All About Osteoarthritis Treatment

Principles of Osteoarthritis Treatment

Since osteoarthritis is a chronic degenerative disease, it's crucial to emphasize that its treatment can never aim to fully restore the patient's integrity and definitively resolve the clinical picture, unlike many other diseases.

This concept is fundamental not only for understanding the treatment logic but also for avoiding false hopes in the patient or leading them to wrongly believe they have been mistreated. Furthermore, due to the chronic and slowly progressive nature of osteoarthritis, managing the clinical picture requires active and, above all, daily commitment from the patient, which should be encouraged from the outset.

What Does Conservative Treatment for Osteoarthritis Involve?

First, it's essential to carefully assess the lifestyle of the person with osteoarthritis to avoid situations that unnecessarily stress already affected joints and promote activities that encourage their proper use. In this regard, it's important to remember that pain is a natural warning sign that should be heeded, spontaneously indicating to the individual what is best to do and what is best to avoid.

In individuals with osteoarthritis, this symptom is usually felt in the groin and less frequently in the buttock or radiating to the knee. At the beginning of the disease, the pain typically disappears or lessens with rest and lying down, reappearing intermittently with weight-bearing, especially in the first steps and after prolonged walking.

For patients who lack motivation or are significantly overweight, a consultation with a dietitian may be recommended to better understand the necessary weight loss, personalize the diet, and objectively monitor results over time. Reduced food intake should also be accompanied by increased physical activity.

For athletes, activities involving jumps or frequent changes of direction, such as volleyball, football, basketball, martial arts, or dance, should be limited in the early stages of the disease and preferably avoided in more advanced stages. However, these can be replaced with walking (according to individual tolerance) in comfortable shoes, swimming (preferably backstroke or freestyle), or cycling (preferably with a generally high saddle to minimize hip flexion).

Surgical Treatment of Osteoarthritis

Indications for Surgical Treatment of Osteoarthritis

Contrary to popular belief, it is not so much, or only, the radiological changes that indicate surgical treatment for osteoarthritis. Indeed, it is not uncommon to observe minimally compromised images associated with significant painful symptoms or, conversely, severely compromised radiographs in asymptomatic patients.

To make a calm and professional judgment, other important factors must also be considered, such as the lack of benefit from various possible conservative treatments and the actual limitation of the clinical picture on daily activities, sports, or work.

Furthermore, a successful prosthetic surgery does not begin in the operating room but requires a precise preoperative evaluation that cannot disregard the anatomical characteristics, functional expectations, and overall health profile of the patient, as well as their adherence and participation in the treatment process.

The Role of Hip Prosthesis in the Surgical Treatment of Osteoarthritis

Indeed, depending on the specific case, the choice of prosthesis type by the orthopedic surgeon is fundamental in planning the intervention. This choice must take into account anthropometric aspects such as the bone dimensions of the patient (i.e., whether they are a child or adult, male or female), and more technical aspects related to the particular conformation of the hip to be reconstructed.

Each prosthesis is composed of several elements. Specifically, the stem is the elongated lower part implanted into the femur, while the cup is the upper part positioned inside the acetabular cavity of the pelvis. The head, on the other hand, is the central spherical part that allows the individual to move the hip joint due to its positioning in the neo-acetabulum, which can be direct or mediated by an additional polyethylene insert that, in turn, optimizes congruency and sliding between the two surfaces. Finally, the neck is the metallic connection between the stem and the head. Since prostheses are now modular, the surgeon's experience in the careful and reasoned choice of each component is fundamental.

Surgical reports confirm that hip arthroplasty is now a reliable surgical procedure. The average implant survival time is over 20 years, and surgery has multiple objectives such as reducing joint pain, increasing range of motion, and improving quality of life.

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Rehabilitation in Patients with Osteoarthritis

More specific rehabilitation work, tailored to the problems of the individual patient in terms of both type and intensity, benefits patients with osteoarthritis. This may include active motor exercises to strengthen deficient muscles, recover joint mobility (also through stretching), optimize posture in static and dynamic situations, improve balance if precarious, and make the gait more propulsive and harmonious. After verifying the absence of certain contraindications, physical therapies using different principles such as heat, cold, electrical or magnetic fields can also be combined with physiotherapy sessions in the office.

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