REASONS FOR ORTHOPAEDIC SURGEONS TO PROVIDE RECOMMENDED NON-SURGICAL TREATMENTS TO PATIENTS WITH HIP OR KNEE OSTEOARTHRITIS

Purpose: To assess the extent to which recommended non-surgical treatments are prescribed by orthopaedic surgeons and to identify barriers and facilitators influencing this prescription.

Method: We performed a survey among 172 orthopaedic surgeons to assess the extent to which non-surgical treatments were prescribed and which barriers and facilitators affected this prescription. The list of potential barriers and facilitators was derived from explanatory interviews (n=10). We asked “If patients did not receive the following non-surgical treatments in their previous care trajectory, do you prescribe these treatments?”(never-sometimes-often-almost always). To assess barriers and facilitators we asked the extent to which each factor influenced the prescription of non-surgical treatments (not at all-a little-a reasonable extent-a large extent). The answers of both questions were dichotomized. Multivariate logistic regression was used for analyses.

Result: Treatments prescribed most frequently were education about OA (87%), education about different treatment options (95%) and lifestyle advice (98%). Less prescribed were dietary and physical therapy, and glucocorticoids injections. More factors were identified that could increase the prescription non-surgical treatments, as shown by the large odds ratios in table 1. For example orthopaedic surgeons who perceived short communication lines with a dietician, were 7 times more likely to prescribe a dietician consult.

Table 1. Barriers and facilitators for the provision of non-surgical treatments

Non-surgical treatment	Percentage prescribed by orthopaedic surgeons	Barrier or facilitator for prescriptiona	Odds ratio (95% Confidence interval)
Dietician	28	Short communication lines with a dietician An obesity clinic	7.057 (1.926-25.852) 2.553 (1.011-6.449)
(Physical)therapy	54	Good results of (physical)therapy (Physical)therapy for hip OA is not effective Insurance companies do not reimburse all (physical)therapy treatments	7.990 (3.807-16.772) 0.344 (0.163-0.728) 2.312 (1.003-5.332)
Acetaminophen	64	Acetaminophen has few side effects Important to try non-surgical treatments first Patients benefit from Acetaminophen	6.295 (2.167-18.289) 3.966 (1.088-14.451) 6.076 (2.709-13.627)
NSAIDs	59	Patients benefit from NSAIDs The guideline is outdated	5.918 (2.728-12.836) 3.634 (1.283-10.292)
Glucocorticoids injections	43	Patients benefit from Glucocorticoids injections Pressure by patient for surgery Reduced success rate of TKA/ THA when surgery is delayed	8.639 (3.774-19.777) 4.929 (1.988-12.222) 0.105 (0.020-0.551)

^aOnly barriers and facilitators with α<0.05 are displayed

Conclusion: Prescription of non-surgical treatments by orthopaedic surgeons is mostly influenced by the expected benefit of treatment. Especially dietary and physical therapy, and glucocorticoids injections are underused and could be improved.