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From joint preservation to joint replacement — a stepped-care approach
Osteoarthritis (OA) is the most common joint disease worldwide, affecting over 500 million people globally, and is the leading cause of disability in older adults. At Dr. Bodh Raj’s clinic, osteoarthritis management follows a stepped-care model: patient education, weight management, exercise therapy, pharmacological management (analgesia and intra-articular injections), and surgical referral (arthroscopy in select cases, osteotomy, or joint replacement) when conservative measures fail. The emphasis is on function and quality of life, not just radiographic appearance.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Bodh Raj Gautam (MBBS (KU), MS-Orthopedics (GMC), Cert. Podiatry & Diabetic Foot (India), NMC 23071). Evidence-based, no fabricated outcomes.
Osteoarthritis (OA) is the most common joint disease worldwide, affecting over 500 million people globally, and is the leading cause of disability in older adults. At Dr. Bodh Raj’s clinic, osteoarthritis management follows a stepped-care model: patient education, weight management, exercise therapy, pharmacological management (analgesia and intra-articular injections), and surgical referral (arthroscopy in select cases, osteotomy, or joint replacement) when conservative measures fail. The emphasis is on function and quality of life, not just radiographic appearance.
Reviewed by Dr. Bodh Raj Gautam, MBBS, MS-Orthopedics — Consultant Orthopedic Surgeon & Foot Nail Specialist (NMC 23071), Kathmandu Neurology Clinic. For evaluation, book an appointment.
The foundations of OA management are exercise, weight management, and education. Exercise therapy is the single most effective non-operative intervention — supervised land-based exercise programs reduce pain and improve function with effect sizes comparable to NSAIDs. Weight loss of ≥5% body weight in obese patients reduces joint loading, systemic inflammation, and pain. Education addresses disease understanding, self-management strategies, and activity modification. Walking aids, joint protection strategies, and appropriate footwear provide symptomatic relief.
Pharmacological management follows a stepwise approach: topical NSAIDs first (fewer systemic side effects), oral NSAIDs with gastroprotection for persistent symptoms, duloxetine for multimodal pain management, and intra-articular corticosteroid injections for acute flares. Hyaluronic acid injections have limited evidence but are used in some clinical settings. Arthroscopic lavage and debridement for mechanical symptoms (locked meniscal tear) is effective but arthroscopy alone for OA pain has no benefit over placebo. Joint replacement remains the definitive treatment for end-stage disease.
Guidelines referenced:
Bannuru RR et al. OARSI guidelines for the non-surgical management of knee OA. Osteoarthritis CartilageNICE NG157 — Osteoarthritis: care and managementMcAlindon TE et al. OARSI guidelines for the management of knee OA. Osteoarthritis CartilageContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.