Osteoarthritis is one of the main causes of long-term pain and disability, affecting over two million people in Australia.
Surprisingly, getting an x-ray isn’t necessary to diagnose this condition.
Doctors can usually tell if someone has knee osteoarthritis just by talking with them and looking at their symptoms and medical history.
Still, about half of the people who see a GP for knee osteoarthritis are sent for imaging. These unnecessary scans cost the Australian healthcare system more than $100 million every year.
A new study has shown that using x-rays to diagnose knee osteoarthritis may actually affect how people think about their pain. It could even lead some to consider knee replacement surgery, even when it might not be needed.
What is osteoarthritis, and how does it affect people? The condition happens when the joint tries to repair itself from wear, injury, or overuse. It affects not just the bones, but also the cartilage, muscles, and ligaments around the joint.
Older people, people with past knee injuries, and those with higher body weight are more likely to have it. Symptoms usually include pain and difficulty doing everyday things like walking or using stairs.
While some people end up needing surgery, that’s not always necessary. In fact, more than 53,000 people had knee replacements in 2021–22 in Australia, but this option should be saved for those with very severe symptoms. Surgery has risks, including blood clots and infections, and doesn’t always lead to full recovery.
The good news is that most people with knee osteoarthritis can manage their condition through non-surgical treatments such as learning how to manage their condition, staying active, losing weight if needed, and using medication like paracetamol or anti-inflammatory drugs.
One common myth is that osteoarthritis is simply “wear and tear.” But x-rays don’t show the full story. Some people with mild joint changes on x-rays have very bad pain, while others with more severe changes might feel fine.
That’s why guidelines now recommend that doctors diagnose knee osteoarthritis based on symptoms, especially if the person is over 45 and has joint pain during activity, but not stiffness lasting more than 30 minutes in the morning.
Even though x-rays aren’t recommended, many doctors still use them—and many patients expect them. So what did the recent study look at?
Researchers asked 617 people from across Australia to watch videos of a doctor diagnosing knee osteoarthritis in three different ways: with no x-ray, with an x-ray but no image shown, and with an x-ray and the image shown.
After watching the videos, participants filled out a survey. The results showed that people who were shown their x-ray felt they needed surgery more than those who didn’t get an x-ray. They also feared that exercise could harm their joint, were more worried their condition would get worse, and were more afraid to move.
People were slightly more satisfied when they saw their x-ray. This might be because many still believe the idea of “wear and tear,” and they think seeing damage is necessary to choose a treatment.
So what can we learn from this? Avoiding unnecessary x-rays can reduce fear, lower anxiety about joint damage, and may prevent some people from rushing into costly and risky surgery. It can also reduce exposure to radiation and save money for the healthcare system.
If you have knee osteoarthritis, remember: an x-ray isn’t always needed. There are many ways to treat your pain and improve your movement without surgery. Speak with your doctor about the best treatment plan for you.
If you care about pain, please read studies about Scientists find a new way to manage knee pain and findings of Promising new drug offers hope for chronic nerve pain relief.
For more about pain, please read studies about Chronic morphine use for cancer pain may increase bone loss and findings of Scientists find a new hope for chronic pain.
The study is published in PLOS Medicine.
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