Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    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

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  2. 2.

    Bennell KL, Messier SP (2010) Osteoarthritis: strength training, self-management or both for early knee OA. Nat Rev Rheumatol 6:313–314

    PubMed  Article  Google Scholar 

  3. 3.

    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

    PubMed  Article  Google Scholar 

  4. 4.

    Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ (2012) Knee replacement. Lancet 379:1331–1340

    PubMed  Article  Google Scholar 

  5. 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:S124

    Article  Google Scholar 

  6. 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 26:793–798

    CAS  PubMed  Google Scholar 

  7. 7.

    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

    PubMed Central  PubMed  Article  Google Scholar 

  8. 8.

    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

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Gabay O (2012) Osteoarthritis: new perspectives. J Spine 1:e101

    PubMed Central  PubMed  Google Scholar 

  10. 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) 64:455–474

    Article  Google Scholar 

  11. 11.

    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

    CAS  PubMed  Article  Google Scholar 

  12. 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 62:1145–1155

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Kao MH, Tsai YF (2012) Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase. Disabil Rehabil 34:1827–1834

    PubMed  Article  Google Scholar 

  14. 14.

    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

    PubMed  Article  Google Scholar 

  15. 15.

    Krishnan SP, Skinneremail JA (2005) Novel treatments for early osteoarthritis of the knee. Curr Orthop 19:407–414

    Article  Google Scholar 

  16. 16.

    London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76:887–892

    PubMed  Article  Google Scholar 

  17. 17.

    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

    CAS  PubMed  Article  Google Scholar 

  18. 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. 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 59:936–944

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    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

    PubMed  Article  Google Scholar 

  21. 21.

    SAS (2012) SAS for Windows Version 9.3. SAS Institute, Cary, NC. USA. (Online) Available: http://www.sas.com

  22. 22.

    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

    PubMed  Article  Google Scholar 

  23. 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):1976–1978

    Google Scholar 

  24. 24.

    Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    PubMed Central  PubMed  Google Scholar 

  25. 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 69:483–489

    CAS  PubMed  Article  Google Scholar 

  26. 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 15:981–1000

    CAS  PubMed  Article  Google Scholar 

  27. 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 16:137–162

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Zhu ZA (2010) Pay attention to early diagnosis and treatment of knee osteoarthritis. Zhongguo Gu Shang 23:887–889

    PubMed  Google Scholar 

Download references

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

Affiliations

Authors

Corresponding author

Correspondence to Mohit Bhandari.

Appendix

Appendix

See Tables 5 and 6.

Table 5 Regression analysis of demographics and surgical experiences of the respondents
Table 6 Regression analysis of demographics and surgical experiences of the respondents versus current diagnosis, treatment pattern of knee OA, and perception of treatment gap

Rights and permissions

Reprints 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

Download citation

Keywords

  • Orthopedic surgeon
  • Knee
  • Osteoarthritis
  • Evidence
  • Treatment