Patients awaiting knee joint replacement: is waiting time well spent?

Abstract

Purpose: International guidelines for first-line treatment of knee osteoarthritis (OA) include education, exercise, and weight-management when appropriate. Whilst on the waiting list for joint replacement, non-surgical management of knee OA may improve outcome of surgery. It is unclear when and to what extent these guidelines are implemented. Hence the purpose of this study was to investigate to what extent individuals participated in non-surgical treatments before being assigned to a waiting list for knee replacement for OA, and to what extent they were recommended non-surgical treatments once on the list. Factors associated with participation in, or being recommended non-surgical management, were also investigated. Methods: All patients on the waiting list for more than three months for knee joint replacement due to knee OA at a hospital in southern Sweden (n=229) were invited to participate. 136 individuals (mean age 70±8.6 years, 59% women) answered self-reported questionnaires including demographics, physical activity level, knee function and non-surgical treatments before and during their time on the waiting list. Results: Before being referred to the waiting list, 40% had participated in a education, exercise and weight-management program (Better management of patients with OsteoArthritis (BOA)), 53% in physiotherapy, whilst 22% of the over-weight patients had received weight-management advice. Women had participated in the BOA program and physiotherapy twice as often as men (51% vs. 25%, p=0.002 and 66% vs. 34%, p<0.001) prior to waiting list referral. During their time on the waiting list, only 10% were recommended the BOA program, 30% physiotherapy and 15% of those over-weight, weight-management. Women were more often recommended physiotherapy while waiting for surgery, compared to men (37.5% vs 19.6%, p=0.026). 38% of the patients that had never participated in the BOA program indicated that they were interested in participating while waiting for their knee replacement. Conclusions: Our Results suggest that recommended treatment guidelines for OA may not be adequately implemented in Swedish healthcare. Further exploration of barriers to guideline implementation appears warranted, and of possible variation or lack of equality of care associated with sex, clinics and healthcare regions.