Expert adviser Professor Flavia Cicuttini

A model of care for osteoarthritis developed for the Victorian government could help many patients avoid unnecessary hip and knee replacements, according to its developers.

The Victorian Model of Care for Osteoarthritis of the Hip and Knee,  commissioned by the state’s Department of Health and Human Services, is being described as a best practice guide for clinicians and organisations providing care for people with hip and/or knee OA.

Developed by an expert committee including rheumatologists, the document from the Victorian Musculoskeletal Clinical Leadership Group provides a framework for diagnosis, management and care standards for people with OA.

If implemented at a state-wide level, the model of care could help people with OA access the best care and avoid unnecessary and inappropriate interventions such as arthroscopy, the report authors say.

“Osteoarthritis is not an inevitable part of ageing and there are simple and effective management and prevention strategies that could be deployed at scale across Victoria to reduce the burden of disease and contain the growing pressure on Victoria’s health service,” they write.

Co-author Professor Peter Choong, Director of Orthopaedic Surgery at St Vincent’s Hospital, Melbourne, says the education component in the model of care would help patients with OA who mistakenly think they need a joint replacement when it is not required.

“Joint replacement surgery provides relief for people with advanced joint disease. For those who don’t need it, surgery can cause more problems than it solves. People need to understand there can be much better ways to treat OA, and surgery should be a last resort” he says.

Best practice recommendations for hip and knee arthritis in the model include:

• OA can be diagnosed without the need for imaging, and MRI should not be used unless a differential diagnosis is required for atypical pathologies
• Functional outcomes measures such as the 30-second chair test should be done routinely for all OA patients
• GPs should be the central care co-ordinator
• Opioids are not usually indicated for OA but a short term  trial with a discontinuation plan in place, may be appropriate for a few patients,
• Referral to a dietitian for dietary management and support is indicated for most adults where BMI > 27 kg/m2
• Arthroscopic debridement and/or lavage is not recommended as a primary treatment for knee OA
• Total joint replacement surgery should be considered a last resort for people with advanced disease for whom there is a good probability of success.

Rheumatologists on the Model of Care’s expert advisory committee include Professor Flavia Cicuttini, Head of the Department of Rheumatology, The Alfred Hospital , Dr Chris Fong, President, of the Australian Rheumatology Association (Victorian Branch), Clinical Associate Professor Keith Lim, Head, Osteoarthritis Clinic, Rheumatologist, St Vincent’s Hospital Melbourne, and Dr Andrea Bendrups, rheumatologist at the Royal Melbourne Hospital.