Degenerative Arthritis (Osteoarthritis)

Degenerative arthritis, also called osteoarthritis (OA) or degenerative joint disease, is a common cause of joint pain, stiffness, and reduced mobility. It is often described as a wear-and-tear disease, but current research shows that OA is a whole-joint condition involving cartilage, bone, ligaments, muscles, the synovial lining, and low-grade inflammation. A global analysis estimated that 595 million people were living with OA in 2020, and cases are expected to rise [1].

What is it?

In a healthy joint, smooth cartilage covers the ends of bones so they can glide with minimal friction. In OA, this cartilage becomes rough, cracked, and thinner. As protection is lost, the joint space narrows, and the bone beneath the cartilage may thicken or change shape. Small bony growths, called osteophytes or bone spurs, can form around the joint edges. The synovium may also become irritated and release inflammatory chemicals that add to pain and swelling [2,3].

OA most often affects the knees, hips, hands, feet, neck, and lower back. Symptoms usually develop slowly and may include pain after activity, stiffness after rest, swelling, tenderness, grinding or clicking, reduced range of motion, and difficulty with tasks such as walking, climbing stairs, gripping objects, or standing [2].

How do you get it?

OA usually develops when mechanical stress, biology, and personal risk factors act together over time. Chronic repetitive motion can overload a joint, especially when supporting muscles are weak, alignment is poor, or there has been a previous injury. Repeated stress creates small areas of tissue damage. The body tries to repair the joint, but in OA the repair process becomes unbalanced, causing cartilage loss, bone remodeling, and continued inflammatory signaling [3].

Age is a major risk factor because joint tissues lose some repair capacity over time. Excess body weight increases pressure through the knees and hips, and fat tissue may promote inflammatory pathways. Previous ligament tears, meniscal injuries, fractures, or sports trauma can also raise later OA risk. Family history, female sex after midlife, high-impact work or sport, and structural problems such as hip dysplasia or leg malalignment may contribute [2,5].

Diagnosis

Diagnosis begins with a clinical evaluation. A clinician asks where the pain is, what worsens or relieves it, how long stiffness lasts, and how symptoms affect daily life. Examination checks tenderness, swelling, bony enlargement, movement, strength, and walking pattern. X-rays may be used when symptoms persist or when treatment planning requires imaging. Typical findings include joint-space narrowing, osteophytes, and changes in the bone under the cartilage [2]. Blood tests are not usually needed, but they may help rule out gout, infection, rheumatoid arthritis, or another inflammatory condition.

Treatment options: non-surgical and surgical care

Treatment depends on the affected joint, pain severity, function, medical history, imaging findings, activity goals, and response to earlier care. Most patients start with non-surgical treatment. Surgery is usually considered only when pain, disability, and structural damage remain severe despite appropriate conservative management [2,4].

Non-surgical treatment options

Education is important because OA is usually managed over time rather than cured with one quick treatment. The main goals are to reduce pain, maintain movement, protect the joint, and keep the person active. Exercise is one of the most useful treatments. Strengthening supports the joint, aerobic activity improves fitness, and stretching maintains motion. Physical therapy can teach safer movement patterns, balance training, and a practical home program [2,4].

Weight management can reduce load on the knees and hips. Braces, shoe inserts, canes, walkers, splints, heat, ice, and activity modification may also help. Medicines may be added when these steps are not enough. Topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac gel, are often used before oral NSAIDs because they limit whole-body exposure. Oral NSAIDs can help pain and inflammation, but they may be unsafe for some people with kidney disease, stomach ulcers, bleeding risk, heart disease, uncontrolled blood pressure, or interacting medicines [2].

Acetaminophen may help some patients, although benefit is often modest. Duloxetine may be considered for selected patients with chronic OA pain. Corticosteroid injections can provide short-term relief during painful flares, but repeated injections should be discussed carefully. Other injections, including hyaluronic acid and platelet-rich plasma, are used in some settings, but recommendations vary because study results and patient responses are inconsistent [4]. Long-term opioid treatment is generally avoided because risks are substantial [2].

Surgical treatment options

Surgery is considered when OA causes severe pain, major functional loss, and clear structural damage after non-surgical care has been tried. Arthroscopy is not routinely recommended as a general clean-out procedure for typical degenerative knee OA because it usually does not improve long-term arthritis pain. It may still be appropriate for selected mechanical problems, such as a true locked knee from a loose body, but this is different from treating routine OA pain [2].

Joint-preserving surgery may help selected younger or active patients. Osteotomy realigns bone so weight passes through a less damaged area, most often around the knee. For advanced OA, joint replacement is the most established operation. Total hip or knee replacement removes damaged joint surfaces and replaces them with artificial components; partial knee replacement may be possible when disease is limited to one compartment. Joint replacement can greatly improve pain and function, but it is major surgery with risks such as infection, blood clots, stiffness, persistent pain, implant wear, and possible revision [2,5].

When to seek medical care

Medical review is recommended when joint pain lasts more than a few weeks, limits walking or hand use, follows an injury, wakes a person at night, or causes increasing swelling. Urgent assessment is important for sudden severe pain, fever, inability to bear weight, major redness or heat, or rapid deformity.

Come see us at The Orthopedic and Sports Medicine Institute if you are concerned about persistent joint pain or suspect arthritis. Our goal at The Orthopedic & Sports Medicine Institute (OSMI) is to provide our patients with quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you would like to book an appointment, please submit an online appointment request or contact our office. We have clinic locations in Fort Worth, Mansfield, Decatur, and Willow Park.

References

1.     Steinmetz JD, Culbreth GT, Haile LM, et al.: Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023, 5:e508-e522. doi: 10.1016/S2665-9913(23)00163-7

2.     Katz JN, Arant KR, Loeser RF: Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021, 325:568-578. doi: 10.1001/jama.2020.22171

3.     Yao Q, Wu X, Tao C, et al.: Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023, 8:56. doi: 10.1038/s41392-023-01330-w

4.     Langworthy M, Dasa V, Spitzer AI: Knee osteoarthritis: disease burden, available treatments, and emerging options. Ther Adv Musculoskelet Dis. 2024, 16:1759720X241273009. doi: 10.1177/1759720X241273009

5.     Tang S, Zhang C, Oo WM, et al.: Osteoarthritis. Nat Rev Dis Primers. 2025, 11:10. doi: 10.1038/s41572-025-00594-6