January 27, 2023

A Comprehensive Guide to the Management of Hip and Knee Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is a highly prevalent disease affecting the joints and is among one of the leading causes of inactivity in people over 65. While OA is often thought to be the result of “wear and tear”, it is more accurately described as general joint failure due to an imbalance between cartilage degeneration and regeneration. Factors contributing to cartilage breakdown and improper regeneration include poor joint alignment and loading, repetitive overuse, and/or acute injury to the joint. OA can affect multiple different joints in our body and commonly affects the hip and knee joints. Those more at risk for developing OA include individuals over age 40 with more females affected than males, increased body mass index, previous joint injury, muscle weakness and those with a family history of OA. 

Signs and Symptoms 

  • Decreased range of motion in the affected joint 
  • Joint tenderness 
  • Mild swelling 
  • Pain with weight bearing activities, such as walking, squatting, kneeling, stair climbing and high impact activities 
  • Gradual or insidious onset
  • Stiffness in the affected joints in the morning of after periods of inactivity for less than 30 minutes 

Treatment and Self-Management of Osteoarthritis 

All patients with OA can benefit from a comprehensive treatment program including education, exercise, weight management strategies and self-management practices. 


Since OA is a disease related to the integrity and function of our joints, it is important to first understand the basic anatomy of our joints. Joints are where two bony surfaces meet. During movement, our bones glide smoothly over one another because they are covered in a friction-reducing substance called cartilage. The joint is also surrounded by an articular capsule which secretes synovial fluid to help lubricate and nourish cartilage. 

A common myth about OA is that movement is harmful to our joints. This is not entirely true. Cartilage needs moderate load to regenerate itself. Movement fosters the secretion of synovial fluid into our joints to help cartilage regenerate so that our joints can function safely and smoothly over one another when we move. What is important to consider in protecting our joints is finding a balance between rest and exercise, staying within your pain tolerance and maintaining proper form and joint alignment when exercising. 


Engaging in regular exercise is good for our joint health. Exercise programs for people living with OA consist of walking daily to promote cardiovascular health benefits and strength training to help prevent muscle weakness and improper joint loading patterns. What is important to remember is that our joints like to be loaded, but we need to find a balance between too much and too little activity. Those beginning an exercise program for OA should always remember to “Load and Unload”. This means do not engage in any one activity for too long. If you are sitting all day, try to get up every hour and move. If you are out walking for an hour, be sure to take frequent sitting breaks. It is also important to maintain joint alignment during exercises, such as walking or squatting, meaning there is a straight line maintained between joints as seen in the images below.

Weight Management 

Increased load on our joints can contribute to greater cartilage breakdown and stress through our joints. Therefore, it is important to maintain a healthy weight. Weight management strategies can consist of exercise, diet and maintaining good sleep hygiene. Seeing a dietician, family doctor or naturopath can be helpful in establishing weight management strategies appropriate for you. 


The more aware and knowledgeable you are about your pain and how it comes on, the better you will be able to implement appropriate strategies for pain and lifestyle management while living with OA. Recognizing and identifying challenges associated with OA can help pinpoint pain triggers or barriers to disease management. Goal setting can help keep you on track with your treatment program and creating an action plan can assist in developing a consistent routine. Finally, utilizing a particular method to monitor progress can help keep you accountable to your goals and achieve adherence to your management program long term. Other less obvious effects of OA include social isolation and mental health issues, lack of energy or fatigue or comorbidities such as cardiovascular disease because of increased sedentary behavior. 

Seeking help from a qualified health care professional can provide you will the tools you need to better manage your pain and live a more active healthy lifestyle while living with osteoarthritis. 

Health Care Practitioners who can help you with managing your OA include: