Topic Overview

What is osteoarthritis?

Healthy joints help your body move, bend, and twist. Knees glide up and down stairs without creaking or crunching. Hips move you along on a walk without a complaint. But when osteoarthritis affects your joints, such simple, everyday movements can hurt. Taking the stairs can be painful. Walking a few steps, opening a door, and even combing your hair can be hard.

Osteoarthritis is mainly a disease of the hips, knees, hands, neck, and low back . But it can happen in other joints too. A joint is where two bones connect. And you have them all over your body.

Osteoarthritis is most common in older people. Although you cannot cure arthritis, there are many treatments that can help with your pain and make it easier for you to move. And you can do things to keep the damage from getting worse.

What causes osteoarthritis?

The simplest way to describe osteoarthritis is that it is wear and tear on the cartilage of your joints. Your joints have cushioning inside them called cartilage. This tissue is firm, thick, and slippery. It covers and protects the ends of bones where they meet to form a joint.

With osteoarthritis, there are changes in the cartilage that cause it to break down. When it breaks down, the bones rub together and cause damage and pain. Experts do not know why this breakdown in cartilage happens. But aging, joint injury, and genetics may be a part of the reason.

What are the symptoms?

• Pain: Your joints may ache, or the pain may feel burning or sharp. For some people, it may get better after a while. Pain while sleeping or constant pain may be a sign that your arthritis is getting worse.
• Stiffness: When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short time, until you get moving. You may also get stiff from sitting.
• Muscle weakness: The muscles around the joint may get weaker. This happens a lot with arthritis in the knee.
• Swelling: Arthritis can cause swelling in joints, making them feel tender and sore.
• Deformed joints: Joints can start to look like they are the wrong shape, especially as arthritis gets worse.
• Cracking and creaking: Your joints may make crunching, creaking sounds.

How is osteoarthritis diagnosed?

Your doctor will want to make sure your pain is caused by arthritis and not another problem. So first, you will need to describe your symptoms as best you can. Your doctor will ask you questions about your symptoms. Examples of questions include:

• Is the pain burning, aching, or sharp?
• Are your joints stiff in the morning? If yes, how long does the stiffness last?
• Do you have any joint swelling?

Knowing these things will help your doctor make a diagnosis. If your joints are tender and swollen and the muscles are weak, this will also help your doctor confirm whether you have arthritis. You may also have X-rays to check your joints for damage. Your doctor may want to do blood tests or other tests to see if there are other causes for your pain.

How is it treated?

There are many treatments for arthritis, but what works for someone else may not help you. Work with your doctor to find what is best for you. Often a mix of things helps most.

If your pain is mild, you may only need pain medicines you can buy without a prescription. These include acetaminophen (such as Tylenol), aspirin, ibuprofen, or naproxen (such as Aleve). But if you still have pain, you may need a stronger prescription medicine. Because you will take these medicines for a long time, you will need to have regular checkups from your doctor.

Using ice or heat on the painful joint can help. Heat may help you loosen up before an activity. Ice is a good pain reliever after activity or exercise. Your doctor may give you gels or creams that you can rub on the joint to make it stop hurting. Having shots of medicine in the joint also helps some people.

If you are overweight, losing weight may be one of the best things you can do for your arthritis. It helps take some stress off your joints. Exercise is also good, because it can help make your muscles stronger. Having stronger thigh muscles, for example, can help reduce stress on your knees. Swimming, bicycling, and walking are good activities. But make sure you talk to your doctor about what kind of activity is best for you. You may also get help from a physical therapist.

If your pain gets so bad that you have trouble walking, you may need surgery. Hips and knees that have been severely damaged can be replaced with man-made joints.

Frequently Asked Questions

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	Osteoarthritis: Exercising with arthritis

Cause

Osteoarthritis results from chemical changes in the cartilage that cause it to break down faster than it can be produced. In most cases, experts don't know the cause of this cartilage breakdown.

In some cases, osteoarthritis may develop as a result of another condition (secondary osteoarthritis).

• Excess weight puts extra strain on the joints, particularly the large weight-bearing joints, such as the knees, hips, and balls of the feet. Experts estimate that every 1 lb (0.5 kg) of body weight means at least 3 lb (1.4 kg) of stress at the knee joint, and even more at the hip joint. Studies show that weight loss can decrease the symptoms of knee osteoarthritis or the chances of developing those symptoms.¹
• A single major joint injury or several minor joint injuries may result in cartilage changes over time. Although normal activities of everyday life do not cause osteoarthritis, certain types of activities—such as the frequent or repetitive heavy lifting, squatting, and kneeling of some sports or jobs—put repeated stress on a joint and may increase the risk of developing osteoarthritis.
• Muscle weakness increases the chances of developing osteoarthritis. For example, weakness of the quadriceps muscles in the front of the thigh makes osteoarthritis of the knee more likely.²
• Daily activity in a joint that is not aligned normally or is more loose and mobile than normal can lead to wear and tear and increase the risk of osteoarthritis.
• A previous infection of the joint may alter the chemical makeup of cartilage and lead to osteoarthritis.

In a few people, there seems to be a link between cartilage breakdown and certain factors.

• A family history of osteoarthritis may have some influence on the makeup of cartilage.
• Unusual metabolic or endocrine conditions, such as excess body iron (hemochromatosis), excess body copper (Wilson's disease), or excess production of thyroid or parathyroidhormones, can lead to cartilage changes and osteoarthritis.
• Defects in joint development or growth can accelerate cartilage loss and lead to osteoarthritis at a younger age. These unusual conditions most commonly involve the hip joint.

Symptoms

Symptoms of osteoarthritis include:

• Pain, commonly in the hands , hips , knees , or feet , and sometimes in the spine . Pain usually is related to activity of the joint and is worse at the end of the day or after periods of activity. As the disease progresses, pain is present even during rest.
• Stiffness (lasting less than 1 hour) after periods of inactivity, such as in the morning after a night's sleep or after sitting for a long time.
• Limited joint motion.
• Tenderness and occasional swelling.
• Joint deformity (usually in later stages of osteoarthritis).
• Joint cracking or "creaking" (crepitation), often accompanied by pain. This creaking also may occur in a normal (nonarthritic) joint and is usually painless.

Symptoms of osteoarthritis range from minor to severe. Symptoms may depend on which joints are involved. If your weight-bearing joints (such as hips and knees) are affected, it often results in more problems than if you have osteoarthritis in non-weight-bearing joints, such as your fingers.

Usually, osteoarthritis is limited to one set of joints, such as both knees. But osteoarthritis may affect more than one location in the body (for example, the knees and hands). Osteoarthritis usually only causes symptoms in one or more joints. Symptoms that affect the whole body, such as fever, weight loss, or rash, are not seen in osteoarthritis.

As osteoarthritis becomes more severe, symptoms may include a total loss of function in the affected joints.

Compare osteoarthritis with rheumatoid arthritis.

Learn about other conditions with symptoms similar to osteoarthritis.

What Happens

Osteoarthritis is a slow, progressive disease. Cartilage gradually breaks down until the bones, which were once separated by cartilage, begin to rub against each other.

The rate at which osteoarthritis progresses varies widely from person to person. Symptoms may not develop for years, until bones and tissues become damaged. It is hard to predict the course of osteoarthritis, as symptoms may stop for periods of time. Joint symptoms may either remain constant or gradually get worse over several years. You may have symptoms that come and go (flares), as you would with other forms of arthritis.

Although the disease process of osteoarthritis affects joint cartilage throughout the body, you most likely will have symptoms in only one or two joints or groups of joints . Symptoms most often affect the spine, fingers, hips, knees, or toes. At first, pain may occur only when you are active. As the disease progresses, pain may also occur when you are resting.

Bones in the finger joints may enlarge, developing bumps known as Heberden's and Bouchard's nodes .

Bowleg and knock-knee alignments of the knees are common in osteoarthritis. These misalignments result in uneven cartilage loss and, as the cartilage wears down, the bowleg or knock-knee condition becomes even worse.

Many people can manage their osteoarthritis symptoms with medicine and lifestyle changes, although there is no cure for the condition. In a few people, osteoarthritis becomes severe enough to require surgery to replace the worn joint or fuse the bones together so that the joint will not bend. Surgical techniques and the artificial joint parts used for the surgeries are constantly improving.

Learn about the complications of osteoarthritis.

What Increases Your Risk

Certain factors seem to increase the risk of developing osteoarthritis, including:^{3 4}

• Aging, which does not cause osteoarthritis but is a factor in developing symptoms. Most people older than 65 years of age show X-ray evidence of osteoarthritis in the hands, knees, or spine. But not all people will have pain from osteoarthritis.
• Extra body weight, which is clearly associated with osteoarthritis of the knee. Being overweight puts extra strain on the joints, particularly the large weight-bearing joints such as the hips, the knees, and the balls of the feet. Carrying more than healthy weight on your body may also alter the joint structure and increase the risk for osteoarthritis.
• A family history of osteoarthritis.
• Other forms of arthritis, such as rheumatoid arthritis or psoriatic arthritis.
• Repeated minor injuries or a single injury to a joint, which may change the normal joint structure. Activities that put repeated stress on a joint include the repetitive squatting, kneeling, or heavy lifting common to some sports and jobs.
• Increased bone density, which may result in bones that are less able to absorb impacts and to protect cartilage from trauma. The opposite is also true—women with osteoporosis have a decreased risk of osteoarthritis.
• Decreased strength and a decrease in the sensations that tell you where your body is positioned in the space around you (proprioception). This can be seen in people who have nerve damage (neuropathy), sometimes due to diabetes or a vitamin B12 deficiency.
• Estrogen deficiency in women, particularly after menopause.
• Vitamin D deficiency. Vitamin D is necessary for healthy bone and may also be important for keeping cartilage healthy. Vitamin D deficiency is associated with faster progression of osteoarthritis.

When To Call a Doctor

Many conditions can cause symptoms similar to osteoarthritis. In order to determine the cause of your symptoms, call your health professional if you experience:

• Sudden, unexplained swelling, warmth, or pain in any joint or joints.
• Joint pain associated with a fever or rash.
• Pain so severe that you are unable to use the joint.
• Mild joint symptoms that continue despite home treatment for more than 6 weeks.

Side effects can develop from taking large doses of aspirin or other arthritis medicine to relieve pain. Do not exceed the recommended dose of medicine without first talking to your health professional.

Watchful Waiting

If you have mild joint pain and stiffness, try home treatment first. If there is no improvement in 6 weeks, or if joint symptoms persist, call your doctor.

Who To See

The following health professionals can evaluate and manage the symptoms of osteoarthritis:

• Family medicine physician
• Internist
• Nurse practitioner
• Physician assistant
• Rheumatologist

Individualized treatment programs can be designed that consider the severity of your symptoms, level of physical activity, and general health. In addition to your health professional, a therapeutic team may include:

• Physiatrists.
• Pain management specialists.
• Orthopedic surgeons.
• Physical therapists.
• Occupational therapists.
• Dietitians.
• Social workers.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Doctors usually diagnose osteoarthritis by evaluating your symptoms and doing a physical exam. Sometimes your doctor will include other tests in the evaluation. The following tests can confirm the diagnosis or rule out other conditions with similar symptoms:

• Joint fluid analysis
• X-ray. See X-rays showing osteoarthritis of the hip and osteoarthritis of the knee .
• Arthroscopy (rarely done)
• Urinalysis
• Blood tests
  • Complete blood count (CBC)
  • Rheumatoid factor (RF)
  • Antinuclear antibody (ANA)
  • Sedimentation rate (sed rate)
  • C-reactive protein (CRP)
  • Chemistry screen
  • Thyroid-stimulating hormone (TSH)
  • Ferritin

If you have symptoms in more than one joint, your doctor should evaluate each joint individually so that he or she does not overlook any other medical cause for your symptoms.³

Treatment Overview

Although there is no cure for osteoarthritis, treatment can help you reduce your symptoms. The more you understand about osteoarthritis and what you can do to treat your pain and stay active, the less discomfort and disability you are likely to have. You may also be able to limit further joint damage.

The goals of treatment are to:

• Reduce symptoms.
• Maintain joint function.
• Minimize disability.
• Limit structural changes.

Treatment is based on:

• How severe your symptoms are (mild to severe).
• How your symptoms affect your daily activities.
• The success or failure of prior treatments.
• The amount of joint damage.

Initial treatment

When your doctor first diagnoses your osteoarthritis, he or she will probably recommend a treatment plan that combines medicine with education about how to treat your symptoms yourself. Your initial treatment plan may include:

• Medicines, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Exercise to keep your joints mobile.
• Weight loss, if you are overweight.
• Changing activities to reduce additional stress on your joints.
• Heat and cold therapy, such as hot compresses, cold packs, ice massage, or Paraffin wax.
• Learning all you can about the natural course of osteoarthritis.

Ongoing treatment

Osteoarthritis normally is a slowly progressing condition, though its course is difficult to predict. Some people remain stable for a number of years or even experience periods of remission. For mild to moderate osteoarthritis, you can usually manage your symptoms over many years with a program that includes:

• Medicines, such as acetaminophen or topical capsaicin.
• Exercise to keep your joints mobile.

  Osteoarthritis: Exercising with arthritis

• Weight loss, if you are overweight.
• Protection of your joints from injury or trauma.
• Use of assistive devices and orthotics, such as tape, braces, splints, or canes.
• Changing activities to reduce additional stress on your joints.
• Heat and cold therapy, such as hot compresses or cold packs or ice massage.
• Paraffin wax. This is a form of moist heat for your hands or feet.
• Physical therapy or occupational therapy.
• Education about the natural course of osteoarthritis.
• Learning and practicing a "good-health attitude."

Research suggests that, for people who have depression in addition to osteoarthritis, treatment of the depression may also decrease the pain of osteoarthritis and improve the ability to perform daily activities.⁵

Treatment if the condition gets worse

If pain and stiffness from osteoarthritis fail to improve or are getting worse, your doctor may recommend treatment, such as:

• Corticosteroid injections.
• Opioids.
• Physical therapy.
• Hyaluronan (hyaluronic acid) injections.

You may need joint replacement or other surgical treatments to maintain joint function and prevent progressive disability:

• Arthroscopy
• Osteotomy (knee or hip)
• Shoulder replacement
• Hip replacement
• Knee replacement
• Finger or toe surgery
• Arthrodesis

Should I have hip replacement surgery?

Should I have knee replacement surgery?

Prevention

You can take steps to help prevent the development of osteoarthritis or to help prevent the progression of this condition. These steps include:

• Weight control. Maintaining a healthy weight may be the single most important thing you can do to prevent osteoarthritis.⁴ Being overweight puts extra strain on the joints, particularly the large weight-bearing joints such as the knees, the hips, and the balls of the feet. It is estimated that every 1 lb (0.5 kg) of body weight means at least 3 lb (1.4 kg) of stress at the knee joint, and even more at the hip joint. That would mean that losing just 5 lb (2.3 kg) would take at least 15 lb (6.8 kg) of stress off your knees. Extra weight may also alter the normal structure of the joint and increase the risk for osteoarthritis. Maintain a healthy weight to prevent or reduce joint damage and lower the stress on osteoarthritic joints. For more information, see the topic Healthy Weight.
• Injury prevention. Protect your joints from serious injury or repeated minor injuries to decrease your risk of damaging cartilage. Repeated minor injuries include those from job-related activities such as frequent or constant kneeling, squatting, or other postures that place stress on the knee joint.
• Exercise. Exercise can help reduce joint pain and stiffness. Light- to moderate-intensity physical activity may prevent a decline in, and may even restore, health and function.⁶ But some people with osteoarthritis may be reluctant to exercise because of joint pain after activity. You can take various steps to help relieve pain, such as heat and cold therapy or taking pain relievers, which may make it easier for you to exercise and stay active. Choose partial– or non–weight-bearing exercise, such as bicycling, swimming, or water exercise. You can also try light weight-lifting exercises, with supervision.

Osteoarthritis: Exercising with arthritis

Research shows that even modest weight loss combined with exercise is more effective in decreasing pain and restoring function than either weight loss or exercise alone.⁷

Young adults who have significant knee injuries have an increased risk of future osteoarthritis. Prevention of joint injuries during youth depends in good part on the use of proper sports equipment and on playing under safe playing conditions.⁸ A young person who has a serious knee injury can limit further damage by using a brace to stabilize the knee joint and by changing the way he or she does high-impact exercise.

A physical therapist or athletic trainer can help advise you on returning to activities after an injury.

Home Treatment

You can take steps to help relieve the pain caused by osteoarthritis and improve your joint function. Rest your joint if it is extremely painful or swollen, but avoid long periods of rest or inactivity that will cause muscle weakness and more instability in the joint. To reduce your symptoms of osteoarthritis, try to:

• Maintain a healthy weight. Being overweight puts extra strain on the joints, particularly the large weight-bearing joints such as the hips, the knees, and the balls of the feet. It is estimated that every 1 lb (0.5 kg) of body weight means at least 3 lb (1.4 kg) of stress at the knee joint, and even more at the hip joint. That would mean that losing just 5 lb (2.3 kg) would take at least 15 lb (6.8 kg) of stress off your knees. Extra weight may also alter the joint structure and increase the risk for osteoarthritis.
• Exercise. Talk to your doctor or physical therapist about exercises that will help relieve joint pain. Studies show that exercise is beneficial for people with arthritis, including hip and knee arthritis.² Older adults with osteoarthritis can improve posture and balance and thus reduce the chance of falls by following a program of walking and weight lifting.⁹ If you start a weight-lifting program, start out with supervision to make sure you lift weights safely.
• Use assistive devices and orthotics such as doorknob extenders, tape, braces, splints, or canes. If you have osteoarthritis of the knee, wedged insoles or cushioned shoes may help redistribute weight and reduce joint stress. For more information on how to use assistive devices, see:
  • Using a cane.
  • Using crutches.
  • Using a walker.
• Change activities to reduce stress on your joints. For example, walk instead of jog. Other types of exercise that are less stressful on the joints include riding a bicycle, swimming, or water exercise.
• Use heat and cold therapy such as hot compresses, cold packs, or ice massage.
• Take nonprescription pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Talk to your health professional about dietary supplements, such as glucosamine and chondroitin.

Many people benefit from joining a support group or taking an arthritis management course from the Arthritis Foundation. Several studies have shown that people in education courses and support groups have less pain and depression and better joint activity.¹⁰ A small study suggests people who participate in exercise classes in addition to their home exercise have less pain with walking even after the class ends.¹¹

Adopting a "good-health attitude" and healthy habits, such as eating a nutritious diet, maintaining a healthy weight, and getting enough sleep, will make you feel better and allow you to stay active.

Osteoarthritis: Exercising with arthritis

Exercise can help keep osteoarthritis from getting worse. But you want to make sure you do not damage your joints while exercising. Some tips for exercising safely with osteoarthritis include:

• If you have not exercised for a while, start exercising at a low level and work your way up gradually to exercise for a longer time or at a higher intensity.
• If your joint pain gets worse after exercise, take an NSAID before exercise and ice your painful joints after exercise.
• If your knees are swollen:
  • Avoid walking and running.
  • Swim, or ride a stationary bike.
• If an exercise causes joint pain that lasts for more than a day, try one or more of the following:
  • Rest the joint until your pain returns to a level it was before.
  • Exercise for less time or exercise easier.
  • Try another exercise that does not cause pain.
• Recognize when you have muscle soreness compared to joint pain. If you have muscle soreness, you may exercise through the soreness. But if you have joint pain, rest the joint or try another exercise.

Medications

Medicine can often help you to relieve the symptoms of osteoarthritis and allow you to continue daily activities. But pain relief medicine does not cure arthritis or decrease the rate of cartilage breakdown and should be used along with home treatment and other treatments, as recommended by your health professional.

• You can often manage mild to moderate arthritis pain with nonprescription pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Moderate to severe pain may require stronger pain relievers, such as opioids. Your doctor may also prescribe opioids if you cannot tolerate NSAIDs.

Medication Choices

Medicines doctors use to treat osteoarthritis include:

• Acetaminophen, which may help relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation and relieve fever.
• Corticosteroid injections in the joint (intra-articular), which reduce inflammation.
• Hyaluronan injections, which may relieve pain.
• Opioids, which may relieve moderate to severe pain.

Some studies have shown that acetaminophen and nonsteroidal anti-inflammatory drugs are equally effective for mild to moderate joint pain.² Other studies suggest that NSAIDs are more effective than acetaminophen and that side effects are similar.^{12 13}

Topical (applied to the skin) agents may provide short-term pain relief.¹⁴ These include topical NSAIDs, capsaicin, and pain-relieving creams.

What To Think About

Pain relief is important, not just for quality of life and for your mood, but for maintenance of joint function and rehabilitation. If you limit or decrease the movement of your joints because of pain, you will develop tightening, shortening, and weakness of the ligaments, tendons, and muscles that move the joint. This leads to less mobility and function.

When using pain medicine, your goal is to find relief without side effects. Acetaminophen has the fewest side effects of any pain medicine for osteoarthritis. In some studies it is as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) and in some studies it is not. But because it has the fewest side effects, it is the medicine to try first for pain relief.

If you have no history of gastrointestinal bleeding (such as stomach ulcers), kidney insufficiency, or heart failure and if you are not taking blood thinners, you can try nonprescription NSAIDs, including ibuprofen (such as Motrin or Advil) or naproxen (Aleve). Take the lowest possible dose that controls your pain. It may take a couple of weeks before NSAIDs can relieve your pain well.

In addition to relieving pain, NSAIDS also reduce inflammation. But inflammation does not commonly occur with osteoarthritis, so most cases of osteoarthritis do not require an anti-inflammatory drug (NSAID). Even so, many people with osteoarthritis say that NSAIDs work well for them. Just remember that NSAIDS do not stop joint tissue from breaking down as osteoarthritis progresses.

If you are taking NSAIDs every day, especially for longer than 1 month, your doctor may want to check a blood count or a blood test for kidney function. He or she may also suggest that you take omeprazole to protect you from stomach ulcers. If NSAIDs are not effective, contact your doctor, who may prescribe a higher dose, a different NSAID, or an opioid.

Doctors may prescribe opioid pain relievers (such as codeine or hydrocodone) for people who cannot take NSAIDs or whose pain is unrelieved by other therapies. Used correctly, opioids can be a safe and effective means of pain control. Studies show that you can discontinue opioids without withdrawal difficulties if the opioid is tapered off.¹⁵

Talk to your health professional about what medicines may be best for you. The effectiveness of medicines and the risk of side effects are different for different people. You can try different medicines until your symptoms are controlled.

Medicines that are being studied for osteoarthritis include diacerein and doxycycline. Diacerein helps reduce inflammation. Doxycycline is an antibiotic but it may help keep the joint space from getting smaller in osteoarthritis. These medicines are not available yet for use with osteoarthritis.

Surgery

Surgery is reserved for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other treatments and who have significant loss of cartilage.

Surgery relieves severe, disabling pain and may restore joint function and mobility. Some surgical procedures, such as osteotomy or arthroscopy, may postpone total joint replacement.

Surgery Choices

Surgeries to treat osteoarthritis may include:

• Arthroscopy, which can provide temporary (and sometimes long-term) relief of symptoms of osteoarthritis. Arthroscopy also can fix a joint if it becomes “locked” or stuck due to loose cartilage or bone fragments.¹⁶
• Osteotomy of the knee or hip, used in cases of hip deformity and abnormality of the legs in active people younger than 60 with mild osteoarthritis.
• Joint replacement surgery, considered when pain and disability have not been controlled by conservative treatment such as exercise and medicine, and joint damage is visible on X-rays.¹⁶
  • Shoulder replacement surgery
  • Hip replacement surgery
  • Knee replacement surgery
• Hip resurfacing surgery, which doctors use primarily for younger, more active people with pain and disability due to hip deterioration. No long-term results are available yet, but short-term results are positive up to about 8 years after surgery.¹⁷
• Arthrodesis, surgery that joins (fuses) two bones in a diseased joint so that the joint can no longer move. Doctors may use it for the spine, ankles, hands, and feet, but rarely for the knees and hips.
• Small joint surgery, used if the joints of the hands or feet are so disabled that function is impossible. Severe finger deformity is more commonly seen in rheumatoid arthritis than in osteoarthritis. Doctors replace toe joints occasionally, in cases of severe pain and disability, but rarely in younger or more active people.

Should I have hip replacement surgery?

Should I have knee replacement surgery?

What To Think About

Surgery for osteoarthritis is considered a choice (elective surgery). Surgery may not be appropriate for some people who are in poor health or who have other diseases that would make surgery less successful.

You will need several months of rehabilitation following surgery.

An artificial joint may only last for 10 to 20 years. You may need repeat surgery if an implanted joint wears out. Shoulder replacement for osteoarthritis is less common, and generally less successful, than hip or knee replacement.

Many people with arthritis have symptoms and degeneration in the inner knee. A new procedure inserts a small C-shaped cup called a UniSpacer in the joint space of the inner knee. The intent is to cushion the joint to delay the need for a knee replacement. Studies on the UniSpacer continue.

General information on joint replacement

If you decide to have surgery: Before you go to the hospital, it's a good idea to make sure your home is ready for your return. Be sure you have someone to help you for a few days after you come home, and put a telephone and important phone numbers near where you will be spending time. If your surgery will be on your leg or foot, you may need to avoid stairs for a while. Be sure there's a bed for you to sleep in without having to go up or down stairs. If your bed is low, consider raising it with extensions under the legs or even an extra mattress on top. Finally, clear away any extra furniture and clutter, small rugs, or cords on the floor. You need a safe walking surface with plenty of space to move around safely.

Other Treatment

Other treatment, such as experimental medical therapies and complementary and alternative therapies, may be used to relieve pain and improve joint function for people who have osteoarthritis.

Other Treatment Choices

Other medicines used to treat osteoarthritis include:

• Glucosamine and chondroitin. It is not clear if glucosamine and chondroitin, taken alone or together, can relieve pain of osteoarthritis.^{18 19} But some studies show that chondroitin alone may relieve pain and improve function.¹⁹
• Capsaicin. Capsaicin is a cream you apply to the skin for pain relief.

Other non-medicine treatment choices for osteoarthritis include:

• Transcutaneous electrical nerve stimulation, or TENS, which uses electrical impulses to block pain signals to the brain.
• Acupuncture. Research has shown that acupuncture may relieve pain for osteoarthritis of the knee.²⁰
• Physical therapy.
• Ultrasound, which uses sound waves to produce heat in body tissues for pain relief.
• Diathermy, which uses heat to increase blood flow for pain relief and rapid healing.
• Taping. This involves using an adhesive tape to help position the knee cap for pain relief.²¹ You can do taping at home, but an experienced health professional, such as your doctor or physical therapist, should teach you how to do it first.
• Braces to try to shift weight off of the affected area of your knee joint. It is unclear how well these work, but there is little risk in trying them.

Experimental medical therapies

Because osteoarthritis is caused by the breakdown of cartilage, research continues for developing therapies that prevent or reduce cartilage damage. Cartilage repair, an experimental medical therapy for osteoarthritis of the knee, has been studied in small numbers of selected people. Cartilage repair techniques include removing damaged cartilage and stimulating remaining tissue to try to fill in new cartilage, transplantation of cartilage from one joint to another, transplantation of cartilage from another donor, and transplantation of cells that are grown in a lab and then injected into the joint. These therapies are still under study. To date, researchers have only studied cartilage repair therapies in younger people with small, well-defined holes in cartilage, an uncommon situation for the great majority of older people with osteoarthritis of the knee.²²

Complementary and alternative therapies

Complementary and alternative medicine is the term for a wide variety of health care practices that may be used along with or in place of standard medical treatment. There may or may not be studies that show if these therapies work or how well they work. But, many people with osteoarthritis use complementary therapies to help relieve joint pain and improve joint function.²³

Complementary and alternative therapies for osteoarthritis include dietary supplements.²³ Some dietary supplements include:

• Glucosamine and chondroitin, which may be thought of as dietary supplements. It is not clear if glucosamine and chondroitin, taken alone or together, can relieve pain of osteoarthritis.^{18 19} But some studies show that chondroitin alone may relieve pain and improve function.¹⁹
• Vitamin D, to slow the progression of osteoarthritis.
• Vitamin E, for pain.
• Avocado/soybean (ASU) extract, to decrease pain.
• Vitamin B3, to ease pain and stiffness.
• S-adenosylmethionine (SAM-e), for pain and stiffness.
• Boron, to decrease pain and inflammation.

Complementary and alternative therapies for osteoarthritis include physical therapies such as:

• Acupuncture, which appears to improve function and provide pain relief for people with osteoarthritis.²⁴
• Pulsed electromagnetic field therapy, to stimulate cartilage growth. Small positive results have been shown, but further research is needed.²⁵
• Mind/body control, such as yoga, tai chi, and qi gong.
• Magnetic bracelets. A small study suggests that hip and knee pain from arthritis may decrease when a person wears a magnetic bracelet, although why this may happen is not clear.²⁶ Most evidence shows the effect is no greater than with a placebo.

These therapies may be helpful for some people, although their effectiveness has not been proven. Most of the studies on complementary and alternative therapies for osteoarthritis have been done on glucosamine and acupuncture and involve osteoarthritis of the knee. Most of these studies show that either of these therapies is better than treatment with a placebo.

What To Think About

Talk to your doctor about other treatments for osteoarthritis. There are many medicines, exercises, braces, assistive devices, and other treatments, and different combinations of treatments work for different people.

Research continues on developing medicines and other ways to change the structure of cartilage. Researchers hope these methods will reduce cartilage destruction and stimulate repair of existing damage. Tetracyclines are some of the medicines that researchers are currently studying. Other agents being studied include protease and collagenase inhibitors, growth factors, and cytokine inhibitors. Researchers are also investigating cartilage transplants and use of stem cells to grow new cartilage.^{1 3}

Note that most research studies for osteoarthritis have been of knee osteoarthritis. So it is hard to know if treatments that work for the knee might also work for other joints such as the hands, hip, or spine joints.

Other Places To Get Help

Online Resource

Organizations

Related Information

• Rheumatoid Arthritis

References

Citations

1. Lozada CJ (2005). Management of osteoarthritis. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1528–1540. Philadelphia: Elsevier Saunders.

2. Subcommittee on Osteoarthritis Guidelines, American College of Rheumatology (2000). Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis and Rheumatism, 43(9): 1905–1915.

3. Wise C (2005). Osteoarthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 10. New York: WebMD.

4. Hinton R, et al. (2002). Osteoarthritis: Diagnosis and therapeutic considerations. American Family Physician, 65(5): 841–848.

5. Lin EHB, et al. (2003). Effect of improving depression care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial. JAMA, 290(18): 2428–2434.

6. American Geriatrics Society Panel on Exercise and Osteoarthritis (2001). Exercise prescription for older adults with osteoarthritis pain: Consensus practice recommendations. Journal of the American Geriatrics Society, 49(6): 808–823.

7. Messier SP, et al. (2004). Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial. Arthritis and Rheumatism, 50(5): 1501–1510.

8. Gelber AC, et al. (2000). Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine, 133(5): 321–328.

9. Messier SP, et al. (2000). Long-term exercise and its effect on balance in older, osteoarthritic adults: Results from the Fitness, Arthritis, and Seniors Trial (FAST). Journal of the American Geriatrics Society, 48(2): 131–138.

10. Friedrick MJ (1999). Steps toward understanding, alleviating osteoarthritis will help aging population. JAMA, 282(11): 1023–1025.

11. McCarthy CJ, et al. (2004). Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology, 43(7): 880–886.

12. Pincus T, et al. (2004). Patient preference for placebo, acetaminophen (paracetamol) or celecoxib efficacy studies (PACES): Two randomised, double blind, placebo controlled, crossover clinical trials in patients with knee or hip osteoarthritis. Annals of the Rheumatic Diseases, 63(8): 931–939.

13. Towheed TE, et al. (2006). Acetaminophen for osteoarthritis. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

14. Scott D, et al. (2004). Osteoarthritis. Clinical Evidence (11): 1560–1588.

15. Lipman AG (2001). Treatment of chronic pain in osteoarthritis: Do opioids have a clinical role? Current Rheumatology Reports, 6(3): 513–519.

16. Günther K-P (2001). Surgical approaches for osteoarthritis. Best Practice and Research Clinical Rheumatology, 15(4): 627–643.

17. Daniel J, et al. (2004). Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. Journal of Bone and Joint Surgery, 86-B(2): 177–183.

18. Clegg DO, et al. (2006). Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine, 354(8): 795–808.

19. Chard J, et al. (2005). Osteoarthritis of the knee. Clinical Evidence (14): 1506–1522.

20. Scharf H-P, et al. (2006). Acupuncture and knee osteoarthritis: A three-armed randomized trial. Annals of Internal Medicine, 145(1): 12–20.

21. Hinman RS, et al. (2003). Efficacy of knee tape in the management of osteoarthritis of the knee: Blinded randomised controlled trial. BMJ, 327(7407): 135.

22. Sledge CB (2005). Principles of reconstructive surgery for arthritis: The knee. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1890–1900. Philadelphia: Elsevier Saunders.

23. Luskin FM, et al. (2003). Select populations: Elderly patients. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 482–502. St. Louis: Mosby.

24. Berman BM, et al. (2004). Effectiveness of acupuncture as adjunctive therapy in ostearthritis of the knee: A randomized, controlled trial. Annals of Internal Medicine, 141(12): 901–910.

25. Cochrane Musculoskeletal Group (2004). Electromagnetic fields for the treatment of osteoarthritis. Cochrane Database of Sytematic Reviews (4). Oxford: Update Software.

26. Harlow T, et al. (2004). Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee. BMJ, 329(7480): 1450–1454.

Other Works Consulted

• American Academy of Orthopaedic Surgeons. Activities after a hip replacement. Available online: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=274&topcategory=Hip.

• American Academy of Orthopaedic Surgeons. Activities after a knee replacement. Available online: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=275&topcategory=Knee.

• Archibeck MJ, White RE Jr (2003). What's new in adult reconstructive knee surgery. Journal of Bone and Joint Surgery, 85-A(7): 1404–1411.

• Biundo JJ Jr, Rush PJ (2005). Rehabilitation of patients with rheumatic diseases. In ED Harris Jr et al., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp. 826–838. Philadelphia: Elsevier Saunders.

• Boureau F, et al. (2004). The IPSO study: Ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip. Annals of the Rheumatic Diseases, 63(9): 1028–1034.

• Brosseau L, et al. (2004). Efficacy of continuous passive motion following total knee arthroplasty: A meta-analysis. Journal of Rheumatology, 31(11): 2251–2264.

• Felson DT, et al. (2004). The effect of body weight on progression of knee osteoarthritis is dependent on alignment. Arthritis and Rheumatism, 50(12): 3904–3909.

• Guccione AA, et al. (1994). The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health, 84(3): 351–358.

• Kremers HM, Gabriel SE (2005). Broad issues in the approach to rheumatic diseases. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp. 407–414. Philadelphia: Elsevier Saunders.

• Morelli V, et al. (2003). Alternative therapies for traditional disease states: Osteoarthritis. American Family Physician, 67(2): 339–344.

• Roth SH, Shainhouse JZ (2004). Efficacy and safety of a topical diclofenac solution (Pennsaid) in the treatment of primary osteoarthritis of the knee: A randomized, double-blind, vehicle-controlled clinical trial. Archives of Internal Medicine 164(18): 2017–2023.

• Silva M, et al. (2004). The biomechanical results of total hip resurfacing arthroplasty.Journal of Bone and Joint Surgery, 86-A(1): 40–46.

• Zhang W, et al. (2004). Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases, 63(8): 901–907.

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