Radiation therapy offers hope for osteoarthritis pain relief

When you hear "radiation therapy" you may think of cancer care. But radiation therapy has been used to treat osteoarthritis for more than 100 years.

The most common type of arthritis, osteoarthritis affects 32 million Americans, causing debilitating pain that can severely limit daily activities and affect quality of life. Low-dose radiation therapy (LDRT) can be used to treat mild to moderate cases of osteoarthritis when other treatments are not an option or are not working well.

"The key difference is the size of the dose," says Anthony Ricco, MD, radiation oncologist at Main Line Health. "For arthritis treatment, we are delivering small doses — a fraction of what we use in cancer treatment — to the joint, which helps to reduce inflammation and pain with virtually no side effects."

Who might benefit

LDRT can help people who have tried standard treatments but still have pain. It can also help people who are not ready for joint replacement or are not candidates because of age or other health conditions.

Which joints LDRT can treat

LDRT can treat joints in your:

• Shoulders
• Elbows
• Hands
• Hips
• Knees
• Ankles

How treatment works

Similar to how NSAIDS work, LDRT is anti-inflammatory, not regenerative so the underlying arthritis will continue to progress. It can significantly improve quality of life and delay or avoid surgery, but it's not a cure.

LDRT is given in six short outpatient sessions over two to three weeks. Each visit takes about 10 minutes.

What to expect on treatment days:

• You lie on the table while the machine moves around you. It does not touch you.
• Therapists line up your position with imaging, then turn on the beam.
• You will not feel the radiation. Most people do not need to change skin care or activity. Sessions take around 10 minutes.

What safety measures are taken

Before treatment, the team maps the exact area using a CT scan to protect healthy tissue. Small skin dots may be placed to guide positioning. Your plan is programmed into the treatment machine, called a linear accelerator. Therapists use imaging to line things up each time before turning on the radiation beam.

What you will feel

You will not feel the radiation. Most people have no side effects during or after treatment. Mild skin redness is rare. Since it doesn't impact your health, you can keep your normal routine.

"LDRT is painless and noninvasive, so there are no cuts or needles," Dr. Ricco says. "A single course of treatment provides a safe and effective option that can help you get back to the things you love."

Is it safe and how much radiation is used

LDRT uses a much lower dose than cancer treatment. The total dose is usually 3.0 to 6.0 Gray, given in small parts of 0.5 Gray per session, which is about 1/20th of a typical cancer dose. The lifetime risk of a radiation‑related problem is estimated to be less than 1 in 1,000, and if it occurs it is most often a small skin cancer. Your team weighs risks and benefits with you.

How LDRT compares to other treatments

Osteoarthritis is typically treated with nonsteroidal anti-inflammatory drugs (NSAIDS) such as Aleve® or ibuprofen, physical therapy (PT), pain medications, corticosteroid injections and visco supplementation injections. These treatments may not provide adequate pain relief or can have unwanted side effects. Joint replacement surgery can offer significant and long-lasting relief but may not be an option for everyone.

"LDRT can provide significant pain relief to people who have exhausted traditional treatments but are not candidates for joint replacement surgery due to age or medical conditions, or who are not yet ready for a major operation with a long recovery," says Dr. Ricco.

Can LDRT offer better pain relief than steroid or hyaluronic acid injections

Typically, LDRT is in a sweet spot for helping patients feel better with pain relief starting off gradually but building over several weeks. The average timeline for pain relief and benefits breaks down as:

• LDRT: ~65–80% pain relief, lasting 6–24 months for many patients. Noninvasive with no needles.
• Corticosteroid injections: ~60% relief that often lasts 4–6 weeks. May raise infection risk or blood sugar. Repeated use may speed up arthritis over time.
• Hyaluronic acid injections: ~60% relief over 3–6 months. Small risk of irritation or allergy.
• NSAIDs: Help some people but carry stomach or heart risks with long‑term use.

Can LDRT delay or prevent joint replacement surgery

Yes. By easing pain and inflammation, LDRT can help some patients delay or avoid more invasive procedures. Your doctor will discuss if this fits your situation.

How well does LDRT work by joint

Results can differ by joint and by how advanced the arthritis is. In published data and clinical experience:

• Overall success is about 60–90%, with an average around 75% for a good pain response.
• Shoulders tend to respond the best, at 88%.
• Knees are the most studied success rate with solid results, at 75%.
• Hips have the lowest success rate, but they still average 65%.

People with moderate arthritis often do better than those whose arthritis has advanced.

How often can a patient get LDRT

If your pain returns, LDRT can be repeated up to three times per joint.

Who should not get LDRT

You may not be a candidate if you:

• Are pregnant
• Have an active infection at the site
• Already had high‑dose radiation to the same area
• Are younger than 40 or 50 years old (due to long‑term risks)
• Have autoimmune inflammatory arthritis like rheumatoid or psoriatic arthritis
• Have severe bone‑on‑bone arthritis as you may do better with surgery

Will this cure my arthritis

No. LDRT eases pain and swelling, but it does not stop arthritis from progressing. It improves quality of life and may delay surgery, but it is not a cure.

Is LDRT covered by insurance

LDRT for benign joint pain is generally covered by Medicare and most private insurers when other treatments have been documented as not having worked for you. Some plans may need prior authorization. Your care team will help with approvals.

Next steps

Schedule a consultation with a radiation oncologist to see if LDRT is right for you. Call 484.476.2433.

Learn more about osteoarthritis treatment options at Main Line Health.

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