Greater support needed to improve the treatment of knee osteoarthritis

A new Curtin University-led paper has outlined that many people living with knee osteoarthritis may be needlessly suffering or receiving the wrong treatments for their symptoms, recommending a major change in how osteoarthritis is understood and treated.

The paper, published in the British Journal of Sports Medicine, concluded that people with osteoarthritis are often provided potentially risky treatments with limited benefit such as opioid medication, injections, and arthroscopic surgery to manage their pain.

Lead author Dr. JP Caneiro, from Curtin's School of Physiotherapy and Exercise Science, said most people with osteoarthritis around the globe are not receiving the best practice care, including education, strengthening exercises, physical activity and weight management, that they require. Greater support from the health system is needed.

"This editorial is a call to action by international leaders in the field, from physiotherapy, rheumatology and orthopaedic surgery, including an outline of three key steps that are needed to change the way healthcare professionals understand and manage knee osteoarthritis," Dr. Caneiro said.

"This includes changing the way clinicians understand and explain the condition to patients, how they treat the condition and by coaching patients to put them in charge of managing their own condition. Together, this helps to reduce the disability burden and suffering associated with knee osteoarthritis."

Dr. Caneiro said the proposed steps would enable healthcare professionals to promote a new and better understanding of knee osteoarthritis that is aligned with contemporary evidence.

"Knee osteoarthritis can be painful and debilitating, and the pain is often blamed on structural damage, with people frequently given scans and told that their knees are 'bone on bone,' leading them to believe that a knee replacement is inevitable," Dr. Caneiro said.

"Because of this, treatment often aims to 'fix' the structure, leading to many people receiving knee arthroscopic surgery or a knee replacement. In contrast, research tells us that non-surgical treatments targeting physical, lifestyle and psychological factors can reduce pain, disability, reliance on medication and need for surgery. However, effective non-surgical approaches are often not prescribed, and there is very little support within the health system to fund them."

Co-author John Curtin Distinguished Professor Peter O'Sullivan, also from Curtin's School of Physiotherapy and Exercise Science, said it was critical to spread the message to international and national healthcare professionals and the general public to change society's misconceptions about knee osteoarthritis.

"It is important for clinicians to shift away from labeling this condition as 'structural damage' and instead focus on knee health, encouraging exercise therapy, physical activity and weight loss, as well as reassuring patients that it is safe to exercise and strengthen their knee," Professor O'Sullivan said.

"People with osteoarthritis need health professionals to coach them to develop a positive mindset, engage with exercise, and learn how to manage possible flare-ups. To facilitate a shift in the treatment of osteoarthritis, important changes need to occur at the health system level such as funding, and better reimbursement for exercise, weight loss and education programs for osteoarthritis care."