Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey
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To understand orthopedic surgeons’ views, preferences, and awareness on “treatment gap” and various conservative and surgical treatments for early to mid-stage knee osteoarthritis (OA).
A self-administered questionnaire on the treatment of knee OA was developed in collaboration with orthopedic surgeons with extensive research experience and methodological expertise. The survey was distributed electronically to a group of international orthopedic surgeons and surgical trainees. The data were collected, reviewed, and analyzed using descriptive statistics.
One hundred and seventy-three surgeons and surgical trainees completed the survey. The respondents reported that about 58 % of the patients they treat have early to mid-stage knee OA (Kellgren and Lawrence grade I–III). There were significantly higher usage of medications and lower usage of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) (P < 0.05) in developing countries than in developed countries. Four of five surgeons (84 %) perceived a need for better treatments for younger (<60 years old) physically active OA patients in which UKA or TKA is not indicated. Most respondents (80 %) would be willing to adjust age/activity threshold for surgery if a procedure was reversible and recovery was minimal. Two of three surgeons (68.4 %) perceived a treatment gap for early knee OA. However, effective treatments for patients within the treatment gap would have substantial positive social, and economic impacts.
The study suggests an ongoing treatment gap for patients with early knee OA and the need for better evidence to guide practice.
KeywordsOrthopedic surgeon Knee Osteoarthritis Evidence Treatment
This study was supported by the research grant from Moximed, Inc. (Hayward, California, USA).
Conflict of interest
Dr. Mohit Bhandari is a consultant for Smith & Nephew, Stryker, Amgen, Zimmer, Moximed, and Bioventus and receives grants from Smith & Nephew, DePuy, Eli Lily, and Bioventus.
- 5.Cibere J, Zhang H, Thorne A, Wong H, Kopec JA, Singer J, Guermazi A, Peterfy C, Nicolaou S, Munk P, Garnero P, Poole AR, Lobanok T, Kraus VB, Way A, Saxne T, Esdaile JM (2006) Identification of early knee osteoarthritis: results from the development of a Model for the Diagnosis of Early Knee Osteoarthritis (MoDEKO) study. Osteoarthr Cartil 14:S124CrossRefGoogle Scholar
- 6.Conrozier T, Marre JP, Payen-Champenois C, Vignon E (2008) National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence. Clin Exp Rheumatol 26:793–798PubMedGoogle Scholar
- 10.Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64:455–474CrossRefGoogle Scholar
- 12.Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M (2003) EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62:1145–1155PubMedCrossRefGoogle Scholar
- 18.Nelson FR, Zvirbulis R, Pilla AA (2012) Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study Journal. Rheumatol Int. doi: 10.1007/s00296-012-2366-8
- 19.Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, Cluzeau F, Cooper C, Dieppe PA, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Kaklamanis PM, Leeb B, Lequesne M, Lohmander S, Mazieres B, Mola EM, Pavelka K, Serni U, Swoboda B, Verbruggen AA, Weseloh G, Zimmermann-Gorska I (2000) EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 59:936–944PubMedCrossRefGoogle Scholar
- 21.SAS (2012) SAS for Windows Version 9.3. SAS Institute, Cary, NC. USA. (Online) Available: http://www.sas.com
- 23.Traynor V, Britt H, Neary S, Sayer GP, Charles J, Meza RA (1994) The management of osteoarthritis in general practice. Results from the Australian Morbidity and Treatment Survey, 1990–1991. Aust Fam Physician 23(1971–1973):1976–1978Google Scholar
- 25.Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, Herrero-Beaumont G, Kirschner S, Leeb BF, Lohmander LS, Mazieres B, Pavelka K, Punzi L, So AK, Tuncer T, Watt I, Bijlsma JW (2010) EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 69:483–489PubMedCrossRefGoogle Scholar
- 26.Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2007) OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 15:981–1000PubMedCrossRefGoogle Scholar
- 27.Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16:137–162PubMedCrossRefGoogle Scholar