Just 23% of Medicare beneficiaries with osteoarthritis who eventually underwent knee replacement ever had a physical therapy visit, according to data published in Arthritis & Rheumatology.

Among those who avoided knee replacement, that figure is only slightly higher, at 28.9%.

The frequency of nonsurgical care use in patients with knee OA in the United States is unknown, Michael M. Ward, MD, MPH, of the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, in Bethesda, Maryland, tells Healio Rheumatology .

“It is not clear how often patients are seen for knee complaints, how commonly specialists such as rheumatologists or physiatrists are consulted, and how commonly physical therapy and intra-articular medications are used. If non-operative measures are infrequently used, particularly among patients who later have TKA, it could suggest opportunities to improve the health status in patients with knee OA and potentially lessen the need for [total knee arthroplasty (TKA)].”

— Michael M. Ward, MD, MPH

Retrospective Cohort Study

To analyze health care use among older patients with knee OA and determine whether said use differs in regions with high and low rates of total knee replacement, Ward conducted a retrospective cohort study of US Medicare beneficiaries from 2005 to 2010. The analysis included a total of 988,570 beneficiaries with knee OA, among whom 33.1% received total knee arthroplasty during a median 5.6 years of follow-up.

Ward reviewed the health care use for knee complaints, including rates of physician visits, physical therapy, knee injections and arthroscopy, using Medicare claims files for all patients until knee replacement or 2015, when the study ended. He then compared health care use among beneficiaries who lived in regions with high or low rates of total knee arthroplasty, Healio Rheumatology continues.

According to the researchers, higher rates of visits for knee complaints were associated with an increased risk for knee replacement, while the use of physical therapy, specialist care and intra-articular injections were associated with a lower risk. The frequency of knee replacement surgery varied from 26.4% in the lowest quintile region to 42.1% in the highest quintile, Ward wrote.

Rates of physician visits, physical therapy, specialist care and the use of intra-articular injections varied inversely with arthroplasty quintile, with physical therapy used by 32.5% of beneficiaries in the lowest quintile region and by 23.6% in the highest quintile region. In addition, physical therapy was associated with lower rates of knee replacement in all quintiles.

“Many aspects of conservative care were not used often, even among patients with subsequently went on to have a knee replacement. For example, only 28.9% of those who did not have a knee replacement, and only 23% of those who later had a knee replacement, had any physical therapy visit. Visits to physiatrists and rheumatologists were similarly low. Intra-articular corticosteroids were used in only 40% of patients. These results suggest that there is room to expand the use of conservative care, which may impact the need for knee replacement.

“In addition, rates of many types of conservative care were lower in regions of the country with the highest rates of knee replacement, suggesting that knee replacement was substituting for more reliance on conservative care in the high-surgery regions. Patients with knee OA and their primary care providers should consider whether conservative treatments are appropriate before having a referral to an orthopedic surgeon. Some patients may benefit and avoid or postpone the need for arthroplasty.”

— Michael M. Ward, MD, MPH

[Source: Healio Rheumatology]

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