Osteoarthritis
Swipe through these images or read below to learn about osteoarthritis!
All About OA
Osteoarthritis (OA) is a common joint condition that mostly affects middle-aged and elderly people, characterized by joint pain, stiffness and reduced range of motion. Other symptoms may include, joint crepitus (creaking/grating sounds), joint instability/giving way and catching/locking.
Fast Facts:
– OA involves cartilage loss, bony changes, and inflammation
– Mostly affects hands, spine, hips, knees & big toes
– Currently, no treatment to reverse OA joint changes
– Symptoms do not always directly relate to changes on scans
– Symptoms can be fluctuating and modifiable
– Exercise and weight loss can improve symptoms and function
– Most patients will not need joint replacement surgery
OA Myths
OA is inevitable with age
While you are more likely to get osteoarthritis with age, it is not a guarantee. Some old people never develop OA, and conversely, some young people do.
Physical activity wears down your joints
Increased joint loading in elite athletes does not appear to be related to loss of joint cartilage, but rather increased cartilage hydration and thickness. Some studies indicate recreational running is likely associated with reduced risk of OA compared to being sedentary. Appropriate exercise and loading is great for joint health.
Cracking your knuckles causes arthritis
There is no evidence to support this – the cracking sound is just the harmless release of gas around the joint.
“it’s bone on bone, I’ll need surgery”
While joint replacement may be appropriate for some with end-stage disease, OA can be managed conservatively and effectively in the majority of patients with exercise, diet and lifestyle changes
Diagnosis
A diagnosis of OA can be made based on history and clinical presentation alone if:
– Patient is over 45 and,
– Has activity-related joint pain and,
– Has either no morning joint-related stiffness or morning stiffness lasts no longer than 30 minutes
Imaging may be useful to rule out other conditions or gauge severity of disease, though a diagnosis cannot be made without symptoms. It must be noted that degenerative joint changes on a scan are common in people without pain and disability.
Exercise
Moderate and graded activity has demonstrated significant improvements in pain and disability for hip and knee osteoarthritis. This further challenges the belief that activity wears down your joints.
Pick simple exercises you enjoy – start gradually and practice regularly!
Weight Loss
Obesity is a widely known risk factor for developing OA and severity of joint changes.
It’s estimated that each pound of weight lost will result in a 4-fold reduction in load exerted on the knee with each step during daily activity. Researchers have found a 10% reduction in weight has been associated with substantial pain relief in obese individuals.
Interestingly, obesity is also associated with an increased risk of developing OA in non-weight bearing joints (e.g hands).
This is likely due to a systemic increase of inflammation-promoting cells associated with excessive adipose (fatty) tissue, contributing to joint inflammation.
Supplements
Chondroitin and glucosamine are low-risk supplements that may provide small to moderate benefits for pain in OA. Combining both supplements does not appear to result in additional benefit.
Most studies investigating these supplements are low-quality – more research is needed!
Knee Arthroscope
Arthroscopic repair has shown no benefit compared to placebo in pain or function at 2-year follow-up for knee OA.
Resection of degenerative meniscal tears also showed no benefit compared to placebo in terms of reducing mechanical symptoms of catching or joint locking.
Joint Replacement
Hip replacement is a very successful operation for pain in progressed OA, with ~89-90% of patients experiencing only mild or no pain 5-years after surgery. Replacements typically last 10-25 years, before needing a revision.
Knee replacement is similar in effiacy with about a 90-95% success rate for pain in younger patients. These replacements can be expected to last 15-25 years.
Despite their effectiveness, conservative management should always be the first line of management for OA as surgeries carry significant costs and risks, such as infection, blood clots, hardware failure and the possible need for revision.
Infection, blood clots, hardware failure, revision
Written by: David Resic (Osteopath)
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