Tips for osteoarthritis of the hip or knee

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The information below has been written for people with osteoarthritis of the hip and/or knee. There are many treatments that may be helpful if you have osteoarthritis (OA) of the hip and/or knee. Here are some things you could try.

Self management course
These courses help you develop skills to manage your symptoms, communicate with your healthcare team and lessen the impact of arthritis on your life. Contact your local Arthritis Office for more information.

Exercise
Exercise is one of the most important treatments for OA of the hip and knee. It helps to reduce pain and maintain your general health. To protect your sore joints, try low-impact activities, where there is less weight going through your hips and knees. Examples of low-impact activities include cycling and walking. You could also try:

Water exercise: The buoyancy of the water takes pressure off your hips and knees and you may find you can move more freely than you can on land. You could swim, do a hydrotherapy session with a physiotherapist or join a local warm water exercise class. See the Water exercise sheet for more information.
Strengthening exercises: Physiotherapy exercises to strengthen the muscles around your hip and knee can also help reduce pain from OA.
Tai chi: Studies show that tai chi can help reduce pain and stiffness for people with arthritis. See the Tai chi information sheet for more information. See the Physical activitysheet for more information about exercise. If possible, consult a physiotherapist or exercise physiologist for advice about a program to suit you.

Weight loss
Being overweight can lead to more pain and damage to hips and knees affected by OA. Even modest weight loss (less than five kilograms) can reduce symptoms of knee OA. You may find it useful to see a dietitian for advice about healthy eating and weight loss.

Medicines
• Paracetamol is a simple pain reliever that can relieve mild to moderate pain from OA.
• Anti-inflammatory medicines may relieve symptoms of OA. Always talk to your doctor or pharmacist before take these medicines as they are not suitable for all people.
• Stronger pain medicine, such as codeine or tramadol, may be useful if simple pain relievers are not effective
and anti-inflammatory medicines cannot be used.
• A corticosteroid injection into the knee or hip joint may relieve pain.
• Hyaluronan injections may reduce pain in knee OA but can be expensive and do not work for all people. Injecting hyaluronan into the joint can help lubricate and protect the cartilage.
• Creams containing anti-inflammatory medicines have been shown to reduce pain in knee OA. It is not known whether these creams have the same effect for hip OA. Creams containing capsaicin (an ingredient in cayenne and chilli peppers) may also help relieve pain in knee or hip OA.

Talk to your doctor or pharmacist about medicines and the best way to use them for your condition. See the Medicines and arthritis informtation sheet.

Aids or supports
Some people may find using a walking stick helps reduce pain, although there are no studies to prove this claim. Always use the walking stick on the opposite side to your sore joint (if your right hip is affected, use the walking stick in your left hand). Your physiotherapist may also suggest the following treatments to reduce pain from knee OA:

•Taping the kneecap (patella)
• knee braces
•Orthotics (small wedges placed in your shoes to improve the alignment (position) of your knee when standing and walking).

See a physiotherapist for advice about any of these aids or supports.

Heat and cold
Cold therapy such as ice packs or ice massage may help reduce pain in knee OA. Heat packs have been found to be less useful than cold packs for OA. See the Dealing with pain sheet for more information.

Glucosamine and chondroitin
The results from studies of glucosamine sulfate and chondroitin sulfate are unclear. See the Glucosamine and chondroitin sheet for more information.

Herbal therapies
There is limited proof that certain herbal therapies are useful for OA of the hip and knee. See the Complementary therapies sheet for more information.

TENS, ultrasound, laser
A TENS machine applies very mild electric pulses to block pain messages going to your brain. This may help reduce pain in your hip or knee. See a physiotherapist to trial a TENS machine, and to learn how to use it correctly, before you buy one. Ultrasound may provide some benefit for knee OA but has been shown to have no benefit for the hip. It is unclear whether laser therapy is an effective treatment for knee or hip OA.

Acupuncture
Acupuncture may help to improve pain and function for some people with knee OA. The effects on hip OA have not been clearly proven. The Australian Acupuncture and Chinese Medicine Association can help you find an accredited practitioner at www.acupuncture.org.au or 1300 725 334.

Magnets
It is unclear whether magnetic belts or bracelets have any effect on pain for people with OA of the hip and knee.

There are many things that can help you manage OA of the hip or knee. The first steps are regular exercise, weight loss and using medicines wisely.

For more information:

To find a physiotherapist, talk to your doctor, see the Australian Physiotherapy Association website at www.physiotherapy.asn.au or look under ‘Physiotherapist’ in the Yellow Pages.
To find an exercise physiologist, talk to your doctor, contact Exercise and Sports Science Australia on (07) 3856 5622 or use the ‘find an exercise physiologist’ feature at www.essa.org.au
To find a dietitian, talk to your doctor, contact the Dietitians Association of Australia on (02) 6282 9555 or use the ‘find a dietitian’ service at www.daa.asn.au

Books
Living with osteoarthritis: A guide for people with osteoarthritis of the hip or knee, 2005, Clinical Epidemiology and Health Service Evaluation Unit Royal Melbourne Hospital, Melbourne. Available also for download from www.arthritisvic.org.au
Allen, Ronald J 1998, Arthritis of the hip and knee: The active person’s guide to taking charge, Peachtree Publishers, Atlanta, Georgia.