Why Getting an X-Ray for Knee Pain Might Not Be the Best Idea

ByHerman J. Nord

If you’ve ever felt that stubborn ache in your knees and thought, “Maybe I need an X-ray,” you’re definitely not alone. Knee pain is one of the most common reasons people visit their doctor, and for many, the first step seems to be some form of imaging.

But here’s the surprising part: most knee X-rays for osteoarthritis might be doing more harm than good.

The Growing Burden of Osteoarthritis

Osteoarthritis, often shortened to OA, is one of the leading causes of long-term pain and disability worldwide. In Australia alone, it affects over two million people, and the numbers are rising. The condition is most common in older adults, people with higher body weight, or those who’ve injured their knees in the past.

The tricky part?

While osteoarthritis affects the entire joint—bones, cartilage, ligaments, and muscles—an X-ray doesn’t always give the full picture. Even though doctors are advised not to rely on routine imaging, nearly half of Australians who visit their GP with knee pain still end up getting an X-ray. That adds up to a staggering A$104.7 million every year in costs to the health system.

Why X-Rays Aren’t Always Helpful

It’s easy to think that seeing the inside of your knee will explain the pain you’re feeling. But research shows that the severity of changes seen on an X-ray often doesn’t match the level of pain or disability a person experiences. Some people with only slight changes have severe pain, while others with significant changes get by with only mild discomfort.

This mismatch can have a big psychological impact. When patients see their X-ray results, they may start to believe their knee is “damaged” beyond repair. In fact, one study found that people shown their X-rays were 36% more likely to feel they needed surgery compared to those given a clinical diagnosis based purely on symptoms.

And here’s the kicker: seeing those images also made people more fearful of movement, more anxious about their condition getting worse, and more hesitant to exercise—exactly the opposite of what helps in managing osteoarthritis.

Surgery Isn’t Always the Answer

Knee replacement surgery has become increasingly common, with more than 53,000 Australians undergoing the procedure in 2021–22. It’s often seen as inevitable for people with OA, but the truth is, surgery should only be considered if symptoms are severe and persistent, and if non-surgical treatments haven’t worked.

Surgery carries risks like blood clots, infections, and incomplete recovery. Plus, it’s expensive—hospital services for osteoarthritis cost $3.7 billion in 2020–21 alone.

The good news? Most people can manage knee osteoarthritis without going under the knife. Effective strategies include:

  • Education and self-management (understanding the condition and how to live with it)
  • Exercise and physical activity (to strengthen muscles and support joints)
  • Weight management (if needed, to reduce stress on the knees)
  • Medication like paracetamol or non-steroidal anti-inflammatory drugs for pain relief

Busting the “Wear and Tear” Myth

One of the biggest misconceptions is that osteoarthritis is simply “wear and tear.” This idea makes people think the more they move, the worse it will get. But in reality, movement and exercise are crucial for managing the condition.

Guidelines recommend a clinical diagnosis instead of imaging. For anyone aged 45 or older, experiencing joint pain with activity, and having either no morning stiffness or stiffness lasting less than 30 minutes, osteoarthritis can usually be diagnosed without the need for an X-ray.

A Better Way Forward

So, what does this mean if you have knee pain? The bottom line is: you don’t always need an X-ray to get answers. In fact, skipping unnecessary imaging could save you stress, reduce healthcare costs, and help you focus on treatments that actually work.

Instead of worrying about what an X-ray shows, it’s often better to focus on how you feel, how you move, and what you can do to manage your symptoms. Exercise, education, and lifestyle changes may not sound as dramatic as surgery, but they can make a huge difference in improving mobility and quality of life.

So next time your knees ache and someone suggests an X-ray, remember this: seeing inside your joint doesn’t always tell the full story—but moving your body and managing your health certainly does.