Osteoarthritis is often described as wear and tear, which suggests joints are used up like tyres and should be used less. That framing is wrong and it leads people to reduce activity, which makes the condition considerably worse.
Most people with osteoarthritis manage well for decades without surgery, and the measures that work are unglamorous and effective.
What Is Actually Happening in the Joint
Osteoarthritis involves the whole joint, not just cartilage. Cartilage thins, the underlying bone thickens and forms spurs, the joint lining becomes mildly inflamed, and the surrounding muscles weaken.
That last element is important and often overlooked. Muscle weakness both results from and worsens osteoarthritis, because strong muscles absorb load that would otherwise pass through the joint surface.
Pain correlates poorly with X ray appearance. Many people with severe changes have mild symptoms and vice versa, which is why treatment is guided by function rather than by imaging.
Weight Is the Most Powerful Lever
For knee and hip osteoarthritis, weight reduction outperforms almost every other intervention.
Each kilogram lost removes roughly four kilograms of load from the knee during walking, and considerably more when climbing stairs. A five kilogram reduction meaningfully changes symptoms for most people.
Weight also has a metabolic effect. Fat tissue produces inflammatory signals that contribute to joint inflammation, which is why osteoarthritis of the hands, which bear no weight, is also more common in people with obesity.
Our dietetics team works with patients on realistic, sustained reduction rather than rapid diets that rebound.
Exercise Does Not Wear the Joint Out
This is the most common misconception and the most damaging. Patients reduce activity to protect the joint, muscles weaken, load on the joint increases, pain worsens, and they reduce activity further.
Appropriate exercise reduces pain and improves function in osteoarthritis, with evidence as strong as for many drugs. Cartilage is nourished by movement, which circulates joint fluid.
- Strengthening: quadriceps for the knee, glutes for the hip, two or three times weekly
- Low impact aerobic: walking, cycling, swimming
- Range of movement: daily gentle movement through the full available range
- Balance work, which reduces falls
Some discomfort during and shortly after exercise is acceptable. Pain that persists for more than a day afterwards means the load was too high, not that exercise is wrong.
Pain Relief That Works
Medication has a role, used sensibly and alongside the measures above rather than instead of them.
- Paracetamol: modest effect, useful for mild symptoms
- Topical anti inflammatory gels: effective for knee and hand osteoarthritis, with far fewer systemic side effects than tablets. Underused
- Oral anti inflammatories: more effective but carry stomach, kidney and cardiovascular risks, particularly in older patients. Use at the lowest dose for the shortest period
- Steroid injections: useful for flares, with relief typically lasting weeks to a few months. Limited in frequency
- Heat and cold: heat for stiffness, cold for a swollen painful flare
Long term daily anti inflammatory use is common and carries real risk. If you are taking them daily for months, that warrants a review rather than a repeat prescription.
Supplements: What the Evidence Says
This is where a great deal of money is spent for little return.
Glucosamine and chondroitin: extensively studied with largely disappointing results. Some individuals report benefit. They are safe, so a three month trial is not unreasonable, but stop if there is no clear difference.
Vitamin D: worth correcting if deficient, which is common, though it is not a treatment for osteoarthritis itself.
Turmeric and curcumin: some evidence of modest anti inflammatory effect, though absorption is poor without enhancement.
Collagen supplements: limited evidence.
None of these substitutes for weight reduction and strengthening, which is where the effort is better spent.
Practical Joint Protection
Small adaptations reduce daily load considerably.
- A walking stick in the hand opposite the affected leg, which reduces joint load meaningfully. Refused by most patients out of pride, and genuinely effective
- Cushioned footwear, replaced when worn
- Raised chair and toilet seats, avoiding very low seating
- Avoiding prolonged squatting and floor sitting where the knees are affected
- Using a rucksack rather than carrying weight on one side
- Breaking tasks into shorter periods rather than long sessions
- Jar openers and tap turners for hand osteoarthritis
Squatting and floor sitting deserve mention, since they are common in Indian households and impose high knee loads. Modifying these habits early makes a difference over years.
Osteoarthritis of the Hands
Hand osteoarthritis presents differently and is often more visible than disabling.
Bony swellings at the finger joints, particularly nearest the nails, are characteristic. The joint at the base of the thumb is commonly affected and causes difficulty with gripping, opening jars and turning keys.
Treatment includes topical anti inflammatories, hand exercises, a thumb splint for base of thumb arthritis, and adapted tools with thicker handles. Injections help selected joints. Surgery is reserved for severe cases.
Note that inflammatory arthritis affects different joints in the hand, so new swelling with prolonged morning stiffness should be assessed by our rheumatology team rather than assumed to be osteoarthritis.
When to Consider Surgery
Surgery becomes appropriate when conservative management has been genuinely tried and pain still dominates daily life.
- Pain at rest and at night
- Walking distance severely limited
- Sleep consistently disturbed
- Failure of several months of proper exercise, weight reduction and medication
- Significant deformity
Note that arthroscopy, or keyhole washout, has no benefit for osteoarthritis of the knee despite being widely performed in the past. It is appropriate for mechanical symptoms such as a locking meniscal tear, not for arthritis itself.
When surgery is right, joint replacement is highly effective. Our orthopaedics department assesses when that point has been reached.
The two interventions with the strongest evidence in osteoarthritis are weight reduction and muscle strengthening, and both require sustained effort rather than a prescription. Keep moving, use a stick if it helps, use topical gels before oral tablets, and spend on physiotherapy rather than on supplements.
Our orthopaedics and physiotherapy departments at T. Nagar manage osteoarthritis without surgery wherever possible.
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