Osteoarthritis (OA) afflicts a significant number of aging adults with a rapid increase due to rising life expectancy, modern lifestyles and obesity. 

Symptomatic knee and hip OA affects 20-30% of adults over 65 years of age. The lifetime risk of developing knee and hip OA symptoms is estimated at 45%. Aggravating factors are age, injuries, mechanical stress and obesity, genetic as well as anatomical factors such as laxity or vulsion of the joint. 

The incidence of shoulder OA is 94% in women and 85% in men over 80 years of age. Significant pain, functional limitation and deficiency is present in 4-26%. 

The radiological picture does not reliably correlate with the clinical manifestations. 25.8% of patients with Kellgren-Lawrence (KL) grade 3-4 OA report no pain, with underlying pathology, pain sensitization, adaptation to chronic pain, and reduced mobility to avoid pain playing a regulatory role. Knee pain is reported by 15-81% of individuals with fluoroscopic knee AO.

 In advanced OA, surgical arthroplasty is the solution. 

• 90% of patients are better after Total Knee Arthroplasty 

• 95% of patients are better after Total Hip Arthroplasty. 

• However, 15-20% of patients have chronic pain after arthroplasty without obvious clinical or radiological reasons. 

• The frequency of chronic pain after Hip Arthroplasty is up to 28% of patients. 

There are though patients in which the surgical solution is not possible or desirable such as: 

 • When arthroplasty is not an appropriate option such as in mild to moderate OA, relatively young or very old age, coexisting pathological problems, obesity, implant life and revision surgery.

  • When it is not acceptable to the patient, for example when perioperative and long-term risks coexist.

  • When there is already persistent pain after previous arthroplasty such as in failed arthroplasty, infection, neuromas, central sensitization, surgical denervation, neovascularization and disorders of neural architecture.

  • Long wait for joint replacement.

 What are the options for conservative treatment of pain and functional limitation in the above cases based on the existing clinical evidence? • Weight loss in patients with a Body Mass Index greater than 25%.

  • Strength training and low-intensity aerobic exercise to help slow progression, reduce pain and reduce the risk of falling. 

  • Non-Steroidal Anti-Inflammatory Medicines which are the most effective treatment for osteoarthritis pain and joint function for four to six weeks, topically or systemically, when there are no contraindications.

  • Intra-articular injection of steroid with or without a combination of hyaluronic acid that can provide relief for four to six weeks.

  • Prolotherapy and biological agents with relief for three to six months.

  • Blockage or electrical stimulation of the sensory nerves of the joint and neurolysis with relief for three to six months to a year. 

Blockade, electrostimulation and neurolysis of the sensory nerves of the knee, hip and shoulder joints are used in the treatment of chronic osteoarthritis pain as well as perioperative pain since they do not affect muscle function and therefore mobility. The basis of the pathophysiology in osteoarthritis is chronic inflammation rather than wear and tear of the joint. This chronic inflammation causes peripheral and central sensitization of the nervous system in which the autonomic nervous system also participates, causing functional changes and systemic inflammation. Peripheral neuromodulation through blocks, electrical stimulation and neurolysis intervenes and rebalances the nervous system and reduces the associated inflammation, resulting in decreased pain and increased functionality. In this way, it can potentially affect as well the progression of osteoarthritis. In combination with intra-articular injections and prolotherapy for better results, it helps to limit drug therapy to a maintenance regimen.

 Perioperatively, nerve blocks and electrical stimulation provide excellent analgesia, reduce to a minimum the need of opioid analgesics and their related side effects, making immediate mobilization of the patient possible.

 Finally, they can contribute to restoring the mobility of a joint after an injury or in chronic pain conditions by facilitating the performance of physiotherapy exercises without pain