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OA Joint Replacement Referral — SCE Rheumatology MCQ

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EasyOsteoarthritisOA Joint Replacement ReferralSCE Rheumatology

A 65-year-old woman with symptomatic knee osteoarthritis is being considered for orthopaedic referral for possible total knee replacement. Which ONE statement best reflects NICE criteria for referral?

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Correct answer: B — Consider referral when joint symptoms substantially affect quality of life and non-surgical management is ineffective or unsuitable.

NICE recommends considering referral for joint replacement when osteoarthritis symptoms—such as pain, stiffness, reduced function or progressive deformity—substantially affect quality of life and non-surgical management is ineffective or unsuitable. Referral is based on clinical assessment rather than a numerical severity or radiographic threshold. Age alone is not an exclusion criterion, so A is incorrect. Bilateral disease is not required, excluding B. Kellgren–Lawrence grade 4 disease is not a prerequisite, so D is incorrect. Conversely, radiographic osteoarthritis without a substantial symptomatic and functional impact does not itself justify referral, excluding E. Appropriate non-surgical management includes therapeutic exercise, weight management where relevant and pain relief; NICE does not require every possible treatment, such as injections, to have been tried.

Reference: National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226), section 1.6, Referral for joint replacement, recommendations 1.6.1–1.6.3. 2022. https://www.nice.org.uk/guidance/NG226/chapter/recommendations