Which doctor to see for knee pain or knee degeneration: how primary care handles it, when to see a specialist, public or private
Primary care is the first point of contact for common musculoskeletal problems such as knee osteoarthritis; knee osteoarthritis can be diagnosed by clinical assessment, typical patients generally do not have routine imaging, and patients with end-stage disease should be referred to a specialist to consider surgery, which is advice addressed to primary care professionals (Primary Healthcare Commission reference framework on Common Musculoskeletal Problems, December 2022). The treating doctor decides individual cases.
Which doctor should I see first for knee pain or knee degeneration?
Primary healthcare is the first point of contact for individuals and families in a continuous healthcare process, and family doctors are the main providers of primary healthcare (Health Bureau Primary Healthcare Blueprint, December 2022); for choosing a family doctor, see How to choose a family doctor, and for public Family Medicine Clinics, see Booking a general outpatient clinic.
Knee osteoarthritis, low back pain and osteoporosis are common musculoskeletal problems in primary care; primary care professionals can provide education, assess patients' needs, monitor the response to treatment and, when needed, refer patients to other allied health professionals and specialists (Primary Healthcare Commission reference framework on Common Musculoskeletal Problems, December 2022, for adults in primary care settings in Hong Kong).
Patients whose knee pain persists or affects daily activities should seek medical advice as soon as possible so that appropriate treatment can be arranged (Department of Health Elderly Health Service ‘Osteoarthritis of Knee’ information, for older adults, accessed October 2026).
Which doctor follows up an individual patient is decided by the treating doctor.
How is knee osteoarthritis diagnosed? Do I need an X-ray or MRI?
Knee osteoarthritis can be diagnosed clinically, and typical patients generally do not have routine imaging, which is advice addressed to primary care professionals (reference framework on Common Musculoskeletal Problems, December 2022). The reason is that imaging findings of knee osteoarthritis without symptoms are common in middle-aged and older people, so when assessing knee pain, other diagnoses should be excluded before the symptoms are put down to degeneration (reference framework on Common Musculoskeletal Problems, December 2022).
The important diagnoses to exclude include life- or limb-threatening conditions such as infection or malignancy, and joint problems that make degeneration worsen rapidly, such as a meniscal root tear or spontaneous osteonecrosis of the knee (reference framework on Common Musculoskeletal Problems, December 2022). The atypical features for primary care doctors to consider further investigation are: a younger patient, a history of trauma, prolonged morning stiffness, rapidly worsening symptoms, a red, swollen and hot joint with fever, marked pain at rest or at night, weight loss, and true locking of the knee (summary chart of the reference framework on Common Musculoskeletal Problems, December 2022); whether a case is atypical is judged by the doctor.
Which test to do is decided by the doctor according to the situation; for private MRI fees, see MRI fees compared.
How is knee osteoarthritis treated?
Offering all patients with knee osteoarthritis non-drug treatment (education and self-management, activity modification, exercise, and weight loss for those who are overweight or obese) is advice addressed to primary care professionals; drug treatment can be started at the same time as non-drug treatment, or used after a trial of non-drug treatment (reference framework on Common Musculoskeletal Problems, December 2022). What two Hong Kong documents say about drugs is in the table below.
| Document | What it says about drug treatment |
|---|---|
| Primary Healthcare Commission (Health Bureau) reference framework on Common Musculoskeletal Problems (December 2022, for primary care professionals) | The drug options in the summary chart are oral and topical non-steroidal anti-inflammatory drugs, paracetamol and duloxetine; the core document separately describes research findings on opioids, intra-articular steroid injections and hyaluronic acid injections; the potential harms, cost and patient preferences should be considered before drugs are used |
| Hong Kong College of Orthopaedic Surgeons, Position Statement in Management of Osteoarthritis of Knee (published 10 August 2022) | Recommends paracetamol and topical non-steroidal anti-inflammatory drugs as first-line painkillers; oral non-steroidal anti-inflammatory drugs (together with a proton-pump inhibitor) are second-line, for patients with no contraindications who respond poorly to the first-line drugs; for opioid painkillers and intra-articular injections (steroid, hyaluronic acid, platelet-rich plasma), the College says it is not able to advocate for or against |
What non-drug treatment and self-care are there for knee osteoarthritis?
The recommended management includes patient education and self-management, land-based exercise, water-based exercise, and weight control for patients with a high body mass index; arthroscopic lavage and denervation therapy are not recommended (Hong Kong College of Orthopaedic Surgeons Position Statement, August 2022).
Ice can be applied when the affected area has acute inflammation such as redness, swelling and warmth, and heat can be applied when the pain is milder and there is no warmth or redness; the side effects of non-steroidal anti-inflammatory painkillers include gastrointestinal discomfort and gastrointestinal ulcers, so patients must use them as the doctor instructs; for exercises that strengthen the thigh muscles and the knee joint, patients can ask a doctor or physiotherapist (Department of Health Elderly Health Service, for older adults, accessed October 2026).
Which treatment an individual patient uses is decided by the treating doctor.
Can I see a physiotherapist directly for knee pain (knee osteoarthritis)?
Yes, in specified circumstances. The Government introduced a direct-access arrangement under the Allied Health Professions Ordinance (Cap. 359) in July 2025, under which physiotherapists may provide services without a doctor's referral in specified circumstances; one of these is when the patient's condition is of a kind that a clinical guideline published by a referencing authority recognises as one for which physiotherapy may be provided without referral (Primary Healthcare Commission clinical guideline for first-contact physiotherapists, first issued December 2025).
The reference framework on Common Musculoskeletal Problems covers knee osteoarthritis and low back pain; in this circumstance, a physiotherapist may only treat problems consistent with knee osteoarthritis, low back pain or other conditions listed in the clinical guidelines (clinical guideline for first-contact physiotherapists, December 2025). If treatment does not work as expected, the physiotherapist must refer the patient to a doctor; if the problem is still unresolved after one course of treatment (30 days or 10 treatment sessions, whichever comes first), the physiotherapist should refer the patient to a doctor for a detailed assessment (clinical guideline for first-contact physiotherapists, December 2025). For low back pain, see Which doctor to see for low back pain.
Can I see a chiropractor directly for knee pain?
Yes, directly: Hong Kong law does not require a referral before seeing a chiropractor (see Do you need a referral to see a chiropractor?). Under the Chiropractors Registration Ordinance (Cap. 428), chiropractors are persons trained and qualified in the prevention, diagnosis and treatment of functional disorders of the human body through manipulation of the joints, particularly of the vertebral column and peripheral joints, including the pelvis; a chiropractor should refer a patient whose condition needs alternate care to the appropriate healthcare practitioner (Chiropractors Council of Hong Kong, Code of Practice, Part II).
This site does not compare or rank family doctors, physiotherapists and registered chiropractors; the site's chiropractor list is ordered by English name.
When should knee degeneration be referred to a specialist? When is joint replacement considered?
Persistent symptoms after initial non-surgical management are an indication for surgery; patients with end-stage knee osteoarthritis should be referred to a specialist to consider surgery, which is advice addressed to primary care professionals (reference framework on Common Musculoskeletal Problems, December 2022).
Knee replacement surgery is recommended for patients with symptomatic end-stage knee osteoarthritis after initial non-surgical management has failed; for symptomatic degeneration of the medial compartment of the knee, high tibial osteotomy is recommended in selected patients (Hong Kong College of Orthopaedic Surgeons Position Statement, August 2022).
Orthopaedics and Traumatology treats diseases and injuries of the spine and limbs with medication and surgery, and its scope includes adult joint reconstruction (Hong Kong Academy of Medicine, Specialty Descriptions, April 2025); for choosing an orthopaedic surgeon, see How to choose an orthopaedic surgeon.
Whether an individual patient needs surgery, and which operation, is decided by the treating doctor according to the condition.
Public or private?
Hospital Authority specialist outpatient clinics provide specialist care for patients referred by general outpatient clinics, private doctors or family doctors; new referral cases are first screened by nurses and then reviewed by the specialists concerned, and are classified as urgent, semi-urgent or routine (stable) cases (Government reply to the Legislative Council, November 2023).
For the steps to book a new case at a public specialist outpatient clinic, see How to book a public specialist outpatient clinic, and for orthopaedic waiting times, see public waiting times for orthopaedics; for public and private knee replacement surgery compared, see Knee replacement surgery: public or private?, for private fees see Knee replacement fees compared, and for the English name see Knee replacement.
Frequently asked questions
Which doctor should I see for knee pain?
Family doctors are the main providers of primary healthcare (Health Bureau Primary Healthcare Blueprint, December 2022); primary care is the first point of contact for common musculoskeletal problems such as knee osteoarthritis, and patients with end-stage disease should be referred to a specialist to consider surgery (reference framework on Common Musculoskeletal Problems, December 2022). Which doctor follows up an individual patient is decided by the treating doctor.
Do I need an X-ray or MRI for knee degeneration?
Typical knee osteoarthritis generally does not need routine imaging, which is advice addressed to primary care professionals; when assessing knee pain, other diagnoses should be excluded first (reference framework on Common Musculoskeletal Problems, December 2022). Which test to do is decided by the doctor.
Does knee degeneration always need surgery?
Persistent symptoms after initial non-surgical management are an indication for surgery (reference framework on Common Musculoskeletal Problems, December 2022); knee replacement is recommended for patients with symptomatic end-stage disease after initial non-surgical management has failed (Hong Kong College of Orthopaedic Surgeons Position Statement, August 2022). Whether surgery is needed is decided by the treating doctor according to the condition.
Can I see a physiotherapist directly for knee pain (knee osteoarthritis)?
From July 2025 physiotherapists may provide services without a doctor's referral for problems consistent with conditions listed in the clinical guidelines, such as knee osteoarthritis; if treatment does not work as expected, the physiotherapist must refer the patient to a doctor (Primary Healthcare Commission clinical guideline for first-contact physiotherapists, December 2025).
How can I look after my knee myself?
Keeping an ideal body weight, avoiding carrying heavy objects, avoiding holding the same position for a long time, and doing exercises that strengthen the thigh muscles and the knee joint (ask a doctor or physiotherapist) all help reduce symptoms (Department of Health Elderly Health Service, accessed October 2026). The treating doctor decides individual cases.