Knee Osteoarthritis: Treatment Practice and Treatment Guidelines Not in Synch

A review of administrative claims data suggests that physicians are not following the treatment guidelines for knee osteoarthritis.

The findings, reported this week at the 2017 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in San Diego, shows that physicians increasingly treated patients with hyaluronic acid or corticosteroid injections, physical therapy, braces and wedge insoles, pain medication and non-steroidal anti-inflammatory drugs; however, only three of these treatments - physical therapy, NSAIDs, and tramadol for short-term severe pain - are included in the AAOS clinical practice guidelines, "Non-arthroplasty Treatment of Osteoarthritis of the Knee."

"As we transition to an era of value-based health care, it will be important to consider both the quality of our interventions as well as the costs associated with that care," said Nicholas Bedard, M.D., in a statement issued by AAOS. Dr. Bedard is the author of the study and an orthopaedic surgeon at the University of Iowa Hospitals & Clinics.

The study is based on a review of Humana, Inc., claims data from 2007-2015 for 86,073 patients who underwent total knee arthroplasty.

In the years prior to knee surgery, over half of the non-inpatient costs associated with knee osteoarthritis are from injections, therapy, prosthetics, and prescriptions. Approximately 30% of this cost is due to hyaluronic acid injections alone, for which the clinical guidelines cite strong evidence against their use in the management of knee osteoarthritis, the authors wrote.

The top three most costly treatments included:  were hyaluronic acid injections, corticosteroid injections and physical therapy. The treatments analyzed made up 57.6% of the total non-inpatient cost of knee osteoarthritis in the year prior to knee surgery. This compares to the costs of AAOS-recommended treatments which represented 11.1% of non-inpatient knee osteoarthritis costs. In contrast, 46.5% of non-inpatient cost associated with the diagnosis of knee osteoarthritis in the year prior to knee surgery are not recommend by AAOS.

Cost associated with interventions not recommend by the clinical practice guidelines with strong or moderate evidence against their use is 29.3% of non-inpatient knee OA costs.

“If only interventions recommend by AAOS in their clinical practice guidelines are utilized then cost associated with outpatient management of knee osteoarthritis could be decreased by 90%. Future research is needed to evaluate the impact of the clinical practice guidelines on unnecessary costs as further time elapses from their publication,” the authors wrote.

References:

Nicholas Bedard, Spencer B Dowdle, Christopher Anthony, David Demik, Michael Andrew McHugh, Kevin John Bozic, John J Callaghan. “What are the Costs of Knee Osteoarthritis in the Year Prior to Total Knee Arthroplasty?” 2017 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in San Diego. March 2017.