Not everyone with knee osteoarthritis needs surgery — and for many patients, a structured exercise programme can significantly reduce pain, improve function and delay or even avoid the need for knee replacement altogether. Mr Dennis Kosuge, Consultant Orthopaedic Surgeon at The Rivers Hospital, Sawbridgeworth, always discusses non-operative options with patients before recommending surgery.

Here are five evidence-based exercises recommended for patients with knee osteoarthritis. As always, if you are unsure whether these are appropriate for your specific condition, consult your GP or specialist first.

1. Straight leg raises

Lie on your back with one knee bent and the other straight. Tighten the quadriceps muscle of the straight leg and slowly raise it to the height of the bent knee. Hold for two to three seconds, then lower slowly. Repeat 10 to 15 times per leg.

This exercise strengthens the quadriceps without placing load through the knee joint itself — making it ideal even when the knee is painful.

2. Wall squats (mini squats)

Stand with your back against a wall, feet hip-width apart and slightly in front of you. Slide slowly down the wall until your knees are at roughly 30 to 45 degrees of bend — do not go below 90 degrees. Hold for five seconds, then slide back up. Repeat 10 times.

This strengthens the quadriceps and glutes in a controlled, low-impact way. If this causes pain, reduce the range and stop if discomfort is significant.

3. Calf raises

Stand holding a chair for balance. Slowly rise onto your toes, hold for two seconds, then lower. Repeat 15 to 20 times. This improves lower limb circulation, strengthens the calf and indirectly reduces load on the knee by improving overall leg muscle function.

4. Seated knee extension

Sit in a chair with your feet flat on the floor. Slowly straighten one knee until the leg is as straight as possible, hold for three seconds, then lower slowly. Repeat 10 to 15 times per leg. This directly targets the quadriceps and helps maintain range of motion.

5. Step-ups

Using a low step (start with a 10 cm step), step up with your affected leg leading, bring the other foot up, then step back down. Perform 10 repetitions per leg. As your strength improves, you can increase the height of the step gradually.

Step-ups replicate a functional movement and build the strength needed for daily activities like stairs.

Other non-surgical measures worth considering

Exercise is the single most evidence-based conservative treatment for knee osteoarthritis, but Mr Kosuge discusses all other non-operative treatment options with patients:

• Weight management — even modest weight loss significantly reduces load through the knee joint

• Walking aids — a walking stick used in the opposite hand reduces joint loading

• Physiotherapy — a qualified physiotherapist can tailor a programme to your specific needs. Mr Kosuge will be happy to make a referral to the physiotherapy team at Rivers Hospital for you.

• Joint injections — steroid or Arthrosamid injections for patients who need additional pain relief

When is surgery the right next step?

If you have been doing these exercises consistently for three to six months and your quality of life remains significantly affected by knee pain, it is worth seeking a specialist assessment. Mr Kosuge provides honest, evidence-based advice regarding the option of a knee replacement.

Ready to take the next step?

Mr Kosuge offers private consultations at The Rivers Hospital, Sawbridgeworth and The Princess Alexandra Hospital NHS Trust, Harlow.

To book an appointment with Mr Kosuge:

• Online booking

• Telephone: 01279 602675

If you have been living with persistent hip pain and find yourself wondering whether you might eventually need surgery, you are not alone. Hip replacement is one of the most commonly performed orthopaedic operations in the UK, and for most patients it is genuinely life-changing. But how do you know when the time is right?

Mr Dennis Kosuge is a Consultant Orthopaedic Surgeon specialising in hip and knee surgery, based at The Rivers Hospital in Sawbridgeworth and The Princess Alexandra Hospital NHS Trust in Harlow. He sees many patients across West Essex and East Hertfordshire who arrive unsure whether surgery is the right option. Here, he shares the signs that suggest it may be time for a specialist assessment.

1. Your pain is affecting your daily life

The most important question is not how much pain you have on a good day, but how much it limits what you can do. If hip pain is stopping you from walking to the shops, getting a good night's sleep, climbing stairs without discomfort, or doing activities you enjoy, that is a significant quality-of-life issue worth addressing.

Mr Kosuge explains: "My main focus in a consultation is always the patient's quality of life. Pain scores alone don't tell the full story — what matters is how the hip is affecting your daily function, your sleep and your wellbeing."

2. Conservative treatments are no longer working

Most patients have already tried painkillers, physiotherapy, walking aids, weight management and sometimes joint injections before reaching a surgeon. If these have provided diminishing returns and your symptoms continue to worsen, it may be time to discuss surgical options.

Mr Kosuge reviews all non-operative treatments before recommending surgery and will discuss whether further conservative measures offer meaningful relief first.

3. You have been told you have osteoarthritis of the hip

Osteoarthritis is the most common reason for hip replacement in the UK. On X-ray, the joint space narrows as cartilage wears away, and the bones may begin to rub together. Symptoms include a deep groin ache, stiffness first thing in the morning, and pain that worsens after activity or prolonged sitting.

Not everyone with osteoarthritis on X-ray needs surgery — the degree of symptoms matters more than the X-ray appearance alone. But significant osteoarthritis combined with poor function is a strong indicator that replacement may offer substantial benefit.

4. You are struggling to put on shoes or socks

This sounds simple, but limited range of motion in the hip — making it difficult to bend, rotate or reach your feet — is a very telling symptom. It often indicates advanced joint degeneration and is something Mr Kosuge assesses directly in clinic.

5. You have been told to "wait until it gets worse"

Historically, patients were advised to delay hip replacement for as long as possible. The evidence has shifted. Modern implants are extremely durable, and delaying surgery too long can lead to muscle weakness, compensatory gait problems and a longer recovery. Mr Kosuge takes an individualised approach and will advise you on the right timing for your specific circumstances.

What happens at a consultation with Mr Kosuge?

At your first appointment, Mr Kosuge will take a detailed history of your symptoms, examine your hip and review any existing X-rays or MRI scans. He will explain your diagnosis clearly and discuss all available treatment options — both surgical and non-surgical — so that you can make an informed decision.

Mr Kosuge's patient outcome data is consistently above the national average for hip replacement surgery, and he has been awarded the Certificate of Excellence by iWantGreatCare every year from 2019 to 2025.

Ready to take the next step?

For more information about hip osteoarthritis or hip replacement surgery - Mr Kosuge offers private consultations at The Rivers Hospital, Sawbridgeworth and The Princess Alexandra Hospital NHS Trust, Harlow.

To book an appointment with Mr Kosuge:

• Online booking

• Telephone: 01279 602675