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Physiotherapy should be first-line treatment for hip and knee OA, not surgery

Osteoarthritis, or OA, is the most common form of arthritis, affecting more than 2.1 million Australians.

Defined as the progressive dysfunction of the entire joint, including bone, ligaments, cartilage and muscles, the symptoms associated with OA may include pain, stiffness, swelling and instability – irrespective of the cause – which may lead to impaired function.

The traditional course of action for an individual with hip and knee OA is a visit to the GP, analgesia, and possibly imaging of the affected joint. For persistent pain, the patient is usually referred to a specialist, where further interventions, such as injections or surgery may be offered.

Surgery has become an extremely common method of treatment, with as many as 100,000 knee arthroscopies being performed per year at a cost of over half a billion dollars.

In recent years though, surgery to manage hip and knee OA has been under increased scrutiny, primarily due to the significant increases in surgeries being carried out nationally.

“To some extent, this is to be expected given our aging population, however, of primary concern is the number of individuals being offered surgery prior to having engaged in any non-surgical interventions, which have proven to be effective,” says Australian Physiotherapy Association member Matthew Williams.

“In the NSW Osteoarthritis Chronic Care Program for example, up to 70% of participants on the waiting list for knee surgery had no conservative management except for medication.

“Ultimately, joint replacement surgery is a very good option for individuals with end stage hip and knee OA, but only once all other treatment options have been exhausted, as, like with any surgical procedure it is not without its risks.”

Some of the possible negative consequences of surgery include infection, fracture, blood clots, dislocation, among others.

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