Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands

Journal article (2015)

Authors

Stefanie N. Hofstede Leiden University Medical Center
Thea P.M.V. Vlieland Leiden University Medical Center
Cornelia H.M. Van Den Ende Sint Maartenskliniek, Nijmegen
R.G.H.H. Nelissen Leiden University Medical Center
P.J. Marang-van de Mheen Leiden University Medical Center
Leti van Bodegom-Vos Leiden University Medical Center
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Published Date

2015

Language

English

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Abstract

Objectives: National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons. Setting: We performed two cross-sectional internetbased surveys among patients and orthopaedic surgeons throughout the Netherlands. Participants: 195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate. Primary and secondary outcome measures: The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections. Results: 174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients. Conclusions: While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy may be improved to help patients manage their symptoms, and potentially delay the need for joint arthroplasty.