A guide to osteoarthritis

In this article, a consultant orthopaedic surgeon discusses osteoarthritis, including its causes, and various methods for treating..



What is osteoarthritis?

Osteoarthritis is a degenerative condition that affects the joints of the body in which the cushioning between bones deteriorates. This leads to swelling, stiffness, and pain for patients with the condition, which can greatly reduce their mobility. It typically affects the hips, knees, and hands, but it can, in theory, affect any joint in the body. It is the most common form of arthritis.

It differs from other forms of arthritis; rheumatoid arthritis, for example, is an autoimmune disease and occurs due to the immune system attacking the synovial fluid in the joints. Gout, another form of arthritis, occurs due to an excess of uric acid in the body, which causes crystal-like formations within the joints.

It is a condition that cannot be reversed or fully ‘cured’.

What causes osteoarthritis?

Osteoarthritis occurs due to wear and tear on the cartilage over time. This can be due to repetitive movements (such as certain actions that may be constantly performed at a long-held job or hobby). This is why athletes are more predisposed to developing it.

Women are also more at risk of developing osteoarthritis, particularly in menopause, as the drop in oestrogen production contributes to bone and joint health. Some cases of osteoarthritis are related to genetics.

Osteoarthritis can also occur after a traumatic injury, and as a response to strain on the joints in patients with obesity.

How is osteoarthritis treated?

Treatment for osteoarthritis looks to primarily alleviate the symptoms and improve mobility and comfort for the patient. There is no way yet to restore the deteriorated joint tissue, but there are surgical prostheses that can be explored, though not all patients will be suitable to undergo the procedure.

The non-surgical options for treatment include physical therapy and exercise in order to strengthen the muscles around the joint, which can reduce pressure and increase stability and flexibility. This can also help with weight loss. Activities that are low impact are beneficial, such as cycling, speedwalking, and swimming.

Aids and devices like crutches, splints, insoles, and orthopaedic shoes can make life and movement more comfortable for the patient.

Patients can consider joint injections to increase mobility and reduce pain. The most common substances used for this approach are corticosteroids, for their anti-inflammatory properties, and hyaluronic acid, which mimics synovial fluid and can lubricate the joints. Painkillers in the form of pills and topical creams are also available.

When patients have exhausted more conservative methods of management, more intensive or invasive options are considered, such as radiotherapy and arthroplasty.

Arthroplasty is a surgical approach that involves reshaping or replacing dysfunctional joints in order to restore function. This can include osteotomy, where the ends of the bones are shaved to better fit together, or joint replacement, where the ends of the bones are implanted with prosthetic parts. The benefit of a surgical approach is that it can eliminate or greatly reduce pain whilst improving mobility, but not every patient will be suitable for surgery or even want to undergo one. The most common replacements are done on the hip, knee, elbow, ankle, and shoulder. Replacement prosthetics are expected to be functional for around twenty years, which is why this avenue is not recommended to younger patients as to avoid the need for revision surgery in the future.

Radiotherapy might pose a suitable alternative in such cases. Radiotherapy for osteoarthritis avoids the risks of surgery – infection, misalignment, scarring, long recovery periods, and misalignment – though it cannot address the physical deformity of the joint. Rather, it primarily targets pain by reducing the inflammation in the joint area. The radiation dose is low, not like that used for treating cancer. Patients who have undergone this avenue of treatment report a significant improvement in pain and mobility.