Knee osteoarthritis: only 50% of treatments are guideline-adherent

  • Meiyappan KP & al.
  • J Arthroplasty
  • 29/08/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Only 50.2% of visits to orthopedists for nonoperative treatment of knee osteoarthritis (KOA) adhere to the clinical practice guideline (CPG) recommendations of the American Academy of Orthopedic Surgeons (AAOS).

Why this matters

  • Guideline adherence promotes patient health and saves money by avoiding unsupported or inconclusive treatments.

Study design

  • Retrospective cohort of 1096 consecutive ambulatory visits to orthopedists with KOA as primary diagnosis.
  • Adherence is defined by a strong recommendation of support by the AAOS; lack of adherence is defined by inconclusive or unsupported treatments.
  • Severity of patients defined by Kellgren-Lawrence grades I-IV, with IV being the worst.
  • Funding: None disclosed.

Key results

  • Total number of interventions, 1955.
  • Adherence to AAOS CPGs varies by type of patient:
    • 50.2% of total interventions;
    • 65% of interventions for new visit/never treated patients;
    • 60% of interventions for new visit/previously treated patients; and
    • 40% of interventions for return patients.
  • Adherence decreases as severity increases:
    • 61% of interventions for Kellgren-Lawrence grade I;
    • 60% of interventions for Kellgren-Lawrence grade II;
    • 54% of interventions for Kellgren-Lawrence grade III; and
    • 49% of interventions for Kellgren-Lawrence grade IV.
  • Annual costs (estimated) associated with any type of AAOS recommendation (ranging from "strong" to "not recommended") was $2,403,543.18, of which $1,206,757.80 (50.2%) was associated with a strong recommendation.

Limitations

  • Single-center study.