Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands.
OBJECTIVE
National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons.


METHODS
We performed two cross-sectional internet-based surveys among patients and orthopaedic surgeons throughout the Netherlands.


METHODS
195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate.


METHODS
The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections.


RESULTS
174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients.


CONCLUSIONS
While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy may be improved to help patients manage their symptoms, and potentially delay the need for joint arthroplasty.
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Stefanie N
SN
Hofstede
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Thea P M
TP
Vliet Vlieland
Department of Rheumatology, Sint Maartenskliniek Nijmegen, Ubbergen, The Netherlands.
Cornelia H M
CH
van den Ende
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Rob G H H
RG
Nelissen
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Perla J
PJ
Marang-van de Mheen
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Leti
L
van Bodegom-Vos
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004035:Diet Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009985:Orthopedics / Q000379:methods*; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods; D026741:Physical Therapy Modalities
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen