Osteoarthritis in 2020 and beyond

We applaud the bold move of creating the Lancet Commission on Osteoarthritis, an often forgotten illness.1Hunter DJ March L Chew M Osteoarthritis in 2020 and beyond: a Lancet Commission.Lancet. 2020; 396: 1711-1712Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar Globally applicable and acceptable solutions need transdisciplinary action, which the Commission has clearly thought about, given its diverse professional make-up. In this line of thought, we would like to highlight two other Lancet Commissions, the Lancet Commission on Global Surgery and the ongoing Lancet Commission on Diagnostics.2Wilson ML Atun R DeStigter K et al.The Lancet Commission on diagnostics: advancing equitable access to diagnostics.Lancet. 2019; 393: 2018-2020Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar Total hip arthroplasty is considered one of the most successful and cost-effective surgical interventions ever developed.3Learmonth ID Young C Rorabeck C The operation of the century: total hip replacement.Lancet. 2007; 370: 1508-1519Summary Full Text Full Text PDF PubMed Scopus (1188) Google Scholar Furthermore, even though the mantra we treat patients and not x-rays remains a core value in orthopaedic surgery, treating patients with osteoarthritis without access to diagnostics is near to impossible. Despite the benefits of diagnostics, economic constraints in low-income and middle-income countries severely restrict access to surgical care and diagnostic technology.2Wilson ML Atun R DeStigter K et al.The Lancet Commission on diagnostics: advancing equitable access to diagnostics.Lancet. 2019; 393: 2018-2020Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 4Meara JG Leather AJM Hagander L et al.Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.Lancet. 2015; 386: 569-624Summary Full Text Full Text PDF PubMed Scopus (1415) Google Scholar We believe that the work done by the Lancet Commission on Global Surgery and the Lancet Commission on Diagnostics can meaningfully inform the work of the Lancet Commission on Osteoarthritis. Additionally, we would like to ask the commissioners to consider inviting a paediatrician or paediatric (orthopaedic) surgeon to further the transdisciplinary nature of the Commission. Such an expert could provide valuable insights on paediatric conditions that predispose osteoarthritis, such as scoliosis, developmental dysplasia of the hip, Legg-Calvé-Perthes disease, or septic arthritis, and possible pathways for prevention and mitigation.5Engesæter LB Engesæter IO Fenstad AM et al.Low revision rate after total hip arthroplasty in patients with pediatric hip diseases.Acta Orthop. 2012; 83: 436-441Crossref PubMed Scopus (28) Google Scholar We wish the commissioners all the best in their important work, and we hope that they are willing to consider our reflections and suggestions. MP is supported by a grant from the Belgian Kids' Fund for paediatric research. JGM is a commissioner on the Lancet Commission on Global Surgery and the Lancet Commission on diagnostics. All other authors declare no competing interests. Osteoarthritis in 2020 and beyond: a Lancet CommissionOsteoarthritis affects 7% of the global population, more than 500 million people worldwide, with women disproportionately affected by the condition.1 The number of people affected globally rose by 48% from 1990 to 2019, and in 2019 osteoarthritis was the 15th highest cause of years lived with disability (YLDs) worldwide and was responsible for 2% of the total global YLDs.1,2 Although YLDs for osteoarthritis are higher in high Socio-demographic Index (SDI) countries than in middle SDI regions (about 525 vs 220 YLDs per 100 000 population), since 1990 the rate of change in YLDs has been far greater in middle SDI countries than in high SDI countries (89% vs 48%). Full-Text PDF Osteoarthritis in 2020 and beyond – Authors' replyWe thank Manon Pigeolet and colleagues for their thoughtful suggestions. We agree that the Lancet Commission on Global Surgery and the Lancet Commission on Diagnostics are critically relevant in the osteoarthritis field, and we look forward to interacting with both groups. Full-Text PDF