Osteoarthritis of the Hip and Knee; Non-operative Management

Osteoarthritis is the most common type of arthritis. Arthritis means inflammation of a joint, while osteoarthritis refers to damage to the surface of the joint or the cushion known as cartilage. In severe cases, the cartilage is damaged down to the level of bone. The body’s response to this is for the joint to become inflamed. People feel this as pain, swelling, warmth and restriction of movement or stiffness.

There are a number of measures that can help with the pain or stiffness due to osteoarthritis. You may have tried some of these already. The treatments listed below are some of the common measures used to try to relieve the symptoms of osteoarthritis. They do not stop the progression of the disease, nor do they restore the joint to normality. The aim of these treatments is purely symptom relief, not restoring a normal joint. In many cases, symptom relief alone can allow people to maintain their quality of life.

  • Regular paracetamol (Panadol, Panamax or Panadol Osteo) two tablets, 2-3 times per day. These are primarily for pain relief and can be taken for long periods of time.
  • Topical warmth. For example, a heated wheat bag.
  • Weight loss.
  • Physiotherapy/hydrotherapy – a combination of stretching exercises to keep the joint as supple as possible and strengthening exercises to maintain as much strength around the joint as possible. This is particularly helpful if surgery is ultimately necessary.
  • Supportive bracing. Either simple braces to assist with warmth and support of the joint or more complex braces to attempt to unload the affected side of the joint. The latter tends to be more expensive.
  • Orthotics in shoes, usually prescribed by a Podiatrist.
  • Anti-inflammatory medication such as Brufen or Naprosyn. These are best used on a short-term basis for acute flare-ups of pain. They can also be used in the form of creams or liniment to offer some relief.
  • Nutraceuticals, such as glucosamine and krill and fish oil. A trial of these is at least worthwhile. Some people find these excellent for symptomatic relief, while others experience little benefit from them whatsoever. The medical trials are not yet conclusive about their efficacy and usefulness.
  • Injection of Cortisone/steroid into a joint, particularly useful when the joint is quite inflamed. The Cortisone remains in the joint. Cortisone is used to attempt to give relief from pain and stiffness; its effect is not curative and may be of short-term benefit only.

The natural history of osteoarthritis while the disease remains untreated, is for patients to experience episodes of pain and stiffness, followed by episodes where symptoms settle. When the symptoms do not settle despite trialling the above measures, and when quality of life is significantly compromised, then surgery is a potential option.