Aims: Schuss radiographs are PA weight bearing views of the knee taken in 30 degrees of ßexion. Several studies have shown them to be more sensitive detectors of osteoarthritic changes in the knee than standard extension AP views. The aim of this study was to determine whether the increased severity of degenerate change shown on these radiographs is sufþcient to alter proposed orthopaedic management of patients. Methods: Fifty consecutive patients aged 45–75 presenting to clinic with symptoms suggestive of tibiofemoral osteoarthritis were included. Each underwent standard clinical assessment and weight bearing extension AP and lateral radiographs of the knee. In addition a digital photograph of the legs and a single schuss radiograph were taken. This information was collated onto slides, two per patient. One slide included the history and examination þndings plus the photograph, extension AP and lateral radiographs. The other was identical save that the extension AP was replaced by the schuss radiograph. The slides were randomised and shown to eight consultant orthopaedic surgeons. For each slide each consultant was asked to give his preferred management. Responses for the two slides of each patient were compared. Results: The panel changed their management plan in over 40% of cases. This represented a reduction of almost 50% in arthroscopies in the schuss group with a move towards deþnitive surgery. Total number of procedures proposed was also reduced. Conclusion: The schuss radiograph is a valuable tool in the assessment of knee osteoarthritis the use of which can alter clinical management. By reducing non-therapeutic arthroscopies it may signiþcantly reduce total number of operations to be performed in this patient group.