Ozone Therapy for Osteoarthritis of the Knee and Hip – Mechanisms of Action and Therapeutic Potential

What is Osteoarthritis

Osteoarthritis is one of the most common degenerative diseases of the joints. It is characterized by the gradual wear and degeneration of the articular cartilage, which leads to:

  • pain

  • stiffness

  • limited mobility

  • joint inflammation

The knee and hip joints are most frequently affected because they bear a large part of the body’s mechanical load.

As the disease progresses, structural changes occur such as:

  • degradation of articular cartilage

  • changes in the subchondral bone

  • inflammation of the synovial membrane

  • reduced amount of synovial fluid

These processes lead to a progressive deterioration of joint function.

Main Causes of Osteoarthritis

The development of osteoarthritis is associated with multiple factors, including:

  • age

  • genetic predisposition

  • excess body weight

  • joint injuries

  • excessive mechanical stress

  • chronic inflammatory processes

In addition to mechanical factors, inflammatory and metabolic processes also play an important role in the destruction of cartilage tissue.

What is Ozone Therapy

Ozone therapy is a medical method that uses a mixture of oxygen and ozone (O₂–O₃) in controlled concentrations.

Ozone is an active form of oxygen that can trigger various biological reactions in the body.

In orthopedics and rehabilitation medicine, ozone therapy is used as a minimally invasive approach to support the treatment of joint diseases.

Clinical studies have shown that ozone injections can lead to a reduction in pain and stiffness and improve knee joint function in patients with osteoarthritis.

Mechanisms of Action of Ozone in Osteoarthritis

Reduction of Inflammation

Osteoarthritis is associated with chronic inflammatory processes in the joint.

Ozone can influence inflammatory mediators such as:

  • interleukins

  • prostaglandins

  • TNF-α

Through these mechanisms, ozone therapy may help:

  • reduce inflammation

  • decrease swelling

  • relieve pain

Some studies indicate that ozone may suppress inflammatory mediators by regulating cytokine pathways.

Analgesic Effect

One of the main effects of ozone therapy is pain relief.

Meta-analyses and clinical studies show that intra-articular ozone injections can significantly reduce chronic pain in knee osteoarthritis.

The reduction of pain is related to:

  • decreased inflammation

  • improved microcirculation

  • reduced nerve sensitivity

Improvement of Microcirculation

Microcirculation in joint tissues is crucial for cartilage nutrition.

Ozone may help support:

  • capillary blood flow

  • oxygen delivery to tissues

  • metabolic processes in cartilage

Improved microcirculation supports tissue recovery and cellular metabolism.

Stimulation of the Antioxidant System

Ozone therapy may activate antioxidant enzymes such as:

  • superoxide dismutase

  • catalase

  • glutathione peroxidase

These enzymes protect cells from oxidative stress, which plays an important role in the destruction of articular cartilage.

Improvement of Joint Function

Clinical studies show that patients with osteoarthritis treated with ozone may experience:

  • reduced stiffness

  • improved mobility

  • better quality of life

Some studies report significant improvement in functional indicators such as the WOMAC index after ozone treatment.

Methods of Application in Osteoarthritis

Intra-articular Injections

The most commonly used method is the injection of ozone directly into the joint.

This approach may:

  • reduce inflammation

  • improve joint function

  • relieve pain

Para-articular Injections

Ozone may also be injected around the joint to influence:

  • muscle spasm

  • local inflammation

  • blood circulation

Systemic Ozone Therapy

Systemic methods include:

  • major autohemotherapy

  • rectal insufflation

  • molecular microencapsulated ozone

These methods may support overall metabolic balance and anti-inflammatory processes.

Ozone Therapy as Part of a Comprehensive Treatment Approach

Ozone therapy is usually used as part of a combined therapeutic strategy that may include:

  • physiotherapy

  • therapeutic exercise

  • body weight control

  • nutritional therapy

  • pharmacological treatment

The combination of different methods may improve long-term outcomes in osteoarthritis management.

Conclusion

Osteoarthritis of the knee and hip joints is a chronic degenerative condition that significantly affects quality of life.

Ozone therapy may support treatment through:

  • reduction of inflammation

  • pain relief

  • improvement of microcirculation

  • stimulation of antioxidant defense

Because of these mechanisms, ozone therapy is considered a complementary therapeutic approach in the management of osteoarthritis.

The Role of Dehydration and Electrolyte Balance in Osteoarthritis

Articular cartilage contains approximately 70–80% water, which is essential for its elasticity and ability to absorb mechanical stress.

The water in cartilage is bound to molecules called proteoglycans, which retain fluid within the cartilage matrix. These molecules function like a biological “sponge,” allowing cartilage to absorb mechanical load during movement.

When the body is in a state of chronic dehydration or electrolyte imbalance, the following changes may occur:

  • reduced water content in cartilage

  • decreased elasticity of joint structures

  • increased mechanical stress on the joint

  • accelerated degradation of cartilage tissue

Electrolytes such as:

  • sodium

  • potassium

  • magnesium

  • calcium

play an important role in cellular metabolism and the osmotic balance of joint cells (chondrocytes).

When this balance is disrupted, the osmotic pressure in cartilage tissue may change, leading to:

  • reduced hydration of the joint

  • impaired metabolism of chondrocytes

  • accelerated cartilage degeneration

Therefore, maintaining adequate hydration and electrolyte balance is an important factor for joint health and may support the normal function of cartilage tissue.