Precise diagnosis and treatment

doi:10.1136/bmj.b3747

Published 14 September 2009, doi:10.1136/bmj.b3747
Cite this as: BMJ 2009;339:b3747

Letters

Osteoarthritis of the knee

Precise diagnosis and treatment

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

The more knees wear out the more they hurt—this is themessage from a clinical epidemiology group in Boston.¹ But thatis not the whole story. The radiographic paper published bythe same group last year shows that this progressive wear remainsconfined to the single compartment initially affected.²

By calling the condition osteoarthritis of the knee, the authorscontinue a sophistry that suggests that the knee is an organlike the pancreas, where inflammation is the key process, andtotal excision the final solution. However, treating unicompartmentalwear by unicompartmental knee replacement effectively restoresfunction and prevents disease progression over decades.³ ⁴ Partialreplacement, whether of the medial or lateral tibiofemoral jointor of the patellofemoral joint, is not only more functionalbut also much more cost effective than total knee replacementdriven by a diagnosis of osteoarthritis of the knee. It couldsave the NHS over £50m a year.⁵

. . . [Full text of this article]

Justin Cobb, professor of orthopaedics, Imperial College¹

¹ Charing Cross Hospital, London W6 8RF

j.cobb@imperial.ac.uk

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