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The Best Treatment for Osteoarthritis

Hip and Knee osteoarthritis (OA) is a very common condition in people of all ages, however is more likely to be prevalent in the older population. Osteoarthritis is a leading burden of disease in Australia, with there being around 52,000 hips and 67,000 knees operated on in 2021 alone. Unfortunately, although surgery rates for hips and knees are steadily increasing, is this best treatment for osteoarthritis?.[1][2]

Osteoarthritis is more likely to occur in hips and knees due to the weight-bearing nature of these joints. If you have had a genetic history of osteoarthritis,  previous surgery or trauma to the hips or knees, you may be more likely to be diagnosed with osteoarthritis .

The pain presenting with osteoarthritis is not from cartilage damage in the joint itself. Cartilage in fact is aneural – meaning it has no nerve supply. Your pain from arthritis is directly related to irritation of the lining of the joint, the synovium.  Synovitis, the inflammation of the synovium, is due to bits of cartilage lodging into and irritating your synovium.

Currently, common treatments for osteoarthritis include physiotherapy, hydrotherapy, surgery, dietary supplements and joint injections. This article will outline the most evidence-based, proven treatment methods for hip and knee osteoarthritis.

Surgery

Surgery is a very common management method for people with hip and knee osteoarthritis . Surgeries range from arthroscopes (sometimes called “clean outs”) to full joint replacement surgeries. Surgery should be a last resort treatment when managing hip and knee osteoarthritis. The Royal Australian College of General Practitioners (RACGP) recommends the following:

  • “There is a strong recommendation against surgery such as arthroscopic lavage and debridement, meniscectomy and cartilage repair for people with knee osteoarthritis , unless the person also has signs and symptoms of a ‘locked knee’”.
  • “Total joint replacement for end-stage osteoarthritis can be considered when all appropriate conservative options, delivered for a reasonable period of time, have failed. The indication for referral to an orthopaedic surgeon should be based on a significant decline in quality of life because of established and end-stage joint osteoarthritis ”. [3]

End-stage osteoarthritis can be diagnosed when that individual has severe pain, joint swelling/deformity, and severe restriction in activities of daily living.

Injections

There are a range of injections that are sometimes given when managing hip and knee osteoarthritis . It is important to consider that injections merely mask the pain state of an arthritic joint,. Injections are often hit or miss in terms of whether they work or not. Common injections and the recommendations for/against are listed below:

  • Corticosteroid injection – may be recommended in certain circumstances for short-term relief of pain. Repeat injection is NOT recommended, as this can lead to further degradation of cartilage.
  • Platelet-Rich Plasma (PRP) Injection – there is no sufficient evidence to suggest that PRP injections help with managing OA, therefore it is not recommended. They are also very expensive!
  • Stem Cell injection – this is strongly not recommended.[4]

Natural supplements and alternative therapies

There is limited evidence to support a wide range of dietary supplements and alternative therapies in the treatment of osteoarthritis. However, some of these will do no further harm, so may be used if it helps control symptoms. Just remember it won’t be a long-term effect! It is recommended against the use of supplements such as glucosamine and vitamin D, and treatments like acupuncture, when treating osteoarthritis . Speak to your GP about the effectiveness of supplements and alternative therapies.

Physiotherapy

First, let’s break physio down into a few different categories: Manual therapy, exercise, and education.

Manual therapy

This can be helpful when the arthritic joint is “angry” or in an inflammation stage. Manual therapy can be helpful in reducing some pain and stiffness in the short term. However, it is recommended that manual therapy is used sparingly when managing osteoarthritis .

Exercise

The most proven, evidence-based treatment for osteoarthritis is exercise! Physical activity has the following benefits: prevention of chronic disease, improved physical function, improved psychological wellbeing, improved social outcomes (participation & community involvement). Supervised, guided exercise for individuals with osteoarthritis by a qualified professional can help improve pain, function and overall wellbeing. Neuromuscular exercises (strength and function focused exercises) seem to be the best at achieving this.[5][6]

Education

Education about the nature of osteoarthritis is also a proven method of treatment, as it helps patients understand their symptoms and how best to control them. One of the main roles of a physiotherapist is empowerment and education with their patients, and it is particularly important in treating osteoarthritis .

In Summary:

The first-line treatment for osteoarthritis should be as follows: exercise, education, and lifestyle changes (diet, exercise, weight management). Physiotherapy can help you achieve these first-line treatments, and help you function better with osteoarthritis ! Second-line treatments may involve pharmacological treatment (pain-killers) and manual therapy. Injections and surgery should be a last resort treatment only.

[1] https://aoanjrr.sahmri.com/hips

[2] https://aoanjrr.sahmri.com/knees

[3] https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf

[4] https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf

[5] Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine 2015;49:1554-1557.

[6] Ageberg, E., Link, A. & Roos, E.M. Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord 11, 126 (2010). https://doi.org/10.1186/1471-2474-11-126

 

Want to know more about the physiotherapy treatment of OA?

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