Top 10 OA Treatment Qs (Including When It’s Time for Surgery)
After receiving a diagnosis of osteoarthritis (OA), you might ask: What is it? How can I decrease my pain? What treatments should I consider? This chronic condition, which wreaks havoc on the body by breaking down joints and their surrounding cartilage, ligaments, and bone, affects more than 32.5 million Americans, making it a top cause of disability in adults. While there’s no magic remedy that can rewind the damage of OA, there are several treatment options available that can reduce pain, improve function, and bolster quality of life. Let’s walk through your biggest concerns now.
Can weight loss ease symptoms of OA?
Yes. “Healthy weight management is an important part of reducing symptoms related to osteoarthritis,” says Dominic King, D.O., an orthopaedic and sports medicine physician at the Cleveland Clinic in Ohio. Why? Because weight loss reduces the load carried by your joints. Research shows that every pound lost can result in a fourfold reduction in the load exerted on the knee. That’s why guidelines from the 2019 American College of Rheumatology (ACR) recommend weight loss (along with exercise) for managing knee and/or hip OA for folks who are overweight or obese. (Shed just 5% of your body weight and you’ll see benefits.)
Do doctors encourage exercise for arthritis pain?
Absolutely. Exercise engages the muscles that support the joints, reducing pain and improving physical function for those with OA, notes the Arthritis Foundation, which recommends daily range-of-motion and flexibility exercises such as ankle circles and gentle stretching. ACR gives tai chi two big thumbs up—its strengthening moves may even help protect you from future falls. “Low-impact activities, such as riding a stationary bike or [using a] light exercise band are important, too,” adds Dr. King. “They allow for muscle strengthening without overloading the joints.” Bonus: Regular exercise can also improve depression in folks with OA, per recent research.
Do I need physical therapy before I’ve had surgery?
Possibly. “If you have osteoarthritis, meet with a physical therapist in order to learn how movement can become your best friend in the journey to joint health,” says Dr. King. These specialists assist you when you’re unable to engage in exercise on your own and can teach you how to safely and effectively strengthen and stabilize your joints with special exercises. “Physical therapy is really the best starting place,” he adds. In fact, OA exercise is more effective if supervised by physical therapists, rather than when performed solo at home, according to a 2020 report in Arthritis Care & Research.
Can OTC and Rx medications effectively treat OA?
Oftentimes, yes. “Over-the-counter and prescription anti-inflammatories (NSAIDS) such as ibuprofen, naproxen, meloxicam, and diclofenac are all commonly used to treat OA pain,” says Elizabeth B. Gausden, M.D., a hip and knee surgeon at the Hospital for Special Surgery in New York City. “We typically recommend taking these as needed for arthritis pain. When someone has a sudden flare, I suggest two weeks of NSAIDs daily, as long as you can tolerate it.” Acetaminophen can be a good option for people who can’t take NSAIDs due to kidney disease or issues with stomach upset.
Should I consider getting corticosteroid injections?
Maybe. “Corticosteroid injections are commonly used to treat symptomatic knee pain from OA and can be used if pain is not adequately treated by over-the-counter medications,” says Dr. Gausden. In fact, the ACR guidelines strongly recommends these shots for hip and knee pain associated OA, but notes that there’s less evidence of their effectiveness for hand OA. “Unfortunately, the pain relief is usually best with the first injection, with shots becoming less effective over time,” says Dr. Gausden. “A good response would be several months of relief.”
How about natural remedies? Should I try them?
Sure—with some caveats. Some hold more promise than others. For instance, ACR recommends that folks with knee, hip, and/or hand OA consider acupuncture. (A 2020 study in the journal Pain found that people with knee osteoarthritis who had three acupuncture sessions a week for eight weeks experienced significantly greater improvements in pain, function, and stiffness than those who had the treatment once a week.) On the other hand, studies have been mixed on supplements like glucosamine, chondroitin, vitamin D, and fish oil for OA, which has led ACR to recommend against their use.
Will I know when it’s time for OA surgery?
Most likely—when the time comes, you’ll probably know it. “When pain or lack of mobility is affecting you every day—if you’re cancelling plans or modifying your life because of OA—I advise my patients to start thinking about surgery,” says Dr. Gausden. However, most people with osteoarthritis don’t need joint replacement surgery, according to ACR. This option should only be considered if non-surgical management has been unsuccessful. (Joint replacement surgery, also called arthroplasty, involves removing your worn out cartilage and replacing the joint with a metal and plastic version.) “Ultimately, the decision is best made by you,” he adds.
Will surgery likely be successful?
Resounding odds say yes! While all surgeries carry risk and can be scary to commit to, take heed knowing that 80% to 100% of individuals who’ve undergone a total knee replacement are satisfied with the results, according to a study in HSS Journal. Meanwhile, a report in Arthroplasty notes that total hip replacement earns roughly a 93% satisfaction score. These days, a hip or knee replacement can be expected to last for 20 or more years, making it a lifelong OA solution for many people.
Is recovery from surgery a tough road?
We won’t sugarcoat it—it can be. “The road to recovery isn’t easy and requires a lot of effort to regain mobility and range of motion,” says Dr. Gausden. It can take three to six weeks to resume most daily activities after knee replacement surgery. For the hip, you’ll likely be able to get back to some normal activities by week 12—and most folks can expect great progress between weeks 12 and 15, with continued improvement for up to a year. It’s important to start physical therapy the day of surgery, reports a study in the journal Advanced Orthopedics.
Will my post-op pain decrease significantly?
Almost certainly. Through it all—after surgery and after recovery—“my patients often say to me, ‘I shouldn’t have waited so long for joint replacement surgery’,” says Dr. Gausden. “They love how much their life has improved following the procedure.” To wit, individuals who had joint replacement surgery, on average, noted that their post-op pain was at .9 out of 10. That’s significant, especially considering that, pre-surgery, the average pain score was 7.5 out of 10, according to a 2020 report presented at the American Academy of Orthopaedic Surgeons’ annual meeting.
Osteoarthritis Stats: Centers for Disease Control and Prevention. (2020.) “Osteoarthritis (OA).” cdc.gov/arthritis/basics/osteoarthritis.htm
What Is OA?: American College of Rheumatology. (2019.) “Osteoarthritis.” rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis
The Impact of Weight on the Knees: Obesity Reviews. (2014.) “Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review.” ncbi.nlm.nih.gov/pmc/articles/PMC4238740/
American College of Rheumatology OA Guidelines: Arthritis Care & Research. (2020.) “2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.” rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf
Exercise and OA: Arthritis Foundation. (n.d.) “Benefits of Exercise for Osteoarthritis.” arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis
Exercise and Depression: Cochrane Database of Systematic Reviews. (2018.) “Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review.” ncbi.nlm.nih.gov/pmc/articles/PMC6494515/
Acupuncture for OA Pain: Pain. (2020.) “Acupuncture of different treatment frequencies in knee osteoarthritis: a pilot randomised controlled trial.” journals.lww.com/pain/Abstract/2020/11000/Acupuncture_of_different_treatment_frequencies_in.11.aspx
Joint Replacement Surgery: American College of Rheumatology. (2018.) “Joint Replacement Surgery.” rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Joint-Replacement-Surgery
Knee Replacement Satisfaction: HSS Journal.(2018.) “Patient Satisfaction After Total Knee Replacement: A Systematic Review.” link.springer.com/article/10.1007%2Fs11420-018-9614-8
Hip Replacement Satisfaction: Arthroplasty. (2019.) “Patient satisfaction and total hip arthroplasty: a review.” link.springer.com/article/10.1186/s42836-019-0007-3
Knee Replacement Recovery: Mayo Clinic. (2020.) “Knee Replacement.” mayoclinic.org/tests-procedures/knee-replacement/about/pac-20385276
Hip Replacement: Mayo Clinic. (2020.) “Hip Replacement.” mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042
Hip Replacement Recovery: Journal of Orthopaedic & Sports Physical Therapy. (2011.) “Total Hip Replacement: How Long Does It Take to Recover?” jospt.org/doi/10.2519/jospt.2011.0502
Post-op Physical Therapy: Advanced Orthopedics. (2019.) “Immediate Physical Therapy following Total Joint Arthroplasty: Barriers and Impact on Short-Term Outcomes.” hindawi.com/journals/aorth/2019/6051476/
Post-op Pain Improvement: American Academy of Orthopaedic Surgeons’ Virtual Education Experience. (2020) “Marital Functioning and Spouse-Reported Improvements in Quality of Life after Joint Arthroplasty.” aaos.scientificposters.com/epsAbstractAAOS.cfm?id=