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The clinical case of Mr. Gary Allen

A 66-year-old male patient presents to the outpatient clinic due to a 2-year duration right knee pain, refractory to optimized medical treatment. This is having a severe impact in his quality of live.
On physical exam, he complaints of severe pain on active mobilization, the knee is stiff and with crepitus. X-ray shows joint space narrowing, subchondral sclerosis, and marginal osteophytes.

Learning goals

  • Gonarthrosis progression assessment
  • Treatment according to clinical and radiological assessment


  1. Surgical treatment referral

Key medication

  • Symptomatic slow-acting drugs for OA (SYSADOAs)
  • Paracetamol
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids
  • Duloxetine
  • Opioids


  • Brown GA. AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):577–9.
  • McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee: Evidence-based guideline: Evidence-based guideline. J Am Acad Orthop Surg. 2016;24(8):e87-93.
  • Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–89.
  • Miller LE, Fredericson M, Altman RD. Hyaluronic acid injections or oral nonsteroidal anti-inflammatory drugs for knee osteoarthritis: Systematic review and meta-analysis of randomized trials. Orthop J Sports Med. 2020;8(1):232596711989790.
  • Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017;7(5):e016114.
  • Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, et al. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev. 2019;7:CD012128.
  • Odgaard A, Madsen F, Kristensen PW, Kappel A, Fabrin J. The Mark Coventry award: Patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA: Patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res. 2018;476(1):87–100.
  • Newman JM, Sodhi N, Dekis JC, Khlopas A, Piuzzi NS, Sultan AA, et al. Survivorship and functional outcomes of cementless versus cemented total knee arthroplasty: A meta-analysis. J Knee Surg. 2020;33(3):270–8.
  • Coory JA, Tan KG, Whitehouse SL, Hatton A, Graves SE, Crawford RW. The outcome of total knee arthroplasty with and without patellar resurfacing up to 17 years: A report from the Australian orthopaedic association national joint replacement registry. J Arthroplasty. 2020;35(1):132–8.
  • Büttner M, Mayer AM, Büchler B, Betz U, Drees P, Susanne S. Economic analyses of fast-track total hip and knee arthroplasty: a systematic review. Eur J Orthop Surg Traumatol. 2020;30(1):67–74.
  • Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, et al. Association between use of Enhanced Recovery After Surgery protocol and postoperative complications in total hip and knee arthroplasty in the postoperative outcomes within Enhanced Recovery After Surgery protocol in elective total hip and knee arthroplasty study (POWER2). JAMA Surg. 2020;155(4):e196024.

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