Non-surgical treatment before hip and knee arthroplasty remains underutilized with low satisfaction regarding performance of work, sports, and leisure activities

Yvonne van Zaanen; Alexander Hoorntje; Koen L M Koenraadt; Leti van Bodegom-Vos; Gino M M J Kerkhoffs; Suzanne Waterval-Witjes; Tim A E J Boymans; Rutger C I van Geenen; P Paul F M Kuijer

doi:10.1080/17453674.2020.1813440

Authors

Yvonne van Zaanen Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam
Alexander Hoorntje Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda; Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam
Koen L M Koenraadt Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda
Leti van Bodegom-Vos Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden
Gino M M J Kerkhoffs Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Academic Center for Evidence based Sports medicine (ACES), Amsterdam Movement Sciences, Amsterdam
Suzanne Waterval-Witjes Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam; Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda; Personalized Knee Care, Maastricht
Tim A E J Boymans Department of Orthopaedic surgery, Maastricht University Medical Center, Maastricht, The Netherlands
Rutger C I van Geenen Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda
P Paul F M Kuijer Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam

DOI:

https://doi.org/10.1080/17453674.2020.1813440

Abstract

Background and purpose — Guidelines for managing hip and knee osteoarthritis (OA) advise extensive non-surgical treatment prior to surgery. We evaluated what percentage of hip and knee OA patients received non-surgical treatment prior to arthroplasty, and assessed patient satisfaction regarding alleviation of symptoms and performance of activities.

Patients and methods — A multi-center cross-sectional study was performed in 2018 among 186 patients who were listed for hip or knee arthroplasty or had undergone surgery within the previous 6 months in the Netherlands. Questions concerned non-surgical treatments received according to the Stepped Care Strategy and were compared with utilization in 2013. Additionally, satisfaction with treatment effects for pain, swelling, stiffness, and activities of daily life, work, and sports/leisure was questioned.

Results — The questionnaire was completed by 175 patients, age 66 years (range 38–84), 57% female, BMI 29 (IQR 25–33). Step 1 treatments, such as acetaminophen and lifestyle advice, were received by 79% and 60% of patients. Step 2 treatments, like exercise-based therapy and diet therapy, were received by 66% and 19%. Step 3—intra-articular injection—was received by 47%. Non-surgical treatment utilization was lower than in 2013. Nearly all treatments showed more satisfied patients regarding pain relief and fewer
regarding activities of work/sports/leisure. Hip and knee OA patients were mostly satisfied with NSAIDs for all outcomes, while exercise-based therapy was rated second best.

Interpretation — Despite international guideline recommendations, non-surgical treatment for hip and knee OA remains underutilized in the Netherlands. Of the patients referred for arthroplasty, more were satisfied with the effect of non-surgical treatment on pain than on work/sports/leisure participation.