A 65-year-old woman with bilateral knee OA has Kellgren–Lawrence Grade III on X-ray and has failed 6 months of physiotherapy, analgesics, and intra-articular corticosteroids. BMI is 32. She has no significant comorbidities. What is the most appropriate next step?

• A Arthroscopic debridement and washout
• B High tibial osteotomy
• C Total knee replacement ✓
• D Platelet-rich plasma injection series

Explanation

Total knee replacement is indicated for symptomatic end-stage knee OA (K-L Grade III–IV) with functional limitation after failure of conservative management including weight loss advice, physiotherapy, and analgesic steps. Evidence from multiple RCTs demonstrates TKR provides superior pain relief and function compared to continued conservative care in this group. Arthroscopic debridement has no evidence benefit in OA and is not recommended by NICE or AAOS. High tibial osteotomy is reserved for younger patients (<55–60) with isolated medial compartment OA and varus deformity. PRP lacks high-quality evidence for Grade III OA.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.