Low-dose radiotherapy for severe osteoarthritis refractory to conservative treatment in older adults: an underexplored option

Abstract

Osteoarthritis is a chronic age-related disorder associated with persistent pain and progressive functional decline. Although arthroplasty is considered the definitive treatment for advanced disease, many older adults with severe symptomatic osteoarthritis are not candidates for surgery because of frailty, multimorbidity, or limited physiological reserve, and some decline operative intervention despite persistent symptoms after comprehensive conservative management. This scenario creates a therapeutic gap in patients whose primary goals are pain relief and preservation of function. Low-dose radiotherapy (LDRT), defined as localized anti-inflammatory irradiation delivered at total doses of approximately 3–6 Gy in small fractions, represents a non-invasive and largely underrecognized therapeutic option. Its biological effects differ from those of oncologic radiotherapy, acting mainly through immunomodulatory and anti-inflammatory mechanisms within the osteoarticular microenvironment. Observational studies and clinical cohorts have reported meaningful pain reduction and functional improvement, whereas randomized and pooled analyses have produced more heterogeneous results. These discrepancies may partly reflect differences in patient selection, baseline disease severity, and outcome assessment across studies. Despite remaining uncertainties, LDRT may represent a reasonable risk-adapted option for carefully selected older adults with severe osteoarthritis refractory to conservative therapy who are not eligible for arthroplasty or decline surgery. Greater clinical awareness and well-designed trials focused on this population are needed to clarify its role in multidisciplinary care.

Keywords: Low dose radiation therapy, osteoarthritis, pain management, joints, musculoskeletal pain disorders, aging, anti-inflammatory agents