Orthopedist Questions Knee Problems

My knee grinds when I climb stairs. What can be done?

I have always had bad knees but as I've gotten older they have gotten noisier! Any time I climb steps I can hear grinding. Does this mean I need knee replacements?

22 Answers

No. The grinding is probably from patella chondromalacia which may well be helped with specific quadriceps strengthening.
Crepitus (grinding) of the patellofemoral (front part of the knee) joint with stair climbing is incredibly common. It often does get more pronounced with age. When it is non-painful, there is not much to worry about, but if it is painful, the first step is to get your quad muscles stronger, as that will allow the kneecap to "float" better and grind less with stairs and activity. It is often part of knee arthritis and when the pain gets bad enough, you may need to consider knee replacements. It is important to note, however, that even after knee replacements, non-painful crepitus occurs in 11-35% of patients. Hope this helps!!

To your musculoskeletal health,

Dr. T
No need for knee replacement if there is no pain just noise !
The grinding may be caused by patellofemoral chondromalacia or osteoarthritis between the knee cap and groove for it in your femur. Grinding doesn't mean you need knee replacement. Knee replacement is typically performed for people with advanced knee arthritis that is causing pain that is limiting their lifestyle. These patients usually have tried oral and injectable medications but have not obtained sufficient relief of their pain.
Thank you for your question, and I apologize for the delay in responding to you.

The grinding is described as "crepitus," and it is indicative of damage to the cartilage joint surface of the knee. Usually, the patella, or kneecap, is the part of the knee that has the damage. The cartilage is the smooth, gliding surface tissue that lines the ends of our bones in all the joints in the body. When the very slick, but delicate surface layer of the cartilage is damaged, the cartilage tissue starts to break down. As the process continues, the surface becomes rough, like a gravel road. We perceive this roughness as a grinding sensation that can be felt and/or heard.

Simply having crepitus does not mean you need to have your knees replaced. In fact, I also have crepitus in my knees, and I am really not bothered by it at all. The important point is pain-- is the grinding painful, or just a nuisance? If it is just a nuisance, nothing more than maintaining a healthy diet and exercise regimen is required to promote the health of your knees. If, however, the grinding is painful, then you should seek out a consultation with an orthopedic surgeon who specializes in knee problems. You can then discuss treatment options like medications, braces, physical therapy, and injections before embarking on knee replacement surgery.

Take care,
Kenneth Brooks, M.D.
It is possible you have arthritis in your knees and that is why you hear or
feeling grinding on stairs. You should have xrays to evaluate if you do
have arthritis
Then a treatment plan can be made
No, not necessarily. If it is arthritis, the initial treatment is not to replace. It could also be chondromalacia of the knees which is very common. These conditions are typically initially treated with NSAIDs, physical therapy, and diet control. Surgery would be the last resort.
What you are experiencing, grinding or crunching in your knee without pain is a common symptom of chondromalacia or softening of the surface coating of the knee. It may be a precursor to arthritis. This condition may be improved with specific exercises, glucosamine and chondroitin sulfate, and weight loss if necessary. The grinding alone without pain or swelling is not an indication for surgery.
Although sounds in your knee can be annoying, this does not equal a reason for a knee arthroplasty. An arthroplasty or "replacement" is performed for severe pain in conjunction with x-rays that demonstrate advanced arthritis. A physical exam is necessary to provide personal information specific to yourself. I hope this helps please call my office if you would like further information 302-990-3280

Audible sound was going up and down the stairs without pain is something that may be an early sign of arthritis but is typically manage just with strengthening. Once the pain starts to interfere with your life there are many options to treat this in a nonsurgical way. We always resort to surgery as a last options. Oftentimes a simple injection can get u back up and running for 6 months to a year. We are happy to help you here at Lourdes 856-796-9393.
As a knee doctor, I rarely worry about "noise" that isn't associated with pain. The audible grinding in the knee is often referred to as "crepitation" and is not an uncommon issue as we age. It may or may not be related to arthritis, especially in the kneecap area if noted during stair climbing, squatting, or kneeling. If it is painless, generally we reassure you not to worry and advise a return visit if it becomes painful. Knee replacements are only considered if patients have painful arthritis that is not responding to conservative treatment options, like medications, injections, physical therapy, or bracing.
Grinding of joints has many reasons. The main reason is the alteration of the consistence of joint fluid, depending on age and load and stress of the joint. Together with wear and tear of the cartilage, an inflammative process can start which becomes chronic, if not treated. This attacks the cartilage and in this inflammative environment, the joint fluid alters. The joint fluid carries all nutritive factors which are necessary for the cartilage stability and function.
In case of grinding, the treatment could be special physiotherapy with exercise (Medical training treatment - MTT) to rebalance the knee function and intra-articular injections of Hyaluronic Acid (Viscosupplementation).
It sounds like some arthritis under your knee cap. Initial treatment for arthritis is usually conservative treatment like NSAIDS, physical therapy, injections. When the arthritis is "bone on bone" and pain is severe, constant and disabling then knee replacement is considered.
Good morning, Unfortunately it is very difficult to diagnose without seeing
any images. You are more than welcome to give our office a call at (954)
491-6969, we will be more than happy to schedule an appointment for you.
It does sound like arthritis, however knee replacements are reserved for painful arthritis. If you are not having pain, then a knee replacement would be premature.

However, a good therapy program and an evaluation could help you avoid further degeneration. Pls go to www.MichaelLimMD.com to schedule an appointment.
You may have a condition called "Chondromalacia" of the cartilage between the kneecap and the femur bone. This is similar to the small cracks that you see in fine china dinnerware. These cracks can be seen and very mildly felt with moving your finger tip over the china's surface. These small cracks in the cartilage also cause grinding in the knee as the surface is a little bit rough but not broken. This is not a reason to do a knee surgery, replacement or otherwise. Pain and deformity are the only reasons to do a knee replacement, so as long as you do not have pain, you won't be headed for any surgery.
The best way to address your concern is with standing X-rays of your knees with multiple views taken to assess carriage wear and the presence of arthritis. It sounds like you may have cartilage wear under the knee caps. Depending on the severity, you may eventually require knee replacement but you should investigate all non operative management first. Hope this helps.
Many people have knee joint replacement. The main indication is pain that does not resolve with time, exercise, and treatments (PT, injections, arthroscopic surgery, etc.). In addition, if someone is unable to perform their daily work, recreational, or social activities dues to inability (weakness, stiffness, swelling) or pain, then at times a joint replacement can help. If there is grinding but not much sharp and disabling pain, then there is no need for total knee replacement. It has been shown that exercise to increase motion and strength of the muscles around the knee joint can alleviate pain and prolong the life of your natural knees. Pop-doc.com has these flexibility, motion, tone, and strengthening mobile exercise programs.
It means that there is rubbing between your patella and femur bone. If it's not painful, PT and avoidance of squatting and minimizing stairs is the way to go. If painful, meds, injections and PT are done first. If that doesn't work, then an arthroscopic procedure may help. Sounds like you are a long way from a knee replacement.
Not necessarily. If the noise is accompanied by pain, then it very well may be related to osteoarthritis. Just because your knees make noise does not mean you need a joint replacement. Pain and diminished range of motion are indicative of advancing OA. If you have those symptoms, then joint replacement surgery may be on the horizon for you.
No, surgery is the last resort. Always try no surgical treatment; exam ,X-ray, brace, physical therapy.
It may, you should get an evaluation by an Orthopaedic surgeon which will involve an examination and/or images like xrays