Key points

  • Advanced osteoarthritis is the most severe form of osteoarthritis.
  • Osteoarthritis is a progressive condition, meaning it gets worse over time.
  • If medication and other therapies no longer help, surgery can improve symptoms and quality of life.
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Osteoarthritis (OA) is a chronic disease. It causes degenerative (progressive) damage to your joints, including those in your:

  • hands and fingers
  • knees
  • hips
  • shoulders
  • lower back
  • neck

While there’s no current cure for OA or a way to reverse the damage it causes, a range of treatment options can help manage your symptoms.

Doctors classify the progressive degeneration of OA as mild, moderate, or severe. In severe, or advanced, OA:

  • Your cartilage has worn away.
  • The space between the bones in your joint is much smaller than it used to be.
  • Your joint feels warm and is inflamed.
  • The amount of fluid that lubricates your joint has decreased, although the joint may be swollen.
  • You have more bone spurs.
  • Bones rub together at the joint.
  • You’ll likely have pain and discomfort when moving the joint.
  • The pain may prevent you carrying out daily activities.

Home remedies and medication may no longer provide relief for severe OA, and you may wish to consider surgery.

The progression of OA depends on a number of factors, such as:

  • how severe your symptoms were at diagnosis
  • which joints have OA
  • your overall health
  • how much you use the affected joint

A review of 30 studies found that OA of the knee progressed more rapidly in people who:

  • were older
  • had a high body mass index (BMI)
  • had OA in more than one joint

With an early diagnosis, it’s possible to slow the progression of OA by following a number of lifestyle and medical choices. Once OA starts, it can take years or even decades to reach severe joint damage.

If severe joint damage develops, and symptoms are affecting your overall well-being and quality of life, surgery or joint replacement may help.

Pain and stiffness, especially in the morning, are the main symptoms of OA. With progressed OA, these symptoms can be severe. They can affect your mobility and ability to carry out daily tasks.

Other symptoms include:

  • loss of flexibility in the joint
  • grating or crackling noise when you move the joint
  • swelling around the joint

If OA affects your hands, you may find it hard to do things that need dexterity or grasping, such as opening a jar.

If you have OA in your knee or hip joints, it may be difficult to walk, climb stairs, or lift objects.

Doctors believe the following factors may contribute to OA.

Genetic features

According to some scientists, individual genetic features may increase your chances of developing OA. They could affect how your body makes cartilage or how your bones fit together at the joint.

Genetic factors could also influence how quickly OA progresses.


Extra weight can put pressure on your hips and knees, which can cause the cartilage in your joints to deteriorate faster.

Obesity can also affect the production of hormones and the immune system in ways that can increase the risk of damage. Obesity may also aggravate inflammation, research shows.

Past injuries

Joint injuries or repetitive motion can lead to cartilage breakdown and OA. If the muscles supporting your joints are imbalanced or weak, this can also lead to cartilage breakdown.

Various measures may slow the progression of OA:

  • Weight management can take pressure off your lower body joints and may help reduce inflammation.
  • Regular exercise and stretching can improve flexibility, relieve stiffness, and improve your overall physical condition.
  • Physical therapy can help strengthen the muscles around specific joints.
  • Supportive devices, such as braces, splints, and kinesiology tape, can help you stay active.
  • Assistive devices, such as a cane, can help you balance and lower the risk of falls.

For people with a high BMI, the American College of Rheumatology and the Arthritis Foundation strongly recommend losing weight to help manage OA.

The organizations note that, for people with overweight or obesity, the amount of weight a person loses may have an equivalent impact on their OA symptoms.

In its early stages, physical therapy, regular exercise, weight loss, and assistive devices can help you manage OA.

You can use these lifestyle changes alongside over-the-counter (OTC) and home remedies to manage pain and inflammation, such as:

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • acetaminophen
  • topical creams and ointments containing NSAIDs or capsaicin
  • heat or cold pads

Acupuncture may help, but there’s not enough research evidence to confirm its effectiveness.

Experts no longer recommend massage therapy as a treatment for OA. However, it may help relieve stress and anxiety, which are common with conditions that involve chronic pain.

Pain management

In time, OTC and home remedies may no longer be effective. Your doctor may prescribe stronger medication, such as:

Advanced OA, however, may have a profound impact on your daily life. At this point, surgery may be appropriate.


In rare cases, partial surgery may be suitable if OA results from an injury, or if your OA isn’t advanced. However, partial surgery isn’t usually performed, as the outcomes don’t last long.

As OA progresses, a total joint replacement may be a more suitable option. Here’s a general breakdown of the types of OA surgery:

  • Osteotomy. Your surgeon will reshape the bone to improve the alignment of the joint.
  • Arthroscopic debridement. Your surgeon removes loose pieces of bone and cartilage that have broken off in the joint due to OA damage.
  • Total joint replacement. Your surgeon will remove damaged tissue and replace the joint with an artificial one made of plastic and metal.

Joint replacement surgery can be disruptive to your life, but it’s temporary. Many people find it has a positive impact on their quality of life once they recover.

For example, more than 90 percent of those who undergo knee replacement surgery report a significant improvement in their pain levels and mobility levels, according to the American Academy of Orthopaedic Surgeons.

OA is a common problem with symptoms that tend to worsen over time.

A range of treatment options can help you manage OA in the early stages, but advanced OA can have a significant impact on your mobility and quality of life. Managing pain becomes more challenging.

Talk to your doctor about suitable options. If you think joint replacement surgery may be appropriate for you, discuss the pros and cons with your doctor. They can help you decide what’s best for you.

There’s currently no cure for advanced OA, but research is ongoing. One day, it may be possible to get an early diagnosis that would enable treatment before OA symptoms appear.

Other options include regenerative therapies, which could heal cartilage or trigger new growth.