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Study: Treatment of patients with OA varies from AAOS guidelines


Study: Treatment of patients with OA varies from AAOS guidelines 

Dhawan A. Arthroscopy. 2014;doi:10.1016/j.arthro.2013.09.002 

There is a discord between current clinical practice guidelines and recent arthroscopic treatment for patients with osteoarthritis, according to recently published data.
“Significant gaps do exist between the evidence-based American Academy of Orthopaedic Surgeons (AAOS) recommendations and actual practice patterns in the United States between 2004 and 2009,” Aman Dhawan, MD, and colleagues wrote in their study.
Using the United Healthcare Database, the clinical practice patterns of 12,806 patients who underwent knee arthroplasty in 2009 and were diagnosed with osteoarthritis (OA) were reviewed. Dhawan and colleagues found that during the 5-year span prior to arthroplasty, 10% of patients were prescribed rehabilitation specific to OA while 45% of patients received a corticosteroid injection for OA.As per the AAOS, “these two guidelines have relatively strong support at grade B and with level II evidence,” the researchers wrote.
The researchers also found that 2,505 patients had arthroscopy with either debridement or lavage in the 5-year period prior to knee arthroplasty.Additionally, 877 patients (34.9%) of these 2,505 patients did not have a diagnosis of a meniscal tear or a loose body. Overall, 80.9% of patients were found to have had knee arthroscopy within the first year after knee arthroplasty.
“Despite the mounting evidence of the ineffectiveness of knee arthroscopy as a treatment for OA of the knee without mechanical symptoms, this procedure continues to be performed and the modality overused,” the researchers wrote in the study.  – by Christian Ingram
Disclosures: Dhawan receives support from Smith & Nephew and Biomet.Mather receives support from KNG Health Consulting and National Institutes of Health. Young is president and CIO of the PearlDiver unit of AFCell Medical and owns stock options and stock in AFCell Medical. Cole receives support from DePuy, Arthrex, Regentis, Carticept, Zimmer, and Smith & Nephew.