When should I consider referring a patient with osteoarthritis for surgical evaluation?

Consider referring a patient with osteoarthritis for surgical evaluation if:

• Non-surgical management (such as therapeutic exercise, weight loss, and pain relief) has been ineffective or is unsuitable after approximately 3 months.
• The patient’s joint symptoms—including pain, stiffness, reduced function, or progressive joint deformity—are substantially impacting their quality of life.
• There is diagnostic uncertainty or atypical features suggesting alternative diagnoses or complications.
• There is a sudden worsening of symptoms.
• Referral decisions should be based on clinical assessment rather than numerical scoring tools, and should not be influenced by age, sex, smoking status, comorbidities, or BMI.

Before referral, ensure the patient wishes to be referred and consider referral before prolonged and established functional limitation or severe pain develops.

Do not offer arthroscopic lavage or debridement as a surgical option for osteoarthritis.

These recommendations apply to hip, knee, and shoulder osteoarthritis.

References: NICE CKS, NICE NG226, NICE CKS