Online ISSN: 2515-8260

Keywords : Osteoarthritis

To assess the clinical and radiological outcomes of patients with osteoarthritis knee undergone total knee arthroplasty

Dr. Ratnesh Kumar, Dr. Siddharth Yadav

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 2, Pages 2149-2153

Many total knee arthroplasties in osteoarthritis Knees are being performed nowadays. The clinic-radiological profile of these cases is varied. The study is to assess the clinical and radiological outcome in cases of osteoarthritis knee that have undergone total knee arthroplasty (TKA).
Materials & methods: The randomly selected 64 patients, who had undergone TKR for osteoarthritis knee during the preceding 36 months were studied, retrospectively. Their records were evaluated in depth after getting ethical clearance. The preoperative routine and clinical assessment data were noted from the records. Wherever needed, the patients were also examined and interviewed physically during their follow-up at their convenience and after taking the individual’s due consent. It was to fill the gaps wherever felt. The data and results thus collected were recorded in a Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Student t-test and Pearson’s correlation were used for evaluation of the level of significance.
Results: According to KL grading, 28.13 per cent and 26.56 per cent of the patients were of Grades 3 and 4, respectively while 25 per cent and 20.31 per cent of the patients were of Grades 2 and 1, respectively.
Conclusion: It seems possible that the relationship between clinical and radiographic osteoarthritis severity and postoperative outcomes might be relatively unrelated to the relationship seen between preoperative KSS and postoperative outcomes. To understand and establish this relationship, further work is needed

Assessment of relationship between lower extremity alignment-pelvic angle, genu recurvatum, medial and lateral rotation of hip in normal and patients with osteoarthritis and quadriceps tendinitis

Arulsakthi S, Paarthipan, Gajanand Pujari, N M Suresh, Sukesh Bhat

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 9, Pages 525-536

People who live an extremely active lifestyle, such as participating in sports or running for fitness, a properly positioned lower extremity is very important. The load distribution at the knee may be affected by lower extremity position, thus subjecting the anterior cruciate ligament to more stress. The current study is aimed at assessing the relationship between lower extremity alignments like the pelvic angle, genu recurvatum, and medial & lateral rotation of the hip in patients with osteoarthritis, and quadriceps tendinitis. The study included 150 asymptomatic (control) male and female patients as well as 150 patients with osteoarthritis, or quadriceps tendinitis. Clinical assessment was done to measure the pelvic angle, genu recurvatum, medial & lateral rotation of the hip by following standard procedures. The results of the study showed that there was a significant difference in the pelvic angle, but there was no significant difference in the genu recurvatum, medial & lateral rotation of the hip. The conclusion of the study was that the pelvic angle was affected, but the genu recurvatum and medial & lateral of the hip were not affected in the patients with osteoarthritis, quadriceps tendinitis.

Comparative study of intra-articular hyaluronic acid (HA) injection versus platelet rich plasma (PRP) in early knee osteoarthritis

Dr. Abhishek Tiwari, Dr. Harjot Singh Gurudatta, Dr. Ekjot Singh Gurudatta, Dr. Dilpreet Kaur Gurudatta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 9, Pages 447-452

The purpose of the present research was to explore this biologic approach to treat OA, analysing and comparing results of hyaluronic acid (HA) versus platelet-rich plasma (PRP).
Methodology: A prospective study with randomised selection of 47 ( 80 knees) patients for the assessment of outcome of treatment of early Osteoarthrosis of knee with intra-articular infiltration of platelet rich plasma (PRP) versus hyaluronic acid (HA) was carried out in the department of orthopaedics at Jawaharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha from July 2012 to April 2014. The patients were grouped into two categories- where 40 knees were injected with intra-articular HA injections and rest was injected with PRP injections. The mean was compared using paired t- test or independent t- test depending on the distribution of samples. The proportions were analysed using Binominal and Chi Square Test.
Results: At 3 months there was significant reduction in VAS and WOMAC scores in both the groups as compared to baseline. At 6 months, the subjects treated with PRP showed a continuous improvement, whereas the subjects treated with HA showed a sharp worsening for both the scores. Although the mean VAS score was 3.50 in the PRP group (SD= 0.847), it was 4.73 in the HA group (SD= 1.219) whereas mean WOMAC score was 37.25 in the PRP group (SD= 5.54), it was 61.98 in the HA group (SD= 4.85).
Conclusion: Treatment with PRP show significantly better outcome compared with HA treatment.

Incidence, prevalence and etiological factors for primary osteoarthritis knee in 40 years and less age group

Dr. Ratnesh Kumar, Dr. Siddharth Yadav, Dr. Prakash Jha, Dr. Navin K Shukla

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 860-865

Background: Osteoarthritis (OA) and other disorders of the musculoskeletal system are the most frequently reported causes of impairment affecting the elderly population. The present study was conducted to assess incidence, prevalence and etiological factors for primary osteoarthritis knee in 40 years and less age group.
Materials & Methods: 200 patients in the department of Orthopaedics in the Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, U.P, India of either sex coming to the OPD of the department with chief complaint of knee pain were the subjects of the study. Cases were assessed and subjected to AP view of both knee in standing position. Parameters such as height, weight, BMI were recorded. Cases were divided as per the Kellgren Lawrence Grading system
Results: Out of the total of 200 cases observed, 64 % were in the age group (35-40) years, 28 % were in the age group of (30-34) years, 8 % were in the age group (25-29)years. there were 44 males and 156 females. 74% of the cases had BMI > 24.9 kg/m2, 26% of the cases had BMI between 18.9-24.9 kg/m2, while none of the cases had BMI below 18.9 kg/m2. Primary osteoarthritis knee was present in 112 and absent in 88. Out of the 112 cases of OA, 60 (45.4%) had predominantly right side knee involvement while 16(12.1%) cases had left knee involved. 56(42.4%) had bilateral knee involvement. Bilateral cases had similar KL grading on both sides. Grade 0 were only symptomatic, 20(10%) had KL grade I, 32(16%) had KL grade II, 72(36%) had KL grade III while 8(4%) cases had KL grade IV. Grade II and III combined constituted 52% cases.60 (53.5%) had predominantly sitting/ squatting/kneeling as household habit. 48 (42.8%) cases had predominantly standing as household habit while 4 (3.5%) cases had nothing specific as a predominant household habit. Occupation was housemaker in 40, skilled workers in 4, tailor in 16, trader in 4, farming in 8, housemaid in 30, teacher in 2, nurse in 4 and paramedics in 4 cases.
Conclusion: OA knee is a significant contributor to pain and disability and poses severe burden on economy, primary prevention of knee OA should become a major aim of health care.

Comparative study between thickness of menisci of both the knee joints & its clinical application: A Cadaveric study

Shashi Bhushan Pandey, Manoj Kulkarni, Hetal Vaishnani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 5701-5709

Background :The most important joint is the knee joint which is a type of
synovial variety of hinge joint has three articulations viz. Femoral, Tibial and
Patellar. The two cruciate ligaments are also present in it with medial and lateral
collateral ligaments. There are two cresentic intracapsular strcutures are also
present which are called as medial and lateral meniscus. Both the menisci work
together to maintain stability while their morphometry are differ each other. On the
process of bone remodeling and cartilage deterioration the therapeutic strategic
needed for it.

Prospective study of functional outcome of total hip replacement at VIMS, Ballari

Dr. Shiva Naik R, Dr. Veeresh Gourshetty, Dr. Vinay Reddy S, Dr. Shivaji

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2128-2140

Purpose: To study the functional outcome of Total Hip Replacement in primary and secondary osteoarthritis of hip.
Materials and methods: The study consisted of 20 patients with diseased hips treated with total hip replacement operated in the Department of Orthopaedics, Vijayanagar Institute of Medical Sciences, Ballari from August 2020 to August 2022. Information of the patients was compiled from clinical details, case files and operation theatre records. This was a prospective study. The patient follow up was for a minimum of 6 months to maximum of 24 months (2 years). Modified Harris hip score was used for evaluation of functional outcome.
Results: Functional outcome of the procedure was done by following Modified Harris hip score. The results showed excellent results in 10 (50%) diseased hips, good in 06(30%) hips, fair 04(20%) hips. No poor outcome was noted in the study.
Conclusion: Our study demonstrated that total hip replacement provides an overall satisfactory functional and clinical outcome. Even though the study was not free of complications, the overall functional and radiological outcome showed excellent results.

Comparative Analysis of Efficacy of Oxaceprol Versus Tramadol for Knee Osteoarthritis: An Institutional Based Study

Kirti Vishwakarma, Deepty Arora, Navpreet Kaur, Mukesh Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 616-619

Background: The most common form of arthritis with approximately 250 million people worldwide conservatively estimated to be suffering from osteoarthritis of the knee alone. The present study was conducted to compare Oxaceprol and tramadol for knee osteoarthritis.
Material and methods: This prospective, comparative study was carried among patients diagnosed as Osteoarthritis. A total of 200 patients randomized in two study groups of 100 patients each. Each group was given either oxaceprol 200 mg capsule or tramadol 50 mg capsule, thrice daily after food, for 12 weeks. The primary efficacy variable for this study was symptom relief and was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The data have subjected to Paired and Independent t-test as applicable. P values less than 0.05 were considered as significant.
Results: In the present study a total of 200 patients randomized in two study groups of 100 patients each were included in the study. Each group was given either oxaceprol 200 mg capsule or tramadol 50 mg capsule. In tramadol group 45% were males and 55% were females and mean age of participants was 51.37yrs whereas in Oxaceprol group 48% were males and 52% were females and mean age of participants was 50.42 yrs. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between oxaceprol and tramadol group at baseline and after 6 months follow-up.
Conclusion: The present study concluded that Oxaceprol efficacy and tolerability was comparable with tramadol and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.

Outcome of total knee replacement in osteoarthritis

Dr. Venugopal Palakurthi, Dr. Srimukthi Madhusudan, Dr. B Srinivas, Dr. V Krishna Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3147-3155

Background and Objectives: To investigate and assess the functional results of complete knee replacement surgery. To determine whether or not there has been an improvement in post-operative pain relief. The knee joint's degree of stability as well as its range of motion to investigate the risks and potential problems of total knee replacement surgery. The pre-operative Knee Clinical Score will be compared to the post-operative Knee Clinical Score. The pre-operative Knee Functional Score will be compared to the post-operative Knee Functional Score. In order to evaluate the radiological results of the total knee replacement procedure. Research will be conducted to investigate the connection between the Knee Clinical Score and the Knee Functional Score.
Methods: A total of 20 patients who had total knee replacements were included in this prospective analysis. Cases were selected based on certain criteria, both for inclusion and disqualification. At each patient's scheduled follow-up appointment, the Knee Society Score was applied to assess their condition. Within the participants of our study, there were a total of 20 female patients and 10 male patients. Indications were 15 cases of OA and 1 case of RA. The duration of the follow-up period was typically twenty weeks.
Results: In the course of our research, prior to surgery, every one of our patients experienced moderate to severe pain; but, following surgery, 16 of the patients only experienced mild discomfort. Following surgery, the patient's average flexion, which was 75 degrees preoperatively, increased to 94 degrees. Before surgery, each of the 15 knees received a knee score of less than 60, but after surgery, some of the knees received an exceptional score (80 to 100), while the other knees received a good score (72-79). Prior to surgery, 10 patients had a functional score that was below 60, and two patients had a functional score that was between 60 and 69. Postoperatively, 20 patients had a score that was considered to be outstanding (85-100), 10 patients had a score that was considered to be good (72-79), 6 patients had a score that was considered to be acceptable (61-69), and 2 patients had a score that was considered to be poor (60).
Conclusion: The surgical method known as total knee arthroplasty is now widely practiced and well-established. The functional outcome of the surgery is impressive, long-lasting, and gratifying, and patient acceptability is very high.

The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing in Chronic Tendinopathies

Dr. Uma Durga Vinod D, Dr Rakesh Chandra M, Dr Jakku Kranthi, Dr Pradeep Chandra Chetamoni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1618-1623

Background: Platelet-rich plasma [PRP] has received increasing interest across many
musculoskeletal disciplines and has been widely applied clinically to stimulate tissue
healing in numerous anatomical regions. The known actions of platelet-derived factors
suggest that PRP may have significant potential in the treatment of pathological
conditions of cartilage, tendon, ligament, and muscle.
Purpose: The aim of this manuscript is to review current literature regarding the
biology of PRP and the efficacy of using PRP to augment healing of tendon ligament
and muscle injuries, as well as early osteoarthritis.
Methods: A comprehensive literature review of musculoskeletal applications of PRP
was performed, including basic science and clinical studies such as randomized
controlled trials, case controlled series, and case series.
Results: The most compelling evidence to support the efficacy of PRP is for its
application to tendon damage associated with lateral and medial epicondylitis. Although
some promising studies have been reported supporting the use of PRP in osteoarthritis
and ligament and muscle injuries, it currently remains unknown whether PRP
effectively alters the progression of osteoarthritis or aids the healing of ligament and
muscle tissues.
Conclusion: The rationale for the use of PRP to improve tissue healing is strong, but the
efficacy for many musculoskeletal applications remains unproven. PRP has been shown
to be a safe treatment. A number of questions regarding PRP remain unanswered,
including the optimal concentration of platelets, what cell types should be present, the
ideal frequency of application, or the optimal rehabilitation regimen for tissue repair
and return to full function


Dr. Sumit Pal Singh, Dr. Manmeet Singh , Dr. Shubham Pandoh, Dr. Anil Gupta, Dr. Nitish Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2382-2386

Background: Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovial joints. The present study was conducted to assess the role of PRP in management of osteoarthritis of the knee.
Materials & Methods: 65 patients of osteoarthritis of the knee of both genders were enrolled.
Cartilage thicknesses were measured radiologically by ultrasound before and at third and sixth months after treatment. The severity of pain was evaluated by using VAS.
Results: Out of 65 patients, males were 30 and females were 35. Right side was involved in 34 cases and left in 31 cases. The mean VAS before treatment was 5.4, after 3 months it was 2.3 and after 6 months it was 0.8. The difference was significant (P< 0.05). The mean cartilage thickness before treatment was 0.5 mm, after 3 months was 0.7 mm and after 6 months it was 0.8 mm. The difference was significant (P< 0.05).
Conclusion: PRP is found to be effective in management of cases of osteoarthritis of the knee.

Functional outcomes of proximal fibular osteotomy in osteoarthritis knee grade II & III

Govind Pratap Singh, Bhupinder Singh Brar, Dr. Punit, Navneet Singh, Sandeep Singh Jaura

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1059-1066

Introduction: Osteoarthritis of the knee is a degenerative condition with a variety of treatment options like high tibial osteotomy (HTO), arthroscopic debridement, unicompartmental knee arthroplasty and total knee arthroplasty. This study was conducted with an aim to assess the outcomes of individuals with Grade II and III medial compartment osteoarthritis treated with a proximal fibular osteotomy (PFO) to alleviate discomfort, improve medial joint space and function of the knee joint.
Methodology: From November 2019 to October 2021, 25 Patients aged 45 to 65 years with knee OA of grade II or III (Kellgren-Lawrence classification) involving the medial compartment of the knee were included and underwent proximal fibular osteotomy and were followed up. Preoperatively as well as postoperatively, the entire lower extremity radiographs were obtained to assess the alignment of the lower extremity and the ratio of the knee joint space (medial/lateral compartment), knee pain was assessed using a visual analogy scale and knee ambulation activities were assessed using the American Knee Society score.
Results: All patients experienced alleviation from medial knee discomfort postoperatively. Postoperative weight-bearing lower limb radiographs revealed an average increase in medial knee joint space. The mean preoperative AKSS improved from 43.92 to 63.88 till the last follow-up.
Conclusion: PFO is a safe, simple and effective procedure that significantly decreases knee discomfort. It also enhances the joint's radiographic appearance and functional outcome in patients with medial compartment osteoarthritis of the knee.

An observational study to assess the serum Vitamin D levels and Kellgren-Lawrence grading in patients of primary osteoarthritis

Dr. Sangeeta Khyalia, Dr. Ravinder Kumar Lamoria, Dr. Rahul Dhaka, Dr. Pramod Singh Chahar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 608-614

Aim: To assess the serum Vitamin D levels and Kellgren-Lawrence grading in patients of
Primary Osteoarthritis.
Materials and Methods: The present observational study was carried out on the patients
coming to the OPD of the Department of Orthopedics, SMS Medical College and Hospital,
Jaipur. All patients complaining of Osteoarthritis of the knee joint and willing to participate
in the study were interviewed for age, sex, history of inflammatory arthritis or any rheumatic
disease, complain of celiac disease & malabsorption syndrome or any history of intake of any
drug that might affect serum Vit D levels. After the successful running of Quality Controls
the clear serum obtained from patient’s serum was analyzed on Advia Centaur XP (for
Vitamin D & PTH) & fully automated chemistry analyzer Beckman Coulter AU 680 (for
routine biochemical parameters). Based on the serum biochemistry results, patients with
deranged RFT & LFT were excluded from the study & the Serum Vitamin D, PTH, Calcium
and Phosphorus levels of the patients with normal RFT & LFT were documented.
Results: In our study maximum number of patients (109, 41.44%) fell in the age group 51-60
years with age ranging from 37-70 years. Mean age is 55.37 ± 8.04 years. Male female ratio
was 0.81:1. Mean serum Vitamin D level is 18.27±8.34 ng/ml with range from 4.2-44.34
ng/ml. Maximum no. of patients were in the Vitamin D deficient group (148, 56.27%), 96
(36.5%) patients were Vitamin D insufficient while only 19 (7.23%) patients had Vitamin D
levels above normal range. Maximum number of cases were of grade 3 (90, 34.22%).
followed by grade 2 (82, 31.18%). Minimum no. of cases are of grade 0 (7, 2.66%) followed
by grade 1 (22, 8.36%). The mean Kellgren- Lawrence grading for the cases is 2.68 ± 1.01.
Conclusion: There is high prevalence of Vitamin D deficiency in Osteoarthritis patients. But
this prevalence needs to be compared with the prevalence in general population by including
age & sex-matched healthy controls. The present study could be further taken in this

Association Between Knee Inflammation and Knee Pain in Patients with Knee Osteoarthritis: An Institutional Based Study

Shakti Condil Sharma, Vijay Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 657-662

Objective: The aim of the present study is to determine the association between knee
inflammation and knee pain in patients with knee osteoarthritis.
Methods: A total of 250 patients with knee OA were included in this study. The
diagnosis was based on the American College of Rheumatology (ACR) criteria for knee
OA. The severity of knee pain, stiffness, and disability were measured using the
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: The mean age of the patients was 50.11 ± 6.34 years. Kellgren-Lawrence
grading scale and age or disease duration were positively and significantly associated,
whereas none of the WOMAC sub-scores were found to be related with Kellgren-
Lawrence grading scale (P > 0.05). On the other hand, WOMAC disability scores were
significantly associated with WOMAC pain and WOMAC stiffness (P < 0.01).
Conclusion: Knee pain, stiffness, and duration of disease may affect the level of
disability in the patients with knee OA. Therefore, treatment of knee OA could be
planned according to the clinical features and functional status.


Sankaralingam P; Parthasarathy M.P; ThulasiRaman D; ArulVignesh .; Aravind MC; Vijay MSV

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 9, Pages 1064-1074
DOI: 10.31838/ejmcm.07.09.109

Background: Total knee replacement has arisen, with outstanding pain relief and work, as a safe, longer-lasting form of knee arthroplasty. The goal of this research was to examine the therapeutic, functional and radiological aspects of complete knee replacement with Buechel-Pappas knee Prosthesis for osteoarthritis and rheumatoid arthritis.
Material and Methods:
Material: Buechal Pappas spinning bearing prothesis was implanted in all the surgeries.
Method: The study is a prospective study in which the Meenakshi Medical College& Research Institute from OCT 2016 to SEP 2018 included patients over 50 years of age who have primary knee osteoarthritis and those with rheumatoid arthritis knee who do not respond to conservative treatment. Both cases were implanted with Complete knee arthroplasty using the Buechel Pappas implant Distance balance procedure above the age range of 50yrs. Both patients have cases that do not lead to conservative management. Serious brain defects, poliomyelitis with muscle weakness, or knee joint sepsis were omitted from the study. The study involved 45 total knee replacements. Initially, both patients were judged by the American Knee Society Ranking. To come to a conclusion, pre and post-operative scores were compared.
Results: In the American knee society ratings, there was a major change. The pre-operative average score was 27.44 and the post-operative score was 91.5. After the TKR, there was a 70% increase in the ratings. The average functional preoperative score was 34.6 and the postoperative score was 83.5, indicating a functional score improvement of 80 percent after TKR.
Conclusions: Total knee arthroplasty with Buechel-Pappas knee resulted in an increase in the patient's functional capacity to return to the pre-disease state, as demonstrated by the post-op society score improvement.


Mohammad Hamzah Mlibary, Hassan Ali Mohammad Saeed Alahmadi, Yasser Ali Mohammad Saeed Alahmadi, Ahmed Mohsen BakheetAlharbi Mohammed Mohsen BakheetAlharbi, FahadMohammed Mosfer Alqarni, AbdulazizAbdullahhMayudhAlwuthaynani, Ahmad WaselAlharbi, WaadNaser Alotaibi

European Journal of Molecular & Clinical Medicine, 2019, Volume 6, Issue 1, Pages 245-255

Primary health care physicians manage most patients with osteoarthritis. Osteoarthritis (OA) is one of the leading causes of disability. The prevalence of OA is expected to increase because of ageing and obesity, and health care professionals must prepare for a rise in the demand for OA care. Osteoarthritis (OA) is the most common form of arthritis and the leading source of physical disability in elderly people. The Prevalence of OA is increasing and will continue to do so as the population gets older. The OA is predominantly managed in primary care centers by primary health care physicians and much can be done to alleviate symptoms from osteoarthritis by combinations of therapeutic options including pharmacological and non-pharmacological treatments, in the Kingdom of Saudi Arabia. The diagnosis is made by history, typical x-ray findings and non-contributory laboratory investigations. The understanding of the pathogenesis of the condition is undergoing change. The development of osteoarthritis is dependent on age, sex, genetic predisposition, and previous trauma to the joint and abnormal mechanical forces caused primarily by obesity.
Aim of the study:To  assess the level of knowledge of Osteoarthritis Management among Primary Health Care Physicians at Primary Health CareCenters of Ministry of Health.
Methods:Cross-sectional study was done, including a representative random sample of PHC physicians working at PHC centers of MOH in Makkah city. during the October to December, 2019, the Sample size of physicians working at PHC centers . Our total participants were (150)
.Results:the majority of participant (44.0%) have weak level of total knowledge about Osteoarthritis Management followed by (35.0%) of participant average while Range(2-8) and Mean ±SD(5.15±2.877) and also shows that is a statistical significant were Chi-square 12.52and P=0.0019
Conclusion:Conduct Saudi guidelines and further studies to assess the practice of PHC physicians regarding osteoarthritis, is recommended. Overall knowledge of PHC physicians in Makkah city regarding OA is acceptable; despite being deficient in some important issues.  Finally, when the conservative management by the primary care physician is of benefit no longer, judicious referral to an experienced Orthopedic Surgeon for the modern surgical approaches should be