Arthrose du genou

• Use culturally safe, trauma- and violence-informed care. Explain why questions matter, seek permission before sensitive topics, and adapt communication to the patient’s language, identity, culture, disability and previous health care experiences (Public Health Agency of Canada, 2018).
• Patient and contextual information: age; sex and gender when clinically relevant; preferred language and communication needs; work or school; caregiving; mobility and transportation; and the activities, roles, cultural practices and community connections important to the patient.

Primary concerns

• Context and onset: gradual or sudden onset; first episode or recurrence; recent or remote trauma; previous knee injury, surgery or inflammatory joint disease; changes in activity or load; and whether symptoms are improving, stable, fluctuating or worsening.
• Pain and symptom pattern: location, intensity, duration and irritability; activity-related pain; rest or night pain; morning stiffness and its duration; swelling or warmth; crepitus; catching, locking or giving way; and flare frequency, triggers and recovery.
• Aggravating and easing factors: walking, stairs, standing, sitting, kneeling, squatting, rising from a chair, lifting, work or sport tasks, sleep, movement, rest, pacing, heat or cold, walking aids, braces and medication.
• Functioning and participation: effects on mobility, transfers, self-care, household tasks, work or school, caregiving, driving, sleep, recreation, physical activity, social and community roles, confidence and falls risk.
• Revue des systèmes corporels : constitutional symptoms; skin; cardiovascular and vascular; respiratory; neurological; musculoskeletal and bone health; gastrointestinal and genitourinary; endocrine or metabolic; immune, infectious or inflammatory; haematologic or bleeding; sleep; and mood symptoms that may change safety, the differential diagnosis, medication decisions or referral.
• Health and safety context: other joint symptoms; inflammatory disease; gout; osteoporosis or fracture risk; cancer or infection history; diabetes, cardiovascular, renal, liver or gastrointestinal conditions; recent surgery, hospitalization, immobility or travel; venous thromboembolism risk; falls; pregnancy when relevant; and current medications and supplements, including analgesics, anti-inflammatory drugs, anticoagulants and corticosteroids.
• Knee and lower-limb history: prior ligament, meniscal, patellar, cartilage or bone injury; surgery; alignment or developmental concerns; hip, ankle, foot, lumbar or neurological symptoms; previous rehabilitation; and the current diagnosis, imaging or specialist plan when available.
• Physical activity and broader health: current and preferred activity; strength, balance and aerobic capacity; nutrition; sleep; smoking, alcohol or substance use; body-weight concerns raised by the patient; and readiness for health-related change without assuming these factors explain the symptoms.
• Social and access context: work or school demands and support, caregiving, income, housing, food security, transportation, discrimination, safety, social support, access to care, technology and suitable space or equipment (Public Health Agency of Canada, 2026).
• Soins et interventions antérieurs : education, activity change, exercise, hands-on care, heat or cold, walking aid, brace, taping, medication, injection, nutrition or weight-management support and other approaches tried; benefits, adverse effects, burden and reasons care was difficult to use or continue.
• Patient perspective: understanding of OA and imaging, concerns about damage or worsening, priorities, preferences, cultural context, expectations, confidence, strengths, previous experiences of care and interest in medical or surgical options.
• Flag review: check Red Flags and refer to the separate fixed Orange Flags and Yellow Flags modules when relevant. Reassess when knee symptoms or general health change.

Outcome measures

• Choose a small set that reflects the patient’s goals and can be repeated. Record relevant testing conditions and any gait aid or brace so results can be compared.
• Patient-specific functioning: Patient-Specific Functional Scale (PSFS).
• Disability and participation: WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF or another suitable validated measure.
• Knee symptoms and activity: the Knee injury and Osteoarthritis Outcome Score (KOOS) can track pain, other symptoms, daily activities, sport and recreation, and knee-related quality of life. Use the separate subscale scores and follow current access requirements.
• Physical performance: repeatable measures such as comfortable walking, sit-to-stand, stairs, balance, knee motion and strength selected for the patient’s goals, abilities and safety.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used.

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

• Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
• Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
• Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

• Suicide or self-harm thoughts: thoughts without immediate danger.
• Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
• Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

• Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
• Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
• Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
• Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

• Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
• Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change safety, the working diagnosis, care or referral. Adapt positioning, pace and loading to pain, comfort, consent, mobility, balance and other health conditions.

• Ongoing consent and comfort: explain each step, provide choices, ask permission before touch or exposure, and stop or modify the examination when requested.
• Immediate safety: observe general appearance and weight-bearing tolerance; inspect for trauma, deformity, heat, marked swelling, skin change or wounds; and assess vital signs, distal circulation or neurological findings when the presentation indicates.
• Observation, gait and mobility: compare alignment, swelling, muscle bulk, posture, transfers, gait, balance, footwear and use of a walking aid or brace. Note the tasks and environments that change symptoms or safety.
• Movement and range of motion: assess active and passive knee extension and flexion as tolerated, noting pain, stiffness, crepitus, end-feel, movement quality and comparison with the other side. Add hip, ankle or patellar movement when it may change the assessment.
• Effusion and palpation: record effusion with a repeatable method when useful; examine relevant bone, joint lines, patellofemoral region and soft tissues. Tenderness or crepitus supports the clinical picture but does not establish symptom source or severity by itself.
• Force et contrôle du moteur : assess quadriceps and hamstring performance, hip and calf strength, balance and lower-limb control as tolerated. Record pain, confidence and compensations that may guide care.
• Functional performance: select meaningful tasks such as comfortable or fast walking, sit-to-stand, stairs, squat, kneeling, lifting, balance, work or caregiving tasks. Record quality, capacity, symptoms, confidence and the effect of a gait aid when relevant.
• Regional and differential examination: examine the hip, patellofemoral joint, ankle, foot, lumbar or neurological system, vascular status or another region when the history or initial findings indicate an alternative or overlapping source.
• Imagerie : not routine for a typical clinical presentation. Use imaging when atypical features, trauma or another diagnosis is suspected, or when the result is likely to change medical, surgical or rehabilitation decisions. Do not use imaging routinely to monitor non-surgical care (National Institute for Health and Care Excellence, 2022; American College of Radiology, 2020).
• Reassessment: repeat the findings and tasks needed to review progress, revisit the working presentation, identify adverse effects and decide whether further assessment, imaging or referral is appropriate.

Working clinical presentations

Use these as working clinical descriptions rather than fixed stages or complete explanations of pain. They can overlap or change, and imaging findings do not determine symptoms or care on their own.

• Typical clinical knee OA presentation: in an adult aged 45 or older, activity-related knee pain with no morning joint stiffness or stiffness lasting no longer than about 30 minutes. Crepitus, reduced movement, bony enlargement, joint-line tenderness or mild swelling may support the clinical impression but are not required in every person (National Institute for Health and Care Excellence, 2022).
• Mobility, strength or balance presentation: knee pain or stiffness is accompanied by reduced knee motion, lower-limb strength, walking tolerance, balance, transfers, stairs or other tasks important to the patient.
• Flare presentation: pain, swelling and stiffness temporarily worsen beyond the usual pattern and affect sleep, activity or wellbeing. Revisit recent changes, safety, self-management, treatment burden and whether medical assessment is needed.
• Persistent or high-impact presentation: symptoms remain substantially limiting despite acceptable conservative options, or pain, sleep, mood, mobility, work, caregiving or participation needs require broader medical, rehabilitation or surgical shared care.
• Bilateral or multisite OA presentation: both knees or other joints contribute to symptoms and activity limits. Assessment and care reflect the combined effect, other health conditions and the person’s priorities rather than treating each joint in isolation.
• Alternative or overlapping presentation: findings may point to fracture, ligament or meniscal injury, patellofemoral pain, tendon disorder, crystal or inflammatory arthritis, infection, venous thromboembolism, nerve involvement, referred pain, malignancy or another condition. Use Red Flags and shared care when needed.

Develop care with the patient. Base choices on safety, the working presentation, goals, preferences, culture, other health conditions, activity demands, access, previous responses and observed progress. Use adaptable options rather than a fixed sequence (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).

Education, self-management and participation

• Understanding OA: clear explanations can address the whole-joint condition, the variable course and flares, the limited link between imaging and symptoms, and the role of movement, exercise and symptom-management choices (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).
• Daily activity and participation: pacing, task variation, sleep strategies, footwear or equipment changes, work or school accommodations and planning for caregiving or transport can support continued participation in valued activities.

Activity, pacing and joint support

• Loading and pacing: daily activity can be adjusted during a flare and built back as symptoms settle. Plans can use manageable starting points, task variation and gradual exposure without treating pain during activity as evidence of new damage (National Institute for Health and Care Excellence, 2022).
• Walking aids and selected supports: a cane, crutches, walker, tibiofemoral or patellofemoral brace, or taping can form part of care when a clear goal is to improve mobility, balance, stability or symptoms. Fit, comfort, skin, use and response are reviewed (American College of Rheumatology and Arthritis Foundation, 2019; American Academy of Orthopaedic Surgeons, 2021; National Institute for Health and Care Excellence, 2022).

Physical activity and exercise

• Progressive exercise: options include knee and hip strengthening, range and flexibility work, balance or neuromuscular training, walking, cycling, aquatic exercise and general aerobic activity. Type, dose, setting and progression reflect goals, capacity, access, other health conditions and response (American Academy of Orthopaedic Surgeons, 2021; American College of Rheumatology and Arthritis Foundation, 2019; National Institute for Health and Care Excellence, 2022).
• Starting and sustaining activity: some temporary discomfort can occur when activity or exercise begins. A feasible plan, supervision when useful, behaviour-change support and regular review can help the patient build consistency and adapt the program (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).

Weight and broader health support

• Weight-management support: when relevant and acceptable to the patient, options include non-stigmatizing support for individualized nutrition, physical activity and behaviour goals, with access to a dietitian, physician or community service when useful. Weight is not a prerequisite for exercise, other suitable care or joint-replacement referral (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).

Hands-on and symptom-relieving care

• Hands-on care: knee or patellar mobilization and soft-tissue techniques can accompany exercise when a short-term goal is to improve comfortable movement, reduce guarding or support activity. Purpose and response are reviewed rather than using hands-on care alone (National Institute for Health and Care Excellence, 2022; American Academy of Orthopaedic Surgeons, 2021).
• Heat, cold and other symptom relief: heat or cold can be used for short-term comfort when acceptable and safe. Protect skin and circulation and connect symptom relief to movement, sleep or meaningful activity (American College of Rheumatology and Arthritis Foundation, 2019).
• Culturally grounded approaches: traditional, spiritual or community-based approaches identified by the patient can be integrated when safe, acceptable and within scope, with coordination across practitioners when needed.

Psychological, social and interdisciplinary support

• Coping and behaviour support: pain-coping skills, self-management programs, goal setting, graded activity and support for sleep, mood or distress can form part of care when these match the patient’s priorities (American College of Rheumatology and Arthritis Foundation, 2019; National Institute for Health and Care Excellence, 2022).
• Interdisciplinary and access support: primary care, rehabilitation, pharmacy, dietetics, rheumatology, orthopaedics, psychology, social care, community services, workplaces and family or chosen supports can contribute according to health needs, goals and barriers.

Medication and medical options

• Medication coordination: medication choices sit with an authorized prescriber or pharmacist. A topical non-steroidal anti-inflammatory drug is a common knee-specific option. Oral non-steroidal anti-inflammatory drugs require individualized review of gastrointestinal, renal, liver and cardiovascular risks, pregnancy, comorbidities, current medicines and treatment duration (National Institute for Health and Care Excellence, 2022; American College of Rheumatology and Arthritis Foundation, 2019; American Academy of Orthopaedic Surgeons, 2021).
• Intra-articular corticosteroid injection: discussion with an authorized medical provider can address short-term symptom relief or support for exercise when other pharmacological options are ineffective or unsuitable. Expected benefit is temporary, and the decision includes contraindications and individual risks (National Institute for Health and Care Excellence, 2022; American College of Rheumatology and Arthritis Foundation, 2019; American Academy of Orthopaedic Surgeons, 2021).

Medical and surgical shared care

• Joint replacement assessment: referral can be arranged when symptoms substantially affect quality of life and suitable non-surgical care is ineffective or unsuitable, or when the patient wants to discuss surgical options. Referral is for individualized assessment and does not promise surgery (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).

Monitoring and reassessment

• Agree on a reassessment point based on the presentation, symptom course, safety, goals, the options being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review pain, stiffness, swelling, knee motion, strength, mobility, task performance, functioning, participation, confidence, benefits, adverse effects, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the working presentation, differential diagnosis, imaging, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Expected course: knee OA is a long-term condition with a variable course. Pain, stiffness, mobility and participation can improve, remain stable, worsen or fluctuate, and flares can occur within that course. No universal symptom timeline applies (National Institute for Health and Care Excellence, 2022; Cijs et al., 2025).
• Factors associated with a less favourable course: greater pain or reduced functioning, higher comorbidity burden and activity avoidance may be associated with worsening pain or functioning. These are group-level associations, not certain causes or individual predictions (Cijs et al., 2025).
• Potential supports for recovery: feasible exercise and physical activity, confidence and active coping, symptom-management skills, supportive relationships and workplaces, suitable mobility aids, care for relevant health conditions, timely shared care and progress toward meaningful activities may support functioning (National Institute for Health and Care Excellence, 2022; Ontario Health, 2024).
• Discussing prognosis: describe uncertainty in plain language, ask what the patient wants to know, and update the outlook using goals, repeated outcomes and the observed response over time. Do not treat age, body weight, an imaging grade or a single score as a fixed prediction.