Knee and hip osteoarthritis

Overview

Osteoarthritis is the most common form of arthritis in adults. Globally 595 million people had it in 2020 — 7.6% of the world population — a 132% rise in total cases since 1990, driven by ageing and obesity; knee was the most common site, and high BMI contributed to 20.4% of disease burden.^[10]

The consultation task has changed shape. Diagnosis no longer needs an X-ray, several once-standard treatments have been retired on evidence, and two interventions — exercise and weight loss — carry effect sizes that match drug therapy. The management conversation is therefore less about prescribing and more about structuring activity, weight and expectations.^[3][14]

References14ShowHide

1. [1]Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA, 2013.PMID 24065013
2. [2]Sihvonen R et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med, 2013.PMID 24369076
3. [3]Fransen M et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev, 2015.PMID 25569281
4. [4]Derry S et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev, 2016.PMID 27103611
5. [5]Messier SP et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis Care Res (Hoboken), 2018.PMID 29911741
6. [6]Leopoldino AO et al. Paracetamol versus placebo for knee and hip osteoarthritis. Cochrane Database Syst Rev, 2019.PMID 30801133
7. [7]Palmer JS et al. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev, 2019.PMID 31322289
8. [8]Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol, 2020.PMID 31908163
9. [9]Saltychev M et al. The Magnitude and Duration of the Effect of Intra-articular Corticosteroid Injections on Pain Severity in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil, 2020.PMID 31972612
10. [10]GBD 2021 Osteoarthritis Collaborators Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023.PMID 37675071
11. [11]Bensa A et al. Intra-articular corticosteroid injections provide a clinically relevant benefit compared to placebo only at short-term follow-up in patients with knee osteoarthritis: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2024.PMID 38294103
12. [12]Henriksen M et al. Intensive diet or knee arthroplasty for severe knee osteoarthritis: The inka randomised trial. Osteoarthritis Cartilage, 2026.PMID 42431586
13. [13]Hall M et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev, 2026.PMID 42486497
14. [14]Wood G et al. Osteoarthritis in people over 16: diagnosis and management-updated summary of NICE guidance. BMJ (Clinical research ed.), 2023.PMID 36693668