June 2, 2025, 5:02 pm | Read time: 7 minutes
Osteoarthritis is the most common joint disease worldwide. How to prevent it and why surgery should be the last resort—FITBOOK summarizes the key facts and latest findings.
Hiking, badminton, dancing—activities that once seemed routine can suddenly become painful with osteoarthritis. The disease attacks all joints, from the shoulder to the ankle, but the knee is particularly affected. Osteoarthritis gradually destroys the cartilage in the joint, which serves as a cushion between the bones. When the bare bones rub against each other, the pain becomes unbearable for those affected. Osteoarthritis is incurable, making it all the more important to prevent it and take timely action at the first signs of the disease.
Overview
What Is Osteoarthritis?
Osteoarthritis refers to the gradual wear and tear of joint cartilage. This involves the smooth cartilage layer that covers the joint surfaces of the bones and acts as a shock absorber to cushion stress. It prevents bones from rubbing directly against each other. As cartilage deteriorates, the joint loses protection, resulting in pain, stiffness, and limited mobility. “Osteoarthritis refers to the wear and tear of joint cartilage, which is usually age-related,” experts explain. When bones rub against each other, symptoms worsen, and joint function further declines. Osteoarthritis is incurable, but there are treatments that can slow the progression of the disease.1
Prevalence
According to the Robert Koch Institute (RKI), osteoarthritis is very rare in young people (ages 18 to 29), but the likelihood increases significantly after age 45. Among women aged 45 to 64, 23.2 percent have osteoarthritis, compared to only 16.6 percent of men. The difference becomes even more pronounced with age: Nearly half of women (48.1 percent) and almost a third of men (31.2 percent) over 65 are affected.
Why women develop osteoarthritis more often than men is unclear. According to the RKI, hormonal changes during menopause could be a reason. However, studies have not yet yielded definitive results.
Types of Osteoarthritis
Generally speaking, the human body has about 140 true joints—meaning joints consisting of two bones separated by a joint gap. Osteoarthritis can occur in any of these joints, but the most commonly affected are:
- Hip joint (Coxarthrosis)
- Knee joint (Gonarthrosis)
- Hand and finger joints
The disease often progresses slowly, making it crucial to pay attention to symptoms like pain and limited mobility early on and take appropriate treatment measures.
Causes of the Disease
The disease primarily occurs when joints are excessively stressed over a long period. This can happen in certain sports, such as squash, especially when practiced professionally. It also includes occupational stresses like constant kneeling and lifting. Injuries, bacterial infections, or misalignments, such as knock-knees or bowlegs, can also trigger osteoarthritis. A major risk factor is obesity, with the knee often being affected in obese individuals.
Symptoms
Osteoarthritis often first manifests with the so-called “start-up pain.” The German Rheumatism League describes this as the uncomfortable feeling when you get up and struggle to get going because of pulling in the knee or hip. Initially, this pain is not very severe and occurs only occasionally. Over time, walking becomes increasingly strenuous, and the pain becomes a constant companion. The affected joint may also swell. The German Rheumatism League warns: “Pain is an alarm signal,” indicating that joint destruction is already in full swing.
Risk Factors that Favor the Development of Osteoarthritis
Various influences can accelerate cartilage wear in the joints. Biological risk factors include:
- Inflammations and previous injuries, such as meniscus damage, ligament tears, or bone fractures
- Genetic factors, if arthritis has occurred frequently in the family
- Misalignments of joints, such as in the knee or hip
- Advancing age, especially after age 50
- Female gender
In addition to these biological causes, lifestyle factors also contribute to the development of osteoarthritis:
- Lack of exercise, such as prolonged sitting in the office, can weaken muscles, promote posture damage, and accelerate cartilage breakdown
- Excess weight puts a heavy strain on the joints—the risk of osteoarthritis in the knee and hip is four to five times higher with severe obesity
- Sports with high joint stress, such as handball, soccer, boxing, or wrestling, can increase the risk
- Unilateral or incorrectly learned movement patterns, such as through monotonous work processes or intense sports stress, can lead to overload
- Activities requiring frequent kneeling, bending, squatting, or heavy lifting, as is common in some professions, also heavily strain the joints2
Diagnosis
If osteoarthritis is suspected, one should see an orthopedist as soon as possible. This is the only way to prevent or delay surgeries. A doctor can use ultrasound and X-ray images to determine whether it is osteoarthritis and how advanced it is.
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Treatment of Osteoarthritis
Avoid or Reduce Excess Weight
Every pound less is a relief for those affected (and for the joints). This is scientifically proven. In a 2018 study, 240 obese participants with mild to moderate osteoarthritis were observed over a long period. The result: Those who lost 20 percent of their weight experienced 25 percent less pain.3
Exercise
Those with joint pain often instinctively tend to rest the affected body part. However, instead of putting your legs up when experiencing knee pain, the German Rheumatism League advises movement—but correctly! Therefore, an orthopedist often prescribes physical therapy in the early stages of osteoarthritis. There, you learn how to keep your joints mobile and properly load them. In general, those who want to exercise should opt for joint-friendly activities like swimming and cycling.
Medication Therapy
- Painkillers: If osteoarthritis is so painful that walking becomes difficult, painkillers can help you stay active. The RKI recommends starting with simple medications like acetaminophen. If these are not enough, nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed. They have anti-inflammatory effects but can affect the stomach and should be taken only for a short time.
- Cortisone: If osteoarthritis is already advanced, cortisone can help. It is injected directly into the joint and reduces inflammation. Patients are usually pain-free for weeks afterward. However, cortisone injections are not a long-term solution due to their strong side effects.
- Hyaluronic acid: Some doctors inject this substance into the joint. Health insurance usually does not cover the costs. This therapy is part of the so-called Individual Health Services (IGeL). The reason is that a positive effect has not been sufficiently proven.4
- Chondroitin: This is a component of cartilage tissue, available in capsule form from various manufacturers. It is said to inhibit cartilage breakdown and relieve symptoms. The Consumer Center is skeptical and points to contradictory study results. This is also why providers have not been allowed to advertise their chondroitin-containing supplements with slogans like “For healthy joints” since 2012.
Joint Endoscopy
During a joint endoscopy, or arthroscopy, the doctor makes small incisions in the skin. Through these, they access the joint and can remove loose cartilage pieces, for example. However, patients should not expect too much from this procedure. The Dresden University Center for Orthopedics, Trauma, and Plastic Surgery notes on its website that osteoarthritis is not eliminated by this procedure, and symptoms can reappear within weeks after the intervention.
Cartilage Transplantation
If osteoarthritis is localized to a specific area, cartilage transplantation can be beneficial and yield good results. If a large area is damaged, such a procedure is less promising. During cartilage transplantation, cartilage tissue is removed from the joint using arthroscopy, multiplied in the lab, and then reinserted.
Surgery and Artificial Joints
If there is a congenital or injury-related misalignment of the legs, the knee joint is often heavily stressed on one side. To compensate for this, the legs are straightened during surgery. Ideally, this slows down knee osteoarthritis, giving patients several years of relief.
If osteoarthritis is severe and all other treatment options (medication, physical therapy) have been exhausted, only one option remains: replacing the damaged joint with an artificial implant–either a partial or full prosthesis. Such surgery always carries the risk of infection. The Dresden University Center for Orthopedics, Trauma, and Plastic Surgery states: “This risk exists not only in the first weeks after surgery but can also occur in later years.” Severe obesity can further increase the risk of infection. Therefore, a joint prosthesis is the last resort and is reserved for older people, as such a prosthesis usually lasts only ten years.