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OA Surgery Timing Not X-ray — SCE Rheumatology MCQ

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EasyOsteoarthritisOA Surgery Timing Not X-raySCE Rheumatology

A 70-year-old woman has radiographic Kellgren–Lawrence grade 3 knee osteoarthritis. With therapeutic exercise and a topical NSAID, she has only mild intermittent pain, walks independently and has no meaningful restriction of daily activities. What is the most appropriate advice about referral for joint replacement?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Continue non-surgical management; do not refer solely because the radiograph is KL grade 3

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

The correct answer is A. NICE recommends considering referral for joint replacement when osteoarthritis symptoms substantially impair quality of life and appropriate non-surgical management is ineffective or unsuitable. Decisions should be based on clinical assessment rather than a numerical severity score. This patient has mild, adequately controlled symptoms and preserved function, so KL grade 3 radiographic disease alone is not an indication for referral or surgery. Arthroplasty is intended to improve otherwise refractory pain and disability, not simply to prevent radiographic progression, so B is incorrect. Options C and E incorrectly make KL grade 3 an automatic indication. Option D is also incorrect because patients with severe, treatment-refractory symptoms may merit referral before KL grade 4, while minimally symptomatic patients do not require replacement solely because grade 4 changes are present.

Reference: National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226), section 1.6, Referral for joint replacement. 2022. https://www.nice.org.uk/guidance/ng226/chapter/recommendations