Osteoarthritis of the knee joint encompasses a spectrum of pathology ranging from early chondral damage and degenerative meniscal pathology to more advanced well-established “bone-on-bone” disease. Deciding on the management of elderly patients with osteoarthritis is a relatively straightforward process, given that joint replacement will usually successfully address advanced disease and meet these patients’ expectations. However, younger patients with osteoarthritis have different activity profiles and expectations, and increasingly commonly, physicians are faced with relatively young patients who are affected by painful joints resulting from articular cartilage pathology, ranging from early wear to well-established osteoarthritis. These patients are typically active and wishing to remain active in sports, work, and family life, and are less accepting of the restrictions placed on them by osteoarthritis. In the absence of a cure for osteoarthritis, it is vitally important that the treating physician has a comprehensive knowledge of the options for managing these patients and allowing them to continue an active lifestyle.

There are many options for management of osteoarthritis in these patients, and in modern society, there are many treatments promoted, through either popular media or direct promotion to patients and clinicians. Given the common nature of the problem, there are obviously strong market forces driving this promotion since any treatment that becomes popular will generate huge ongoing income for the provider. It can be difficult for patients, and even sometimes for clinicians, to sort through the literature and other promotional material to decide which treatments actually have scientific merit from an appropriate evidence base. Clearly, physicians can only provide patients with optimal management if they have an up-to-date knowledge of the available treatment options, the evidence base available for each, and the appropriate timing and indications for each treatment. The purpose of this book has been to create a resource that provides physicians with a practical guide to managing these patients in a comprehensive evidence-based manner.

The chapters of this book have covered the pathogenesis and natural history of osteoarthritis, as well as the nonoperative and operative approaches to the condition. Osteoarthritis is a condition that has been widely studied in recent times, with an improved understanding of its aetiology and progression. As discussed in the first chapter, despite this greater understanding, there are still many areas that are yet to be clearly defined, which will therefore be the subject of ongoing study. Osteoarthritis is clearly not simply loss of articular cartilage, but a disease that affects the joint globally, with wide variation in the clinical response between patients. There are definite factors associated with its development, including a history of injury, family history, and obesity, but the specific “recipe” that defines and predicts the risk profile for the development and progression of osteoarthritis for each individual is still something being defined. At this stage, it should, however, be possible for clinicians to counsel patients regarding the aetiology of their osteoarthritis, the severity of their disease, the risk and rate of likely progression, and the modifiable risk factors that they may be able to address. This fundamental understanding of the condition by the clinician, and imparted to the patient, is critical in the successful management of each patient.

Nonsurgical management of osteoarthritis should in most cases be the first option discussed with patients, with surgery usually reserved for those patients for whom nonsurgical management has not been able to satisfactorily manage their condition. Even in patients for whom surgery has been elected, appropriate ongoing nonsurgical management usually remains an important supplement to their treatment. It is often difficult for the physician to advise patients on nonsurgical management, as patients will often feel that they need to have “something done” to address their problem and will perceive a recommendation for nonsurgical management as an indication that nothing actually can be done. This is probably a reflection of the common approach to nonoperative management, often involving suggestions of various options for patients to self-manage, which can lead to confusion for the patient and a subsequent inefficient application of the treatments. The chapter on nonsurgical management of OA has comprehensively reviewed the many options available for treatment, which is a list that will continue to rapidly evolve as more options arise with considerable regularity. Understanding the evidence base and indications for these options is important, but equally important is the effective application of these options for each patient.