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What is Osteoarthritis

Overview of osteoarthritis

Osteoarthritis is a condition in which the articular cartilage that normally provides a smooth, stable surface, begins to fail leading to breakdown. This compromises the normal smooth, painless functioning of the joint surfaces. The most common cause of osteoarthritis is aging.  However, a number of other factors can lead to osteoarthritis including genetic predisposition, gender, joint injury, obesity and overuse. 


As the cartilage tissue begins to fail, small inflammatory molecules are released into the joint environment which results in inflammatory reaction in joint tissues, most notably the synovium.  This inflammatory reaction leads to aching pain, swelling, weakness and stiffness.  This inflammation accounts for most of the symptoms experienced by patients with osteoarthritis.  Some patients may also experience mechanical symptoms such as crunching, grinding or locking that are caused by unstable fragments of cartilage, loose bodies or unstable soft tissue problems such as meniscus tears.  There are a wide range of treatment options that can be effective for osteoarthritis including weight loss, exercise, physiotherapy, pain medication, anti-inflammatory medication, injectable therapies and surgical options.

Central role of inflammation

It has become apparent that most human disease processes are driven by inflammation.  Osteoarthritis is no exception.  The broken-down molecules that are released into the joint as cartilage begins to fail, leads to inflammatory changes in the synovium, which is the tissue that lines the joint.  This inflammatory reaction drives symptoms such as:

  • Pain;

  • Aching;

  • Swelling;

  • Weakness;

  • Stiffness. 


Increasingly, the treatment of osteoarthritis has focused on managing inflammation.  If the inflammatory reaction of the synovium can be effectively treated, patients can function well with little or no symptoms despite having significant underlying osteoarthritis damage.

Mechanical Symptoms

Although inflammatory symptoms are more common, some patients have mechanical symptoms which can range from relatively mild clicking to much more significant symptoms such as crunching, grinding or in extreme situations locking or mechanical seizing up of the joint.  Patients who have marked mechanical symptoms such as crunching, grinding and locking may require surgical intervention.

Initial Triage

On initially assessing a patient with osteoarthritis, it is important to determine whether or not there are significant mechanical symptoms which require surgical intervention.  Fortunately, most patients do not have marked mechanical symptoms.  Thus, surgery does not need to be the initial form of treatment for the vast majority of patients.  Most patients presenting with osteoarthritis symptoms can be managed with safer, less invasive therapies that are directed at reducing inflammation.

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