Osteoarthritis Treatment

Joint pain and other symptoms caused by osteoarthritis can be treated without surgery, especially if a diagnosis is made at an early stage of the disease. Successful symptom reduction usually requires a combination of treatments.

When devising a treatment strategy with a health care professional, keep in mind:

• Physical therapy and exercise are part of almost every treatment plan. Assigned exercises can accommodate a person’s physical abilities and pain levels.
• Home and alternative treatments are available, and many are considered effective. Others are not well researched and/or controversial among health professionals.
• Trial and error may be necessary to determine the combination of treatments that work best for an individual.
• Surgery is typically recommended only if nonsurgical treatments have been tried and failed to reduce severe symptoms.

Any treatment plan should account for a patient’s lifestyle and health circumstances. For example, a person whose job involves physical labor may not be able to engage in prolonged rest, and a person who has gastrointestinal issues may not want to take nonsteroidal anti-inflammatory drugs (NSAIDs).

This page describes several possible treatments for osteoarthritis, including nonsurgical medical treatments, home and alternative treatments, and surgery.

Physical Therapy

Physical therapy provides targeted exercises that help maintain the ability to perform everyday tasks, such as walking, bathing, and dressing. Stronger muscles provide greater stability for the joint, which in turn helps reduce stress on the joint.

Gait and posture training

A physical therapist or doctor can also evaluate a person’s walking stride and/or other motions to identify biomechanical issues that may contribute to arthritis in weight-bearing joints. Retraining and introducing new habits can limit future problems.

Occupational therapy

A doctor may recommend working with an occupational therapist in addition to a physical therapist. An occupational therapist can demonstrate appropriate modifications for everyday work and home activities that may be exacerbating pain.

Aqua therapy

Physical therapy done in a pool may be helpful for people with osteoarthritis. Pool therapy is a form of resistance training that can be used to strengthen the muscles surrounding the joint without the joint experiencing the strain of full weight-bearing.

See Water Therapy for Osteoarthritis

After sessions with a physical therapist end, it is important to keep up with moderate levels of activity to strengthen and maintain the muscles surrounding the arthritic joint. Regular daily activity, such as doing recommended physical therapy exercises at home, going to the gym or pool, and/or going for regular walks can help.

See Exercising with Arthritis

Home, Alternative, and Other Nonsurgical Treatments

In addition to physical therapy, many other osteoarthritis treatments do not involve surgery or medication. Some of these treatments may be referred to as home or alternative treatments.

These treatments are generally considered safe for most people with osteoarthritis. While they do not require a prescription, it is a good idea to consult a health professional. A professional can consider a patient’s unique circumstances and provide advice to help maximize the benefits and minimize the potential risks of treatments.

Certain physical or lifestyle factors can put a person at greater risk for arthritis symptoms. While factors such as age and genetics cannot be changed, other factors can.

Below are treatment strategies to help reduce risk factors. The goal of these strategies is to reduce joint stress and inflammation so that pain is alleviated and arthritis progression slows down.

• Weight loss is one of the most effective treatments for osteoarthritis. Losing excess weight takes extra pressure off weight-bearing joints. It can also help reduce low-grade, body-wide inflammation thought to exacerbate osteoarthritis.
• Ergonomic changes to the home or workspace can go a long way to reducing joint pain. For example, raising a computer screen to eye level or buying a cushioned mat to stand (in front of the kitchen sink, for example) are small changes that can have a big impact.
• Appropriate footwear and shoe inserts (when appropriately designed and selected) can take the pressure off weight-bearing joints, such as the knees, hips, and spine.
• Supportive devices, such as joint braces and canes, may be used to help stabilize or take the pressure off a severely arthritic joint.
• Periodic rest may ease arthritis inflammation and prevent it from getting worse. When arthritis pain is exacerbated by repetitive motions, such as painting, regular breaks are advised.

The treatments listed above are generally considered reliable strategies for reducing pain and preventing arthritis from getting worse.

The treatments below may also help alleviate arthritis pain. While they may reduce symptoms, they may not effectively reduce joint stress and arthritis progression. Some of these treatments are not well researched and their effects are not fully known. Certain treatments, such as supplements and medical marijuana, are considered controversial, and more study is needed.

• A warm compress can help loosen up stiff arthritic joints before an activity.
• A cold compress after activity can decrease swelling and provide quick pain relief.
• Coping techniques, such as meditation, visual imagery, biofeedback, or hypnosis may help manage arthritis joint pain.
• Transcutaneous electrical nerve stimulation (TENS) typically uses electrodes that attach to the skin to deliver small amounts of electricity to distract nerves and reduce pain. During therapy, most people report feeling a gentle vibration or tingling. This therapy may be done in a medical office or a TENS unit may be prescribed or purchased over-the-counter for at-home use.
• Massage can help reduce osteoarthritis pain,¹Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Sep;96(9):665-672. doi: 10.1097/PHM.0000000000000712. Review. PubMed PMID: 28177937. improve circulation, and reduce muscle tension and spasms. It is preferable to find a physical therapist or massage therapist who is trained in treating arthritis joint pain.
• Acupuncture may help treat osteoarthritis pain as well as other types of chronic pain conditions.²Kim EJ, Lim CY, Lee EY, Lee SD, Kim KS: Comparing the effects of individualized, standard, sham and no acupuncture in the treatment of knee osteoarthritis: a multicenter randomized controlled trial. Trials 2013, 14:129.^,3Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache. J Clin Outcomes Manag. Author manuscript; available in PMC 2010 May 4. Published in final edited form as: J Clin Outcomes Manag. 2009 May 1; 16(5): 224–230. PMCID: PMC2863344^,4Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455‐474. doi: 10.1016/j.jpain.2017.11.005^,5Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493-505. doi: 10.7326/M16-2459 While still considered unproven, this treatment is generally safe and may even be covered by insurance.
• An anti-inflammatory diet aims to reduce unnecessary inflammation that leads to joint degeneration and pain. All anti-inflammatory diets eschew processed and sugary foods for high-fiber, whole foods; however, there is no singular anti-inflammatory diet that works for everyone.

  See An Anti-Inflammatory Diet for Arthritis

• Supplements such as turmeric (curcumin) and omega-3 fatty acids (such as fish oil) are popular options for arthritis treatment. Whether these supplements effectively reduce osteoarthritis symptoms is a matter of ongoing research.⁶Sodha R, Sivanadarajah N, Alam M. The use of glucosamine for chronic low back pain: a systematic review of randomised control trials. BMJ Open. 2013;3(6):e001167. Published 2013 Jun 20. doi: 10.1136/bmjopen-2012-001167^,7Vaishya R, Vijay V, Lama P, Agarwal A. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9–15. doi:10.1097/RHU.0b013e3181b08f20^,8Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, Harari A, Tiosano S, Amital H, Shoenfeld Y. Vitamin D and rheumatoid arthritis: an ongoing mystery. Curr Opin Rheumatol. 2017 Jul;29(4):378-388. doi: 10.1097/BOR.0000000000000397 Supplements are considered generally safe, but side-effects, adverse health events, and drug interactions are possible, so people are encouraged to talk to their doctor or pharmacists before taking one.

  See Dietary Supplements for Treating Arthritis

• Cannabidiol (CBD) products may help relieve pain and anxiety associated with chronic pain conditions.⁹Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4(1):245-259. doi: 10.2147/tcrm.s1928^,10Crippa, J. A. S., Derenusson, G. N., Ferrari, T. B., Wichert-Ana, L., Duran, F. L., Martin-Santos, R., ... & Filho, A. S. (2011). Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of Psychopharmacology, 25(1), 121-130. doi: 10.1177/0269881110379283 CBD does not produce the high or psychogenic effects of marijuana. Consumers are advised to be discerning in their purchases because CBD products are not well regulated.
• Medical marijuana is legal in some states may be used to treat moderate to severe chronic pain. The FDA has not approved marijuana to treat osteoarthritis, and critics of medical marijuana say that there have not been enough large-scale, long-term studies to prove marijuana’s efficacy as a pain reliever.

Certain treatments may need time to work. For example, an anti-inflammatory diet and supplements may require several months before a benefit can be noticed. If no results are seen after that time, it is okay to give it up and try another treatment.

Injections for Osteoarthritis

When first-line treatments, such as losing weight and physical therapy, do not adequately relieve arthritis pain, a doctor may suggest therapeutic injections.

Injections are generally not done in isolation but rather as part of a comprehensive treatment strategy that incorporates physical therapy and exercise.

Several types of injections are available to help alleviate osteoarthritis pain.

• Hyaluronic acid injections provide lubrication and reduce joint friction, potentially reducing symptoms.

  See Hyaluronic Acid Injections for Knee Osteoarthritis

• Regenerative medicine injections, such as platelet-rich plasma (PRP), stem cells, and prolotherapy, attempt to provide pain relief as well as stimulate cell and tissue healing.
• Cortisone (steroid) injections reduce inflammation and may alleviate joint stiffness, swelling, and pain.

  See Cortisone Injections (Steroid Injections)

While steroid injections have been a mainstay of osteoarthritis treatment, recent research suggests they may contribute to cartilage loss in an arthritic joint.¹¹McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017 May 16;317(19):1967-1975. doi: 10.1001/jama.2017.5283. PubMed PMID: 28510679; PubMed Central PMCID: PMC5815012.^,12Seshadri V, Coyle CH, Chu CR. Lidocaine potentiates the chondrotoxicity of methylprednisolone. Arthroscopy. 2009;25(4):337-347. doi: 10.1016/j.arthro.2009.01.003 This is a controversial topic, and more study is needed. In the meantime, some physicians today may recommend steroid injections sparingly and with greater caution.

Hyaluronic acid injections (often called gel or lubricating injections) have been approved by the FDA for treatment of osteoarthritis in the knees. Currently, the FDA has not approved regenerative medicine injections for the treatment of osteoarthritis as more research is required.

Surgery

When joint damage causes moderate to severe pain and restricts mobility, surgery may be recommended. Surgical options will depend on the location and condition of the affected joint as well as the person’s age and overall health. The surgery most commonly recommended is a joint replacement (arthroplasty).

See Total Hip Replacement for Hip Arthritis

See Undergoing Total Knee Replacement for Knee Arthritis

See Total Shoulder Replacement Surgery

While joint surgery can relieve pain and improve joint function, recovery can be lengthy, requiring pain medications and weeks or months of physical therapy. In addition, any surgery comes with risks of adverse events, such as infection. Most adverse events are minor but a few, while rare, are potentially deadly. Risks tend to be higher for people who are overweight or have other co-morbidities.

A person may decide to have surgery or elect to use only nonsurgical treatments. Decisions about treatment should be made in consultation with a physician who can describe the most likely outcomes, side effects, and risks. Most osteoarthritis pain can be successfully controlled with treatment.