A doctor evaluating a person's knee, which is inflicted with knee osteoarthritis, as evident by a red pain spot.
Credit: iStock

Joint replacement surgery is often described as a last-resort option; something that should only be considered after other treatments, such as physical therapy and steroid injections, have been exhausted. Yet a new study suggests the majority of knee osteoarthritis (OA) patients on Medicare who have knee replacement surgery do so without ever having had a single visit with a physical therapist.

To conduct the study, which was published in the journal Arthritis & Rheumatology, researchers examined data on all Medicare beneficiaries with knee OA between 2005 and 2010. They noted the number of physician visits, as well as whether the patient had received physical therapy or knee injections during that timeframe. They also tracked if patients had arthroscopy — a minimally invasive procedure during which a surgeon removes cartilage or bone fragments — or total knee replacement surgery — a more involved procedure that entails replacing parts of the bones of the knee joint with implants.

According to their findings, 33 percent of knee OA patients ended up having total knee replacement surgery; among that group, the overwhelming majority had never tried physical therapy before surgery.

Although it’s not clear whether physical therapy could have prevented some of these people from undergoing surgery, it’s possible. The researchers found that knee OA patients who used physical therapy, sought help from a specialist (such as a rheumatologist), or got joint injections were less likely to require surgery than those who skipped such conservative measures.

“Physical therapy and intra-articular [injections] were used by a minority of patients, and few were treated by rheumatologists, physiatrists, or pain specialists,” the authors wrote. “While this may be because many [patients] had mild [knee OA], use of these services was also low among those who subsequently had [total knee replacement].”

“These results indicate the possibility for greater use of conservative care for [knee OA], with the potential to slow rising rates of [total knee replacement.]”

It’s important for people with knee OA and their health care providers to explore conservative treatments before considering surgery, as the patient may experience symptom relief while avoiding a procedure that can be costly and demanding in terms of recovery (requiring time off work, physical therapy sessions, limitations with driving, and more).

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Knee Replacement. Hospital for Special Surgery. https://www.hss.edu/condition-list_knee-replacement.asp#what.

Ward M. Osteoarthritis care and risk of total knee arthroplasty among Medicare beneficiaries. Arthritis and Rheumatology. June 8, 2021. doi: https://doi.org/10.1002/art.41878.

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