Guest editorial

                                                        Osteoarthritis of the hip and
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British Columbia Medical Journal, October 2010 issue: Osteoarthritis of the hip and knee, Part 1: Pathogenesis and nonsurgical management


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British Columbia Medical Journal, October 2010 issue

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British Columbia Medical Journal, October 2010 issue: Osteoarthritis of the hip and knee, Part 1: Pathogenesis and nonsurgical management

  1. 1. Guest editorial Osteoarthritis of the hip and knee, Part 1: Pathogenesis and nonsurgical management ease and the journey of patients with evidence behind these modalities. OA of the hip or knee from diagnosis This article serves not only as a guide to nonoperative treatment and finally for practitioners, but also as a summa- to surgical intervention. This first part ry for patients who are considering in a two-part theme issue on OA of the each of these modalities. The article hip and knee explores the patholge- demystifies these modalities and netic mechanisms and several aspects allows the physician and patient to of nonsurgical management. understand the relative merits of each In the first article here, Drs Hasan treatment, from footwear and weight and Shuckett discuss the epidemiolo- loss to the use of canes. gy of hip and knee OA and factors in In the third article here, Drs Ken- its genesis. The figures that they in- nedy and Moran continue the discus- clude about the burden of disease are sion of nonoperative management, but indeed sobering. The authors discuss this time from the pharmacological the risk factors for OA, allowing us as point of view. They discuss the role of Dr B.A. Masri practitioners to potentially change oral medications as well as joint injec- patients’ behavior at a young age and tions. This sets the stage for their dis- lessen the likelihood of this disease cussion of the indications for surgical with aging. They also discuss clinical intervention, and when to consider steoarthritis (OA) is the presentation and radiographic find- referral to an orthopaedic surgeon. O most common chronic dis- ease affecting British Col- umbians. Family physicians manage patients with osteoarthritis on a daily basis using strategies that range ings, allowing an easier understand- ing of when to suspect OA in a patient and when to proceed to a radiographic review. The authors clearly delineate the indications for plain radiographs By focusing on the earlier stages of OA and considering diagnosis and nonoperative management, all the articles in Part 1 of this theme issue pave the way for the articles in from reassurance to surgical interven- and MRI. With improved access to Part 2, which will discuss surgical tion. Large joint OA, as exemplified MRI, we often see patients presenting modalities. by hip and knee osteoarthritis, places with OA with an MRI as the initial —B.A. Masri, MD, FRCSC a significant burden on society be- radiographic investigation. The take- Professor and Head, cause of the disability associated with home message is that an MRI should Department of Orthopaedics it. Patients affected by OA of the hip be reserved for use when X-rays do University of British Columbia and knee often require surgical inter- not indicate OA. vention. Many modalities for nonoperative With the increasing emphasis on treatment for OA of the hip and knee joint replacement, it is important to exist. In the second article here, Drs consider the entire spectrum of dis- Hawkeswood and Reebye discuss the 392 BC MEDICAL JOURNAL VOL. 52 NO. 8, OCTOBER 2010