Knee osteoarthritis — structured viva

Structured oral on knee osteoarthritis: defending clinical diagnosis without imaging, quoting the exercise and weight-loss effect sizes, the topical-first NSAID ladder, paracetamol's retirement, intra-articular steroid honesty, and arthroplasty referral without BMI gates.

Prompt

The examiner opens: 'Your patient wants an X-ray, paracetamol, a steroid injection and a knee scope — talk me through what the evidence actually supports.' The viva branches through diagnosis rules, core treatment numbers, the drug ladder, retired therapies and referral thresholds.

Stem

You are the GP. A 59-year-old with classic knee osteoarthritis presents with a list: X-ray, paracetamol, "the needle", and a referral to the surgeon for a clean-out. ^[8]

References8Show

[1]Fransen M et al. Exercise for osteoarthritis of the knee. The Cochrane database of systematic reviews, 2015.PMID 25569281
[2]Derry S et al. Topical NSAIDs for chronic musculoskeletal pain in adults. The Cochrane database of systematic reviews, 2016.PMID 27103611
[3]Leopoldino AO et al. Paracetamol versus placebo for knee and hip osteoarthritis. Annals of the rheumatic diseases, 2019.PMID 30801133
[4]Bensa A et al. Intra-articular corticosteroid injections provide a clinically relevant benefit compared to placebo only at short-term follow-up in patients with knee osteoarthritis: A systematic review and meta-analysis. Knee surgery, sports traumatology, arthroscopy, 2024.PMID 38294103
[5]Sihvonen R et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. The New England journal of medicine, 2013.PMID 24369076
[6]Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA, 2013.PMID 24065013
[7]Messier SP et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis care & research, 2018.PMID 29911741
[8]Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, N.J.), 2020.PMID 31908163

Knee osteoarthritis — structured viva

Stem

You are the GP. A 59-year-old with classic knee osteoarthritis presents with a list: X-ray, paracetamol, "the needle", and a referral to the surgeon for a clean-out. ^[8]

References8Show

[1]Fransen M et al. Exercise for osteoarthritis of the knee. The Cochrane database of systematic reviews, 2015.PMID 25569281
[2]Derry S et al. Topical NSAIDs for chronic musculoskeletal pain in adults. The Cochrane database of systematic reviews, 2016.PMID 27103611
[3]Leopoldino AO et al. Paracetamol versus placebo for knee and hip osteoarthritis. Annals of the rheumatic diseases, 2019.PMID 30801133
[4]Bensa A et al. Intra-articular corticosteroid injections provide a clinically relevant benefit compared to placebo only at short-term follow-up in patients with knee osteoarthritis: A systematic review and meta-analysis. Knee surgery, sports traumatology, arthroscopy, 2024.PMID 38294103
[5]Sihvonen R et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. The New England journal of medicine, 2013.PMID 24369076
[6]Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA, 2013.PMID 24065013
[7]Messier SP et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis care & research, 2018.PMID 29911741
[8]Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, N.J.), 2020.PMID 31908163