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Osteoarthritis is the most common form of arthritis. It is "a progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans."[1]

Cause / etiology

Obesity may contribute to osteoarthritis of the knee.[2][3][4]

Leg-length inequality > 1 cm is associated with osteoarthritis of the knee.[5]


Signs and symptoms

Knee osteoarthritis

Osteoarthritis of the knees is associated with buckling, or sudden giving way, of the knees.[6] This is more likely if the quadriceps muscle is weak.

A screening survey is positive if any one of the following is answered yes:[6]

  • During the last 4 weeks, have you had knee pain on most days?
  • During the last 4 weeks, have you had knee pain while climbing down stairs or walking down slopes?
  • During the last 4 weeks, have you had swelling in one or both knees?
  • Do you have knee OA? (If you do, was the diagnosis made by a rheumatologist or a general practitioner?)

Using the prevalence of disease in this study (5% to 8%), the predictive values are:

Hip osteoarthritis

A screening survey is positive if any one of the following is answered yes:[6]

  • During the last 4 weeks, have you had hip pain (groin or upper thigh) on most days?
  • During the last 4 weeks, have you had hip pain while climbing down stairs or walking down slopes?
  • During the last 4 weeks, have you noticed any limitation in the range of motion of one or both hips?
  • Do you have hip osteoarthritis? (If you do, was the diagnosis made by a rheumatologist or a general practitioner?)

Using the prevalence of disease in this study (5% to 8%), the predictive values are:


Treatment with combined weight loss and exercise is better than either treatment alone.[7]

Analgesic medications

The World Health Organization recognizes a "pain ladder" of increasingly potent analgesics to deal with the pain of osteoarthritis. These may be supplemented with adjuvants.

The Disease-Modifying Anti-Rheumatic Drugs (DMARD) used in rheumatoid arthritis and other autoimmune disorders are not indicated in the essentially mechanical wear involved in osteoarthritis.



A randomized controlled trial comparing acetaminophen to ibuprofen in x-ray proven mild to moderate osteoarthritis of the hip or knee found that equal benefit.[8] However, acetaminophen at a dose of 4 grams per day can increase liver function tests.[9]

Monoclonal antibodies

Adalimumab did not help in a randomized controlled trial.[10]



Adjuvants for pain medications

Dietary supplements

Various dietary supplements and complementary and alternative medicine approaches may help.[11] There is no benefit from glucosamine and chondroitin according to a network meta-analysis.[12]

A combination of glucosamine and chondroitin dietary supplements may help moderate to severe osteoarthritis according to the GAIT study while neither supplement seems effective alone.[13] However, longer follow-up of the GAIT study showed the combination group tended to have the most loss of joint space.[14]


For more information, see: chondroitin.

A meta-analysis of randomized controlled trials found no benefit from chondroitin as monotherapy.[15]


For more information, see: glucosamine.

A molecule derived from glucosamine is used by the body to make some of the components of cartilage and synovial fluid.

Neither glucosamine sulfate[16] nor glucosamine hydrochloride[13][14] is effective as monotherapy for osteoarthritis.


For more information, see: S-adenosylmethionine.


For more information, see: Acupuncture.

Acupuncture is probably not effective according to a meta-analysis that concluded "sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects."[17]

Arthroscopic surgery and joint lavage

Joint lavage, with or without corticosteroids, does not help.[18][19][20] However, a number of patients including those with severe disease of two or more compartments of the knee, were excluded from one trial.[20]

Intra-articular injections

Single intraarticular corticosteroids of the knee may reduce pain for one week after the injection according to a systematic review.[21]

One trial that compared corticosteroid injections every three months to placebo for two years[22] found improvements in outcomes ranging from none to small for the WOMAC pain score[23]

Intraarticular viscosupplementation of the knee with hyaluronic acid is "associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events."[21]

Intra-articular injections of the hip joint for labral tears may not be effective.[24]

Physical therapy

Some types of physical therapy may help according to a systematic review of trials.[25]

Knee bracing and shoe prosthesis

Laterally wedged insoles may (with valgus bracing)[26] or may not (without bracing)[27][28] benefit some patients with arthritis of the medial knee according to randomized controlled trials.



The strongest predictors of poor functional outcome are age, body mass index, anxiety and pain severity.[29]


Among patients presenting with hip pain to their general practitioner, the rates of total hip replacement are:[30]

  • 12% of patients at 3 years
  • 22% after 6 years

Predictors of the need for a total hip replacement are:[30]

  • age >/=60 years, morning stiffness
  • pain in the groin/medial thigh
  • decreased extension/adduction
  • painful internal rotation
  • body mass index </=30 kg/m(2)
  • Kellgren/Lawrence grade of 2 or higher


  1. Anonymous (2023), Osteoarthritis (English). Medical Subject Headings. U.S. National Library of Medicine.
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