Osteoarthritis Treatment

How is Osteoarthritis treated?

Aching knees on the stairs, a stiff hip after sitting, or hands that are sore at the end of the day: for many people, osteoarthritis creeps in gradually and starts to affect the things they enjoy. It is the most common form of arthritis, and while it cannot be cured, there is a great deal that can be done to ease pain, keep you moving, and slow its progress.

Your doctor will recommend the treatment option combination best suited to your joints, health and lifestyle.

Understanding Osteoarthritis

Joints are the places where two bones meet, and the ends of the bones are covered with smooth, slippery cartilage that cushions them and allows them to glide. In osteoarthritis, this cartilage is gradually broken down over time. As it wears away, the bones can rub against each other, which causes pain and stiffness during movement, and can also cause swelling and a loss of flexibility. The areas most affected are the knees, hands, spine, and hips, and pain can make it harder to walk, climb stairs, and perform everyday tasks.

Osteoarthritis is very common in Singapore, particularly among older adults, and the knees are among the joints most often affected. Age, excess weight, previous joint injuries, and family history all play a part. Everyday habits such as climbing many flights of stairs, kneeling, or squatting for long periods can place extra stress on the knees, which is why protecting your joints and building muscle strength matters.

The Aims of Treatment

While there is no cure for osteoarthritis, treatment focuses on three main goals: relieving your symptoms, improving the way your joints function, and slowing the progression of the disease. Most people begin with lifestyle measures and medication, and move on to procedures only when these are no longer enough. Treatment is rarely a single step. It is usually a combination of approaches that is adjusted over time as your needs change.

• Lifestyle management: Exercise, weight management, physical therapy, and assistive devices. These are the foundation of treatment for everyone.
• Pain relief medication: Tablets, topical creams, and injections to ease pain, prescribed according to the severity of your symptoms and your other health conditions.
• Surgery: Considered when the joint is severely damaged or has not responded to non-invasive treatments. Options include arthroscopy and osteotomy.
• Joint replacement: The damaged joint, most commonly the hip or knee, is replaced with an artificial joint in severe osteoarthritis to restore mobility and reduce pain.

Lifestyle Management

What you do every day makes a real difference to your joints. These steps can reduce pain and slow down damage, and they also make medication and other treatments more effective.

• Exercise: Low-impact activities such as walking, swimming, and cycling strengthen the muscles that support your joints, improve flexibility, and reduce pain. Gentle activities such as tai chi and water exercises are also popular choices. Staying active may feel counter-intuitive when your joints hurt, but movement keeps them healthier.
• Weight management: Reducing excess weight decreases the stress on weight-bearing joints such as the knees and hips. Every kilogram lost takes several kilograms of pressure off the knees with each step.
• Physical therapy: A physiotherapist can guide you through exercises that improve mobility and support the stability of your joints, and teach you how to move in ways that protect them.
• Assistive devices: Canes, braces, or shoe inserts help to reduce the strain on affected joints, and can make walking more comfortable and safer.

Pain Relief Medication

Medication is prescribed based on the severity of your pain and on any other conditions or health problems you may have. The options include:

• Paracetamol: Often the first medicine used for mild to moderate pain.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Help to reduce pain and swelling. They are available as tablets, and also as topical creams or gels that are applied directly to the affected joints, which may be a suitable option for some people and cause fewer side effects than tablets.
• Codeine: A stronger painkiller that may be used for a short time when other medicines are not enough. It can cause drowsiness and constipation, so your doctor will monitor you closely.
• Steroid injections: May be given directly into the joint for particularly painful cases, as they can ease pain for several weeks or months. Because they are not suitable for frequent repeated use, your doctor will discuss how often they can be given.

Please take your medicines as prescribed and let your doctor know about any other medication or supplements that you take. NSAIDs in particular can affect the stomach, kidneys, and heart in some people, so they should be used under medical guidance. If you are considering supplements or traditional remedies for your joints, please speak to your doctor first, as the evidence for some of them is mixed and they may interact with your medication

Surgery

Surgery for osteoarthritis is recommended when the joint is severely damaged or has not responded to other non-invasive treatments. Some surgical options include:

• Arthroscopy: A minimally invasive, keyhole procedure used to remove loose pieces of cartilage from the joint. It is less commonly used for osteoarthritis now, as it does not help everyone, and your surgeon will advise whether it is suitable for you.
• Osteotomy: A procedure that reshapes the bone, to relieve pressure on the damaged part of the joint. It is more often considered in younger, active patients with damage that is limited to one side of the joint, and may delay the need for joint replacement.

Joint Replacement

Joint replacement surgery is done to replace the hip and knee joints in severe osteoarthritis. The affected joint is removed and replaced with an artificial joint, or prosthesis, made of plastic and metal, to restore mobility and reduce pain. It is a well-established operation that has given many people back their independence and comfort, and it is usually considered when pain is severe and is affecting your sleep, your daily activities, and your quality of life despite other treatments.

Preparing for Surgery

Your surgeon will explain the procedure, the benefits and risks, and what to expect. Before the operation, you will usually have a check-up and tests to make sure you are fit for surgery, and you will be advised on which medications to continue or pause. It helps to strengthen your muscles beforehand where possible, and to prepare your home for your recovery, for example by arranging help and removing trip hazards.

Recovery and Rehabilitation

Rehabilitation is a key part of recovery, and physiotherapy usually begins soon after surgery, often within a day or so, to help you start moving safely. You will be taught exercises to restore strength and movement in your new joint, and it is important to follow them diligently. Recovery is gradual, and most people notice that their pain eases and their mobility steadily improves over the following weeks and months. Your surgeon will advise you on caring for your wound, and when it is safe to resume driving, return to work, and travel.

As with any operation, there are risks, such as infection, blood clots, stiffness, and wear of the implant over time. Your surgeon will discuss these with you, and the measures taken to minimise them.

Everyday Tips for Living with Osteoarthritis

• Pace yourself: Balance activity with rest, and avoid sitting or standing in one position for too long. Take breaks during long walks or shopping trips.
• Use warmth or cold: A warm shower or heat pack can ease stiffness, while a cold pack can help with swelling after activity.
• Choose supportive footwear: Well-cushioned, supportive shoes can reduce stress on the knees and hips.
• Protect your knees: Avoid prolonged kneeling or squatting where possible, use a raised toilet seat or a chair with arms, and take the lift or escalator when your knees are painful.
• Make your home safer: Grab bars in the bathroom, non-slip mats, and good lighting can help prevent falls.
• Look after your mood: Living with ongoing pain can be tiring and discouraging, so reach out to family, friends, or your care team for support.