Non-Surgical Treatment for Osteoarthritis: Physiotherapy and Medication

This is a common perception, actually — in the first six to eight weeks we don't want the patient to bend beyond 90 degrees, talking about hip replacements, to reduce the chances of dislocation so the capsule heals well. That's the 90 degree rule for hip replacement.

KL is just the WHO classification of osteoarthritis — it's not very good. Diagnosis is a clinical one: patients complaining of typical pain — pain while walking, pain while taking stairs, pain while sitting cross-legged — with definitive tenderness on the joint line, is almost confirmatory. That's the real gold standard, not the X-ray. X-ray is the baseline test, but it's not the criterion for deciding which patient should undergo surgery — a grade four KL arthritis patient with minimal pain treated well with physical therapy may not be a candidate for joint replacement, while a grade three patient who has tried all conservative measures without relief could be. It's a paradox, so X-ray grading alone isn't the gold standard. On location: for osteophytes, the location of weight-bearing matters more, but for me it's typically joint space reduction that matters most, because it indirectly shows the articular cartilage is gone — and that's irreversible.

Medical therapy is the first line of treatment — it should be tried first, and once pain is not relieved with medical therapy and physical therapy, and the patient is having difficulty in activities of daily living, then the patient becomes a candidate for surgery.

The survivorship of newer implants, taking an average value, is more than 20 to 25 years, though there's a range. To measure success there's a prerequisite: we presume the patient has taken care of the joint, followed the precautions, physical therapies and exercises they've been told — the value I've mentioned is the average assuming that's been taken care of.

It's a permanent, non-removable procedure — it doesn't need to be removed. The follow-ups: the first milestone is at two weeks, to remove the stitches, then six weeks post-surgery, then three months, six months, and then annually.

Flexibility, load management, neuromuscular control, muscle strength and movement efficiency together, rather than relying on medication alone.

Simple analgesics such as paracetamol, progressing to opioids if needed, along with topical anti-inflammatory preparations and medications that increase joint lubrication.

When pain persists despite consistent physiotherapy and medication, and the patient's daily function is significantly restricted. The next step is usually an injection-based treatment or surgery.