Lower extremity osteoarthritis management needs a paradigm shift.

The current pre-eminent focus in osteoarthritis research and clinical practice is on persons with established radiographic disease. This is the very end-stage of disease genesis and modern therapies are thus largely palliative. A major shift in the focus of osteoarthritis research and clinical practice is critically needed if an impact is to be made for the millions living with the chronic pain and disability of osteoarthritis. The disease management paradigm needs to be revolutionised to focus on persons at high risk of developing or with early disease in which structural changes may be preventable or reversible. Similarly, current palliation should shift towards coordinated conservative management with reorganisation of the delivery of health services.