Surgical waitlists an opportunity for OA interventions

Patients with knee or hip osteoarthritis on orthopaedic waitlists do not report an increase in pain levels over time, an Australian researcher says.

A meta-analysis of the evidence, comprising 33 studies and 2,490 participants on waiting lists from two weeks to two years receiving no active treatment, found no significant longitudinal change in pain overall.

Speaking at the Australia and New Zealand Bone and Mineral Society annual scientific meeting, exercise physiologist Professor Itamar Levinger said the length of time spent on a waitlist was also not associated with longitudinal changes in pain.

Professor Levinger, leader of the Bone, Muscle and Cardiovascular Research Group at Victoria University, said the study found BMI was the only significant predictor of change in pain scores in univariate but not multivariate analysis.

He said waitlists at Western Health were already out to four years and demand for joint replacements were expected to grow. As such, wait times were an opportunity to deliver alternative interventions.

“Non-surgical, low-cost interventions to reduce or manage pain levels and improve wellbeing of patients should be employed during waiting times,” he told the meeting.

Professor Levinger said that people referred to orthopaedics for hip and knee consultations were likely to already have severe pain and while that pain may not be getting worse, they were at risk of psychological and physiological sequelae of chronic pain.

Improved management of these patients therefore had the potential to reduce the burden on the healthcare system.

A project to improve care for patients on the public waitlist at Western Health is underway, he noted.

Also speaking at the ANZBMS meeting, Dr Zubeyir Salis from the University of NSW’s Centre for Big Data Research in Health, said weight loss interventions could potentially reduce the burden of knee replacement surgery.

While it was known that weight loss in overweight or obese patients could reduce knee symptoms, he said the impact of weight loss on knee replacements was less clear.

A time-to-event survival analysis in three cohorts of people with or at-risk of clinically significant knee osteoarthritis — the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study — comprised data from 16,362 knees from 8,181 participants.

Over seven to 10 years’ follow-up, it found that every 1-unit reduction in BMI was associated with a 3% reduced risk of knee replacement; every 5-unit reduction in BMI would translate to a 15% reduced risk of knee replacement.

“If everyone in the population excluding the underweight BMI category had a decrease in BMI there will be an approximately 3.4% reduction in the incidence of knee replacements in the population,” he told the meeting.

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