“It is surprising that this study found that physical therapy and other conservative strategies are not widely used in older adults with knee pain,” he says. The American Academy of Orthopedic Surgeons clinical practice guideline on treatment of osteoarthritis of the knee “gives a strong recommendation for use of home exercise, strengthening and low-impact exercise as part of conservative treatment,” he says.2
“NSAIDs, non-narcotic pain medication and weight loss are also recommended,” he notes. “The benefit of different injections is not as clear cut. There are numerous other conservative treatments that are not recommended due to lack of quality studies to measure their efficacy.”
“The article refers to total knee arthroplasty as a risk to be avoided, such as cancer or heart attack, yet in the opening paragraph states that it is ‘the most effective treatment for advanced knee osteoarthritis. It is one of the most successful surgeries for improvement in quality of life,” he adds.
“Cost-effective care should include conservative treatments that work, and perhaps delay the need for surgery, but not to avoid the most effective treatment when it is appropriate,” Dr. Gibson says. “The article is concerned about the cost burden of total knee arthroplasty, yet there is cost in using ineffective conservative care, as well.”
References
- Ward MM. Osteoarthritis care and risk of total knee arthroplasty among medicare beneficiaries. Arthritis Rheumatol. 2021 Jun 8. Online ahead of print.
- Jevsevar DS. Treatment of osteoarthritis of the knee: Evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013 Sep;21(9):571–576.
