The Truth About Osteoarthritis: What You Can Do to Stay Active and Pain-Free
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Osteoarthritis (OA) is a progressive degenerative condition characterized by the deterioration of cartilage within the joints. It is highly prevalent and a leading cause of disability worldwide. While the exact cause remains unclear, research suggests that OA develops due to multiple contributing factors.
Key risk factors include aging, female sex, obesity, environmental and geographic influences, repetitive knee bending in certain occupations, physically demanding labor, genetic predisposition, race, previous joint injuries, vitamin D deficiency, and chondrocalcinosis. The condition leads to joint pain, stiffness, and reduced mobility, with the knee being the most commonly affected joint globally.
Osteoarthritis was once considered a condition caused solely by "wear and tear," where excessive strain and poor biomechanics were believed to contribute to the breakdown of articular cartilage, leading to inflammation. However, recent research has shown that OA is far more complex, involving not only mechanical stress but also a combination of inflammatory and metabolic processes.
Understanding Osteoarthritis
Symptoms of Osteoarthritis
Pain is the most common and significant symptom of osteoarthritis. Individuals with OA often experience two types of pain: a persistent, dull aching discomfort and episodes of sharp, intense pain. The progression of OA-related pain is typically gradual and subtle.
In the early stages, pain is usually predictable, occurring in response to specific movements or high-impact activities. However, as the condition advances, pain and other joint symptoms become more persistent and less predictable, often affecting daily activities and overall quality of life.
Examination Findings in Osteoarthritis
OA commonly affects joints such as the knee, hip, distal and proximal interphalangeal joints, first carpometacarpal joints, first metatarsophalangeal joint, and the facet joints of the spine. In contrast, involvement of the elbow, wrist, shoulder, and ankle is less frequent.
Several clinical signs may be present in individuals with OA, often resulting from synovial fluid accumulation, active inflammation, or structural changes in the joint due to bone deformities. These features contribute to pain, stiffness, and reduced joint function.
Imaging in Osteoarthritis
OA is primarily a clinical diagnosis. However, plain radiography can be helpful in confirming the diagnosis and ruling out other pathology. MRI and computed tomography are rarely needed.
Certain plain radiographic findings are characteristic of OA, including joint space narrowing, osteophyte formation, subchondral sclerosis, and cysts.
Laboratory Findings in Osteoarthritis
Laboratory tests in OA are typically within normal ranges. However, they can be useful in distinguishing OA from other conditions when the diagnosis is unclear. Markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can help assess systemic inflammation and rule out autoimmune disorders. Additionally, measuring uric acid levels may aid in identifying gout as a possible differential diagnosis.
Osteoarthritis Treatment Approaches
Currently, there is no cure for OA, but various treatment strategies can help manage symptoms and improve quality of life. Treatment approaches can be categorized into modifying risk factors, intra-articular therapies, physical interventions, alternative treatments, and surgical options. Additionally, new therapies are being explored with promising potential.
In the early stages, treatment primarily aims to reduce pain and stiffness. As the condition progresses, the focus shifts toward preserving mobility and maintaining overall physical function.
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The Role of Physiotherapy in Hip and Knee Osteoarthritis Management
Physiotherapists play a crucial role in managing hip and knee osteoarthritis (HKOA), with strong evidence supporting their involvement in patient care. Education and self-management strategies, combined with exercise therapy, are key components of effective treatment, as highlighted in both international and Dutch multidisciplinary guidelines.
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Exercise and Manual Therapy
Exercise therapy is essential in improving joint function, and when pain is present alongside limited joint mobility, adding manual therapy can enhance outcomes. Postoperative rehabilitation following hip and knee joint replacement surgery should focus on strengthening muscles and improving functional movement.
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Taping for Patellofemoral Osteoarthritis
Taping can be beneficial in managing patellofemoral OA by providing support and allowing patients to perform strengthening and functional exercises with reduced pain. While international guidelines do not provide specific recommendations, taping is commonly used in the Netherlands as a supportive intervention.
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Hydrotherapy, Thermotherapy, and Other Modalities
The use of hydrotherapy, balneotherapy, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and continuous passive motion (CPM) in knee OA remains debated, with conflicting evidence on their effectiveness. Some guidelines suggest hydrotherapy as a potential option for patients with severe pain when other interventions, such as land-based exercise therapy, medication, or surgery, are ineffective. Similarly, ice massage has shown some benefits for knee OA pain relief, while heat or cold applications may provide temporary symptom relief in certain cases.
Surgical Treatments for Osteoarthritis
Total joint arthroplasty is considered the gold standard for individuals with severe OA who have not responded to conservative treatments or whose pain significantly impacts their quality of life. This procedure can provide substantial pain relief and improve joint function, particularly in cases of advanced hip or knee OA.
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Research has shown that patients undergoing surgical intervention experience greater pain relief and enhanced quality of life compared to those receiving only conservative treatments, with noticeable improvements within a year post-surgery.
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A recent report suggests that approximately 25% of joint replacement surgeries performed for osteoarthritis (OA) may not be necessary.
In 2016, nearly 100,000 Australians underwent hip or knee joint replacements to manage OA, with the total cost exceeding $2 billion. Over a 20-year period (1994–2014), the state of Victoria experienced a significant rise in these procedures, with hip replacements increasing by 175% and knee replacements by 285%. Demand for joint replacement surgeries continues to grow, showing no signs of slowing down.
References
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Lieberthal J, Sambrook R, Day R. The role of biomechanical factors in osteoarthritis: insights from recent research. Rheumatology. 2020;59(2):267-276. doi:10.1093/rheumatology/kez453.
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Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759. doi:10.1016/S0140-6736(19)30417-9.
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Zhang W, Doherty M, Peat G, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69(3):483-489. doi:10.1136/ard.2009.113100.
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011
