Osteoarthritis (OA)

Osteoarthritis (OA)

What’s happening inside the joint

• Cartilage wear: Everyday loads (walking, stairs, sport) plus previous injury can damage cartilage. Cartilage has little blood supply, so it repairs slowly.
• Inflammation: The joint lining can get irritated (synovitis). It releases chemicals that amplify pain and stiffness.
• Bone response: As cartilage thins, load transfers to bone. The bone becomes thicker and harder (sclerosis) and forms spurs (osteophytes) to stabilise the joint—this can feel stiff.
• Fluid and mechanics: Extra joint fluid and small cysts may form. Muscles around the joint may weaken or switch off due to pain, which worsens mechanics and symptoms.
• Pain sources: Pain comes from the inflamed lining, overloaded bone, tight capsule, and muscles/tendons—not the cartilage itself (it has no nerves).

You may have a "flare" which is an acute exacerbation, this may be due to bone bruising and inflammation due to loss of the cartilage cushioning.

Why osteoarthritis develops

The exact cause is often multifactorial and poorly understood:

• Age (natural cartilage wear and slower repair)
• Previous injury (e.g., meniscal tear, ACL injury, fracture, hip dysplasia)
• Joint shape/alignment (bow-leg/knock-knee, shallow hip socket)
• Body weight (more load on weight-bearing joints)
• Genetics and sex (family tendency, more common in women after mid-life)
• Activity profile (high-impact or repetitive kneeling/squatting jobs)
• Inflammatory conditions such as rheumatoid arthritis.

Treatment

Treatment depends on whether the tear is partial or complete:

• Non-surgical management is suitable for partial tears and involves:
  • Rest, ice, compression, and elevation (RICE)
  • Gradual  physiotherapy to restore flexibility and strength
  • Avoiding high-speed activities until full recovery
     
• Surgical repair is usually recommended for:
  • Complete avulsion injuries (when all tendons pull off the bone)
  • Tears involving significant retraction (>2 cm) or in very active patients
  • Surgery involves re-attaching the tendons to the bone using strong sutures and anchors.

Common symptoms

• Pain with activity, easing with rest (later, pain can occur at rest or night)
• Morning stiffness or after sitting (“start-up pain”), usually <30–45 min
• Reduced movement, grinding or catching, swelling after activity
• A sense of weakness or giving way from deconditioned muscles.

Diagnosis

• History and examination are key.
• X-rays show joint-space narrowing, osteophytes, and bone changes.
• MRI is rarely needed unless another problem is suspected.
• A sense of weakness or giving way from deconditioned muscles.

Treatment Options

Most people improve with non-surgical care:

• Education & load management: Pace activities; plan rest on flare days.
• Exercise therapy: Targeted strengthening (hip/knee/gluteal), flexibility, and balance; low-impact cardio (walking, cycling, swimming).
• Weight optimisation: Even a small loss reduces joint load and pain.
• Simple medications: Paracetamol or short courses of anti-inflammatories (check safety with your GP).
• Topicals & heat/ice: Gels/creams, warm showers or ice after activity.
• Aids as needed: Shock-absorbing shoes, orthotics, walking aids on tough days.
• Injections (select cases): Corticosteroid for short-term flare control; other injections may help symptoms for some patients in the early phases.

Self-care & flare control

• Keep moving—little and often beats big, irregular efforts.
• Use the “soreness rule”: mild soreness that settles within 24 hours is OK; lasting pain signals you to reduce load next session.
• Treat flares with relative rest, ice/heat, short medication courses, then return gradually to exercise.

When surgery is considered

• Persistent pain and loss of function despite good non-surgical care
• Significant sleep disturbance, walking limitation, or deformity
• For advanced hip/knee OA, joint replacement offers predictable pain relief and function gains.

Prognosis

OA is manageable. The joint changes themselves are often slow; what matters most is muscle strength, body weight, and activity habits. Many people stay active for years without surgery; those who do progress to surgery typically achieve excellent pain relief.