Your Top OA Treatment Questions, Answered
Osteoarthritis (OA) can be a real pain in the knee...hip, spine, hands, and various other joints. The good news? There are ways to manage OA, also known as “wear-and-tear” arthritis, without surgery, says Kirk A. Campbell, M.D., orthopedic surgeon at NYU Langone Health in New York City. And if those don’t suffice, joint replacement surgery is an option for getting back to doing the things you enjoy, he says. “The most important thing to know is that you don’t have to live in pain.” You also don’t have to navigate finding the best treatment option alone. Start here, with these expert answers to common OA treatment questions.
Quick Reminder: What Causes OA
OA is the most common form of arthritis, affecting more than 32 million American adults. It happens when cartilage—the flexible connective tissue that cushions the ends of bones in a joint—wears away. Without cushion, the bones begin to rub together, causing pain, swelling, and sometimes bony growths. In addition to the normal wear and tear joints endure throughout a lifetime of use, an injury or overuse also increases risk of developing OA.
Are There Any Treatments to Repair OA Damage?
The short answer is no, unfortunately. OA is the breakdown of a joint, and “once the process begins, we can only slow it down,” says Savyasachi C. Thakkar, M.D., assistant professor of orthopedic surgery at Johns Hopkins Medicine in Columbia, Maryland. “There’s no way to reverse the changes and make it a pristine joint again, because our bodies can’t regrow cartilage.” However, you can slow down OA progression by switching to low-impact activities (think: swimming or biking over jogging), building strength and flexibility in the arthritic joint, and losing weight if you’re overweight.
What Over-the-Counter Meds Can I Try?
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, and ibuprofen are typically the first thing your doctor will recommend to manage mild to moderate OA. “This medicine is not repairing the cartilage, but it’s treating the inflammation,” says E. Grant Sutter, M.D., orthopedic surgeon at Northwestern Medicine Central DuPage Hospital in Naperville, Illinois. “It’s changing your body’s response to the arthritis, and that can be really effective.” These meds may cause side effects like heartburn, stomach ulcers, or kidney damage if taken regularly, especially if you have a medical condition that predisposes you to these conditions, so talk with your doctor before taking NSAIDs regularly.
Do I Need to Stop Doing My Normal Activities?
It depends. If running is one of your normal activities, your doctor may recommend trading it (or any high-impact exercise) for lower-impact options that cause less wear and tear on your joints, like biking or swimming, Dr. Campbell says. OA pain shouldn’t severely limit your activity, so if that happens, talk to your doctor. The goal of OA management is to be able to keep living your life with minimal symptoms, so it might take some treatment trial and error to get there.
Should I Use Cold or Hot Therapy?
Keep it cold. Icing a swollen joint can help temporarily relieve inflammation and ease discomfort by reducing blood flow to the joint, Dr. Thakkar says. It’s the same thing that’s recommended with a sports injury to reduce the cascade of inflammation. Heat, on the other hand, might make OA inflammation worse because it increases blood flow. “People with OA may prefer warm weather, but when it comes to putting something directly on the joint, a cold pack is the way to go,” Dr. Thakkar says.
Why Is Losing Weight Recommended?
Carrying around extra weight can put a lot of pressure on weight-bearing joints like the knees and hips and contribute to the development of OA. If you’re overweight or obese, there’s strong data showing losing weight can help slow down OA progression, particularly in the knees, Dr. Sutter says. “A huge percentage of overweight patients with mild to moderate OA see their symptoms drastically improve and sometimes go away completely for a period of time if they lose weight.” Need help with healthy weight-loss plan? Talk to your doctor, who can refer you to the appropriate specialists if needed.
Is It Safe to Exercise With OA?
It’s not only safe, but the right form of exercise can help ease OA symptoms. Strength training is your best bet. “When degeneration happens in a joint, the surrounding muscles also get weaker,” Dr. Thakkar explains. “And when muscles get weaker, they can’t support the joint anymore.” Strength training teaches the muscles to work harder so that they can take some of the load off the joint, making its job easier, he says. A trainer who specializes in orthopedic conditions or a physical therapist can help you determine what exercises might help—and how to do them safely.
What's the Deal With Injections?
Injections are typically considered a backup option, meaning your doctor might suggest it if NSAIDs, activity modification, and physical therapy aren’t sufficient. There are two main types: corticosteroids and viscosupplementation. Corticosteroids are powerful, localized anti-inflammatories that offer quick relief (onset within a few days of the injection) and wear off after about three months in most patients, Dr. Campbell says. Viscosupplementation is a gel-like substance that cushions the joint and reduces inflammation. Viscosupplementation takes a few weeks to work, but it typically lasts longer than corticosteroids—up to six months in some cases, he says.
When Should I Consider Joint Replacement Surgery?
“Joint replacement is an elective surgery,” Dr. Campbell says, “so I tell my patients it’s a quality of life decision.” Your X-rays may show significant joint damage, but if you feel okay and are able to function and do the things you enjoy, there’s no need to rush into surgery, he says. “When pain and dysfunction are limiting activities and negatively impacting quality of life and you’ve failed nonsurgical options, that’s when you’d consider it.” A conversation with your doctor is the first step.
What Are the Risks of Joint Replacement?
First, some good news: Joint replacement surgeries are typically very successful and reduce pain and restore joint function, Dr. Thakkar says. But like all surgeries, it’s not free of risks. The biggest ones are persistent stiffness and implant-related risks, like the implant becoming loose or infected, he says. “There’s about a five to seven percent rate of complications, so people seem to do well overall.” Other things to consider include cost of surgery, recovery time, and post-op physical therapy—all of which can be discussed with your doctor.
How Long Will My New Joint Last?
The best answer doctors can give right now: longer than joint replacements have ever lasted before. “Materials that we’re using now are better than ever, but we haven’t put them in for that long yet so we can’t tell people exactly how long it will last,” Dr. Sutter says, adding that the majority of knee replacements will last for 20 to 25 years. With the way technology has advanced so far, it’s not unrealistic that we’ll see joint replacements lasting for 30 years or more in the neat future, he says.
Do I Have to Wait Until I’m a Certain Age to Get Surgery?
No, there’s no specific age requirement for a joint replacement, Dr. Sutter says, but the younger the patient, the more consideration has to be given to the future of the joint. Most people don’t want to have multiple joint replacements in their lifetime, so it comes down to weighing the benefits with the potential downsides of getting surgery early in life. “In the past, joint surgery was reserved for the elderly, but since the goal is preserving quality of life as opposed to restoring it, more younger people are undergoing these procedures,” Dr. Thakkar adds.