Treatment is directed towards relieving symptoms, maintaining and improving joint function and minimizing handicap. Management of OA is based on non-drug and drug treatments targeted towards prevention, modifying risk and disease progression.
1) Analgesics like paracetamol (up to 4g/day) for mild to moderate pain. NSAIDs should be added or substituted in patients who respond inadequately.
2) Intra-articular steroids- in patients who present with acute exacerbations of pain and signs of local inflammation with joint effusion
3) Intra-articular hyaluronan- it is suggested that its effect is small and the placebo response is significant.
Ø Education – Encourage patients to participate in self-management programs, and provide resources for social support and instruction on coping skills.
Ø Weight loss – encourage overweight patients with OA of hip and knee to lose weight through a combination of diet and exercise.
Ø Exercise – increases aerobic capacity, muscle strength, and endurance and also facilitates weight loss.
Physical therapy - some basic approaches are enumerated as follows;
Pain control –
v Suitable electrotherapy modality is used. In the acute phase, pain relief is achieved by superficial heat modalities or cryotherapy. Ultrasound, TENS, pulsed diathermy and stimulation are also effective.
v Hydrotherapy is particularly useful when the weight-bearing joints are affected.
v The compressive forces on the joint can be reduced by rest in the proper position, splints or joint distraction by manual or mechanical traction.
v Improvement of muscle power, endurance and tone – graduated exercise program is initiated which consists of progressive resistance (PRE), strong and sustained repeated sessions of isometrics (5 minutes every hour) holding or sustaining muscle contraction in static mid-range position.
§ Improvement in range of motion (ROM);
Ø Active free relaxed rhythmic movements improve the range as well as promote relaxation of the joint.
Ø Relaxed passive movements to be started first to mobilize stiff joints.
Improvement of functional independence – function of the whole body in relation to degenerated joint can be improved by;
o Proper guidance to relieve compression over the affected joints and
o Providing assistive aids, modified supports, orthoses, adaptations and ergonomic advice, on the performance of ALDS.
The typical indications of surgery are debilitating pain and major limitation of functions such as walking and daily activity or impaired ability to work or sleep.