Management Options

A Stepped Approach to Treatment

There is no single treatment that is right for everyone with osteoarthritis. The appropriate management depends on the severity of your symptoms, the degree of joint damage visible on X-ray, your overall health, your weight, your activity levels, and — crucially — your personal goals and preferences.

In most cases, Mr. Lodge will recommend beginning with the least invasive options first, escalating to more interventional treatments only when conservative measures have been given a genuine chance and found insufficient. Joint replacement surgery is highly effective but is not without risk, and is reserved for patients whose quality of life is significantly affected and in whom non-surgical treatments have not provided adequate relief.

Lifestyle Changes & Self-Management

The most important and effective treatments for osteoarthritis are often the simplest — and they sit entirely within your own control. Lifestyle modification forms the foundation of all osteoarthritis management, regardless of the severity of symptoms.

Exercise

Exercise is one of the most important treatments available for people with osteoarthritis, whatever your age or level of fitness. Many patients worry that exercise will increase their pain or cause further damage to the joint — in fact, the opposite is true. Regular, appropriately guided physical activity helps to strengthen the muscles around the joint, improves stability, reduces pain, and can slow the progression of symptoms.

A good exercise programme will typically combine two components: strengthening exercises — to build the muscles that support and protect the hip or knee — and aerobic conditioning, to improve general fitness, cardiovascular health and weight management. It is important not to do too much too quickly; overdoing it can temporarily worsen symptoms. A physiotherapist can design a safe, progressive plan tailored to your specific joint and fitness level.

Weight Management

Excess body weight places considerable additional stress on weight-bearing joints. For every kilogram of extra weight you carry, the force across the knee during normal walking increases by approximately four kilograms. For the hip, the effect is similarly significant. The relationship between weight and joint pain is one of the most important and modifiable factors in osteoarthritis management.

Even a modest reduction in weight can lead to a substantial improvement in pain and function — and will also reduce surgical risk considerably if joint replacement later becomes necessary. If you are overweight, Mr. Lodge will discuss this with you openly and supportively, with the aim of helping you achieve the best possible outcomes from any treatment, surgical or otherwise.

Body Mass Index (BMI) is the most widely used tool to assess weight in relation to height, and whilst it has well-recognised limitations — it does not distinguish between muscle and fat mass, and can misclassify very muscular individuals — it remains the most universally adopted and practically useful measure in clinical practice. It is straightforward to calculate, requires no specialist equipment, and allows consistent comparison across populations and over time. For these reasons it is the measure used to assess surgical risk in the context of joint replacement, and most NHS and private providers use it as part of their pre-operative assessment.

As BMI rises, so does the risk associated with surgery. A BMI above 40 is associated with significantly increased risks at the time of joint replacement, including a higher rate of wound complications and infection, increased risk of implant failure and early loosening, greater technical difficulty during surgery, higher anaesthetic risk, increased risk of deep vein thrombosis and pulmonary embolism, and poorer functional outcomes and patient satisfaction. For these reasons, many surgical units — including Mr. Lodge's practice — will advise patients with a BMI above 40 to prioritise weight loss before proceeding to joint replacement where this is safely achievable. This is not a judgement, but a genuine commitment to giving every patient the best possible chance of a safe operation and a good long-term result.

Other Supportive Measures

Physiotherapy & Structured Exercise

Physiotherapy plays a central role in the management of hip and knee osteoarthritis. A skilled physiotherapist will assess your joint, muscle strength, movement patterns and functional limitations, then design an individualised exercise programme to address them.

Unlike general gym exercise, physiotherapy-led programmes are specifically targeted at the muscles that support and stabilise the affected joint. For knee osteoarthritis, this typically focuses on strengthening the quadriceps (thigh muscles) and the muscles of the hip and lower limb. For hip osteoarthritis, strengthening the hip abductors, extensors and core musculature is particularly beneficial.

Manual therapy — where a physiotherapist uses hands-on stretching and mobilisation techniques — can also help to maintain joint flexibility and reduce stiffness. Not moving a joint regularly can cause surrounding muscles to weaken further, creating a cycle of increasing pain and inactivity that manual therapy aims to break.

Medication for Pain Management

Pain relief medication does not treat the underlying osteoarthritis, but it can make symptoms more manageable and — importantly — allow you to engage with exercise and physiotherapy more comfortably.

Topical Anti-inflammatory Gels (NSAIDs)

For knee and hand osteoarthritis in particular, topical anti-inflammatory gels (such as diclofenac or ibuprofen gel) applied directly to the skin over the joint are often the most effective first-line pain relief. They reduce local inflammation and pain with minimal systemic absorption, making them suitable for many patients who cannot take anti-inflammatory tablets.

Oral Anti-inflammatory Tablets (NSAIDs)

If topical preparations are insufficient, oral non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed. These reduce both pain and inflammation but are not suitable for everyone — particularly those with a history of stomach ulcers, heart disease, kidney problems or asthma. When prescribed, they are usually taken alongside a stomach-protecting medication (a proton pump inhibitor).

Paracetamol

Paracetamol is a simple painkiller that may be recommended for short-term pain relief. While it is safe for most people, evidence for its long-term effectiveness in osteoarthritis is limited, and it is typically used as an adjunct rather than a primary treatment.

Opioid Painkillers

Stronger opioid-based painkillers such as codeine are occasionally used for severe pain but are generally prescribed for short periods only, due to the risk of side effects including drowsiness, constipation and dependency. They are not a long-term solution for osteoarthritis pain.

• Supplements: Glucosamine and chondroitin were previously widely used but are no longer recommended by NICE due to a lack of evidence that they are effective.
• Capsaicin cream: Derived from chilli peppers, capsaicin cream can help block pain signals in some patients with hand or knee OA, though it must be used consistently over several weeks.
• Complementary therapies: Acupuncture and some other complementary therapies are used by some patients and may provide symptomatic benefit, though robust clinical evidence remains limited.

Corticosteroid (Steroid) Injections

Intra-articular corticosteroid injections — commonly referred to as steroid injections — involve the delivery of a steroid medication directly into the hip or knee joint. Their role in managing osteoarthritis is nuanced and has evolved considerably in recent years.

The Primary Role: Diagnostic Clarification

One of the most valuable uses of a steroid injection is diagnostic — particularly for the hip, where the source of pain is not always straightforward to identify. Hip pain can arise from a number of structures in and around the hip and pelvis, including the joint itself, the gluteal tendons, the lumbar spine (referred pain travelling down from the back), the sacroiliac joint, or even referred pain originating as far away as the knee.

When symptoms are atypical — for example, when pain does not follow the expected pattern for hip arthritis, or when it is unclear whether the hip joint itself is truly the primary source — an image-guided steroid injection directly into the hip joint can be invaluable. If a significant and clear improvement in symptoms follows the injection, this strongly suggests that the hip joint articulation is indeed the primary pain generator and supports the case for proceeding with hip replacement surgery. If improvement is minimal, this prompts a re-evaluation of the pain source and may alter the management plan considerably.

Therapeutic Use: Evolving Caution

Steroid injections can also provide meaningful short-term pain relief — often within days — and may allow a patient to engage more effectively with physiotherapy or temporarily reduce symptoms during a difficult period. However, it is important to understand that a steroid injection does not treat osteoarthritis. It reduces the inflammation that occurs as a consequence of the condition; it does not repair cartilage or reverse joint damage.

The duration of benefit varies considerably from person to person. Some patients experience relief for several months; others notice an improvement lasting only weeks, or very little benefit at all. The response to a first injection is generally a reasonable guide to whether repeat injections are likely to be worthwhile.

The use of steroid injections purely as a treatment — rather than a diagnostic tool — is increasingly approached with caution in surgical practice. There is a body of emerging evidence suggesting that intra-articular steroid injections prior to joint replacement surgery may be associated with a modestly increased risk of periprosthetic joint infection (infection of the joint replacement), particularly when given within three months of the operation.

Summary: When Steroid Injections May Be Considered

• Diagnostic uncertainty: When the hip joint is one of several possible pain sources and confirmation is needed before recommending surgery.
• Management of early degenerative changes: Where physiotherapy has not resulted in sufficient symptomatic improvement but the degree of arthritis on imaging is mild enough that joint replacement feels disproportionate. In these circumstances, an injection may provide a period of meaningful relief while allowing time for further conservative measures to be explored and exhausted before surgical options are considered.
• Selected patients: Those for whom surgery carries significant risk and where a period of symptomatic relief is appropriate.
• Not within 3 months of surgery: Given the potential infection risk, Mr. Lodge advises against steroid injections within three months of any planned joint replacement.

Emerging & Novel Therapies

Beyond conventional conservative management, a number of newer treatments have emerged in recent years that sit between physiotherapy and joint replacement surgery. While the evidence base for some of these therapies continues to develop, they may be worth considering in appropriate patients.

Arthrosamid

Arthrosamid is a relatively new injectable treatment for knee osteoarthritis, developed by the Danish medical device company Contura International and CE-marked in Europe since 2017. It is a non-degradable, non-resorbable polyacrylamide hydrogel — composed of 2.5% cross-linked polyacrylamide and 97.5% sterile water — that is administered as a single intra-articular injection directly into the knee joint under image guidance. It is classified as a medical device rather than a drug.

Unlike a corticosteroid injection, which works by suppressing inflammation acutely and temporarily, Arthrosamid does not degrade or get reabsorbed. Once injected, it integrates into the synovial lining of the joint capsule and is thought to remain in place indefinitely. This is both its potential advantage — a longer duration of effect — and a consideration in terms of very long-term safety, since it cannot be removed.

Mechanism of Action — Still Not Fully Understood

It is important to be transparent that the precise mechanism by which Arthrosamid reduces pain and improves function in knee osteoarthritis is not fully understood. Several mechanisms have been proposed. The hydrogel adheres to and integrates with the synovial membrane, acting as a physical scaffold and cushioning layer — potentially reducing the mechanical stress transmitted through the joint and modulating the synovium's inflammatory response. Some describe it as acting like a "fire blanket" for inflammation, reducing the synovium's tendency to become excessively reactive.

Whether its effects are primarily mechanical (cushioning), biological (dampening synovial inflammation), or a combination of both remains an area of active investigation. A 2025 review published in Frontiers in Bioengineering and Biotechnology — examining recent advances in injectable hydrogels for osteoarthritis — noted that while polyacrylamide hydrogels demonstrate excellent biocompatibility and water-exchange capabilities, the full biological interaction between the hydrogel and joint tissue continues to be studied. Separately, a 2025 neurotoxicity study confirmed that the polymerised hydrogel shows no neurotoxic effects, addressing an earlier regulatory concern about residual acrylamide monomer content.

Evidence & Clinical Outcomes

The evidence base for Arthrosamid is still developing, but early results are encouraging. Studies have reported meaningful improvements in pain, stiffness and physical function — measured using validated patient-reported outcome measures (PROMs) — with effects lasting at least two to three years in some cohorts. A 2025 retrospective cohort study comparing Arthrosamid with hyaluronic acid and corticosteroid injections found that Arthrosamid demonstrated numerically superior outcomes in terms of pain and function at twelve months. The LUNA trial — the largest multicentre observational study of the treatment to date, involving nearly 200 participants across Europe — reported encouraging early findings in November 2025, with a single injection appearing to provide sustained relief for up to twelve months.

It should be noted, however, that the overall body of evidence remains relatively limited compared to more established treatments. Many existing studies are observational and lack long-term follow-up beyond five years. Arthrosamid is not currently approved by NICE and is not available on the NHS.