Clinical Review

The orthopaedic approach to managing osteoarthritis of the knee

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1220
  1. Sam Gidwani, specialist registrar1 (,
  2. Adrian Fairbank, consultant2
  1. 1 Department of Orthopaedics, Kingston Hospital, Kingston upon Thames, Surrey KT2 7QB
  2. 2 Department of Orthopaedics, St George's Hospital, London SW17 0QT
  1. Correspondence to: S Gidwani
  • Accepted 13 July 2004


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 this disease, indications for their use, and likely outcomes.

Sources and selection criteria

We searched Medline (1966 to May 2004) using the terms “osteoarthritis”, “knee”, “knee replacement/arthroplasty”, “osteotomy”, “arthroscopy”, “and outcome”. We were particularly interested in papers from leading peer reviewed orthopaedic and rheumatological journals. We searched the Cochrane database of systematic reviews, the health technology assessment database, and the database of abstracts of reviews of effects.

Non-operative treatment

Management of patients with mild osteoarthritis should be tailored to the individual while avoiding over-medicalisation of the condition.w1 A variety of interventions are available, including advice on changes to lifestyle and physical and pharmacological therapies. The effectiveness of many of these treatments has been reviewed elsewhere.2 3

Intra-articular steroid injections

Intra-articular steroid injections can alleviate pain in patients with moderate osteoarthritis of the knee, but this is usually short lived,2 and therefore we believe they have a limited role in treating acute exacerbations of the disease. …

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