Hip/Knee Osteoarthritis · Conservative vs Joint Replacement + Approach

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Conservative failed + affected joint/extent
   Has conservative care adequately failed? Which joint and extent?
   • Symptomatic OA, conservative not yet adequate → Conservative first
   • Advanced hip OA, conservative failed → Advanced hip → THA
   • Advanced knee OA (multicompartmental, KL III–IV), conservative failed → Multicompartmental knee → TKA
   • Knee unicompartmental (medial) OA, intact ligaments, young active → Unicompartmental knee → UKA/osteotomy
2. [End] Conservative first
   Conservative first: weight loss, physiotherapy/strengthening, acetaminophen/NSAIDs, intra-articular corticosteroid; usually document 12–24 weeks of unsatisfactory response before surgery. Bone-on-bone/severe deformity/AVN collapse may go straight to surgical assessment.
3. [End] Advanced hip → THA
   Advanced hip OA, conservative failed, pain limiting daily activity → total hip arthroplasty (THA).
4. [End] Multicompartmental knee → TKA
   Advanced knee OA (multicompartmental, KL III–IV, bone-on-bone), conservative failed → total knee arthroplasty (TKA).
5. [End] Unicompartmental knee → UKA/osteotomy
   Knee unicompartmental (medial) OA + intact ACL/ligaments + correctable deformity, young active → unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO); preserves bone, faster recovery; not for multicompartmental disease.

Source guidelines & references

• Hip and knee osteoarthritis management (ACR/OARSI; AAHKS arthroplasty indications)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways