Knee and Hip pain: non-surgical treatment recommendations are often not followed

Knee and Hip pain: non-surgical treatment recommendations are often not followed | Prolotherapy.org

Despite guidelines that suggest to doctors that they recommend non-surgical options to patients possibly facing knee and hip replacement, researchers say the non-surgical treatment recommendations are often not followed or even overlooked.

Evidence-based guidelines for hip and knee osteoarthritis recommend that patients 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. New research assesses the extent to which all recommended non-surgical treatments were used by patients with hip or knee osteoarthritis who receive(d) a total hip or knee replacement, as reported by patients and surgeons.

One-hundred ninety-five osteoarthritis patients who had 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.

174 osteoarthritis 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 osteoarthritis, 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.

While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of osteoarthritis patients. Especially, use of dietary therapy may be improved to help patients manage their symptoms, and potentially delay the need for joint arthroplasty.

Please see the related Non-surgical options before knee replacement not explored, and the article Weight loss does not influence outcomes in joint replacement.

1. Hofstede SN, Vliet Vlieland TP, van den Ende CH, et al. Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands. BMJ Open. 2015 Sep 9;5(9):e009117. doi: 10.1136/bmjopen-2015-009117.