Treatment & management

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

Treatment options for osteoarthritis include:

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

Physical activity

Exercise is an important and effective component in both management and prevention of osteoarthritis. 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 is also beneficial for other comorbidities and overall health (RACGP 2018). A GP or Exercise Physiologist should be consulted before undertaking an exercise program.

Weight management

Being overweight increases the risk of developing osteoarthritis, due to the increased load on weight bearing joints and increased stress on cartilage. Weight management is strongly recommended for people with knee and/or hip osteoarthritis who are overweight or obese (RACGP 2018). For people with existing osteoarthritis and who are overweight or obese, weight loss can help reduce symptoms (RACGP 2018). Weight loss should be combined with exercise for the greatest benefits (RACGP 2018).

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

Medications

Treatment of osteoarthritis with medication aims to relieve pain, reduce inflammation and improve functioning and quality of life. Analgesics, or pain medications, are commonly used to manage the pain of osteoarthritis. Analgesics include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. For those with hip and/or knee osteoarthritis requiring pain relief, it may be reasonable to trial the use of paracetamol or NSAIDs for a short period and then discontinue use if it is not effective (RACGP 2018). Corticosteroid injections may also be recommended for short term pain relief for hip and/or knee osteoarthritis if appropriate (RACGP 2018). Opioids are not recommended for the treatment of hip and/or knee osteoarthritis (RACGP 2018).

General practitioners and osteoarthritis treatment

General practitioners (GPs) are usually the first point of contact with the health care system for people with osteoarthritis (McKenzie & Torkington 2010; RACGP 2018) and are ideally placed to play the role of care coordinator to ensure treatment continuity (RACGP 2018). GP management of osteoarthritis may include assessment and diagnosis, referral to other health services, prescribing medication and providing education about the condition.

Osteoarthritis is among the most commonly managed conditions in general practice. About 2.6 of every 100 encounters were for osteoarthritis in 2015–16 (Britt et al. 2016). This has not changed significantly since 2006–07 (Figure 1).

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 generally remained stable over the decade.

Source: Britt et al. 2016 (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 (AOA 2018).

Based on the AIHW National Hospital Morbidity Database (NHMD), in 2017–18:

  • there were 269,214 hospitalisations with a principal diagnosis of osteoarthritis, a rate of 1,087 hospitalisations per 100,000 population
  • more than half (57%) of osteoarthritis hospitalisations were for females
  • the hospitalisation rate was lowest among those aged 40 and under and steadily increased until the ages of 70-74, and then decreased again with age (Figure 2).

Figure 2: Rate of hospitalisation for osteoarthritis by sex and age, 2017–18

This vertical bar chart compares the rate (per 100,000 population) of hospitalisations for osteoarthritis, across various age groups by sex, in 2017–18. The rate of hospitalisations was highest in the 75–79 age group for both males (4,826) and females (6,589), and lowest in the ≤40 age group for both males (25) and females (17).

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

Between 2008–09 and 2017–18, 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. This may be due to increased statistical collection of these separations (AIHW 2018).

In 2017–18, osteoarthritis was the most common reason for rehabilitation care with arthrosis of knee accounting for 22% and arthrosis of hip accounting for 9.0% of all rehabilitation hospitalisations (AIHW 2019). 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, 2008–09 to 2017–18

This line graph shows the rate (per 100,000 population) of hospitalisations for osteoarthritis, by care type (acute or sub-acute/non-acute) from 2008–09 to 2017–18. The age-standardised rate of acute hospitalisations for osteoarthritis decreased from 568 in 2008–09 to 556 in 2017–18. The age-standardised rate of sub-acute/non-acute hospitalisations for osteoarthritis increased from 229 in 2008–09 to 549 in 2017–18.

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 (AOANJRR 2019). Joint replacement is a cost-effective and clinically effective treatment for severe osteoarthritis (RACGP 2018). Clinical guidelines in Australia recommend considering joint replacement surgery for severe osteoarthritis if all conservative treatment options have failed (RACGP 2018). These procedures restore joint function, help relieve pain and improve the quality of life of the affected person.

In 2017–18, 54,102 knee replacements (218 per 100,000 population) and 32,929 hip replacements (133 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, 2017–18

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 2017–18. The rate was highest in the 75–79 age group for both knee replacements (1,152) and hip replacements (703), and lowest in the ≤40 age group for both knee replacements (0.57) and hip replacements (2.8).

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


Between 2008–09 and 2017–18, the age-standardised rate of joint replacement surgery in hospitalisations where osteoarthritis was the principal diagnosis steadily increased, by:

  • 27% for total knee replacement (from 144 to 183 per 100,000 population)
  • 33% for total hip replacement (from 85 to 113 per 100,000 population) (Figure 5).

Figure 5: Trends in total knee and hip replacements for osteoarthritis, 2008–09 to 2017–18

This line graph shows the age-standardised rate (per 100,000 population) for total knee and hip replacement in people with osteoarthritis, from 2008–09 to 2017–18. The rate of knee replacements increased from 144 in 2008–09 to 183 in 2017–18. The rate of hip replacements increased from 85 in 2008–09 to 113 in 2017–18.

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 (AOANJRR 2019), there were 65,266 knee replacement surgeries and 49,764 hip replacement surgeries (including primary partial, primary total and revision procedures) reported in 2018.