Osteoarthritis Medication

  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Jan 18, 2012
 

Medication Summary

The goals of pharmacotherapy in osteoarthritis are to reduce morbidity and to prevent complications. Pay careful attention to a particular pharmacologic regimen's adverse-event profile.

Pharmacologic agents used in the treatment of osteoarthritis include the following:

  • Corticosteroids
  • Sodium hyaluronate
  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Glucocorticoids
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Analgesics

Class Summary

Pain control is essential in the management of osteoarthritis. The goals of treatment include pain alleviation and improvement of functional status. Currently, no disease/structure-modifying intervention has been proven effective.

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Acetaminophen (Tylenol, Panadol, Aspirin-Free Anacin)

 

An initial trial with acetaminophen (eg, Tylenol, Panadol, Aspirin-Free Anacin) is warranted in patients with mild to moderate symptoms from osteoarthritis who fail to get sufficient relief from nonpharmacologic measures. Acetaminophen is the drug of choice for patients who have a documented hypersensitivity to aspirin or NSAIDs, who have a history of upper GI disease, or who are on anticoagulants.

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Duloxetine (Cymbalta)

 

Potent inhibitor of neuronal serotonin and norepinephrine reuptake. Indicated for chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain.

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Analgesic, Topical

Class Summary

Topical analgesics are used for osteoarthritis involving relatively superficial joints, such as the knee joint and the joints of the hands. These agents are much less effective for deeper joints, such as the hip joint.

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Capsaicin (Dolorac, Capsin, Zostrix)

 

Capsaicin (Dolorac, Capsin, Zostrix) is a topical analgesic of choice in osteoarthritis. Derived from plants of the Solanaceae family, it may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. Capsaicin must be used for at least 2 weeks for the full effects to be appreciated. Topical analgesics are used for osteoarthritis involving relatively superficial joints, such as the knee joint and the joints of the hands. These agents are much less effective for deeper joints, such as the hip joint.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. They are used to relieve osteoarthritis pain when the clinical response is unsatisfactory to acetaminophen. The mechanism of action is nonselective inhibition of COX-1 and -2, resulting in reduced synthesis of prostaglandins and thromboxanes. Other mechanisms may also exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

In more inflammatory presentations of osteoarthritis, such as knee involvement with effusion, these agents may be used as first-line pharmacologic therapy.

Use the lowest effective dose or intermittent therapy if symptoms are intermittent.

Patients at high risk for GI toxicity may consider adding misoprostol or a proton pump inhibitor to the regimen or substituting a COX-2–specific inhibitor for the NSAID.

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Naproxen (Aleve, Anaprox, Anaprox DS, Naprelan, Naprosyn)

 

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.

NSAIDs decrease intraglomerular pressure and decrease proteinuria.

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Piroxicam (Feldene)

 

Decreases activity of cyclo-oxygenase, which in turn inhibits prostaglandin synthesis. These effects decrease formation of inflammatory mediators.

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Ketoprofen (Orudis, Oruvail)

 

For relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses of more than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.

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Ibuprofen (Ibuprin, Advil, Motrin)

 

Ibuprofen (eg, Ibuprin, Advil, Motrin) relieves pain and inflammation. It is widely available and is relatively inexpensive as a generic drug. After the very early stages of osteoarthritis, inflammation begins to play a role in the disease. Thus, medications with a combination of analgesic and anti-inflammatory properties become more desirable, at least in theory.

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Meloxicam (Mobic)

 

To some extent, meloxicam (Mobic) is more selective for COX-2 receptors, compared with traditional NSAIDs. It decreases activity of cyclooxygenase, which in turn inhibits prostaglandin synthesis. These effects decrease formation of inflammatory mediators.

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Diclofenac (Voltaren, Arthrotec, Cataflam)

 

Designated chemically as 2-[(2,6-dichlorophenyl) amino] benzeneacetic acid, monosodium salt, with an empirical formula of C14 H10 Cl2 NO2 NA. One of a series of phenylacetic acids that has demonstrated anti-inflammatory and analgesic properties in pharmacological studies. Believed to inhibit the enzyme cyclooxygenase, which is essential in the biosynthesis of prostaglandins. Can cause hepatotoxicity; hence, liver enzymes should be monitored in the first 8 weeks of treatment.

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation. Delayed-release, enteric-coated form is diclofenac sodium, and immediate release form is diclofenac potassium. Has relatively low risk for bleeding GI ulcers.

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Esomeprazole and naproxen (Vimovo)

 

Naproxen component is indicated for relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Naproxen is an NSAID that inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.

Esomeprazole component is indicated to decrease risk of gastric ulcers in patients at risk of developing NSAID-associated gastric ulcers. Esomeprazole is the S-isomer of omeprazole, a proton pump inhibitor. Inhibits gastric acid secretion by inhibiting H+/K+-ATPase enzyme system at secretory surface of gastric parietal cells.

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COX-2 inhibitors

Class Summary

Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is less in nonaspirin users receiving COX-2 inhibitors than it is in patients using traditional NSAIDs.

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Celecoxib (Celebrex)

 

Celecoxib (Celebrex) is a COX-2–specific inhibitor. At therapeutic concentrations, COX-2 (inducible by cytokines at sites of inflammation, such as the joints) is inhibited and COX-1 isoenzyme (present in platelets and GI tract) is spared; therefore, in nonaspirin users, incidence of GI toxicity, such as endoscopic peptic ulcers, bleeding ulcers, perforations, and obstructions, is decreased when compared with nonselective NSAIDs. COX-2 is expressed in the kidney; however, the renal safety profile is not significantly superior to that of NSAIDs.

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Opioid Analgesics

Class Summary

These agents are used in patients whose pain has not been controlled with weaker analgesic medications. They are a particularly reasonable choice in patients who do not want joint replacement surgery, are too medically ill for joint replacement, are not candidates for joint replacement for other reasons, or are trying to buy time for subsequent joint-replacement surgery.

The results of a retrospective cohort study found that elderly patients (aged 65 y and older) with arthritis are more likely to incur a fracture when initiating opioids as opposed to NSAIDs (25 fractures per 1000 person-years; hazard ratio, 4.9; confidence interval, 3.5-6.9). Higher opioid dose was associated with greater risk of fracture. In addition, results showed that during the first 2 weeks of initiating opioid treatment, short-acting opioids are associated with a greater fracture risk than are long-acting opioids.[78]

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Oxycodone (OxyContin, Roxicodone)

 

Pure narcotic analgesics, such as oxycodone, might be the initial DOC. Eventually, this short-acting narcotic can be switched to a long-acting transdermal preparation, such as fentanyl (Duragesic patch).

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Tramadol (Ultram, Ultram ER)

 

Inhibits ascending pain pathways, altering perception of and response to pain. Also inhibits reuptake of norepinephrine and serotonin

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Corticosteroids

Class Summary

Intra-articular pharmacologic therapy includes corticosteroid injection and viscosupplementation, which may provide pain relief and have an anti-inflammatory effect on the affected joint.[49, 50] Radiologists may aid in the treatment of osteoarthritis by administering image-guided intra-articular injections of steroids.

Steroid injections generally result in a clinically and statistically significant reduction in osteoarthritic knee pain as soon as 1 week after injection. The effect may last, on average, anywhere from 4-6 weeks per injection, but this benefit is unlikely to continue beyond that time frame.[51]

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Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)

 

Methylprednisolone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Betamethasone (Celestone Soluspan)

 

Betamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Its affects the production of lymphokines and has an inhibitory effect on the Langerhans cells.

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Triamcinolone (Aristospan Intra-Articular)

 

Triamcinolone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

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Sodium Hyaluronate Agents

Class Summary

These agents are used to treat pain in osteoarthritis of knee in patients not responding to conservative, nonpharmacologic therapy and simple analgesics (ie, acetaminophen).

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Sodium Hyaluronate (Euflexxa, Hyalgan, Orthovisc, Supartz, Synvisc, Synvisc-One)

 

This is a hyaluronic acid derivative that supports the lubricating and shock-absorbing properties of articular cartilage.

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Contributor Information and Disclosures
Author

Carlos J Lozada, MD  Director of Rheumatology Fellowship Program, Professor, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine

Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Pfizer Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching

Coauthor(s)

Samuel Agnew, MD, FACS  Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

B Sonny Bal, MD  Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Pat Auveek Basu, MD, MBA  Staff Physician, Department of Radiology, Stanford University Hospitals

Pat Auveek Basu, MD, MBA is a member of the following medical societies: American Medical Association, American Roentgen Ray Society, California Medical Association, Chicago Medical Society, Illinois State Medical Society, Radiological Society of North America, and Society of Interventional Radiology

Disclosure: Nothing to disclose.

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Irim Ciolino, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, Georgetown University Hospital-NRH

Irim Ciolino, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Jaimie A Clodfelter, DO  Resident Physician, Department of Physical Medicine and Rehabilitation, Louisiana State University Health Science Center

Jaimie A Clodfelter, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Mervyn J Cross, MBBS, FRACS  Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia

Mervyn J Cross, MBBS, FRACS is a member of the following medical societies: American Orthopaedic Society for Sports Medicine, Australasian College of Sports Physicians, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Hughston Society, and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Carlos A Garcia-Moral, MD  Clinical Professor, Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Services Center

Carlos A Garcia-Moral, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, and Oklahoma State Medical Association

Disclosure: Nothing to disclose.

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Amilcare Gentili, MD  Professor of Clinical Radiology, University of California, San Diego, School of Medicine; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego Veterans Affairs Healthcare System

Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology

Disclosure: Nothing to disclose.

Dennis P Grogan, MD  Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa

Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Kathleen A Hogan, MD  Fellow in Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital

Kathleen A Hogan, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopedic Surgery, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham School of Medicine; Surgeon-in-Chief, UAB Highlands Hospital

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Royalty Independent contractor; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Stephen Kishner, MD, MHA  Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Nanne P Kort, MD, PhD  Consulting Staff, Department of Orthopedic Surgery, Orbis Medical Park Sittard, The Netherlands

Nanne P Kort, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

James Monroe Laborde, MD, MS  Clinical Assistant Professor, Department of Orthopedics, Louisiana State University Health Sciences Center and Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School

James Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth)  Consultant Spinal Surgeon, Department of Trauma and Orthopaedics, Sunderland Royal Hospital, UK

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) is a member of the following medical societies: AO Spine International and British Orthopaedic Association

Disclosure: Nothing to disclose.

Cato T Laurencin, MD, PhD  Vice President for Health Affairs, Dean of the School of Medicine, Van Dusen Endowed Chair and Professor in Academic Medicine, Distinguished Professor of Orthopedic Surgery, and Chemical, Materials, and Biomolecular Engineering, University of Connecticut School of Medicine

Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Mark D Lazarus, MD  Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

Phillip J Marone, MD, MSPH  Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College

Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Scott E Marwin, MD  Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center

Scott E Marwin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Charles T Mehlman, DO, MPH  Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Pekka A Mooar, MD  Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Peter M Murray, MD  Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital

Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Robert J Nowinski, DO  Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association

Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

Simon H Palmer, MD  Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex

Disclosure: Nothing to disclose.

Albert W Pearsall IV, MD  Associate Professor, Department of Orthopedic Surgery, University of South Alabama College of Medicine; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center

Disclosure: Nothing to disclose.

Marcus Romanowski, MD  Chief, Department of Orthopedic Surgery, Kenmore Mercy Hospital; Director, Knee and Hip Center, Kenmore Mercy Hospital; Partner, Joint Reconstruction Orthopedics

Marcus Romanowski, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthritis Foundation

Disclosure: Nothing to disclose.

Brett J Rothaermel, MD, PT  Clinical Instructor, Department of Physical Medicine and Rehabilitation, Louisiana State University School of Medicine in New Orleans; Staff Physician in Occupational Medicine, East Jefferson Occupational Medicine Clinic; Staff Physician PRN in Urgent Care, East Jefferson After Hours

Brett J Rothaermel, MD, PT is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Occupational and Environmental Medicine, Louisiana State Medical Society, and Orleans Parish Medical Society

Disclosure: Nothing to disclose.

Richard Salcido, MD  Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

H Del Schutte, Jr, MD  Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina

H Del Schutte, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, American Medical Association, American Orthopaedic Association, California Medical Association, Orthopaedic Research Society, South Carolina Medical Association, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Lester Sher, MBBCh, FRCS  Honorary Clinical Lecturer, Department of Orthopedics, Wansbeck Hospital, UK

Disclosure: Nothing to disclose.

Furqan H Siddiqui  MD, Assistant Professor of Medicine and Research, Louisiana State University Medical Center, New Orleans

Furqan H Siddiqui is a member of the following medical societies: American Federation for Clinical Research

Disclosure: Nothing to disclose.

Dev Sinha, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health Systems

Disclosure: Nothing to disclose.

Curtis W Slipman, MD  Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society

Disclosure: Nothing to disclose.

Gregory Scott Stacy, MD  Associate Professor, Department of Radiology, University of Chicago Hospitals

Gregory Scott Stacy, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Skeletal Radiology

Disclosure: Nothing to disclose.

Lynne S Steinbach, MD  Professor, Department of Radiology, University of California, San Francisco, School of Medicine

Lynne S Steinbach, MD is a member of the following medical societies: American College of Radiology, International Skeletal Society, and Radiological Society of North America

Disclosure: Nothing to disclose.

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation, Director, Outpatient Occupational/Musculoskeletal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Ashish Upadhyay, MD, MBMS, MRCS (Edinburgh)  Resident, Department of Orthopedics, University of Illinois at Chicago

Ashish Upadhyay, MD, MBMS, MRCS (Edinburgh) is a member of the following medical societies: Royal College of Surgeons of Edinburgh and Royal Society of Medicine

Disclosure: Nothing to disclose.

Jos van Raay, PhD  Associate Chair, Residency Director, Department of Orthopedic Surgery, Martini Hospital Groningen, Netherlands

Disclosure: Nothing to disclose.

Specialty Editor Board

Felix S Chew, MD, MBA, EdM  Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Eli Steigelfest, MD, Alex Minh Nguyet Tran, MD, Kevin Trapp, MD, Siriporn Janchai, MD, to the development and writing of the source articles.

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This radiograph demonstrates osteoarthritis of the right hip, including the finding of sclerosis at the superior aspect of the acetabulum. Frequently, osteoarthritis at the hip is a bilateral finding, but it may occur unilaterally in an individual who has a previous history of hip trauma that was confined to that one side.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
This radiograph demonstrates osteoarthritis of the right hip, including the finding of sclerosis at the superior aspect of the acetabulum. Frequently, osteoarthritis at the hip is a bilateral finding, but it may occur unilaterally in an individual who has a previous history of hip trauma that was confined to that one side.
Arthroscopic view of a torn meniscus before (top) and after (bottom) removal of loose meniscal fragments.
Arthroscopic view of an arthritic knee.
Arthroscopic view of a knee after the removal of loose fragments of articular and meniscal cartilage.
Arthroscopic view of the removal of cartilaginous loose body.
Anteroposterior radiograph shows knee replacement in 1 knee and arthritis in the other, with medial joint-space narrowing and subchondral sclerosis.
Anteroposterior radiograph of the pelvis and hips shows an arthritic hip not treated surgically and a total hip replacement.
Anteroposterior radiograph obtained after knee replacement.
Lateral radiograph obtained after knee replacement (same patient as in the above image).
Oblique projection demonstrates gradual narrowing and sclerosis of the facet joints as one progresses down the lumbar spine.
Standing radiograph of the knee reveals narrowing of the medial and lateral femorotibial compartments with marginal osteophytes.
 
 
 
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