Osteoarthritis is not simply a joint that wore out. It affects the whole joint and the tissues around it. Its known risk factors include metabolic disease such as diabetes and obesity. Obesity is a risk factor for the hip and knee in particular. It brings metabolic problems and whole-body inflammation, as well as extra load on the joint [1].
That is what terrain means in practice. The biological setting a joint sits in shapes how it wears down and how it acts day to day. It is also why two people with similar X-rays can have very different symptoms.
How common is osteoarthritis, and who gets it?
In 2019, about 528 million people worldwide were living with osteoarthritis. That is up 113% since 1990. About 73% of them are older than 55, and 60% are female. The knee is the joint hit most often, at 365 million, followed by the hip and the hand. Some 344 million people are at moderate or severe levels that could benefit from rehab [1].
One more point from the same source is worth keeping: osteoarthritis is not an unavoidable result of aging [1]. That matters, because “you are just getting older” ends the conversation, and it should not.
What causes osteoarthritis besides wear and tear?
The known risk factors for osteoarthritis go beyond the joint itself. One is injury to the joint from a break, a strain, or repeated stress at work or in sport. Another is an earlier joint disease such as rheumatoid arthritis or gout. Others are metabolic diseases such as diabetes, plus obesity, genes, and social factors such as age and being female [1].
Obesity is the one that most clearly links the mechanical and the metabolic. It is a risk factor specifically for hip and knee osteoarthritis. It brings metabolic problems and whole-body inflammation, and it puts extra load on the joint [1]. Both halves of that description matter.
Why does arthritis pain show up even at rest?
Patients often describe pain that does not match what they did that day. That is documented. Symptoms can build slowly or start fast after an injury or strain. Some people feel pain even at rest [1].
Moving less then feeds back into the whole body. Being less active can lead to heart and blood vessel disease, obesity and diabetes [1]. The joint and the terrain are not two systems having two separate talks.
What this changes about your evaluation
At Regen.MD in St. Louis, terrain is not a slogan. It is a set of inputs. Our evaluation is a physician-led Clinical Evaluation. Your history, imaging and metabolic data are reviewed together. It produces a written roadmap, not an instant procedure.
Where the findings support it, we discuss the orthobiologics we offer. These are platelet-rich plasma (PRP) for joints and tendons, intraosseous and subchondral PRP (placed into the bone), bone marrow aspirate concentrate, Lipogems, and intradiscal orthobiologics (disc treatments). For advanced knee arthritis, PRP is a bridge before joint replacement. Nothing we use is claimed to rebuild lost cartilage.
When is joint replacement surgery the right answer?
Joint replacement surgery can reduce pain, restore movement and improve quality of life for most people with badly affected joints. These operations are done most often at the hip and knee [1]. A terrain-first evaluation does not argue with that.
What it changes is the order. Conservative care comes first. When it has run out, surgery is part of the plan. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a surgeon. The practice provides surgery at that stage instead of handing the decision off.
When the problem started with an event and not with time, the same case holds on a shorter clock: terrain first, then the catalyst, after an injury.
For more information, get our free guide to knee pain and treatment options.
Have your joint pain evaluated as a whole-system problem
Regen.MD begins with a physician-led Clinical Evaluation — a review of your history, imaging, and metabolic data, and a written roadmap for what to do next. Evaluation is contingent upon review of your data.
Questions? Call or text us.
Regen.MD, 4477 Woodson Rd, Suite 103, St. Louis, MO 63134, next to St. Louis Lambert International Airport.
Frequently asked questions
Does this mean my joint pain is not mechanical?
No. Load and injury really do play a part, and joint injury is a known risk factor. The point is that they are not the only things that play a part. That is why the evaluation looks beyond the joint X-ray when we assess the conditions we treat.
Do you sell peptides?
No. Peptides are discussed here as a clinical and teaching topic under physician oversight. They are not offered as a product to buy. What that discussion covers is set out on our peptide and longevity medicine page.
Why do my symptoms flare when I have not done anything?
Pain at rest is a documented feature of osteoarthritis, not a sign you are imagining it. It is one of the things a pure wear-and-load model explains poorly. There is more on symptom patterns in our education library.
If the terrain matters, does that rule out surgery?
No. When conservative care has run out, surgery is part of the plan. Joint replacement can reduce pain and restore movement in badly affected joints. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a surgeon and will say so directly when that is the right answer.
What is the biggest cause of osteoarthritis?
There is no single cause. The known risk factors include joint injury, earlier joint disease such as rheumatoid arthritis or gout, diabetes, obesity, genetics, age and female sex. Obesity matters most for the hip and knee because it works two ways at once. It adds load to the joint. And it brings metabolic problems and body-wide inflammation with it.
Is osteoarthritis hereditary?
Genes are one known risk factor. But they sit on a longer list that includes joint injury, diabetes, obesity, age and being female. Osteoarthritis is also not bound to come with age. That is why we review your history, scans and lab data together. We do not stop at family history or your age.
What are the treatment options for osteoarthritis?
Care here starts with a doctor-led Clinical Evaluation that ends in a written plan. Where the findings support it, options include PRP in the joint, the tendon or the bone under the joint. They also include bone marrow aspirate concentrate, Lipogems and intradiscal orthobiologics. For advanced knee arthritis, PRP is a bridge before joint replacement. None of these is claimed to rebuild lost cartilage. Surgery is part of the plan once other care has run out.
Sources
- World Health Organization. “Osteoarthritis” (fact sheet), 14 July 2023. https://www.who.int/news-room/fact-sheets/detail/osteoarthritis — referenced for the 2019 global figure of about 528 million people and the 113% increase since 1990, the 73% over-55 and 60% female distribution, the 365 million knee prevalence, the 344 million at moderate or severe levels, the statement that osteoarthritis affects the entire joint and surrounding tissues, the full risk factor list including metabolic disease and obesity characterized by metabolic abnormalities and systemic inflammation, the statement that some people feel pain even when resting, the link between inactivity and cardiovascular disease, obesity and diabetes, the statement that osteoarthritis is not an inevitable consequence of aging, and the role of joint replacement surgery in severely affected joints.