Osteoarthritis (OA) is a condition that affects the whole joint including bone, cartilage, ligaments and muscles. Although often described as ‘wear and tear’, OA is now thought to be the result of a joint working extra hard to repair itself. OA may include inflammatory changes of the tissue around a joint, damage to joint cartilage, bony spurs growing around the edge of a joint and/or deterioration of ligaments (Arthritis Australia, 2017).
OA can affect any joint but occurs most often in the knees, hips, finger joints and big toe, and it can develop at any age but tends to be more common in people aged over 40 years or those who have had previous damage to the joint or joint injuries. 1 in 5 Australians (22%) over the age of 45 have osteoarthritis (Arthritis Australia, 2017).
Certain factors can often predispose a person to having an increased risk of developing OA, including, but not limited to previous job history, being overweight, family history of OA or previous injuries.
When it comes to discussing OA, it is important to distinguish between what is called ‘radiographic’ versus ‘clinical’ OA. Put simply, radiographic OA refers to changes on imaging (such as an x-ray) which show the physical changes occurring within the joint. Having said that, some people may have evidence of OA on radiology, but not have any discomfort or pain associated with these changes.
Conversely, others may have radiographic changes of OA and also experience pain associated with these physical changes in addition to other risk factors which may sensitise them to experiencing pain.
The poor relationship between features of osteoarthritis on imaging and symptoms has been well documented, meaning that the reason you may be experiencing pain in your joints is not strictly related to osteoarthritis. It is important to understand how osteoarthritis affects the individual’s function (including physical activity), quality of life, relationships (personal and professional), sleep, medication use and any other relevant medical conditions (RACGP, 2018) as these features can impact the pain experience outside of the physical changes to the joint itself.
Surgery is certainly not a first line recommendation to manage or ‘fix’ OA. Unlike hip replacements, knee replacement outcomes are not quite as good and recovery is definitely longer (Blom, 2016). Aside from the risks associated with surgery, the literature reports a 1 in 5 dissatisfaction rate in knee replacements (Gunaratne, 2017). Mild arthritic changes should not have joint replacement surgery (Arthritis Australia, 2024).
Exercise and weight loss are the recommended first line treatment strategies to managing osteoarthritis as this helps to reduce mechanical stress on the joint and manage the systemic inflammatory changes associated with inactivity and excess weight (Wang et al 2015).
Having a diagnosis of OA is not a sentence to living with lifelong pain – receive the right guidance for you to help get yourself back on track to living well with osteoarthritis.
References:
What is Osteoarthritis? Arthritis Australia. (2017) https://arthritisaustralia.com.au/types-of-arthritis/osteoarthritis/
Guideline for the management of knee and hip osteoarthritis. RACGP (2018). https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/knee-and-hip-osteoarthritis
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017 Dec;32(12):3854-3860. doi: 10.1016/j.arth.2017.07.021. Epub 2017 Jul 21. PMID: 28844632.
Blom AW, Artz N, Beswick AD, et al. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. Southampton (UK): NIHR Journals Library; 2016 Aug. (Programme Grants for Applied Research, No. 4.12.) Chapter 2, General systematic review methods: systematic reviews of long-term pain after hip and knee replacement, methods used to assess chronic pain and pre-operative predictors of long-term patient outcomes.
Physiotherapy In Motion. Five facts about osteoarthritis (2022). The Australian Physiotherapy Association. https://australian.physio/inmotion/five-facts-about-osteoarthritis
Image cited from the Physiotherapy in Motion (APA) (2022).