Hip and knee osteoarthritis (OA) affects millions of people worldwide and remains a leading cause of pain and disability.
Elliot Dunoff-Romero, an advanced practice provider with Northside Hospital Orthopedics | Total Joint Specialists, recently offered a clear overview of what OA is, how it is diagnosed and the range of available treatments.
What osteoarthritis is — and isn’t
“Nearly 53 million adults have arthritis, and that’s expected to grow to about 67 million by 2030,” Dunoff-Romero said about arthritis’s global impact.
Worldwide, an estimated 350 million people live with the condition, according to the Arthritis Foundation. Commonly known as joint inflammation, arthritis has more than 100 types — the two most common are osteoarthritis and rheumatoid arthritis.
Dunoff-Romero said, while rheumatoid arthritis is inflammatory and typically causes “joint stiffness with rest, especially in the morning,” OA is noninflammatory and “usually aggravated by movement and weight-bearing but then relieved by rest.”
OA occurs when “excessive abnormal joint loading or joint injury” triggers the body to produce inflammatory enzymes. Over time, he explained, “those enzymes … eat away at the joint and destroy your tissues.”
How OA affects the hip and knee
OA damages several parts of the joint.
- Cartilage, the low-friction surface that allows smooth motion
- Bone, which can become “as hard as marble” and form bone spurs
- Synovium, which produces joint fluid. When inflamed, it creates swelling
- Soft tissues, including structures such as the ACL, PCL and meniscus
These changes progress through stages, from mild joint-space narrowing to severe bone-on-bone contact.
Diagnosing osteoarthritis
Diagnosis is straightforward. “We diagnose OA really easily with just standard plain X-rays,” Dunoff-Romero said. Physicians look for joint space narrowing, bone spurs (osteophytes), sclerosis (hardening of the bone) and bone cysts. MRIs are rarely needed.
Common symptoms include:
- Pain and tenderness
- Limited motion
- Swelling
- Joint deformity and instability
Treatment options
While there is no cure for arthritis, treatments are available and begin with nonpharmacologic approaches.
“The most important thing is weight management,” he said. Losing even a small amount makes a big difference: “For every pound you lose, you take about four pounds of pressure off your knee.”
Other options include:
- Physical and occupational therapy
- Braces and assistive devices
- NSAIDs or acetaminophen
- Topical diclofenac
- Steroid injections, typically every three months
- Hyaluronic acid (“WD-40-type”) injections, which often relieve symptoms for six months
Dunoff-Romero also noted alternative therapies such as acupuncture and TENS units.
When surgery becomes necessary
When conservative treatments fail, surgery may be the best option.
Total hip arthroplasty is “one of the most successful orthopedic procedures today,” with components made of metal, ceramic and plastic designed to last 15 to 20 years. Knee replacement can also restore function and quality of life, but it involves a more challenging recovery. Implants resurface rather than remove bone and similarly use long-lasting metal and plastic components.
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