May 16, 2018

Study trials non-surgical approach to hip and knee osteoarthritis

Method combines general practice care with tailored diet and exercise program

University of Wollongong researchers, with support from not-for-profit health fund Peoplecare, are developing and testing the feasibility of an evidence-based multidisciplinary care package as a way to delay or even prevent the need for hip or knee replacement surgery for osteoarthritis patients.

The approach translates current clinical-care guidelines for osteoarthritis (OA) of the knee and hip into a real-world general practice setting.

Consultations with health professionals and patients living with hip and knee osteoarthritis supported a nonsurgical intervention to help delay and/or prevent the need for surgery.

Central to the approach is a case-conferencing model in which a general practitioner, nurse, exercise physiologist and dietitian work together to help the patient follow a tailored dietary and exercise regime designed to improve their physical function.

In 2016, nearly 100,000 Australians received joint replacements to treat OA of the hip or knee at an estimated cost of more than $2 billion — placing a significant financial burden on the health-care system.

However, a recent report by MOVE, the national consumer-based organisation for muscle, bone and joint health, suggested that one in four joint replacement surgeries for OA are unnecessary. At the same time, randomised controlled trials have demonstrated that simple non-surgical interventions can successfully delay or avoid the need for knee replacement surgery one year after the intervention.

The University of Wollongong research team is led by Professor Andrew Bonney, the Roberta Williams Chair of General Practice in the School of Medicine, and includes exercise scientist Dr Deirdre McGhee from the Biomechanics Research Laboratory, and dietitian Associate Professor Karen Charlton from the Smart Foods Centre.

Professor Bonney said if the approach proved successful in a clinical practice setting, it could lead to more effective and more affordable treatment of hip and knee osteoarthritis.

“Knee and hip replacement surgery can be traumatic, disruptive and expensive for the individual, as well as placing financial strain on the overall health system,” Professor Bonney said.

“If we can develop an alternative to surgery that is suitable for some patients, and that is demonstrated to be feasible in a real-world setting, then that will have benefits for the health system, but more importantly could improve the quality of life for the patients.”

The first stage of the study involved consultations with health professionals as well as with pre-operative and post-operative hip or knee osteoarthritis patients. The consultations examined the practitioners’ and patients’ beliefs about the potential benefits and challenges of the case conferencing approach and the use of text messaging to prompt participants to stick to their tailored home-exercise program.

Most patients thought the case conferencing method would be a helpful way to manage osteoarthritis, with the individually tailored, team-based aspect noted by many as being beneficial.

“The concept of the team is excellent … I think it’s got a lot of value,” was one comment.

All of the health care practitioners involved in the study felt positive about the case conferencing approach. They saw it as particularly beneficial for treating older patients and those with chronic conditions.

“I find that with chronic conditions and the complexities of aged care, that they seem to respond better to a multidisciplinary approach rather than just one person,” said one.

In the next stage of the study, participants will participate in a case conference with their GP, exercise physiologist and dietitian and together will design a treatment plan to follow with the allied health clinicians over an eight-week period.