At HSS, conservative, non-surgical treatments – aimed at decreasing joint pain and improving mobility – are the first line of management for osteoarthritis.
Treatment is always personalized to the patient. It will depend on the severity of your osteoarthritis, other diseases or conditions you may have, as well as what medications you are currently taking.
Being diagnosed with osteoarthritis does not mean incapacitating pain is inevitable or that disability will rob you of all your favorite activities as you age. There is much you can do.
The human body is meant to move. When osteoarthritis damages a joint, people will often react by becoming more and more sedentary, which leads to more pain and stiffness. When, in fact, learning to move properly can help your body’s natural self repair mechanisms slow down cartilage deterioration. Stronger muscles even help protect joints.
But you must learn the right moves. If necessary, an HSS physical therapist will guide your safe return to exercise and activities through expert rehabilitation. HSS also offers movement classes to help you get active and stay that way.
Carrying extra pounds taxes your joints. Studies have shown time and again that losing even ten pounds can help ease OA pain, while gaining weight can have the opposite results and exacerbate joint pain and stiffness.
Learn more about healthy weight, staying active, and maintaining sports performance, including ways HSS can help.
People’s experience of pain is highly individual. Some people whose x-rays show joint deterioration may report little discomfort. Other people with the same clinical presentation may be experiencing pain so acute it curtails their formerly active lifestyle. Genetics play a role, as do cultural aspects and personal history.
There is no right or wrong experience of pain; there is only your personal experience, and determining (with your doctor’s guidance) what kind of pain management is the best decision for you.
Depending on the level of pain you are experiencing, other medications you may be taking, and how you personally react to certain medicines, your doctor will prescribe pain relief most appropriate for you. These may include any of the following:
Analgesics such as Acetaminophen (Tylenol, others) can provide some relief if you are suffering from mild to moderate osteoarthritis pain. It’s important to understand, however, that while acetaminophen can alleviate pain, it doesn't address inflammation. Be sure to inform your doctor if you are taking acetaminophen, because it can affect other medications that you may be taking. Also, ask your doctor about guidance for alcohol use, as consuming three or more alcoholic drinks a day while taking acetaminophen may cause liver damage.
NSAIDs (Nonsteroidal anti-inflammatory drugs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. Oral NSAIDs can cause stomach upset, so some prescription NSAIDs come in a patch that can be affixed to your skin or in a gel form that you can rub on the painful joint. Other NSAID side effects include ringing in your ears, ulcers, stomach or intestinal bleeding, cardiovascular problems, liver and kidney damage, heart failure, fluid retention, and kidney failure. The risk of major side effects is greatest if you use NSAIDs at high dosages for long-term treatment.
COX-2 Inhibitors are as effective for managing pain and inflammation as NSAIDs, but they have fewer stomach-injuring side effects. One such example is celecoxib (Celebrex). They are more expensive than NSAIDs and do have side effects of their own, including fluid retention (which may worsen heart failure) and stomach ulcers, especially if you have experienced gastrointestinal bleeding in the past. They may also be associated with an increased risk of heart attack, transient ischemic attack, or stroke. The risk is greater if you have heart disease or use NSAIDs for a long time. It's important to discuss the risks and benefits of using these medications with your physician.
Topical Pain Relievers including over-the-counter gels, ointments, creams, and sprays can temporarily ease OA pain and reduce swelling in joints close to the surface of the skin, such as fingers, knees, and elbows. Topical pain relievers include trolamine salicylate (found in Aspercreme and Sportscreme); methyl salicylate, menthol and camphor (found in Double Ice ArthriCare, Eucalyptamint, Icy Hot, and Ben-Gay); or capsaicin from the seeds of hot chili peppers (found in Zostrix and Capzasin-P).
Supplements, such as glucosamine and chondroitin sulfate, are also available. The purported effect of these "nutraceuticals" is to enhance cartilage metabolism, minimize progressive degeneration, and possibly promote cartilage regeneration. However, because these substances are not regulated by the FDA, and because there is insufficient clinical data to demonstrate their efficacy, it is difficult to assess their true value at this time.
Highly effective procedures that are performed on a convenient out-patient basis at HSS include:
Intra-articular injections of cortisone made directly into the arthritic joint can also provide pain relief. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into an area, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further discussion with your physician may be needed to identify other treatment options.
Viscosupplementation is a newer therapy, proven useful in animals, that has been developed to treat patients with long-standing, painful osteoarthritis who might not be appropriate for more traditional therapy. In normal joint function, synovial fluid has the ability to change from viscous properties to elastic properties as load is increased. This is important to provide a frictionless surface. Hyaluronic acid is an important high molecular weight component of synovial fluid. Enzymes and other damaging substances such as free radicals are generated during inflammation in osteoarthritis. They degrade hyaluronic acid so that it loses its viscous and elastic properties. In addition to contributing to loss of joint function, some research has postulated that the degraded hyaluronic acid in itself contributes further to joint damage. Viscosupplementation with hyaluronic acid may delay and possibly halt progression of osteoarthritis. Further research is ongoing and necessary to see if viscosupplementation can provide relief for longer than six months and if the mechanism of action is truly different than just providing excess lubricant for the joint.
Acupuncture, chiropractic, massage, yoga, and T’ai Chi Chih have helped many people manage their osteoarthritis pain. The Integrative Care Center at HSS offers all these therapies and more, including movement classes and posture evaluations.
Because every person’s experience with osteoarthritis is unique, the condition can change, especially if an injury occurs. At HSS, Rheumatologists, Orthopedic Surgeons, Physiatrists, Radiologists, Physical Therapists, and Pain Management Specialists work together as a team to address issues as they occur.
When conservative measures fail and pain in a specific joint disables an active individual, surgery may restore comfort and the ability to pursue normal activities.
Among the advantages of HSS’ team approach is that decisions about surgical procedures can be well considered – over a span of years, if necessary.
The best candidate for surgery is a patient whose daily life has been interrupted to a great degree, like patients who can't walk more than a block or awaken from sleep with pain in the affected joint. Surgery can help restore the quality of daily living.
The type of surgery recommended will depend on a patient’s age, activity level, and the joint involved.
There are same-day procedures – like arthroscopy – that are right for some painful conditions. Hip resurfacing is a procedure may not be right for everyone – especially women – but which can create significant relief for those for whom it is an appropriate procedure. When appropriate, total joint replacements are available for almost every joint in the body.
HSS performs more hip surgeries and more knee replacements than any other hospital in the United States. Our surgeons helped develop the modern total knee replacement. The smaller instruments, surgical techniques, and regional anesthesia necessary for minimally invasive joint replacement were all pioneered at HSS.
Today more and more younger patients, especially ones who have been active in sports their whole lives, are turning to HSS for joint replacement options not always available elsewhere.
Learn more about joint replacement surgery at HSS, including articles, videos, and expert interviews which can help you understand more about joint replacement.
HSS is the largest academic research center devoted exclusively to musculoskeletal medicine in the world. New discoveries that lead to innovative treatments are a hallmark of the hospital’s uniquely collaborative approach to research.
Learn more about the latest research and clinical trials of the HSS Osteoarthritis Initiative.