Osteoarthritis (OA) is a widespread condition, impacting over 3 million Canadians, making it one of the most common forms of arthritis. It occurs when the protective cartilage in joints gradually wears down, leading to symptoms like pain, stiffness, and swelling. Commonly affected areas include the knees, hips, neck, lower back, fingers, and the base of the thumb. Factors such as family history, advancing age, excess body weight, and previous joint injuries increase the risk of developing OA. Although there is no complete cure, a range of treatments can effectively manage symptoms and enhance quality of life.
This article delves into advanced osteoarthritis treatment methods, expanding on foundational home management and professional care.
Advanced osteoarthritis represents a severe stage where cartilage has significantly deteriorated, often resulting in bones rubbing directly against each other. This leads to intense pain during movement, severe morning stiffness, limited mobility, joint instability, swelling, and a grating sound known as crepitus. Everyday tasks such as walking, climbing stairs, or gripping objects become challenging. The condition develops due to prolonged cartilage breakdown, influenced by overuse, genetics, obesity, or prior injuries. Without proper management, progression accelerates, exacerbated by inactivity or certain medications. Advanced OA can also impact life expectancy by reducing physical activity, disrupting sleep, and contributing to mental health issues like anxiety or depression.
Before exploring advanced treatments, foundational management strategies play a critical role in controlling OA symptoms. At home, individuals can use heat and ice therapy: ice reduces swelling and inflammation, while heat eases muscle tightness and improves joint mobility. Joint protection techniques are vital, such as maintaining good posture, managing body weight, frequently changing positions, using assistive devices, and taking rest breaks to minimize stress on joints. Adopting a healthy, active lifestyle, including a balanced diet and regular exercise, helps maintain joint strength. Resistance training combined with static and dynamic stretching further supports joint stability. Professionally, physiotherapy and chiropractic care offer tailored exercises to enhance flexibility and strength, alongside modalities like therapeutic ultrasound, dry needling, and transcutaneous electrical nerve stimulation (TENS). Orthopedic braces, such as the Bauerfeind Genu Train knee brace, provide additional support by offloading pressure from the knee, reducing pain, and improving stability during daily activities.
Corticosteroid injections are a common advanced treatment for managing inflammation and pain in osteoarthritis. These injections deliver steroids directly into the affected joint, providing rapid relief. The process begins with a thorough evaluation by a doctor, who may use imaging like X-rays to assess the joint’s condition. In a sterile procedure room, the patient lies comfortably, and the skin over the joint is cleaned with antiseptic to prevent infection. A local anesthetic numbs the area, and the doctor, often guided by ultrasound or fluoroscopy, inserts a needle to inject the corticosteroid mixed with an anesthetic. After the injection, patients are advised to rest the joint for a day and avoid strenuous activity. Pain relief typically begins within 48 hours and can last for weeks to months. While effective, repeated use is limited to 3-4 times per year due to potential tissue weakening. This method is particularly useful when oral medications are insufficient, often delaying the need for surgery. The procedure takes about 15-30 minutes, with studies showing that over 70% of patients experience significant pain reduction and improved function for up to three months.
Hyaluronic acid injections, also known as viscosupplementation, involve injecting a gel-like substance into the joint to lubricate and cushion it, particularly for advanced knee osteoarthritis. This mimics the natural synovial fluid that diminishes with cartilage loss. The process starts with confirming the diagnosis through MRI or X-ray, which shows joint space narrowing. In a clinic setting, the joint is sterilized, numbed with local anesthetic, and the hyaluronic acid is injected, typically in a series of 3-5 weekly sessions. Patients are advised to avoid strenuous activities for 48 hours post-injection, with relief building gradually over weeks. High-molecular-weight hyaluronic acid tends to be more effective, providing relief for 6-12 months. Side effects are minimal, often limited to temporary swelling at the injection site. The procedure, lasting about 20 minutes per session, has been shown to improve walking distance and reduce reliance on pain medications, making it a valuable option for non-surgical management.
Platelet-rich plasma (PRP) injections utilize the patient’s own blood to promote healing in advanced osteoarthritis. A small blood sample (30-60 ml) is drawn from the arm and processed in a centrifuge to concentrate platelets, which release growth factors to reduce inflammation and potentially repair cartilage. The joint is prepared with cleaning and local anesthetic, and the PRP is injected under imaging guidance for precision. Multiple sessions may be required, with patients resting the joint afterward and avoiding anti-inflammatory medications that could interfere with healing. The procedure takes 30-45 minutes, with benefits lasting 6-12 months or longer. Clinical trials indicate that PRP can reduce pain by up to 50% and improve joint function, offering a regenerative approach for those seeking to delay surgery.
Stem cell injections are an experimental yet promising treatment using mesenchymal stem cells from bone marrow or fat tissue to regenerate cartilage and reduce inflammation. The process begins with harvesting cells, typically via bone marrow aspiration from the hip or liposuction from the abdomen. The sample is processed in a lab to isolate or expand cells, which are then injected into the joint under fluoroscopy for accuracy. Performed as an outpatient procedure, it requires rest for a week and avoidance of anti-inflammatory drugs. Follow-ups over 3-6 months include MRIs to assess cartilage regeneration. The entire process, including cell processing, takes 1-2 hours. Studies report 60-80% pain reduction and improved cartilage thickness, though long-term data is still developing. This option suits patients aiming to avoid surgery, despite risks like infection.
Arthroscopy is a minimally invasive surgery used to treat advanced osteoarthritis by cleaning the joint of loose cartilage or bone fragments. It’s particularly effective for issues like meniscal tears or loose bodies causing mechanical symptoms. Under general or regional anesthesia, small 5mm incisions allow insertion of an arthroscope (a camera) and tools to remove debris and smooth damaged cartilage. The procedure lasts 30-60 minutes, with quick recovery—patients often walk with crutches initially and resume full weight-bearing within 1-2 weeks. Post-operative rehabilitation includes gentle exercises to restore motion. While not curative, arthroscopy relieves symptoms in 50-70% of cases, improving pain and range for 1-2 years, making it ideal for active patients delaying major surgery.
Osteotomy realigns bones to shift weight away from damaged joint areas, commonly used for knee osteoarthritis in younger patients. Pre-operative X-rays determine the correction angle. Under anesthesia, an incision exposes the tibia or femur, where a precise cut is made to reposition the bone, secured with plates or screws. The surgery, lasting 1-2 hours, requires a hospital stay and non-weight-bearing for 6 weeks with crutches. Rehabilitation focuses on restoring motion and strength over 6-12 months. Osteotomy delays joint replacement by 5-10 years, reducing pain in 80% of patients, though risks include non-union or hardware issues. It’s effective for correcting deformities like bowlegs or knock-knees.
Joint replacement, or arthroplasty, is a definitive treatment for end-stage osteoarthritis when other options fail. It involves replacing the damaged joint with a metal and plastic prosthesis, typically for knees or hips. Pre-surgery preparation includes optimizing health through weight loss and smoking cessation. Under spinal or general anesthesia, an incision exposes the joint, and damaged bone and cartilage are removed. The prosthesis is cemented or press-fit, with the procedure lasting 1-2 hours. Hospital stays last 2-3 days, followed by intensive rehabilitation for 3-6 months. Over 95% of patients experience significant pain relief, with implants lasting 15-20 years, restoring mobility and transforming lives, though recovery requires commitment.
Knee embolization is a non-surgical procedure that blocks blood flow to inflamed joint linings, reducing pain in moderate to severe osteoarthritis. Performed by an interventional radiologist, a catheter is inserted through a small groin incision into the femoral artery, guided by X-ray to the knee’s hypervascular areas. Tiny particles are injected to embolize these vessels, decreasing inflammation. The outpatient procedure takes about an hour, with patients discharged the same day. Pain relief begins within 1-2 weeks, lasting up to 2 years in 70-85% of cases. It’s a low-risk option for those ineligible for surgery, avoiding major complications while improving quality of life.
Biologic agents, such as tanezumab, target specific pain-related molecules like nerve growth factor (NGF) or cytokines. Administered via injection or orally in clinical trials, they block pain signals in advanced osteoarthritis. The process involves baseline pain and function assessments, followed by subcutaneous or IV doses every 8 weeks. Monitoring for side effects, like rapid joint progression, is critical. Combined with physical therapy, biologics reduce pain by up to 50%, per phase III trials, offering a novel approach, though long-term safety data is still emerging.
Low-dose radiation therapy uses targeted radiation to reduce joint inflammation non-invasively. After a planning CT scan, patients undergo 6-10 short sessions over weeks, lying still during brief treatments without anesthesia. Minimal side effects make it accessible, with studies showing pain improvement in advanced cases, offering an alternative for non-surgical candidates.
Even in advanced osteoarthritis, physiotherapy and chiropractic care remain essential, complementing other treatments. Customized exercise programs maintain joint range and muscle strength, preventing further deterioration. Modalities like therapeutic ultrasound or TENS alleviate pain, while manual therapy improves mobility. Clinics like ALWC in Brampton integrate these with orthopedic braces, such as the Genu Train, for comprehensive care, enhancing stability and function.
ALWC in Brampton offers a multidisciplinary approach to osteoarthritis, combining physiotherapy, chiropractic care, and specialized orthopedic braces. Their Bauerfeind Genu Train knee brace effectively offloads pressure, reduces pain, and supports daily activities. Initial visits include a detailed health history, assessment by experts like Dr. Sodhi, and X-rays if needed to tailor treatment plans. For more information or to schedule an appointment, visit https://www.alwc.ca/osteoarthritis-treatment-brampton/.
Advanced innovative osteoarthritis therapy options provide significant hope for managing severe symptoms, ranging from intra-articular injections like corticosteroids, hyaluronic acid, PRP, and stem cells to surgical options like arthroscopy, osteotomy, and joint replacement. Emerging therapies such as knee embolization, biologic agents, and low-dose radiation offer innovative solutions. Combining these with physiotherapy, chiropractic care, and specialized braces at clinics like ALWC in Brampton maximizes outcomes. Patients should consult specialists to choose treatments based on their condition’s severity, integrating lifestyle changes for long-term benefits. Professional guidance ensures tailored management, improving mobility and quality of life.
