Use of Recommended Non-surgical Knee Osteoarthritis Management in Patients prior to Total Knee Arthroplasty: A Cross-sectional Study

Abstract

Objective Our aim was to assess prior use of core recommended non-surgical treatment among patients with knee osteoarthritis (OA) scheduled for total knee arthroplasty (TKA), and to assess potential patient-level correlates of underuse, if found. Methods This was a cross-sectional study of patients undergoing TKA for primary knee OA at 2 provincial central intake hip and knee clinics in Alberta, Canada. Standardized questionnaires assessed sociodemographic characteristics, social support, coexisting medical conditions, OA symptoms and coping, and previous non-surgical management. Multivariable logistic regression was used to assess the patient-level variables independently associated with receipt of recommended non-surgical knee OA treatment, defined as prior use of pharmacotherapy for pain, rehabilitation strategies (exercise or physiotherapy), and weight loss if overweight or obese (body mass index ≥ 25 kg/m2). Results There were 1273 patients included: mean age 66.9 years (SD 8.7), 39.9% male, and 44.1% had less than post-secondary education. Recommended non-surgical knee OA treatment had been used by 59.7% of patients. In multivariable modeling, the odds of having received recommended non-surgical knee OA treatment were significantly and independently lower among individuals who were older (OR 0.97, 95% CI 0.95–0.99), male (OR 0.33, 0.25–0.45), and who lacked post-secondary education (OR 0.70, 0.53–0.93). Conclusion In a large cross-sectional analysis of knee OA patients scheduled for TKA, 40% of individuals reported having not received core recommended non-surgical treatments. Older individuals, men, and those with less education had lower odds of having used recommended non-surgical OA treatments.

What You Should Know About Osteoarthritis Rehabilitation: A Bibliometric Analysis of the 50 Most-Cited Articles

“…30 All these factors provide a strong basis for the importance of osteoarthritis rehabilitation evaluation and treatment. 31,32 Through the journal analysis, we found that more than half of the top 50 articles were published in Archives of Physical Medicine and Rehabilitation (IF articles from high-IF journals. Journals with high IFs are considered to be of high quality and have a high degree of influence in this field.…”

“…30 All these factors provide a strong basis for the importance of osteoarthritis rehabilitation evaluation and treatment. 31,32…”

Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study

“…Reasons for this are unclear. This may be due to greater engagement in physical therapy, 16 presumably due to contraindications to non-steroidal anti-inflammatories (NSAIDs), worse baseline pain due to avoidance of NSAIDs and opportunity for improvement post TKA, or due to the links between brain (depression, pain) and GI symptoms 55 - whereby GI disease is additional marker for disease severity and thus greater opportunity to improve with OA treatment. Alternatively, this may have been a spurious finding.…”

“…The BEST-Knee study recruited adults age 30 years or older with primary knee OA referred for consultation regarding elective primary total knee arthroplasty (TKA) between 27 October 2014 and 30 September 2016 at two provincial central intake orthopaedic hip and knee clinics in Calgary and Edmonton, Alberta, Canada. 16 17 All surgeons (n=45) at these centres participated. Participants were required to be able to read and comprehend English.…”

Identification and validation of hub genes of synovial tissue for patients with osteoarthritis and rheumatoid arthritis

“…Although these two diseases have many similarities of symptoms, there are still differences in pathological mechanisms and pathogenesis in terms of the synovial for both. Despite the differences in the occurrence and development between OA and RA, the current therapies for these diseases are partial similarity, including oral medications (nonsteroidal anti-in ammatory drugs) [5,6]; intra-articular injection (hormones and sodium hyaluronate), maintained functional capacities [7,8]; and surgical intervention performed to rescue end-stage lesions [9,10]. However, those interventions are not adequate to impede the occurrence and progression of OA and RA due to the unclear pathogenesis of both diseases.…”