OA Knee Treatment Algorithm
The State of Treatment For Osteoarthritis of the Knee
The average candidate for treatment of osteoarthritis of the knee is 55 years old.1 Comparatively, those suffering from the pain of osteoarthritis of the hip are, on average, older than 75 years old.² This amount of variation can skew a pain treatment algorithm that is designed for the “average” patient. But what’s more, these averages do not necessarily account for candidates suffering from common co-morbidities such as obesity and diabetes.³ Nor do these averages necessarily provide insight into the number of OA patients who have already had some type of surgery in their lifetime.
Missing these essential insights, an “average” pain treatment algorithm is tough to determine. Instead, what’s needed to better treat patients with osteoarthritis of the knee, is an emphasis on unique pain treatments that take into account the patient’s medical history, condition, and is based on that patient’s specific needs.
Common Treatment Algorithms for OA of the Knee
Adjusted for patient data and access to medical information, a common algorithm⁴ for OA knee treatment may consist of both pharmacological and non-pharmacological treatments, such as a referral to a physical therapist. Before any opioids are presented into treatment, the chronic pain patient may be introduced to intra-articular corticosteroids. If ineffective, a low dose opioid prescription may be a treatment option when elevated to the next stage before the last stage treatment: surgery and a higher dosage of opioids.
Generally, clinicians tend to “escalate invasiveness” when approaching knee pain. This isn’t unwarranted—clinicians do wrestle with a variety of factors when making a treatment recommendation for each unique patient. Often, clinicians are burdened with balancing relief from pain with the corresponding risk for their osteoarthritis patients. Many constantly weigh options to guide their decision making when treating osteoarthritis pain, requiring improved pain relief that is non-addictive, has limited side effects, and is delivered in a non-invasive format. A change of focus is required; instead of simply treating the symptoms, it is time to focus on a sorely needed cure for osteoarthritis.
Mapping The Patient Journey: Osteoarthritis of the Knee
Many clinicians see the primary stakeholder of the patient journey as the primary care physician (PCP) and, when applicable to the osteoarthritis patient, the orthopedic surgeon.
As the level of invasiveness of the treatment increases, many believe that the level of patient relief increases. Up until the point of requiring injections, any predetermined treatment algorithm may only be applicable until the orthopedic surgeon takes over, leveraging medication, injections and surgery as part of the new treatment process.
Thus, the stakeholders who are responsible for the entire journey of the OA knee patient are the PCP and orthopedic surgeon.² Much later in the journey, the PCP and orthopedic surgeon may also bring in a Pain Management Physician, who can provide another treatment algorithm for the patient, and administer alternative treatment options.
Moving Forward with OA Treatments
As identified by the Centers for Disease Control and Prevention, 30 million adults in the U.S. are afflicted with OA⁵, and that number will rise as North Americans’ average age and BMI continue to increase.
And while surgery can help some patients with chronic knee pain, it may not help at the onset of the OA diagnosis—the average delay for a surgery treatment is nine years. PCP and orthopedic surgeons need to look to alternative treatments for their patients, and bringing in a pain management physician can help find the best treatment algorithm for the patient.
- Losina E, Weinstein AM, Reichmann WM, et al. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis care & research. Retrieved October 16, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/23203864.
- OA Pain Landscape & Patient Journey: Research Results. KS&R, 2015
- What does “comorbidity” mean? (2017, June 08). Retrieved October 16, 2017, from https://www.cdc.gov/arthritis/data_statistics/comorbidities.htm
- An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) [Internet]. Seminars in Arthritis and Rheumatism. W.B. Saunders; 2014 [cited 2017Oct30]. Available from: http://www.sciencedirect.com/science/article/pii/S0049017214001085
- Arthritis [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2017 [cited 2017Oct30]. Available from: https://www.cdc.gov/arthritis/basics/osteoarthritis.htm