What helps with osteoarthritis (joint degeneration)?
Supervised exercise therapy is the best-proven approach: comparable pain relief to medication, without serious side effects. Combine it with weight loss, education and pain medication if needed. Joint replacement is only the last resort.
Exercise therapy is the best-proven treatment for knee and hip osteoarthritis. Guided exercises relieve pain just as effectively as painkillers, regardless of how severe the joint wear is. You need a minimum of 12 sessions, twice a week, to achieve sufficient results. No serious side effects are known.
If you are overweight, losing weight is the second solid pillar. Less load on the joint reduces both pain and restricted movement. All guidelines recommend this as a standard part of the treatment plan. Good education about osteoarthritis and self-management helps you stay motivated and maintain the gains from exercise. Psychological support and behaviour-change techniques also consistently have a positive effect on pain and on maintaining an active lifestyle.
Aids such as knee braces, walking aids and adapted footwear are a worthwhile addition when exercise and education alone are not sufficient. The exact effect size is not well documented in the available studies.
If medication is needed, start with paracetamol. Anti-inflammatory drugs work effectively but carry risks with long-term use: stomach problems, cardiovascular problems and kidney problems. A gel or cream containing an anti-inflammatory has fewer side effects than a tablet. Injections with corticosteroids or hyaluronic acid are an option when other treatments do not provide enough relief. Non-pharmacological and pharmacological approaches are statistically equally effective for pain relief, which underlines the importance of exercise and lifestyle1,2,3,4,5,6,7.
Glucosamine and chondroitin sulphate appear in some guidelines as an option for pain relief and possibly preserving joint structure. The evidence is limited and mixed: not all experts agree. Discuss this with your doctor before starting, and do not expect too much from it. In cases of severe joint wear where everything else is insufficient, a joint replacement is a well-supported option. Physiotherapy both before and after the operation demonstrably improves recovery. This is explicitly the last step, only after exercise, weight loss, education and medication have been tried.
Based on multiple systematic reviews, meta-analyses and international guidelines (including PMID 31621559, 38212040, 29724726, 31126594, 18279766, 32035570, 32542403). The strength of evidence varies by approach: strong for exercise therapy, moderate for most other interventions, and limited and mixed for glucosamine and chondroitin sulphate.