Knee osteoarthritis — RACGP Fellowship MCQ

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ModerateMusculoskeletal and sportsKnee osteoarthritisRACGP Fellowship

A 47-year-old woman presents with knee pain worse with stairs and rising from a chair. Examination shows crepitus, mild effusion and medial joint line tenderness; X-ray shows mild medial compartment osteoarthritis. BMI is 32 kg/m². What is the most appropriate first-line management?

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Correct answer: B — Exercise therapy, weight management and patient education

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

The RACGP 2018 guideline mandates exercise therapy, weight management and education as first-line care for knee osteoarthritis. This patient has mild OA with functional limitation—an ideal candidate for conservative management. Systemic reviews confirm that exercise combined with education is cost-effective and prevents progression to surgery. Arthroscopic washout (A) is not supported by current evidence and is consistently recommended against. Opioids (B) are not first-line for early–moderate OA due to harms outweighing benefits. Total knee replacement (C) is premature; this patient does not meet surgical criteria (mild disease, preserved function despite symptoms, no failed conservative management trial). Rest (E) contradicts all guidelines—movement is therapeutic. The patient's elevated BMI makes weight management particularly important for symptom reduction and disease modification.

Reference: Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis, 2nd edn. East Melbourne: RACGP, 2018. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/knee-and-hip-osteoarthritis