Background: Knee osteoarthritis (OA) is a chronic, debilitating, musculoskeletal condition that affects millions. The increase in prevalence and its economic impact on healthcare and society raise the need for additional non-surgical interventions.
Objective: To assess the referral rates to secondary care consultation and clinical outcomes in patients with severe knee OA treated with a home-based, non-surgical intervention.
Design: This was a retrospective audit on 571 patients with knee OA who met the clinical criteria for total knee replacement (TKR) and received the service between October 2015 and March 2020.
Methods: Patients were treated with a non-surgical, home-based, biomechanical intervention that aims to reduce pain and improve function, involving a foot-worn device for gait rehabilitation. The device is adjusted to the patient based on their gait patterns and clinical symptoms. Patients are advised to use the device at home or work and continue their routine. Patients are also advised to return to follow-up appointments to readjust the device and treatment plan. The primary outcome measure was the referral rates to secondary care consultation. Secondary outcomes included patient-reported outcome measures to assess pain and function and a computerised gait test. Follow-up time was between 1 and 6 years post-treatment initiation with a mean follow-up time of 1308.1 (SD = 473.4) days (i.e. 3.5 years.).
Results: There were 65 (11.4%) referrals for secondary consultation with an average follow-up of 3.5 years. The mean days to referral was 480.9 (SD = 399.2) days. Of all referrals, 48% (n = 31) occurred during the first year of treatment, and 32% (n = 21) occurred during the second year. The rest were after more than 2 years of treatment.Significant improvements were seen in all clinical outcomes, including a reduction in pain and an improvement in function and gait patterns (p < 0.05 for all).
Conclusion: Utilising this intervention as a non-surgical option for patients with knee OA who met the clinical criteria for TKR led to a significant reduction in pain and improvement in function after 3 months that was maintained for up to 3 years. Most patients (89%) did not proceed to secondary care consultation during their time in treatment for up to 6 years.
Keywords: TKR; biomechanical treatment; function; gait; knee osteoarthritis; pain.
Utilisation of a non-invasive biomechanical intervention improves pain and function and helps postpone total knee replacement Knee osteoarthritis is a degenerative disease that causes pain and functional limitations. Currently, most of the treatments aim to address symptoms (reducing pain and improving function). Those include traditional physical therapy, exercise, body mass loss if appropriate. Other treatments include pain relief medications and intra-articular corticosteroid knee injections. Knee surgery is considered the end-stage solution if the patient has tried all non-surgical interventions and is still in pain. The constant increase in the prevalence of knee osteoarthritis together with limited and short-term effect of the current treatment options, leads to an increase in the burden of knee osteoarthritis on healthcare and society. The purpose of this study was to assess the rates of referral to secondary care consultation and clinical outcomes after using a non-surgical, biomechanical, home-based intervention that focuses on gait rehabilitation amongst NHS patients diagnosed with knee osteoarthritis who meet surgical criteria. The results of the study suggest that 11% of the patients who meet the clinical criteria for a total knee replacement progressed to secondary care consultation. Utilising this intervention as a non-surgical option for patients with knee OA who meet the clinical criteria for TKR led a significant reduction in pain and improvement in function after three months that maintained for up to three years. Most patients (89%) did not proceed to secondary care consultation during their time in treatment. This intervention can potentially help reduce the likelihood of TKR and help manage the surgical waiting lists and the ongoing increase in demand for TKR due to the increase in prevalence and lack of effective non-surgical interventions.
© The Author(s), 2023.