Patient question
I'm over 50 and the outside of my knee aches at night. Is it arthritis?
Dr. Pablo GelberOrthopaedic Knee Surgeon
Quick answer
In people over 50, an outer knee that aches at night and is stiff in the morning is often arthritis in the outer (lateral) compartment, particularly with knock knees, or a degenerative lateral meniscus tear. Night pain on its own is not alarming, but it warrants assessment if it persists, says Dr. Pablo Gelber, knee surgeon at Aman Hospital in Doha.
Likely causes at this age
Arthritis more often affects the inner side of the knee, but when the legs angle inward, known as knock knees or valgus alignment, more load passes through the outer compartment and the cartilage there wears first. Typical features are aching after activity, stiffness when getting up, and a deep ache in bed, sometimes with mild swelling.
The lateral meniscus also becomes more fragile with age, and a degenerative tear can cause outer joint-line pain at night, particularly when lying on that side or with the knee bent. A root tear of the meniscus can cause sudden worsening after a small event like squatting. Less commonly, an insufficiency fracture of the bone in older adults with thin bones causes intense new pain and swelling.
Helping sleep and daily comfort
- A pillow between the knees when lying on your side, or under the knee when on your back
- Gentle cycling, swimming or walking during the day to keep the joint moving
- Strengthening exercises for the thigh and hip, ideally guided by a physiotherapist
- Weight loss where appropriate, which reduces load on the joint
- Painkillers or anti-inflammatory gels after discussing safety with your doctor
When night pain needs a prompt check
See a doctor soon if night pain is severe and constant, if there is unexplained weight loss, fever or a hot swollen knee, or if pain came on suddenly and you cannot bear weight. These are uncommon, but they need investigation rather than waiting.
What a consultation in Doha involves
Dr. Gelber examines alignment, range of motion and the meniscus, and usually requests standing X-rays, which show joint space and leg alignment. An MRI may be added if a meniscus root tear or bone problem is suspected. Treatment usually starts with physiotherapy and activity changes, and may include injections. For persistent pain, options such as a realigning osteotomy, partial knee replacement of the outer compartment or total knee replacement are discussed according to the pattern of wear.
Frequently asked questions
Does outer-compartment arthritis always need replacement?
No. Many people manage well for years with exercise, weight control and occasional injections. Surgery is considered when pain limits daily life despite these.
Is it normal for arthritis to hurt more at night?
Many people with arthritis notice aching at night, especially after a busy day. Pain that is severe and constant should be checked.
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