Osteoarthritis: Debunking a Common Misconception

Osteoarthritis: A Leading Cause of Chronic Pain and Disability

Osteoarthritis is a leading cause of chronic pain and disability, affecting more than two million Australians. Routine x-rays are not recommended to diagnose the condition, and GPs can make a diagnosis based on symptoms and medical history.

However, nearly half of new patients with knee osteoarthritis who visit a GP in Australia are referred for imaging. Osteoarthritis imaging costs the health system A$104.7 million each year.

What Happens When You Get Osteoarthritis?

Osteoarthritis arises from joint changes and the joint working extra hard to repair itself. It affects the entire joint, including the bones, cartilage, ligaments, and muscles. It is most common in older adults, people with a high body weight, and those with a history of knee injury.

Many people with knee osteoarthritis experience persistent pain and have difficulties with everyday activities such as walking and climbing stairs.

How is it Treated?

In 2021-22, more than 53,000 Australians had knee replacement surgery for osteoarthritis. Hospital services for osteoarthritis, primarily driven by joint replacement surgery, cost $3.7 billion in 2020-21.

While joint replacement surgery is often viewed as inevitable for osteoarthritis, it should only be considered for those with severe symptoms who have already tried appropriate non-surgical treatments. Surgery carries the risk of serious adverse events such as blood clot or infection, and not everyone makes a full recovery.

Debunking a Common Misconception

A common misconception is that osteoarthritis is caused by “wear and tear”. However, research shows that the extent of structural changes seen in a joint on an x-ray does not reflect the level of pain or disability a person experiences, nor does it predict how symptoms will change.

Our Study

Our study aimed to find out if using x-rays to diagnose knee osteoarthritis affects a person’s beliefs about osteoarthritis management, compared to getting a clinical diagnosis without x-rays.

We recruited 617 people from across Australia and randomly assigned them to watch one of three videos. Each video showed a hypothetical consultation with a general practitioner about knee pain.

What Did We Find?

People who received an x-ray-based diagnosis and were shown their x-ray images had a 36% higher perceived need for knee replacement surgery than those who received a clinical diagnosis (without x-ray).

Conclusion

Our findings show why it’s important to avoid unnecessary x-rays when diagnosing knee osteoarthritis. Reducing unnecessary x-rays could help ease patient anxiety, prevent unnecessary concern about joint damage, and reduce demand for costly and potentially unnecessary joint replacement surgery.

FAQs

What is Osteoarthritis?

Osteoarthritis is a leading cause of chronic pain and disability, affecting more than two million Australians. It arises from joint changes and the joint working extra hard to repair itself.

How is Osteoarthritis Diagnosed?

Osteoarthritis is diagnosed based on symptoms and medical history, without the need for x-rays. GPs can make a diagnosis based on age (being 45 years or over) and symptoms: experiencing joint pain with activity and, in the morning, having no joint-stiffness or stiffness that lasts less than 30 minutes.

How is Osteoarthritis Treated?

Osteoarthritis is typically managed through education and self-management, exercise and physical activity, weight management (if necessary), and medicines for pain relief (such as paracetamol and non-steroidal anti-inflammatory drugs).

Is Surgery Necessary?

Surgery should only be considered for those with severe symptoms who have already tried appropriate non-surgical treatments. Surgery carries the risk of serious adverse events such as blood clot or infection, and not everyone makes a full recovery.