Exploring views of orthopaedic surgeons, rheumatologists and general practitioners about osteoarthritis management

Abstract

Background: Delivery of recommended treatments for hip and knee osteoarthritis (OA) is known to be discordant with guideline recommendations. However, professional views related to OA management across medical and surgical disciplines are not well understood. The aim of this study was to explore the views of medical professionals about management of hip and knee OA.Methods: Qualitative study. Semistructured individual interviews were conducted with orthopaedic surgeons, rheumatologists and general practitioners routinely involved in the management of OA. Interviews were audiotaped, transcribed, member-checked, coded and thematically analysed.Results: Fifteen medical professionals were interviewed. Three main themes were:(i) recognition of the importance of nonsurgical management of hip and knee OA, focussed on self-management, exercise-therapy, weight management and analgesia;(ii) joint replacement being considered the 'last resort' for end stage disease not responding to nonsurgical management; and (iii) determination of management 'success' through patient perceptions was more common than the use of validated instruments. Views on management broadly converged across disciplines, except for the role of joint replacement, considered an adjunct in the overall management of OA by rheumatologists and as a definitive cure by orthopaedic surgeons. Conclusions:Aligning with current guidelines, medical professionals recognised the importance of nonsurgical management focussed on exercise-therapy for hip and knee OA, and concurred that joint replacement surgery should be a last resort. A focus on patient education was less prominent, which along with implementation of validated outcome measures in routine medical practice, may require greater health system support.

Understanding the management of osteoarthritis: A qualitative study of GPs and orthopaedic surgeons in Tasmania, Australia

“…The overwhelmingly positive attitudes about the importance of exercise are reassuring and may suggest that practice behaviour is changing. This also reflects the findings of a recently published Australian qualitative study in orthopaedic surgeons, GPs, and rheumatologists [ 13 ]. Recently updated national guidelines [ 4 ] and the introduction of an Osteoarthritis of the Knee Clinical Care Standard in Australia [ 7 ] could contribute to this, however our GPs did not specifically mention these updated recommendations.…”

“…Therefore, our results may be transferable to GPs and surgeons in regional Australian centres and may be less readily applicable to other settings. However, our findings were consistent with a recently published qualitative study conducted in metropolitan Melbourne [ 13 ]. Lastly, interviewees may have been generally more interested in treating OA and therefore more aware of updated guidelines.…”

“…It is important to understand the management of OA from diagnosis through to decision making for surgery to identify areas for improvement. To date only one qualitative study has captured the views of different medical professionals [ 13 ], demonstrating the need for further exploration.…”

Acupressure for Managing Osteoarthritis: A Systematic Review and Meta-Analysis

“…Still, there are many treatment approaches for the management of osteoarthritis, and they are generally nonpharmacologic, pharmacologic, surgical, or complementary and alternative approaches [6]. In particular, clinical practice guidelines for hip and knee OA suggest interventions such as patient education, exercise, and weight management as first-line treatments, pharmacological therapies and other therapies as second-line treatment, and surgical interventions for replacement as third-line treatment [7]. The complementary and alternative approaches, including acupuncture, yoga, manual therapy, and electrotherapy, are recommended for the OA treatment by the National Clinical Guideline Centre in United Kingdom and the American Academy of Orthopedic Surgeons (AAOS) [8].…”

Short-term results of intra-articular injections of stromal vascular fraction for early knee osteoarthritis

“…In younger patients with medial compartmental osteoarthritis of the knee, valgus high tibial osteotomy reduces pain and improves knee function [ 7 ]. Definitive solution to provide pain relief for the latest stages of OA is joint replacement, but the limited longevity of prostheses may restrict their use in younger and active patients [ 8 ]. Therefore, the ideal treatment for OA should restore the biomechanical and biochemical properties of damaged cartilage focusing on cartilage repair and restoration [ 9 ].…”