Abstract
Purpose
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).
Methods
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.
Results
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.
Conclusion
The study suggests an ongoing treatment gap for patients with early knee OA and the need for better evidence to guide practice.
Similar content being viewed by others
References
Alami S, Boutron I, Desjeux D, Hirschhorn M, Meric G, Rannou F, Poiraudeau S (2011) Patients’ and practitioners’ views of knee osteoarthritis and its management: a qualitative interview study. PLoS One 6:e19634
Bennell KL, Messier SP (2010) Osteoarthritis: strength training, self-management or both for early knee OA. Nat Rev Rheumatol 6:313–314
Cabitza F, Ragone V, Arrigoni P, Karlsson J, Randelli P (2013) Management of knee injuries: consensus-based indications from a large community of orthopaedic surgeons. Knee Surg Sports Traumatol Arthrosc 21:708–719
Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ (2012) Knee replacement. Lancet 379:1331–1340
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:S124
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 26:793–798
Dominick KL, Ahern FM, Gold CH, Heller DA (2004) Health-related quality of life among older adults with arthritis. Health Qual Life Outcomes 2:5
Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF (1987) The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 30:914–918
Gabay O (2012) Osteoarthritis: new perspectives. J Spine 1:e101
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) 64:455–474
Hochberg MC, Perlmutter DL, Hudson JI, Altman RD (1996) Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community-based rheumatologists in the United States. Arthritis Care Res 9:170–176
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 62:1145–1155
Kao MH, Tsai YF (2012) Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase. Disabil Rehabil 34:1827–1834
Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S (2012) Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 20:436–449
Krishnan SP, Skinneremail JA (2005) Novel treatments for early osteoarthritis of the knee. Curr Orthop 19:407–414
London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76:887–892
Mazieres B, Bannwarth B, Dougados M, Lequesne M (2001) EULAR recommendations for the management of knee osteoarthritis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials. Joint Bone Spine 68:231–240
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
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 59:936–944
Roddy E, Doherty M (2003) Guidelines for management of osteoarthritis published by the American College of Rheumatology and the European League Against Rheumatism: why are they so different? Rheum Dis Clin North Am 29:717–731
SAS (2012) SAS for Windows Version 9.3. SAS Institute, Cary, NC. USA. (Online) Available: http://www.sas.com
Scarpa R, Sarzi-Puttini P, Cimmino MA, Caporali R, Parazzini F, Zaninelli A, Canesi B (2005) Analysis of pharmacologic and nonpharmacologic prescription patterns of general practitioners and specialists in the AMICA study. Semin Arthritis Rheum 35:24–30
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):1976–1978
Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656
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 69:483–489
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 15:981–1000
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 16:137–162
Zhu ZA (2010) Pay attention to early diagnosis and treatment of knee osteoarthritis. Zhongguo Gu Shang 23:887–889
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Li, C.S., Karlsson, J., Winemaker, M. et al. Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 22, 363–378 (2014). https://doi.org/10.1007/s00167-013-2529-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-013-2529-5