Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands

While most recommended non-surgical treatments for OA were used frequently as single therapy, the combination is used in only a small percentage of OA patients who received a THA or TKA.

With regard to wild animals, dogs should also be kept on a lead outdoors in nature. Photo: Anders Gjengedal –

To our knowledge this is the first study that evaluated the full range of combinations of non-surgical treatments for OA, both from the perspective of orthopaedic surgeons and patients.

Despite their potential for reducing symptoms of knee and hip OA, dietary therapy and physical therapy appear to be least frequently used. By increasing the use of these two non-surgical treatments, primary care physicians and orthopaedic surgeons may be able to help patients better manage their symptoms, thereby improving quality of care and potentially postpone the need for joint arthroplasty, resulting in improved long-term patient outcomes.

Future studies should focus on evaluating the reasons (barriers) why some orthopaedic surgeons do not use recommended non-surgical treatments. Such findings may be helpful in developing targeted strategies to improve the use of these treatments in orthopaedic practice and thereby to improve quality of care. Although the recommended non-surgical treatment options have been proven to be effective individually or in combination (eg, physical therapy with dietary therapy), there are no published studies that investigated the combined effect of all of these treatments.

Nevertheless, it has been hypothesised that optimised non-surgical treatment could result in significantly greater pain reduction, functional improvement and increase in quality of life than usual care in knee OA. The results from the present study suggest that such better outcomes may be achieved in a considerable part of OA patients.


Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands, Stefanie N Hofstede, Thea P M Vliet Vlieland, Cornelia H M van den Ende, Rob G H H Nelissen, Perla J Marang-van de Mheen, Leti van Bodegom-Vos. BMJ Open 2015;5:e009117. doi:10.1136/ bmjopen-2015-009117


Non-surgical care in patients with hip or knee osteoarthritis is modestly consistent with a stepped care strategy after its implementation, Agnes J. Smink, Sita M.A. Bierma-Zeinstra, Henk J. Schers, Bart A. Swierstra, Joke H. Kortland, Johannes W.J. Bijlsma, Steven Teerenstra, Theo B. Voorn, Joost Dekker, Thea P.M. Vliet Vlieland, Cornelia H.M. van den Ende. International Journal for Quality in Health Care 2014; Volume 26, Number 4: pp. 490–498. DOI 490-498. First published online 20 May 2014.

Also see
Exercise and Knee OA: What You Can Tell Your Patients Rheumatology Network
Musculoskeletal Hits Top 10 in Primary Care Visits Rheumatology Network
Knee Osteoarthritis Patient Care Benefits From Multidisciplinary Approach Rheumatology Network

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