Traditional medical thinking holds osteoarthritis to be both an inexorable process eventuating in the end-stage knee and the pathoanatomic explanation for knee pain later in life. However, the discordance between osteoarthritis as a pathoanatomic entity and the presence of the knee pain in striking. The latter is far more prevalent and can wax and wane regardless of the progression of the former. Furthermore, seeking recourse in medical care for knee pain is more a reflection of psychosocial limitations in coping than of anatomic progression. This realization suggests management schemes that focus on function and coping skills rather than on suppression of pain of knee surgery.