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

As part of his role at The Princess Alexandra Hospital NHS Trust, Mr Kosuge provides orthopaedic trauma services aimed at treating patients who have sustained injuries and fractures affecting their upper and lower limbs. Whilst Mr Kosuge enjoys elective hip surgery and knee surgery, he also enjoys looking after patients who have broken their bone(s). During his trauma duties, he performs surgery to fix broken bones affecting various parts of the body and he finds this variety stimulating.

In recognition of this and his educational interests, Mr Kosuge is extremely proud to have been a member of faculty at the recently run AO Trauma Blended Course - Basic Principles of Fracture Management held in Leeds, UK. This was his second time at this annually held national course which is aimed at educating trainee orthopaedic surgeons. Mr Kosuge enjoys being involved in the training of orthopaedic surgeons in the work setting on a daily basis but also finds fulfilment in teaching on more formal platforms such as this.

Mr Kosuge hopes to have a long career with AO Trauma and with the education of future orthopaedic surgeons.