Osteoarthritis is one of the most common causes of long-term pain and disability. In Australia alone, more than two million people live with this condition.
It often affects the knees, making everyday activities such as walking, climbing stairs, or standing for long periods more difficult and painful.
Because knee pain can be worrying, many people expect doctors to order an x-ray to find out what is wrong. However, new research suggests that these scans are often unnecessary. In fact, doctors can usually diagnose knee osteoarthritis without any imaging at all.
Most of the time, a doctor can identify knee osteoarthritis simply by talking with the patient about their symptoms and examining the knee. Information such as the person’s age, the type of pain they feel, and how the joint behaves during daily activities can give doctors a clear picture of what is happening.
Even so, about half of the people who visit a general practitioner for knee osteoarthritis are still sent for imaging tests such as x-rays. These tests cost the Australian healthcare system more than 100 million dollars each year.
Besides the cost, researchers now believe these scans may also influence how people think about their condition in ways that are not always helpful.
Osteoarthritis happens when a joint tries to repair itself after years of use, minor injuries, or stress on the joint. The process affects many parts of the joint, including the cartilage that cushions the bones, the surrounding muscles, and the ligaments that hold the joint together. Over time, these changes can lead to pain, stiffness, and reduced movement.
Older adults are more likely to develop osteoarthritis, but other factors can also increase the risk. These include previous knee injuries, carrying extra body weight, or jobs and activities that place repeated stress on the knee joint.
Although osteoarthritis can be painful, surgery is not always the best or only treatment. In Australia, more than 53,000 knee replacement surgeries were performed in the 2021–2022 period.
Knee replacement can be helpful for people with very severe symptoms, but it is a major operation that carries risks such as infection, blood clots, and long recovery times. Some people also continue to experience pain even after surgery.
Fortunately, many people can manage knee osteoarthritis without surgery. Treatments often include learning more about the condition, staying physically active, strengthening the muscles around the knee, losing weight if needed, and using medications such as paracetamol or anti-inflammatory drugs to reduce pain.
One reason x-rays may not always be helpful is that they do not tell the full story about joint pain. Many people who have mild changes visible on an x-ray may experience severe pain, while others with more noticeable joint damage may feel little or no pain at all.
Because of this, medical guidelines now recommend that doctors diagnose knee osteoarthritis mainly based on symptoms. For example, the diagnosis is often made if a person is over 45 years old, has knee pain during movement, and does not have morning stiffness that lasts longer than about 30 minutes.
Despite these guidelines, both doctors and patients sometimes still expect x-rays as part of the diagnosis process.
To understand how imaging might influence patients’ thinking, researchers recently conducted a study involving 617 people from across Australia. The participants were shown videos of a doctor diagnosing knee osteoarthritis in three different ways.
In the first video, the doctor diagnosed the condition without using an x-ray. In the second, the doctor mentioned that an x-ray was taken but did not show the image. In the third video, the doctor showed the patient the actual x-ray image.
After watching the videos, participants answered questions about how they felt about the diagnosis and possible treatments.
The results were interesting. People who were shown the x-ray image were more likely to believe they needed knee replacement surgery compared with those who were not shown an x-ray. They were also more worried that exercise might damage their knee joint and were more fearful that their condition would worsen over time.
These concerns may discourage people from staying active, even though regular movement is one of the best ways to manage osteoarthritis.
Participants who saw the x-ray reported slightly higher satisfaction with the consultation. Researchers believe this may be because many people still think of osteoarthritis as simple “wear and tear,” and seeing an image of the joint damage may make the diagnosis feel more real to them.
However, the study suggests that avoiding unnecessary x-rays could actually help patients feel less fearful about their condition. Without the image, people may be more open to treatments such as exercise, physical therapy, and lifestyle changes rather than immediately thinking about surgery.
Reducing unnecessary scans could also lower healthcare costs, reduce exposure to radiation, and encourage better understanding of how osteoarthritis really works.
For people living with knee osteoarthritis, the message is reassuring. An x-ray is not always needed to understand or treat the condition. Many people can successfully manage their symptoms through simple treatments and healthy lifestyle choices.
If you care about pain, please read studies about how to manage your back pain, and Krill oil could improve muscle health in older people.
For more health information, please see recent studies about how to live pain-free with arthritis, and results showing common native American plant may help reduce diarrhea and pain.
The research showing these findings was published in the journal PLOS Medicine.
Copyright © 2026 Knowridge Science Report. All rights reserved.
