Treatment & management

At present, there is no cure for osteoarthritis (OA) and the disease is long-term and progressive. Treatment for OA aims to manage symptoms, increase mobility and maximise quality of life.

Treatment of OA consists of:

  • physical activity
  • weight management
  • medication
  • joint replacement surgery.

Physical activity

Exercise is an important and effective component in both management and prevention of OA. Exercise helps improve symptoms (especially pain and joint stiffness) and quality of life by increasing range of motion (the ability to move joints through their full motion), strengthening muscles around affected joints, assists in weight control and reduces risk of other chronic diseases (e.g. diabetes and cardiovascular disease). Exercise may also have psychological and social benefits [1].

The American College of Rheumatology guidelines strongly recommend people with OA to participate in cardiovascular (aerobic) and/or resistance land-based and aquatic exercises [2].

A GP or Exercise Physiologist should be consulted before undertaking an exercise program.

Weight management

Being overweight increases the risk of developing OA, due to the increased load on weight bearing joints and increased stress on cartilage. For people with existing OA and who are overweight, weight loss can help decrease pain, prevent further joint damage and increase mobility [1]. 

A GP or Dietitian can be consulted to discuss weight loss/management strategies.

Medications

Treatment of OA with medication aims to relieve pain, reduce inflammation and improve functioning and quality of life.  Analgesics, or painkillers, are commonly used to manage the pain of OA. Analgesics include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics.

In Australia, the clinical practice guidelines for management of OA recommend regular use of paracetamol as the first choice. When paracetamol provides insufficient pain relief, use of NSAIDs is recommended [3].

Australian guidelines recommend intra-articular corticosteroid injections for short-term treatment of hip and knee OA. Oral opioids are used to relieve moderate to severe pain [1].

General practitioners and osteoarthritis treatment

General practitioners (GPs) are usually the first point of contact with the health care system for people with OA [4] and they often play a coordinating role for the multidisciplinary management of OA [1]. GP management of OA includes assessment and diagnosis, referral to other health services, prescribing medication and providing education about the condition.

OA is among the most commonly managed conditions in general practice [5]. About 3.6 million GP encounters were for osteoarthritis in 2015–16 – equal to 2.9 of every 100 encounters. This has not changed since 2006–07.

There is currently no nationally consistent primary health care data collection monitoring provision of care by GPs. Note that statistics on general practice activities based on Bettering the Evaluation and Care of Health (BEACH) data are derived from a sample survey of GPs and their encounters with patients, and need to be interpreted with some caution.

Figure 1: Rate of osteoarthritis managed by GPs, 2006–07 to 2015–16

This line graph shows the rate of encounters (per 100 encounters) for osteoarthritis managed by GPs, from 2006–07 to 2015–16. GP encounters for osteoarthritis increased from 2.6 to 2.9 per 100 encounters.

Source: Britt et al. 2016 [5] (Data table).

Hospitalisation and the treatment of osteoarthritis

A variety of procedures are performed in hospitals to restore joint function, help relieve pain and improve quality of life for someone with osteoarthritis [6].

Based on the AIHW National Hospital Morbidity Database (NHMD), in 2015–16:

  • there were 254,300 hospitalisations with a principal diagnosis of osteoarthritis, a rate of 1,059 hospitalisations per 100,000 population
  • more than half (57%) of osteoarthritis hospitalisations were for females, and the remaining 43% were for males
  • the hospitalisation rate was lowest among those aged 40 and under, steadily increased until the age of 75–79, and then decreased again among people aged 80 and over.

Figure 2: Rate of hospitalisation for osteoarthritis by sex and age, 2015–16

This vertical bar chart compares the rate (per 100,000 population) of hospitalisations for osteoarthritis, across various age groups by sex, in 2015–16. The rate of hospitalisations was highest in the 75–79 age group for both males (4,845) and females (6,196), and lowest in the <40 age group for males (28) and females (19).

Source: AIHW National Hospital Morbidity Database (Data table).

Between 2006–07 and 2015–16, the age-standardised acute care hospitalisation rate for osteoarthritis remained stable (Figure 3). Over the same period, the hospitalisation rate for sub-acute and non-acute care for osteoarthritis increased by 2.5 times.

In 2015–16, osteoarthritis was the most common reason for rehabilitation care with arthrosis of knee accounting for 22% and arthrosis of hip accounting for 9% of all rehabilitation hospitalisations [7]. The primary purpose of rehabilitation care is to improve functioning of a patient with an impairment, activity limitation, or participation restriction due to a health condition.

Figure 3: Age-standardised rate of hospitalisations for osteoarthritis (any diagnosis), by care type, 2006-07 to 2015-16

This line graph shows the rate (per 100,000 population) of hospitalisations (per 100 encounters) for osteoarthritis, by care type (acute or sub-acute/non-acute) from 2006–07 to 2015–16. The rate of acute hospitalisations for osteoarthritis increased from 570 in 2006–07 to 599 in 2015–16. The rate of sub-acute/non-acute hospitalisations for osteoarthritis increased from 150 in 2006–07 to 529 in 2015–16.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database (Data table).

Joint replacement surgery

Osteoarthritis is also the most common condition leading to hip and knee replacement surgery in Australia [6]. Clinical guidelines in Australia recommend joint replacement surgery as a cost effective intervention for people with severe osteoarthritis who are unresponsive to medication and exercise [8]. These procedures restore joint function, help relieve pain and improve quality of life of the affected person.

In 2015–16, 50,600 knee replacements (181 per 100,000 population) and 30,900 hip replacements (112 per 100,000 population) were performed in hospitalisations with a principal diagnosis of osteoarthritis. The rate of knee or hip replacements was lowest in people aged under 40, increased with age to 75–79, and then decreased among those aged 80 and over (Figure 4).

Figure 4: Rate of total knee and hip replacements for osteoarthritis, by age, 2015–16

This vertical bar chart compares the rate (per 100,000 population) of total knee and hip replacement procedures for osteoarthritis, across various age groups in 2015–16. The rate was highest in the 65–69 age group for both knee replacements (1,158) and hip replacements (692), and lowest in the <40 age group for both knee replacements (1) and hip replacements (3).

Source: AIHW National Hospital Morbidity Database (Data table).

Between 2005–06 and 2015–16, the age-standardised rate of joint replacement surgery in hospitalisations where osteoarthritis was the principal diagnosis steadily increased, by:

  • 36% for total knee replacement (from 133 to 181 per 100,000 population)
  • 38% for total hip replacement (from 81 to 112 per 100,000 population) (Figure 5).

Figure 5: Trends in total knee and hip replacements for osteoarthritis, 2005–06 to 2015–16

This line graph shows the age-standardised rate (per 100,000 population) for total knee and hip replacement in people with osteoarthritis, from 2005–06 to 2015–16. The rate of knee replacements increased from 133 in 2005–06 to 181 in 2015–16. The rate of hip replacements increased from 81 in 2005–06 to 112 in 2015–16.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database (Data table).

All joint replacements require correction (revision surgery) over time. Based on data from the Australian Orthopaedic Association National Joint Replacement Registry [6], there were 4,668 revision surgeries for knee replacements and 4,292 revision surgeries for hip replacements reported in 2016.

References

  1. RACGP (The Royal Australian College of General Practitioners) 2009. Guideline for the non-surgical management of hip and knee osteoarthritis. Melbourne: RACGP.
  2. Hochberg MC, Altman RD, April KT, et al. 2012. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip and knee. Arthritis Care & Research 64(4):465–474.
  3. Stitik T, Altschuler E & Foye P 2006. Pharmacotherapy of osteoarthritis. American Journal of Physical Medicine and Rehabilitation 85:S15–S28.
  4. McKenzie S and Torkington A 2010. Osteoarthritis: management options in general practice. Australian Family Physician 39 (9):622–625.
  5. Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, et al. 2016. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press.
  6. AOA (Australian Orthopaedic Association) 2011. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA.
  7. Australian Institute of Health and Welfare 2017. Admitted patient care 2015–16: Australian hospital statistics. Health services series no.75. Cat. no. HSE 185. Canberra: AIHW.
  8. RACGP (The Royal Australian College of General Practitioners) 2007. Referral for joint replacement: a management guide for health providers. Melbourne: RACGP.