By: Roger Dobson
BMJ, Published 31 July 2008

Clinically obese people can benefit almost as much as anyone else from knee replacement surgery, research has shown (Annals of the Rheumatic Diseases 2008; doi 10.1136/ard.2008.093229).

The findings show that there is little justification for policies that deny this type of surgery to obese patients on the grounds of their body mass index (BMI).
BMI should not be a contraindication, provided that the patient is sufficiently fit to undergo the short term rigours of surgery.

However: Obesity is obviously a strong risk factor for developing knee osteoarthritis.

BMJ, published 27 May 2008.

Editorials.
By: Jeremy Fairbank, professor of spinal surgery, Nuffield Orthopaedic Centre, Oxford OX3 7L

• Prolapsed intervertebral disc is common.
• Disc prolapse is genetically driven—twin studies indicate that at least 60% of the variance can be explained on genetic grounds and not by the commonly assumed environmental factors (work, trauma, exposure to excessive driving, smoking, and so on).

Current guidelines indicate that radicular pain should improve within six to eight weeks with conservative management.

• Surgery should be performed before eight weeks only in patients with progressive neurological deficit, which can be detected by magnetic resonance imaging.

If symptoms persist, evidence supports surgery after eight weeks.

Editorials: BMJ 2008;336:105-106 (19 January), by Paul Dieppe.

Many older people have pain in one or both knees from time to time, and the most likely cause is osteoarthritis. And Topical NSAIDS are as effective as oral NSAIDs, and patients prefer them.

BMJ  2007;335:786 (20 October).

Two papers have recently been published on bmj.com on the treatment of osteoarthritis of the knee.

Acupuncture has no additional benefit in people taking a course of exercise.

Janice Hopkins Tanne – 23 November 2007

Five US manufacturers of hip and knee replacements have settled with the federal government after being accused of paying orthopaedic surgeons to use their products.