Youth, obesity and worn knees. A trifecta of trouble

Case scenario

Millie is a very overweight 38-year-old woman with a BMI of 42 kg/m². She has advanced osteoarthritis with relentless pain, particularly in her right knee, imaging of which has shown complete breakdown of cartilage as well as bone oedema and cysts. She has three young children and is finding it difficult physically to cope with all the necessary activities of daily living. She has been told that a knee replacement cannot be contemplated until she reaches the age of 50 years.

Is this age for knee replacement a widely accepted orthopaedic guideline, or might she have been told this as part of a vigorous attempt to get her to lose weight? What can be done for Millie?

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