For knee and hip osteoarthritis, exercise therapy is the most strongly supported treatment: supervised exercise relieves pain just as well as medication, without serious side effects. The evidence for this approach is based on multiple systematic reviews and guidelines. In practice, a combination works best: exercise, weight loss in those who are overweight, education and pain medication if needed. A prosthetic joint is only appropriate when everything else has proven insufficient.
Exercise therapy is the best-supported treatment for knee and hip osteoarthritis. Multiple large studies and guidelines agree: supervised exercise relieves pain just as well as pain-relief medication, and this holds regardless of how severe the joint degeneration is or how much pain a person has. A minimum of 12 sessions at twice per week are needed to achieve sufficient results. No serious side effects are known.
Weight loss in people who are overweight is a second strong pillar. Less load on the joint reduces both pain and restricted movement, and is recommended in all guidelines as part of the treatment plan. Structured education about osteoarthritis and self-management helps people stay motivated and maintain the effects of exercise over the long term. Psychological support and behavioural change techniques also have a consistently positive effect on pain and on sustaining an active lifestyle.
Aids such as knee braces, walking aids and adapted footwear are recommended as additions when exercise and education alone are not sufficient. This is based on associative evidence from guidelines; exact effect sizes are not well documented in the available studies.
When medication is needed, paracetamol is the recommended first step. Anti-inflammatory drugs (NSAIDs) are effective but carry risks: stomach problems, cardiovascular problems and kidney problems, particularly with prolonged use. A gel or cream containing an NSAID has fewer side effects than a tablet. Injections into the joint with corticosteroids or hyaluronic acid are an option when other treatments provide insufficient relief. Non-pharmacological and pharmacological approaches are statistically equally effective for pain relief (mean effect size 0.25 and 0.39 respectively, not significantly different), which underlines the importance of exercise and lifestyle.
Glucosamine and chondroitin sulphate appear in some guidelines as an option for pain relief and possible structural preservation of the joint. The evidence is, however, limited and mixed: not all experts agree, and the effects have not been demonstrated consistently. Anyone considering taking these supplements would do well to discuss this with a doctor, without expecting much on the basis of the available research.
In severe osteoarthritis where all conservative treatments provide insufficient relief, a prosthetic joint (arthroplasty) is an effective and well-supported option. Physiotherapy both before and after surgery demonstrably improves recovery. This is explicitly a last step, 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). Strength of evidence varies by intervention: strong for exercise therapy, moderate for most other interventions, limited and mixed for glucosamine/chondroitin.