BMJ  2004;329:1220-1224 (20 November), doi:10.1136/bmj.329.7476.1220

Clinical review

The orthopaedic approach to managing osteoarthritis of the knee

¹ Department of Orthopaedics, Kingston Hospital, Kingston upon Thames, Surrey KT2 7QB, ² Department of Orthopaedics, St George's Hospital, London SW17 0QT

The first 150 words of the full text of this article appear below.

Introduction

Osteoarthritis of the knee is common, affecting almost a tenth of the population aged over 55.¹ This proportion is likely to increase with extended longevity and a bigger body mass index. Most patients with osteoarthritis of the knee are able to manage their symptoms without medical treatment, but a large proportion of those referred to orthopaedic surgeons have debilitating disease, presenting chiefly with pain and stiffness. Classically the pain depends on activity, and in severe cases not only limits the distance patients can walk and their daily activities, but also disrupts sleep. Moreover, whereas most patients are past retirement, a major proportion is of working age, leading to difficulties with work and presenting an important economic cost to society.

Non-surgical treatment of osteoarthritis of the knee is primarily carried out in the community. This article concentrates on the interventions and surgical options used by orthopaedic surgeons for the treatment of . . . [Full text of this article]

Sources and selection criteria

Non-operative treatment

Intra-articular steroid injections
Viscosupplementation

Surgical intervention

Indications
Arthroscopic washout and debridement
Osteotomy of the proximal tibia or distal femur
Unicompartmental knee replacement
Patellofemoral replacement
Total knee replacement
Evolving techniques
Minimal incision approach
Image guidance

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