Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey

Chuan Silvia Li, Jon Karlsson, Mitchell Winemaker, Parag Sancheti, Mohit Bhandari

To understand orthopedic surgeons' views, preferences, and awareness on "treatment gap" and various conservative and surgical treatments for early to mid-stage knee osteoarthritis (OA). A self-administered questionnaire on the treatment of knee OA was developed in collaboration with orthopedic surgeons with extensive research experience and methodological expertise. The survey was distributed electronically to a group of international orthopedic surgeons and surgical trainees. The data were collected, reviewed, and analyzed using descriptive statistics. One hundred and seventy-three surgeons and surgical trainees completed the survey. The respondents reported that about 58 % of the patients they treat have early to mid-stage knee OA (Kellgren and Lawrence grade I-III). There were significantly higher usage of medications and lower usage of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) (P < 0.05) in developing countries than in developed countries. Four of five surgeons (84 %) perceived a need for better treatments for younger (<60 years old) physically active OA patients in which UKA or TKA is not indicated. Most respondents (80 %) would be willing to adjust age/activity threshold for surgery if a procedure was reversible and recovery was minimal. Two of three surgeons (68.4 %) perceived a treatment gap for early knee OA. However, effective treatments for patients within the treatment gap would have substantial positive social, and economic impacts. The study suggests an ongoing treatment gap for patients with early knee OA and the need for better evidence to guide practice.