Obesity and Anterior Knee Pain


Anterior knee pain (pain in the front of the knee during sitting and walking up and down stairs) is often a burden for those experiencing chronic knee pain. It is quite prominent at any age and may be worse and more common in the overweight population. It may be the result of inactivity, and/or muscle weakness. Obesity complicates this condition as the structures of the anterior knee including the patella experience increased forces up to five times our body weight. By focusing on muscle strengthening and weight loss, anterior knee pain can often be improved through non-surgical measures. Anterior knee pain in the absence of advanced arthritis is rarely improved with surgery (either scope or replacement).


  • Knee pain over the front of the knee during activity, after activity,
  • Increased pain when resuming activity after sitting for long durations
  • Swelling, feelings of stiffness or decreased range of motion
  • Feelings of instability, usually when walking
  • Pain with bending of the knee, going up and down stairs


Depending on your history and physical exam, we will generally recommend an x-ray in the standing position to assess the amount of arthritis in your knee when you are putting weight on your joint.  As long as there is no emergent orthopedic intervention needed we will generally recommend the following:

  • Muscle strengthening:

Your quadriceps muscles are vital to maintain the strength and stability of your knee joint. We would recommend starting out with a home exercise program and incorporating exercises that specifically strengthening these muscles.   If needed, we may want you to undergo a dedicated strengthening program with physical therapy for a few weeks.

  • Weight loss:

Losing weight is a key element in decreasing your anterior knee pain.  Your doctor can provide simple diet modifications and recommendations when you visit their office.  If you have special diet concerns or other medical conditions that require a more tailored approach to weight loss, a referral can be made to a nutritionist, and in certain cases a bariatric surgeon.

Often weight loss can be difficult when it hurts to exercise.  Exercising in the pool takes the pressure off your joints and still allows your muscles to become stronger. 

  • Pain Control:
    • Over the counter pain medicine such as: NSAIDS (Advil, Motrin, Aleve, Ibuprofen, Naproxen), Tylenol
    • Ice, elevation, using a soft knee brace
    • Using a cane or hiking stick
    • Muscle strengthening and aerobic activity
  • Surgical Options:

If you have arthritis in your knee and you are questioning whether or not to have a knee replacement, we will not recommend surgery if your body mass index (BMI) is greater than 35 or 40.   The risks of infection dramatically increase in patients whose BMI is greater than 35.   For those whose BMI is greater than 40 the risks of surgery, including infection, stroke, heart attack, and even death continue to increase and the surgeon’s technical ability to perform the procedure is compromised.  We do not want to put you at this risk and will recommend weight loss through diet or possibly bariatric surgery for those who have failed dieting attempts prior to discussing knee surgical options.