Use of recommended non-surgical knee osteoarthritis management in patients prior to totalv knee arthroplasty: a cross-sectional study

Objective Our aim was to assess prior use of core recommended non-surgical treatment among patients with knee osteoarthritis (OA) scheduled for total knee arthroplasty (TKA); and, to assess potential patient-level correlates of underuse, if found.

Methods This was a cross-sectional study of patients undergoing TKA for primary knee OA at two provincial central intake hip and knee clinics in Alberta, Canada. Standardized questionnaires assessed socio-demographic characteristics, social support, coexisting medical conditions, OA symptoms and coping, and previous non-surgical management. Multivariable logistic regression was used to assess the patient-level variables independently associated with receipt of recommended non-surgical knee OA treatment, defined as prior use of pharmacotherapy for pain, rehabilitation strategies (exercise or physiotherapy), and weight loss if overweight or obese (body mass index ≥25 kg/m²).

Results 1,273 patients were included: mean age 66.9 years [SD 8.7]; 39.9% male; 44.1% had less than post-secondary education. Recommended non-surgical knee OA treatment had been used by 59.7% of patients. In multivariable modeling, the odds of having received recommended non-surgical knee OA treatment was significantly and independently lower among individuals who were older (OR 0.96 [95%CI 0.95–0.98]), male (OR 0.41 [0.31–0.53]), and who lacked post-secondary education (OR 0.67 [0.52–0.87]).

Conclusion In a large cross-sectional analysis of knee OA patients scheduled for TKA, 40% of individuals reported having not received core recommended non-surgical treatments. Older individuals, men and those with less education had lower odds of having used recommended non-surgical OA treatments.