Friday, January 7, 2011

Doctors Not Following Guidelines for Knee Arthritis.

A January 2011 article to be published in Arthritis Care and Research suggests that doctors are ignoring the latest evidence-based guidelines and continuing to prescribe analgesics and refer patients for surgery.

This behavior is consistent with the "traditional" treatment of osteoarthritis - Take painkillers until the pain becomes unbearable then have the joint replaced.

This ignores the strong evidence supporting conservative non-pharmacological management of osteoarthritis. These treatments can be used during the period between diagnosis and end stage disease and aim to delay or prevent the need for surgery.

My personal opinion is that this occurrence is in part due to the culture of today. Treatments proven to benefit knee arthritis but requiring will power and hard work (exercise and weight loss programs), are less popular than "easy" treatments (oral pain medication and arthroscopic surgery) despite their relatively ineffectiveness.

Motivation is the key to success and this will be the challenge to governments looking to reduce the cost of osteoarthritis treatment. The analgesia-surgery model is unsustainable financially and it seems illogical to ignore treating the middle stage of the disease.

Lifestyle programs incorporating weight loss and exercise plus the use of assistive devices such as unloader knee braces will be the focus of future treatment programs as cost effectiveness becomes increasingly important.

I still see the occasional patient who asks for the facts, does every one of the proven treatments, and does very well. The majority however want the magic wand waved over them and all to be fine.

For more, read the article here.


  1. Great comment on non-surgical solutions for knee OA, and the prevalent attitudes regarding to same. My doctor has just suggested an unloader brace for my OA of the medial compartment so that I can get back to a more active outdoor life that I've missed for the past few years. I'm looking forward to relief of my pain and - hopefully - a decrease in the swelling on my knee. I'm lucky - I don't have to take painkillers; I'm not overweight; I bicycle and do exercises to keep my quads strong. Also, use of the unloader brace will help to delay a probably inevitable surgery. I have a couple of questions that I hope you might comment on. (I've googled them but didn't get any useful information.)

    Question 1: Is there any concern with muscle atrophy with the unloader brace?

    Question 2: Do you have any thoughts on viscosupplementation treatment for OA of the knee?

    Keep up the interesting posts!

  2. Answer 1: Pain limits mobility and therefore causes weaker muscles due to lack of use. Unloaders decrease the symptoms of osteoarthritis and by reducing the pain of activity often have the opposite effect. I recommend their use to get started on an exercise program aimed at building quads strength. Unloaders are becoming more commonly spotted in gyms.

    Answer 2: Although the evidence is not great for hyaluronic acid injections, I believe this is due to the fact that this treatment is a bit "hit and miss". The average results are poor but this seems to be because for every person who has a great result there is one that receives no benefit. I think it is worth a try but if there is no significant benefit it is time to explore other options.