Osteoarthritis: the peripheral joints.

UNDERSTANDING OF OSTEOARTHRITIS HAS INCREASED: the simplistic "wear and tear" concept no longer holds and this has positive clinical implications. A parallel development has taken place in treatment techniques: there is increasing expertise in the use of physical measures and in new orthopedic reconstructive surgical approaches to multiple joints. This gives the physician alternative approaches to the patient with painful and disabling osteoarthritis. The timing of these treatment options and some considerations which lead to orthopedic referral are considered in this general discussion.