Diagnosis and treatment of hip and knee osteoarthritis: A review

By J. Katz, Kaetlyn R. Arant, Richard F. Loeser. Journal of the American Medical Association (JAMA), 2021

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Importance: Osteoarthritis (OA) affects more than 240 million people worldwide and is the most frequent reason for activity limitation in adults. This review focuses on hip and knee OA. Observations: OA is the most common type of arthritis. It can involve almost any joint but typically affects the hands, knees, hips and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities. Risk factors include age, female sex, obesity, genetics and major joint injury. Persons with OA have more comorbidities and are more sedentary than those without OA. The reduced physical activity leads to a 20% higher age-adjusted mortality. Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. Radiographic indicators include marginal osteophytes and joint space narrowing. The cornerstones of OA management are prescribed exercises, weight loss if appropriate, and education—complemented by topical or oral NSAIDs, in those without contraindications. Intraarticular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. Opiates should be avoided. Clinical trials have shown promising results for compounds that arrest structural progression (e.g. cathepsin K inhibitors, Wnt inhibitors, anabolic growth factors), or reduce OA pain (e.g. nerve growth factor inhibitors). Persons with advanced symptoms and structural damage are candidates for total joint replacement. Racial and ethnic disparities persist in the utilization and outcomes of joint replacement. Conclusions and Relevance: Hip and knee OA are highly prevalent and disabling. Education, exercise and weight loss are cornerstones of management, complemented by NSAIDS (in those who are candidates), corticosteroid injections, and several adjunctive medications. In persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Subfields: Orthopedics and Sports Medicine, Rheumatology, Surgery

View Paper: https://www.semanticscholar.org/paper/636e23549cf4051672dbec60500c1faa0bd688ed