Introduction: Knee pain related to osteoarthritis (OA) is a common musculoskeletal condition managed in primary care. Despite widely available national, there is persistently significant variation in treatment attempted prior to referral to orthopaedic specialist clinic.
Objectives: To determine prevalence of knee OA in adults referred to orthopaedic clinic for knee pain, define previous treatment trialled prior referral and its concordance with national guidelines.
Methods: 99 consecutive adults (> 40 years) referred for knee pain in 2016-7 to orthopaedic outpatient clinic at Redland Hospital (250 beds, in South Brisbane) were reviewed over a 12-month period . Referral letters, clinical history, assessment (including imaging report) and management determined at outpatient clinic were recorded. For those with referral diagnosis of OA, pre-referral treatment was compared to then current NHMRC guideline (2009). We consider any management trialing at least 80% of therapies listed by guideline as guideline compliant.
Results: 72% of patients referred (51% female, mean 56.2 years) had OA diagnoses. Most common treatment recorded in referrals is oral analgesics (12%), 86% referral letters (RL) did not mention any treatment attempted prior referral. Previous treatment self reported by patients (SR) revealed oral analgesic use in 91%, 49% attempted weight loss, 36% tried physiotherapy. Corroboration of history and treatment of knee OA between RL vs SR shows only 24% concurrence. SR treatment is more likely to be compliant with NHMRC’s recommendation as compared to those recorded by RL (39% vs 6%) but neither achieve better than 39% in adherence to recommendation, hence none of pre-referral management were guideline compliant.
Conclusions: Despite the availability of NHMRC’s guideline for knee OA management for almost a decade, few patients have actually full experience of the recommended management before referral to specialist clinic. This revelation suggests potential success of conservative measures if instituted by both general practitioners and orthopaedic surgeons, if the majority of knee pain is correctly diagnosed as caused by OA.