Treatment for Osteoarthritis

Are Joint Pains Affecting Your Daily Life?

“My knee hurts a lot when I climb stairs. Could it be osteoarthritis?”

“My doctor recommended a joint replacement, but I’m not ready yet — are there other options?”

“Should I choose PRP or hyaluronic acid? What is the difference?”

“I have developed swelling in my finger joints, and they seem to be getting worse.”

Osteoarthritis (OA), also known as joint degeneration or wear-and-tear arthritis, is a chronic joint disease characterized by progressive loss of cartilage, changes in the bone beneath the cartilage, inflammation of the tissues surrounding the joint, and the formation of osteophytes (bone spurs) around the joint edges. Affecting more than 500 million people worldwide, OA is ranked as the 4th most common chronic disease according to the Global Burden of Disease study (Vos et al., The Lancet, 2012).

An important fact: Osteoarthritis is not simply an “aging disease” or an unavoidable outcome of getting older — and not every OA patient requires joint replacement surgery. With the right treatment approach, many patients can maintain an active and high-quality life for years.

Which Condition Are You Experiencing?

(Go directly to the relevant section)

-My knee hurts — could it be knee osteoarthritis?

-My hip hurts — could it be hip osteoarthritis (coxarthrosis)?

-My finger joints hurt and are changing shape — what does this mean?

-OA appears on my X-ray — is surgery necessary?

-PRP or hyaluronic acid — what is the difference?

-Exercise in OA — does it damage the joints?

-What is the relationship between weight and osteoarthritis?

Knee Osteoarthritis (Gonarthrosis) / Reduced Joint Fluid / Knee Calcification

“My Knee Hurts a Lot When I Climb Stairs” — Does This Sound Familiar?

Common symptoms include:

-Knee pain, especially when going down stairs, squatting, or walking for long periods

-Morning stiffness (lasting less than 30 minutes)

-Swelling and increased warmth around the knee (during periods of synovitis)

-Crepitus (crackling or grinding sounds) during movement

-X-ray or MRI findings such as “narrowing of the joint space” and “osteophyte formation”

Knee osteoarthritis is one of the most common joint diseases in people over the age of 45. The prevalence of radiographic knee OA can reach 44% by the age of 70 (Lawrence et al., Arthritis & Rheumatism, 2008).

However, the relationship between radiological severity and pain severity is not always direct. Some individuals may have significant osteoarthritis changes on imaging but experience little or no pain, while others may experience severe pain despite minimal findings on imaging.

Every 1 kg of weight loss can reduce the cumulative load placed on the knee joint by approximately 4 times. This highlights the important role of weight management as part of a comprehensive osteoarthritis treatment approach.

Hip Osteoarthritis (Coxarthrosis): “My Groin Hurts and Walking Has Become Difficult”

Coxarthrosis (hip osteoarthritis) is characterized by deep pain in the groin, front of the hip, or thigh, limited walking ability, and restricted internal rotation of the hip joint. Clinical guidelines from organizations such as NICE and EULAR recommend exercise, weight management, and patient education as first-line approaches before pharmacological or surgical treatments in hip osteoarthritis.

At Dr. Zer Clinic, we utilize regenerative treatment approaches for hip osteoarthritis, including PRP therapy, exosome therapy, and stem cell-based treatments, based on individual patient assessment. For osteonecrosis of the hip, which is one of the important causes associated with hip joint deterioration, advanced technologies such as shock wave therapy may also be considered. Combined with personalized physical therapy programs, these approaches may help patients achieve a more comfortable and active lifestyle.

Hand Osteoarthritis: “I Have Developed Swelling in My Finger Joints”

Hand osteoarthritis (OA) includes involvement of:

-Heberden’s nodes (DIP joint involvement)

-Bouchard’s nodes (PIP joint involvement)

-CMC1 joint osteoarthritis (thumb base joint)

The prevalence of radiographic hand osteoarthritis exceeds 70% in individuals over the age of 70.

Thumb base osteoarthritis is one of the conditions that most significantly affects gripping and pinching functions. Since the thumb joint is actively involved in approximately 90% of daily hand activities, involvement of this joint can lead to significant functional limitations. It is frequently observed in individuals performing repetitive hand activities and tends to increase after menopause.

Hand osteoarthritis can sometimes be confused with rheumatological diseases. However, with expert evaluation and musculoskeletal ultrasound, an accurate diagnosis can often be made quickly.

At our clinic, regenerative treatment approaches used for osteoarthritis may help reduce symptoms and slow functional decline related to finger joint degeneration. Preserving the biomechanical function of the hand — one of the most important tools in human daily life — can help maintain independence and quality of life.

Is Surgery Always Necessary for Osteoarthritis?

No — especially not in early and moderate stages.

According to AAOS and EULAR guidelines, surgery is generally considered for patients with severe functional limitations who do not respond adequately to comprehensive non-surgical treatments.

Important factors in joint replacement decisions include:

-Severity of pain

-Limitation of daily activities

-Response to conservative treatments

-Degree of joint damage

-Overall health condition of the patient

At Dr. Zer Clinic, we focus on improving symptoms with non-surgical treatment approaches whenever appropriate. Many patients can be managed without surgery. Only a small percentage of patients have advanced osteoarthritis that does not respond to available treatment options and may require surgical evaluation.

PRP or Hyaluronic Acid? Comparison of Biological Treatments

Hyaluronic Acid (Viscosupplementation)

Hyaluronic acid injections are designed to support the natural hyaluronic acid found within the joint. They may help reduce friction between cartilage surfaces and improve the viscoelastic properties of joint fluid.

Commonly described as a “lubricating gel” injection, hyaluronic acid products are prepared medical treatments used to support joint function.

Evidence: Meta-analyses suggest that hyaluronic acid injections may provide moderate improvements in pain and function compared with placebo in knee osteoarthritis. The effect generally begins later than corticosteroid injections but may last longer, typically around 3–6 months.

PRP (Platelet-Rich Plasma)

PRP is a regenerative treatment prepared from the patient’s own blood. Platelet-rich plasma contains growth factors that may support tissue repair processes, help regulate inflammation, and contribute to joint health.

PRP is obtained entirely from the patient’s own blood, making it an autologous and natural treatment approach. It is one of the commonly used methods in regenerative medicine.

At Dr. Zer Clinic, a small amount of blood is collected from the patient, and platelets with regenerative potential are separated using specialized techniques. The prepared PRP can then be administered into the affected area, with or without ultrasound guidance depending on the clinical situation.

Evidence: Systematic reviews suggest that PRP may provide longer-lasting and more significant pain relief compared with hyaluronic acid injections in knee osteoarthritis. The most favorable outcomes are generally observed in early to moderate stages of osteoarthritis.

Corticosteroid Injections

Corticosteroid injections can provide rapid inflammation control during periods of acute synovitis (joint inflammation).

However, repeated corticosteroid injections may have negative effects on cartilage health. Therefore, their use should be carefully planned and generally limited, often to approximately one injection per year depending on the individual clinical situation and medical assessment.

New Generation Biological Treatments

Ozone Therapy

Intra-articular ozone injections may provide anti-inflammatory and analgesic effects for joint-related conditions. The scientific evidence base for this approach is continuing to develop.

Exosome and Stem Cell Therapies

Exosome and stem cell-based treatments are emerging regenerative approaches that aim to support cartilage repair and tissue regeneration. Although they have not yet become part of standard treatment protocols, ongoing research suggests potential regenerative benefits.

One example is the use of stromal vascular fraction (SVF) obtained from adipose (fat) tissue. In this approach, a small amount of the patient’s own fat tissue is collected, processed, and prepared for injection. Since adipose tissue contains a rich source of mesenchymal stem cells, these cells may support tissue repair processes and potentially contribute to cartilage regeneration.

This regenerative approach aims to improve joint function and influence disease progression. Regenerative changes may develop gradually, typically over a period of 3–6 months, depending on individual patient factors.

Exercise in Osteoarthritis: “Does Movement Wear Out the Joints?”

No — on the contrary. This is one of the most common and potentially harmful misconceptions about osteoarthritis.

Cochrane systematic reviews have shown strong evidence that exercise can reduce pain and improve function in knee osteoarthritis. Exercise supports cartilage nutrition (cartilage does not contain blood vessels; nutrients are supplied through diffusion), strengthens the surrounding muscles, and helps reduce stress placed on the joint.

Recommended Exercises for Osteoarthritis:

-Swimming and water aerobics (minimal joint loading)

-Cycling (with low resistance)

-Walking (preferably on flat surfaces)

-Tai Chi (balance and muscle strength)

-Pilates (core strengthening)

-Quadriceps strengthening exercises (especially important for knee osteoarthritis)

Quadriceps Weakness and Knee Osteoarthritis

Quadriceps muscle strength is both associated with the development and progression of knee osteoarthritis.

Weak quadriceps muscles reduce the knee’s shock absorption capacity, increasing stress on the cartilage. Strong quadriceps muscles have the opposite effect by improving joint stability and reducing mechanical load.

For this reason, quadriceps strengthening is one of the most important exercise components in knee osteoarthritis management.

The Relationship Between Weight and Osteoarthritis: The Most Important Modifiable Factor

Obesity is one of the strongest modifiable risk factors for osteoarthritis.

Every 1 kg of excess body weight may place approximately 4 kg of additional load on the knee joint during movement. Losing 10 kg of weight may significantly reduce the mechanical stress placed on the knees.

The Framingham Study demonstrated that overweight women had approximately a fourfold higher risk of developing symptomatic knee osteoarthritis compared with women at a healthy weight. The same study reported that losing 5 kg of body weight was associated with a significant reduction in the risk of developing knee OA.

Osteoarthritis Treatment: A Step-by-Step Approach

Step 1 (Recommended for Every Patient)

-Patient education and understanding of the condition

-Individualized exercise program

-Weight management

Step 2 (In Addition to Step 1)

-Topical NSAIDs (local anti-inflammatory pain relief)

-Oral NSAIDs (short-term and medically controlled use)

-Physical therapy modalities (TENS, ultrasound, laser therapy)

Step 3 (For Patients Who Do Not Respond Adequately to Steps 1–2)

-PRP injections

-Stem cell and/or exosome-based treatments

-Polynucleotide injections

-Hyaluronic acid and biological hydrogel injections

-Corticosteroid injections (for acute inflammatory flare-ups)

Step 4 (For Advanced Cases Not Responding to Previous Treatments)

-Surgical evaluation

-Total joint arthroplasty (joint replacement surgery)

At Dr. Zer Clinic, treatment planning is personalized according to the patient’s symptoms, clinical findings, imaging results, and individual needs. The goal is to support joint function, reduce pain, and help patients maintain an active quality of life whenever possible.