well as a lack of presence of the cartilage. In the case of an asymmetrical loss of the cartilage, there may be severe deformation of the knees, which may only be corrected by surgical treatment.

Treatment of Bilateral Knee Osteoarthritis

non-surgical option for the treatment of bilateral knee arthritis Non-surgical option for the treatment of bilateral knee arthritis

The non-surgical option for the treatment of bilateral knee arthritis involves the usage of certain drugs like NSAIDs (Nonsteroidal anti-inflammatory drugs), which are used to reduce the inflammation associated with the disease. Moreover, weight loss is also an approach for the prevention and treatment of Osteoarthritis, as knees are weight-bearing joints, and the reduction of weight may help take the excessive pressure off them. Regular Physical Therapy under the supervision of an experienced health professional may also help relieve the symptoms and facilitate quick recovery. Although these approaches may be practiced individually as well, they are most commonly recommended in adjunct to each other to allow the most efficient and long-term results.

Moreover, it has also been recommended that a person should get both their knees treated even if they are suffering from Unilateral Knee Osteoarthritis. This is because previous studies have shown that those who are suffering from Unilateral Osteoarthritis have an 80% chance of suffering from bilateral Osteoarthritis within the next 12 year. The opposite knee may have already started to show signs of damage without you realising (2)

Simultaneous bilateral knee replacement is when both knees are replaced at the same time.

Staged bilateral knee replacement is when each knee is replaced one at a time and at a different times.

These surgeries may involve any combination of total knee replacement or partial knee replacement (3)

Simultaneous bilateral knee replacement means a longer rehabilitation period and require assistance during recovery. The surgery requires a high dosage of anaesthesia, therefore increases the risk of any complications.

Staged bilateral knee replacement is a shorter surgery and recovery period, however the overall recovery time could be longer as it is two surgeries. The knee that has not yet been operated will also be in pain, however an off-loading brace can be used to treat the knee awaiting surgery. Knee braces work by off-loading the side of the knee joint with osteoarthritis and shifting the weigh to the healthier side. Össur’s Unloader One knee brace is the most clinically studied off-loading brace available (Unloader One).

If you think you may have bilateral knee osteoarthritis, you should contact your doctor to discuss your options.


  • Grazio S, Balen D. Debljina: cimbenik rizika i prediktor razvoja osteoartritisa [Obesity: risk factor and predictor of Osteoarthritis]. Lijec Vjesn. 2009 Jan-Feb;131(1-2):22-6. Croatian. PMID: 19348352.
  • Metcalfe AJ, Andersson ML, Goodfellow R, Thorstensson CA. Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord. 2012 Aug 22;13:153. doi: 10.1186/1471-2474-13-153. PMID: 22917179; PMCID: PMC3485166.
  • Healthline. 2021. Considering Double Knee Replacement Surgery?. [online] Available at: https://www.healthline.com/health/total-knee-replacement-surgery/bilateral#types

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