Surgery for osteoarthritis

Bannuru, 2019Kloppenburg, 2019Kroon, 2014Sakellariou, 2017

Surgical options for hip and knee osteoarthritis include osteotomy and joint replacement. Refer patients for surgery if they have severe persisting functional impairment or pain despite maximal nonsurgical management (see Components of management for osteoarthritis). Timely referral is important (ie before significant functional decline occurs). Around 30% of patients with knee osteoarthritis will require surgery, and this figure is likely to be higher for patients with hip osteoarthritis. For discussion of surgery for hand osteoarthritis, see Osteoarthritis of the hand.

While awaiting surgery, encourage patients to persist with lifestyle measures such as weight loss and exercise, because a higher preoperative level of functioning may improve outcomes from surgery and will enable better participation in postoperative rehabilitation. Weight loss before surgery is often recommended because obesity increases the risk of perioperative complications, delays the benefits of surgery, and is associated with higher rates of surgical revision. Management of patients who are awaiting joint replacement is discussed in The Royal Australian College of General Practitioners (RACGP) management guide on referral for joint replacement.

Arthroscopic lavage or debridement is not recommended for osteoarthritis of the knee, and partial meniscectomy is not recommended for degenerative meniscal tears (with or without underlying osteoarthritis), because these treatments have not been found to be more effective than placebo or exercise, and have the potential for harm. There are no randomised controlled trials of arthroscopy for hip osteoarthritis.