Osteoarthritis: Conservative therapy delays need for knee and hip joint replacement surgery

Patients benefit from long-lasting effects.

by European League Against Rheumatism (EULAR) via EurekAlert! AAAS and Medical Xpress 19 August 2020

“It is wise to consider all non-surgical treatment options before resorting to an artificial hip or knee joint implant,” said EULAR President Professor Iain B. McInnes, University of Glasgow, Scotland. Yet in many cases, doctors and patients fail to exhaust the full range of conservative therapy options. A Norwegian study has now shown how many patients with osteoarthritis (OA) can benefit from a qualified, conservative therapy program.

The study design, a so-called cluster-randomized trial (CRT), comprised a program developed based on international treatment recommendations for hip and knee osteoarthritis (OA). It included an initial three-hour patient education program, among other things. This was followed by 8–12 weeks of individually tailored exercises supervised by physiotherapists.

The program was facilitated by general practitioners, primary care physicians and physiotherapists, who also received prior training. A total of 393 patients participated in the study; 284 were included in the special osteoarthritis program and 109 (control group) continued their usual care.

The participants were at least 45 years old and presented with clinical OA symptoms such as reduced mobility or pain. They were re-examined 12 months after the beginning of the program. The study parameters included but were not limited to quality of care, satisfaction with care, physical activity, and referrals to physiotherapy or orthopedic surgeons. The researchers also recorded whether joint replacement surgery was performed.

92 percent of the patients participated in the patient education programme and 64 percent completed a minimum participation period of at least eight weeks of exercise. Twelve months later, the intervention group reported a significantly higher quality of care (score of 58, versus 41 for the control group).

The study participants also reported significantly higher satisfaction with care (Odds ratio (OR) 7.8; 95% CI 3.55, 17.27). A significantly larger proportion (OR: 4.0; 95% CI 1.27, 12.63) also met the recommendations for physical activity compared to the control group.

A smaller proportion was referred to orthopaedic surgeons (OR 0.5; 95% CI 0.29, 1.00) and an even smaller proportion (4%) received joint replacement surgery during the observation period, compared to the control group (11%, OR 0.3; 95% CI 0.14, 0.74).

“The implementation of a structured model for OA care led to an improved quality of care, higher patient satisfaction and increased physical activity, despite OA,” stated co-author of the study Tuva Moseng, Diakonhjemmet Hospital, Oslo, Norway. There is also some evidence to suggest that a structured OA programme including patient education and exercise may delay or even reduce the need for surgery after 12 months.

Professor John Isaacs from Newcastle University, UK, and Chair of the EULAR 2020 Scientific Programme Committee summarised: “Once again, we see just how important and effective consistent, conservative therapy is for our OA patients.” He urged that “conservative care based on the international recommendations for OA treatment should become the standard for all patients.”

Source EurekAlert! AAAS and Medical Xpress

References

OP0321-HPR Higher Quality of Care and Less Surgery After Implementing Osteoarthritis Guidelines In Primary Care – Long-term Results From A Cluster Randomized Controlled Trial, Østerås, N. Moseng, T. Van Bodegom-Vos, L. Dziedzic, K. Andreassen, Ø. Fenstad, A. M. Furnes, O. Nygren Hansen, J. Natvig, B. Røtterud, J. H. Schjervheim, U. B. Vliet Vlieland, T. P. M. Hagen, K. B. Annals of the Rheumatic Diseases 2020;79:198. PDF

OP0198-HPR A Structured Model For OA Care In Primary Healthcare Is A Cost-effective Alternative Compared To Usual Care For People With Hip And Knee OA, Østerås N, Aas E, Moseng T, L. Van Bodegom-Vos, K. Dziedzic, B. Natvig, J. H. Røtterud, T. P. M. Vliet Vlieland, K. B. Hagen. Annals of the Rheumatic Diseases 2021;80:119-120. Full text. PDF

Implementing international osteoarthritis guidelines in primary care: uptake and fidelity among health professionals and patients, Moseng T, Dagfinrud H, Østerås N. Osteoarthritis Cartilage. 2019 Aug;27(8):1138-1147. doi: 10.1016/j.joca.2019.03.010. Epub 2019 May 8.

Further reading

Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study, Østerås N, Blaker IB, Hjortland T, Cottrell E, Quicke JG, Dziedzic KS, Blackburn S, Paulsen A. BMC Musculoskelet Disord. 2021 Jan 14;22(1):79. doi: 10.1186/s12891-021-03959-6. Full text

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials, Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Southampton (UK): NIHR Journals Library; 2018 Jul. Full text

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, 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. Osteoarthritis Cartilage. 2007 Sep;15(9):981-1000. doi: 10.1016/j.joca.2007.06.014. Epub 2007 Aug 27.

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines, 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. Osteoarthritis Cartilage. 2008 Feb;16(2):137-62. doi: 10.1016/j.joca.2007.12.013.

OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through January 2009, Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. Osteoarthritis Cartilage. 2010 Apr;18(4):476-99. doi: 10.1016/j.joca.2010.01.013. Epub 2010 Feb 11.