Six steps to ease knee osteoarthritis pain and delay surgery, experts say

Osteoarthritis remains a leading cause of knee pain in Britain, affecting about ten million people. Of those, more than half of cases involve the knee, and about 100,000 individuals are added to the NHS waiting list for joint replacement each year. One case illustrating the potential impact of lifestyle changes involves Jon Reeves, a 54-year-old from Oxfordshire who was diagnosed with osteoarthritis in 2020 after years of daily running and badminton. Doctors initially warned that he would need a double knee replacement, but by combining acupuncture, weight training and a Mediterranean-style diet, Reeves was able to slash his pain and postpone surgery. Experts say thousands more could similarly delay or avoid joint replacement by adopting simple, structured changes.

1. Follow the Mediterranean diet. Hailed as a key to longevity, the Mediterranean eating pattern emphasizes fresh fruit and vegetables, fish and chicken, whole grains and olive oil while limiting red meat and sweets. A 2016 study of more than 4,000 people with knee osteoarthritis found those who adhered most closely to the diet were significantly less likely to suffer crippling joint pain, with better overall physical health and fewer signs of depression. Experts say the diet’s anti-inflammatory properties can help soothe swollen joints and support heart health and weight control, two essential factors for arthritis management. Dr Wendy Holden, medical advisor for Arthritis Action, notes that a diet high in fruit, vegetables, fish and whole grains—paired with reduced ultra-processed foods—helps reduce inflammation. Nutrition guidance also stresses the importance of protein intake to maintain muscle mass, which declines after age 40. Dr Lucy Donaldson, director of research at Versus Arthritis, says people should aim for about 40 grams of protein daily from varied sources; leucine-rich foods such as fish, nuts and legumes are particularly effective at stimulating muscle protein synthesis. Beyond inflammation, weight management remains a central piece of relief, since excess weight adds joint load and drives inflammatory processes.

2. Weight-loss injections may help some patients. Emerging evidence suggests that weight-loss injections can ease pain from osteoarthritis and may slow disease progression in some cases. A private prescription of tirzepatide (brand name Mounjaro) helped a 54-year-old woman with hip osteoarthritis regain mobility and reduce pain, delaying a planned hip replacement. A 2025 Taiwanese study, involving nearly 1,000 knee osteoarthritis patients, found that weight-loss injections reduced the risk of needing joint replacement. Dr Wendy Holden of Arthritis Action cautions that while early findings are encouraging, arthritis is not currently included in prescribing guidelines for weight-loss drugs, and further research is needed before these treatments become standard care. Still, some clinicians see potential for the drugs to protect cartilage and slow disease progression as weight falls, with patients reporting improved mobility and fewer flare-ups.

3. Build strength first. Experts emphasize that strengthening the muscles around affected joints is a cornerstone of managing osteoarthritis pain and may help prevent surgery. Professor Philip Conaghan explains that muscle weakness is common in patients with knee and hip joint problems, and that “first, get strong, then get fit.” He suggests starting with resistance training to build muscle before moving to cardio activities such as cycling or swimming. A recent review in the Annals of Physical and Rehabilitation Medicine concluded that strength training significantly reduces pain and improves function and quality of life for knee and hip osteoarthritis. Isaac Selby-Burton, a trainer who specializes in arthritis coaching, recommends starting with resistance bands to work the quadriceps—crucial for knee support—and gradually increasing intensity as pain allows.

4. Acupuncture can complement exercise. Many patients turn to acupuncture to manage osteoarthritis pain and enable more consistent participation in strengthening programs. A 2025 review of 18 studies involving about 14,000 people found acupuncture was effective in reducing pain and improving function in osteoarthritis, though results across studies vary. While the National Institute for Health and Care Excellence does not formally recommend acupuncture for osteoarthritis, Versus Arthritis notes that many patients report some relief, and surveys indicate acupuncture remains a popular option for chronic pain and inflammation. Clinicians emphasize that acupuncture is not a universal remedy, but many patients use it in combination with exercise to sustain gains.

5. Supplements that work have limited, cautious support. Many patients try supplements such as turmeric or curcumin, glucosamine or chondroitin. Medical advisors caution that evidence for these products is mixed or weak overall. The two supplements with any appreciable evidence are cod liver oil and rosehip—though even here results vary and benefits tend to be modest. Cod liver oil provides omega-3 fatty acids with anti-inflammatory potential, but clinical trials in osteoarthritis have not consistently shown clear benefit. Rosehip powder has shown some promise in small studies, but more research is needed to determine its role in routine treatment. In short, doctors say supplements may help some individuals, but they are not a substitute for weight management, structured exercise or other proven strategies.

6. Specialist knee braces can ease symptoms and delay surgery. Offloading or unloading knee braces can realign the joint and reduce pressure, supporting more active living for people with osteoarthritis. A 2017 study followed 63 patients awaiting knee replacement who wore an unloading brace; after eight years, 40 percent of those who wore the brace consistently for two years no longer needed surgery. The brace, such as the Unloader One from Ossur, redistributes load away from the worn compartment of the knee and can enable greater activity. The brace gained public attention when a high-profile patient wore it after knee problems; clinicians note that continued use for several months or more correlates with reduced progression toward surgery for some patients.

The composite evidence from these approaches does not offer a cure, but experts stress that disciplined lifestyle changes can meaningfully reduce pain, improve function and help some patients delay or avoid joint replacement. Reeves’s experience—driven by a combination of acupuncture, strengthening work and Mediterranean-style eating—illustrates how even advanced osteoarthritis can be managed through non-surgical means. Health professionals advise patients to consult with their doctors before starting any major new regimen, particularly weight-loss therapies or new exercise programs, to ensure plans are tailored to individual medical needs and safety considerations.

Health professionals emphasize that osteoarthritis management is highly individualized. While many patients benefit from diet and exercise, others may still require surgery or medications to manage pain. The overarching goal is to reduce inflammation, strengthen supporting muscles, protect joints from further damage and preserve mobility and quality of life. As researchers continue to study the potential roles of weight-loss therapies, acupuncture and targeted supplementation, patients and clinicians are increasingly collaborating to build comprehensive, multi-modal treatment plans that can adapt to changing symptoms and disease progression.