Osteoarthritis in Young People

Definition[edit | edit source]

Runners-knee SAG.jpeg

Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly (who are mostly inactive), athletes and younger individuals are also susceptible.

  • Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations.
  • Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance.
  • However, the treatment of OA in these populations does not differ from its management in the general population[1].

Potential Causes[edit | edit source]

There are a whole range of potential causes of osteoarthritis in young adults (14-40). These include –

  • Leading a sedentary (non-active) lifestyle
  • Poor posture when sitting for long periods
  • Heavy lifting (potentially with poor technique, but not necessarily)
  • Doing an office job with large amounts of sitting at a desk/ computer
  • Being overweight or clinically obese
  • Being very active (running lots of marathons for example)
  • Playing impact sports such as rugby or football
  • Joint injuries
  • Birth defects such as hip dysplasia or different length legs
  • Hormone disorders that affect growth
  • Diabetes
  • Osteoarthritis in the family[2][3]

Assessment[edit | edit source]


Assessment of OA in younger people should focus on a:

  • Patient-centred history,
  • Comprehensive physical examination,
  • Performance-based measures
  • Patient-reported outcome measures to enable monitoring of symptoms and function over time.

Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA.

Treatment Approach[edit | edit source]


The treatment of OA in these populations does not differ from its management in the general population.[1] See


Nonpharmacological approaches are core strategies for the management of OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss.

  1. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA.[4]
  2. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective.[2]

Prevention[edit | edit source]


The prevention of development of osteoarthritis in the adolescent can be achieved by reducing risk factors.

  1. Physiotherapists can promote the maintenance of a healthy weight, low-impact activities (eg aquatherapy) giving exercises to improve joint stability to prevent joint injuries.[5] They can have influence by preventing further progression or complications of a disorder and improving the patient’s self-efficacy.[6]
  2. In case of malalignments (leg-length discrepancy, varus/valgus, etc.) young patients should be referred to a podiatrist for Introduction to Orthotics to prevent the development of OA (in the hip or knee).
  3. During the very early stages, physiotherapists can guide on strengthening the muscles of the knee joint which can reduce further damage to joint.

References[edit | edit source]

  1. 1.0 1.1 Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2014 Jan;7:CMAMD-S14386.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/(accessed 17.10.20210
  2. 2.0 2.1 Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. journal of orthopaedic & sports physical therapy. 2017 Feb;47(2):67-79.Available: https://www.jospt.org/doi/full/10.2519/jospt.2017.7286(accessed 17.10.2021)
  3. Oddis CV. New perspectives on osteoarthritis. The American journal of medicine. 1996 Feb 26;100(2):10S-5S.Available: https://www.sciencedirect.com/science/article/abs/pii/S0002934397895411(accessed 17.10.2021)
  4. Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (nonarthroplasty). JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2022 May 1;30(9):e721-9.
  5. Nicholson S. et al. Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening. (2009) Journal of Pediatric Nursing, 24, 69-74 (B)
  6. van Doormaal MC, Meerhoff GA, Vliet Vlieland TP, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020 Dec;18(4):575-95. Availabe: https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1492(accessed 23.10.2021)