Osteoarthritis natural history, complications and prognosis

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Osteoarthritis natural history, complications and prognosis

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Natural History, Complications and Prognosis


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2], Irfan Dotani [3].


The orthopedic surgeons are frequently asked by their patients regarding the final outcome and the prognosis of their diseased joint/joints caused by OA.

Natural History

Information about the natural history of OA is very important for upcoming determinations and planning for patients management. A small number of studies are available studied the role of the radiographic findings, joint congruence, or even the daily life activity on the OA progression [1][2][3][4][5] :

Hip OA

Its been reported that the patients with unilateral idiopathic hip OA are most likely to develop OA in the contralateral hip. In a 10 years expectancy, the frequencies of OA development and undergoing the total hip total hip replacement (THR) among the contralateral hips considered as normal are 35-45% and 5-20%, respectively. Therefore, due to the importance of this topic and lack of confidential information in this regard, a long-term longitudinal study is needed in order to answer this big question that how often and how long does takes for symptomatic joint injury and the requirement of surgical involvement in this regard. Meanwhile, the incidence and prevalence rates of THR in hip OA were 2.5% and 17%, respectively.

Knee OA

Based on the radiological evaluation of knee OA, the incidence rate of knee OA was 2-4% annually and this incidence rate was higher among women. Though most importantly, its been reported that the incidence rate of OA in radiography evaluations was twice higher than symptomatic OA which highlights the role of radiography in this regard. In a cohort study, the OA progression in a 3-year evaluation reported to be 15.5%.

Hand OA

The hand as the most common and important peripheral site of osteoarthritis (OA), because the hand involvement in OA could affect patients life through disability. Meanwhile, the base of the thumb, and distal interphalangeal joints (DIPs), proximal interphalangeal joints (PIPs) of fingers are the most common site for hand OA. The prevalence of hand OA among men and women older than 65 years is 64-78% and 71 to 99%, respectively.


OA is a leading cause of morbidity having significant effects on patients life and the health care system and even it could cause heavy economic burden. According to the American Academy of Orthopedic Surgeons report movement limitation are found in 80% of adults diagnosed with osteoarthritis. Meanwhile, 25% of these patients facing difficulties in their of daily living activities. 11% of them need personal care assistance and 14% required help with their routine needs.

Unfortunately, despite high prevalence and influence of OA on human life, there are only a limited studies working on the complications caused by OA. Possible complications of osteoarthritis include[6][7][8][9]:

  • Gout.

Gout is known as an inflammatory form of arthritis caused by high amount of urate leading to sodium urate crystals formation around the involved joints. Gout may affect the cartilage system and trigger the crystal formation, especially in cases with higher serum levels of urate. In the foot, osteoarthritis in the big toe is a common site for involvement it could be considered as a common site of the occurrence of gout.

Osteoarthritis can also lead to calcium pyrophosphate crystals formation in diseased cartilage. This is process named calcification or chondrocalcinosis. Chondrocalcinosis can be developed in any joint, with/without the existence of osteoarthritis. In a patient with osteoarthritis, chondrocalcinosis is common in the knee.

  • Long-term (chronic) pain.
  • Rapid and the complete breakdown of cartilage resulting in loose tissue material in the joint (chondrolysis).
  • Joint deformities (hard or bony nodules that form where two bones come together, often giving the joint a knobby or knotted appearance)
  • Bone death (osteonecrosis).
  • Stress fractures (hairline crack in the bone that develops gradually in response to repeated injury or stress).
  • Muscle weakness (often occurs when a joint becomes too painful to use, especially with knee osteoarthritis).
  • Bleeding within the joint.
  • Infection in the joint.
  • Deterioration or rupture of the tendons and ligaments around the joint, leading to loss of stability.
  • Pinched nerve (in osteoarthritis of the spine).
  • Depression.
  • Anxiety.
  • Sleep disruption.
  • Weight gain.
  • Difficulty performing daily activities and Reduced productivity.
  • Loss of independent living.
  • Impaired balance.
  • Increased risk of falling.


  • Most osteoarthritis cases do stabilize[10].
  • Some osteoarthritis cases progress[11].
  • A small number of osteoarthritis patients improve spontaneously[11].


  1. Anania A, Abdel MP, Lee YY, Lyman S, González Della Valle A (October 2013). "The natural history of a newly developed flexion contracture following primary total knee arthroplasty". Int Orthop. 37 (10): 1917–23. doi:10.1007/s00264-013-1993-3. PMC 3779550. PMID 23835560.
  2. Amstutz HC, Le Duff MJ (August 2016). "The Natural History of Osteoarthritis: What Happens to the Other Hip?". Clin. Orthop. Relat. Res. 474 (8): 1802–9. doi:10.1007/s11999-016-4888-y. PMC 4925421. PMID 27172820.
  3. Wyles CC, Heidenreich MJ, Jeng J, Larson DR, Trousdale RT, Sierra RJ (February 2017). "The John Charnley Award: Redefining the Natural History of Osteoarthritis in Patients With Hip Dysplasia and Impingement". Clin. Orthop. Relat. Res. 475 (2): 336–350. doi:10.1007/s11999-016-4815-2. PMC 5213917. PMID 27071391.
  4. Clarson LE, Nicholl BI, Bishop A, Daniel R, Mallen CD (April 2016). "Discussing prognosis with patients with osteoarthritis: a cross-sectional survey in general practice". Clin. Rheumatol. 35 (4): 1011–7. doi:10.1007/s10067-015-3094-8. PMC 4819557. PMID 26474771.
  5. Bloch B, Srinivasan S, Mangwani J (2015). "Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review". J Foot Ankle Surg. 54 (5): 932–9. doi:10.1053/j.jfas.2014.12.042. PMID 26028603.
  6. Hawker GA, Croxford R, Bierman AS, Harvey P, Ravi B, Kendzerska T, Stanaitis I, King LK, Lipscombe L (January 2017). "Osteoarthritis-related difficulty walking and risk for diabetes complications". Osteoarthr. Cartil. 25 (1): 67–75. doi:10.1016/j.joca.2016.08.003. PMID 27539890.
  7. NEUWIRTH E (September 1954). "Neurologic complications of osteoarthritis of the cervical spine". N Y State J Med. 54 (18): 2583–90. PMID 13194134.
  8. Dekker J, van Dijk GM, Veenhof C (September 2009). "Risk factors for functional decline in osteoarthritis of the hip or knee". Curr Opin Rheumatol. 21 (5): 520–4. doi:10.1097/BOR.0b013e32832e6eaa. PMID 19550331.
  9. Heidari B (2011). "Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I". Caspian J Intern Med. 2 (2): 205–12. PMC 3766936. PMID 24024017.
  10. Hochberg MC (September 1996). "Prognosis of osteoarthritis". Ann. Rheum. Dis. 55 (9): 685–8. PMC 1010279. PMID 8882152.
  11. 11.0 11.1 Anandacoomarasamy A, March L (February 2010). "Current evidence for osteoarthritis treatments". Ther Adv Musculoskelet Dis. 2 (1): 17–28. doi:10.1177/1759720X09359889. PMC 3383468. PMID 22870434.

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