Osteoarthritis of the Knee

Background:Osteoarthritis affects 15% of Australians or around 3.2 million people. This figure will rise owing to the ageing of the Australian population. Over 38000 knee arthroplasties are performed each year in Australia. There are limited resources for arthroplasty and ever increasing numbers of patients with osteoarthritis of the knee that will ultimately require one. It is therefore paramount to promptly diagnose the condition and utilise simple efficacious management options to alleviate suffering for patients and the overburdened health system. Evaluation of current investigations and management in comparison with published guidelines is the first step.Method: Ninty-five patients with 100 symptomatic knees referred from their GP with a provisional diagnosis of osteoarthritis, were surveyed on the investigations and management they had received prior to presentation. The results were then compared with accepted clinical guidelines.Results:There is a disparity between the clinical guidelines and the results of the survey from clinical practice. 27.5% of patients had not undertaken the gold standard weight bearing radiograph prior to presentation. With 6% of patients not having a plain radiograph at all. Simple efficacious treatments with high levels of evidence such as physiotherapy and weight loss had only been utilised in 41% and 58% respectively. Whilst 55% had used glucosamine which is not recommended in the guidelines. Conclusion: A better awareness of the rationale for investigations by GPs and improved communication between specialists and GPs can prevent duplication of resources and minimise the costs of investigations. Increased awareness of the efficacy of simple treatment modalities can increase their utilisation. Streamlining of investigation and management requires a multidisciplinary approach and both patient and service provider education.