Category: Orthopedics
Posted: 10/25/2025 by Brian Corwell, MD
(Updated: 12/5/2025)
Click here to contact Brian Corwell, MD
Low-Dose Radiation Therapy for Osteoarthritis
Current options for osteoarthritis include NSAIDs, physical therapy, intraarticular steroid injections, and lifestyle modifications, such as weight loss and exercise. After these options have been exhausted, there is joint replacement.
Problems with these options in older patients are that about 25% of all patients will not respond to these therapies or lose their responsiveness over time. NSAIDs also may not be great options in those with renal impairment and increased risk of GI bleeding.
Conventional radiation therapy (RT) in the treatment of malignant disorders relies on its antiproliferative effects. Alternatively, at doses of less than 1 Gray, RT has been shown to have strong anti-inflammatory effects.
RT may be an appropriate option for those with OA who have failed other conservative measures but are not ready for joint replacement…ideally before the onset of bone-on-bone changes at which point RT is less likely to be effective.
Appropriate candidates are older than 50 years. Patients do not typically experience acute side effects. There may be slight redness, milder than a sunburn, on the skin of the area radiated. Malignancy induced by RT treatment remains a small theoretical risk and is mitigated by selection of non central joints (i.e. not for spine OA).
The most commonly treated joints include hands, feet, knees, and elbows.
Pain relief can last from several months to years, with studies reporting that 30%-60% of patients maintain significant pain reduction 1-2 years after treatment. In one study, patients reported 85% decreased use of analgesic medications.
Typical treatment regimens involve 6 sessions of 0.5 Gy each conducted 2-3 times per week.
RT may be an effective modality for patients who have failed conventional treatment and are either not ready for surgery or are poor surgical candidates.
The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review
Dove, Austin P.H. et al. International Journal of Radiation Oncology, Biology, Physics, Volume 114, Issue 2, 203 - 220
