Arthritis is a significant health concern in Australia, affecting over 2.5 million people and accounting for more than $20 billion annually in healthcare costs.
By Associate Professor Chris Jones, Orthopaedic Surgeon, St John of God Mt Lawley & Murdoch.
Among the most common forms of arthritis are hip and knee osteoarthritis (OA), conditions that severely impair mobility and quality of life. As life expectancy increases, so does the burden of these conditions with a projected 370% increase in joint replacements by 2030.
Osteoarthritis is a degenerative joint disease caused primarily by ‘wear and tear’. Common symptoms include pain, stiffness and reduced function.
Hip and knee OA are the most prevalent forms, particularly among individuals aged over 70. While mild to moderate cases can often be managed conservatively, severe OA typically necessitates surgical intervention.
Diagnosis and assessment
GPs play a pivotal role in identifying OA early. A thorough patient history should explore pain characteristics, for example nocturnal hip pain or knee stiffness, functional limitations and mechanical symptoms such as locking or clicking.
Physical examination is equally critical. Key tests include an assessment of range of motion, the valgus/varus stress test for knee stability and the FABER test for hip flexibility.
X-rays are first-line imaging for both hip and knee OA [Figure 1]. Findings include joint space narrowing, osteophytes, and subchondral sclerosis.
Ultrasound is useful for diagnosing gluteal tendinopathy or bursitis. CT/MRI are reserved for detecting labral tears or subtle OA changes, however MRI and/or CT are rarely indicated for GP referral.
Hip pain
While hip OA is a common cause of groin pain, other conditions may mimic its presentation, including:
- Femoroacetabular impingement: characterised by ‘pistol grip’ thigh pain
- Stress fractures: consider in patients with sudden onset pain, especially athletes or those with osteoporosis
- Referred pain: lumbar spine pathology often manifests as hip or knee pain.
When in doubt, advanced imaging or specialist referral is warranted.
RELATED: Non-operative management of hip and knee osteoarthritis
Knee pain
Knee OA often coexists with other pathologies including meniscal tears, ligament injuries, for example ACL or PCL tears, and patellar tendinopathy.
Differentiating between these conditions requires a combination of history, examination, and imaging.
GPs role
General practitioners are the first point of contact for patients considering joint replacement. It’s crucial to identify candidates early, particularly those with persistent pain unresponsive to conservative measures, functional limitations affecting daily activities, or structural changes evident on imaging.
Reassure patients that outcomes are overwhelmingly positive, with over 90% of total joint replacements lasting more than 20 years.
Treatment options
For mild to moderate OA, non-surgical options can provide substantial relief. These include:
- Lifestyle modifications: encourage weight loss and low-impact activities
- Medications: NSAIDs, paracetamol and COX-2 inhibitors remain mainstays
- Injections: corticosteroids and viscosupplementation are useful adjuncts.
When conservative measures fail, referral for surgery should be considered [Figure 2]. Options include:
- Total joint replacement: the gold standard for advanced OA
- Partial knee replacement: suitable for unicompartmental arthritis, offering faster recovery and better range of motion
- Hip resurfacing: ideal for younger, active males under 65 years.
Robotic-assisted surgery
Robotic-assisted and technology enabled surgery is revolutionising total and partial knee replacements [Figure 3].
These systems allow for enhanced preoperative planning using 3D imaging, precise bone resection and implant placement, and improved alignment which correlates with reduced wear and longer implant life.
Studies reveal that robotic-assisted knee replacements reduce postoperative pain and accelerate recovery compared to conventional techniques.
Similarly, technology assisted hip replacements have been shown to have improved accuracy and precision of component placement with fewer outliers in terms of leg length discrepancy. Furthermore, technology enabled surgery may lower the risk of complications, contributing to better overall patient satisfaction.
As the prevalence of hip and knee arthritis grows, GPs must stay informed about advancements in diagnosis, management, and surgical options. Robotic-assisted surgery is a promising development, offering precision and potentially better patient outcomes.
Early intervention and clear communication can significantly improve quality of life for patients with OA.
Key messages
- As the prevalence of hip and knee arthritis grows stay informed about advancements in diagnosis, management, and surgical options.
- Early intervention and clear communication can significantly improve quality of life for patients with OA.
- Robotic-assisted surgery is a promising development, offering precision and potentially better patient outcomes.
Author competing interests – consultant for J+J MedTech, Enovis, MatOrotho, NavBit
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