What it is

Osteoarthritis is the progressive breakdown of cartilage in a joint, along with changes to the underlying bone. It most often affects knees, hips, hands and the spine. It is the most common form of arthritis and one of the leading causes of disability in older Australians.

It is often described as "wear and tear", which is misleading. It is an active disease process involving inflammation and remodelling, not simply a joint wearing out with use. That distinction matters, because "wear and tear" implies rest is the answer, and it usually is not.

Common symptoms

  • Joint pain that worsens with activity and eases with rest, at least early on
  • Stiffness after sitting or on waking, usually easing within about half an hour
  • Reduced range of movement and a grating sensation
  • Swelling, and joints that feel unstable or give way
  • Difficulty with stairs, getting out of a low chair, or standing from the toilet

The functional consequences matter more than the pain score. When someone stops walking to the shops, stops going out because a toilet might be difficult, or starts sleeping in a chair because getting into bed hurts, the condition has begun to shrink their life, and that shrinkage is what leads to deconditioning, isolation and falls.

How it is usually managed

Contrary to what many people assume, the first-line treatments for osteoarthritis are not medication.

  • Exercise and movement - strengthening the muscles around the joint reduces pain and improves function. This is consistently the best-supported intervention, and resting the joint makes things worse over time.
  • Weight management where relevant, since load through the knee is a multiple of body weight.
  • Pain relief - approaches vary and need to be individualised by a GP, particularly in older people where many common analgesics carry real risks.
  • Equipment and aids - a correctly fitted walking stick, raised toilet seat, chair raiser or shower stool can restore function immediately.
  • Joint replacement for severe hip and knee disease, which remains one of the most successful operations in medicine.

The most useful question to ask: not "how do we reduce the pain" but "what has she stopped doing because of this, and how do we get that back". Function is recoverable more often than people assume.

Where aged care fits

  • Occupational therapy - equipment, home modifications and different techniques for the specific tasks that have become painful.
  • Allied health assistance to carry out a prescribed exercise program consistently, which is where most programs fail.
  • Personal care for showering and dressing, which are frequently the first things to become genuinely difficult with shoulder, hip or knee disease.
  • General house cleaning, laundry and gardening - the heavy tasks that cause flare-ups and that people keep attempting until something goes badly wrong.
  • Podiatry, because foot and knee mechanics are connected and appropriate footwear or orthoses can change knee loading.
  • Direct transport and accompanied activities so that reduced walking tolerance does not become social isolation.

Reduced mobility is also the main pathway into falls. If someone with osteoarthritis has started stumbling or is avoiding stairs, read our page on falls and frailty next.

General information only, not clinical advice. Speak to a GP about individual pain management. Musculoskeletal Health Australia Help Line: 1800 263 265. My Aged Care: 1800 200 422.