From the Guidelines
Total joint replacement is the definitive treatment for end-stage degenerative joint disease (DJD), particularly for the hip and knee joints, as it relieves pain and restores function when conservative measures fail. The management of end-stage DJD typically involves a combination of non-surgical and surgical approaches. Before considering surgery, patients should try various non-pharmacological and pharmacological interventions. Non-pharmacological interventions include:
- Education on the disease and its management
- Physical therapy focusing on strengthening, range of motion, and gait training
- Weight management, as each pound lost reduces joint stress by 3-4 pounds
- Assistive devices like canes, walkers, or braces to reduce joint stress
Pharmacological interventions include:
- Analgesics like acetaminophen (up to 3000mg daily in divided doses) and NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), though these should be used cautiously due to gastrointestinal and cardiovascular risks 1
- Topical NSAIDs like diclofenac gel (apply to affected joint 4 times daily) may provide localized relief with fewer systemic effects
- Intra-articular corticosteroid injections (typically methylprednisolone 40-80mg or triamcinolone 20-40mg) can temporarily reduce inflammation and pain, usually limited to 3-4 injections yearly
However, when these conservative approaches no longer provide adequate relief, surgical consultation should be pursued, as joint replacement can dramatically improve quality of life by eliminating pain and restoring mobility in end-stage disease. According to the most recent guidelines, knee joint replacement has been shown to be effective in the management of knee OA symptoms, although it might not be suitable for all patients as up to 20% report dissatisfaction and/or persistent symptoms postoperatively 1. Arthroscopic surgery is not recommended for patients with clear radiographic evidence of osteoarthritis alone 1.
From the Research
Treatment Options for End-Stage Degenerative Joint Disease
- Intra-articular injections of hyaluronic acid (HA) have been shown to improve functional activity and pain management in patients with degenerative joint disease 2, 3
- Viscosupplementation, which involves the injection of HA into affected joints, is effective in reducing pain and improving functionality, and can delay the need for surgery 3
- Advanced arthroscopic debridement, a minimally invasive procedure, has been associated with improved quality of life and pain reduction in patients with end-stage temporomandibular joint degenerative joint disease 4
- Conservative management, including lifestyle changes and anti-inflammatory regimens, is often the initial approach for treating chronic knee osteoarthritis, with more invasive interventions such as injections and surgery considered for escalation of care 5
- Pharmaceutical treatment options for osteoarthritis include oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and intra-articular hyaluronic acid, among others, with varying recommendations and considerations for use 6
Intra-Articular Injections
- HA injections have been shown to downregulate pro-inflammatory factors and improve pain and function in patients with osteoarthritis 3
- Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects 6