Osteoarthritis treatment with and without surgery

Last modified: December 11, 2019

Osteoarthritis is a widespread disease that affects one in four people over 45 years of age. Unfortunately, osteoarthritis is still widely considered to be a natural part of aging. Many people believe that the joints are simply worn out. This leads to the conclusion that the person affected should move as little as possible in order to avoid further wear and tear. Osteoarthritis is a sign of an imbalance in the joint’s  restorative and destructive functions. The joint breaks down faster than it is able to create more cartilage. This can be due to many reasons, but long-tern overstrain or incorrect strain on the joint are risk factors. Osteoarthritis treatment is primarily based on reducing the negative load that is placed on the joint.

Osteoarthritis treatment in brief

People who have problems with stiff and painful joints should contact a healthcare provider to get a diagnosis. This is namely the first stage in correct treatment. Several types of medical professionals can establish this diagnosis: general physicians, orthopedists and physiotherapists (previously called physical therapists). Osteoarthritis is currently considered a clinical diagnosis, which means that it is determined by assessing medical history, symptoms and joint function. X-ray images are generally not needed to confirm the diagnosis.

When the diagnosis is made, the patient should be sent to a physiotherapist. Osteoarthritis can be prevented, slowed and alleviated using customized, regular training. (This training should be guided by a physiotherapist for the best results.) Most people who are affected by the disease will become so much better from the training that they do not need to undergo surgery for their pain and discomfort. In certain cases, pain-relieving medications can be used to make it easier to perform their exercises.

Osteoarthritis treatment can be viewed as a pyramid.

The treatment of arthritis can be seen as a pyramid or ladder with different steps. Not everyone affected by the disease needs to go through all steps in the treatment. However, it can be good recognize what the different steps look like, so that you are prepared for what the treatment will look like. It is also good to know that not everyone who is affected by the disease needs surgery.

The first stage in treatment is customized training and exercise, ideally together with a physiotherapist. For best results, the exercises must be performed regularly over a long period of time. Many people notice that they get better after just a few weeks, but the longer they try, the better they feel. The training should also be combined with education about the disease. This increases understanding of how and why the exercises should be performed.

The second stage in the pyramid is pain relief. This includes a number of tablets in the NSAID category (Diklofenak, Voltaren) or paracetamol (Alvedon, Panodil). Gentle medications that can be purchased without a prescription at the pharmacy are often sufficient. With more severe pain, cortisone injections can be used. These are often injected directly in the painful joint. Regardless of the type of pain reliever chosen, it should not be considered a long-term treatment. Instead, it is something that makes it easier to complete the training.

The last step is surgery with a prosthesis. Only a small number of people affected by the disease develop such severe osteoarthritis that surgery is needed. It is also good to know that even if surgery is needed, this does not mean that training and exercise is not necessary. Exercise and training can reduce the risks associated with the surgery and shorten the rehabilitation time. In addition, the subsequent results will be better.

Why training works to treat osteoarthritis

There are several reasons that osteoarthritis develops. These reasons are usually called risk factors. These are simply things that we know negatively affect the course of the disease. A risk factor does not mean that osteoarthritis will develop. Some of the common risk factors include being overweight (more body weight than the muscles can support), inactivity, heredity, monotonous, heavy lifting and previous joint injuries. Increased age also results in an increased occurrence of osteoarthritis. Osteoarthritis treatment is based on minimizing these factors.

The basis of osteoarthritis treatment is customized training in combination with education. Training and exercise strengthens the muscles around the affected joint. This makes it easier to absorb the strain. New, better strain patterns are adopted at the same time. In addition, the cartilage is stimulated to repair itself. This does not necessarily result in the cartilage “growing back”, but the quality of it can improve. Overall, this results in fewer symptoms for the person affected.

Patient education as osteoarthritis treatment

The arthritis patient education program was started by BOA (Better Management of patients with Osteoarthritis) based on a combination of training and education. The information and exercises that the participants learn in a patient education program often lead to better insights about the importance of training. The education component also increases understanding of how much a person’s lifestyle in general can affect the disease. For example, you learn that it is more important to be strong than to be thin, but also how important all forms of physical activity are. This can increase the motivation to perform the training.

Here is more information about patient education programs as treatment.

Surgery – last stage in osteoarthritis treatment

In those cases where training and pain-relief do not produce the results, surgery may be necessary. The most common surgery is prosthetic surgery, primarily for osteoarthritis in the hips and knees. (Arthrodesis, for example, can be required in other joints). The decision to undergo surgery is made between the patient and an orthopedist. The patient should also try to exercise based on their ability, both before and after the surgery, to get the best results possible.

Read more about Total Joint Replacement (TJR).