OBJECTIVE: To evaluate a surgical screening clinic for patients with knee osteoarthritis (OA) referred for total knee arthroplasty (TKA) and explore management before referral. DESIGN: Descriptive study using retrospective chart review. SETTING: Large Canadian teaching hospital. PARTICIPANTS: Patients with knee OA referred for TKA over a 1-year period. INTERVENTIONS: Patients underwent standardized assessment by physicians who practice sport medicine to determine eligibility for surgical consultation. MAIN OUTCOME MEASURES: Proportion of patients deemed eligible for surgical consultation and undergoing TKA, and conservative management options tried before clinic referral. RESULTS: Of the 327 patients, 172 (52.6%) were referred to the surgeon, of whom 76% underwent TKA. Options used before referral were medications (92.0%), injections (41.3%), and physiotherapy (34.9%). Patients referred to the surgeon, compared with those who were not, were more likely to have met all referral criteria (86.5% vs 33.3%, P < 0.001), tried 3 or more options (70.9% vs 49.7%, P < 0.01), used injections (58.7% vs 32.3%, P < 0.001), scored higher on the Hip-Knee Priority Tool (45 vs 24, P < 0.001), and had been referred by a physician who practices sport medicine (88.2% vs 46.2%, P < 0.001). CONCLUSIONS: Orthopedic surgical screening by trained physicians using standardized tools halved the number of surgical consultations. Few conservative management options were tried before referral, indicating the need to enhance presurgical care for patients with knee OA.
OBJECTIVE: To evaluate a surgical screening clinic for patients with knee osteoarthritis (OA) referred for total knee arthroplasty (TKA) and explore management before referral. DESIGN: Descriptive study using retrospective chart review. SETTING: Large Canadian teaching hospital. PARTICIPANTS: Patients with knee OA referred for TKA over a 1-year period. INTERVENTIONS:Patients underwent standardized assessment by physicians who practice sport medicine to determine eligibility for surgical consultation. MAIN OUTCOME MEASURES: Proportion of patients deemed eligible for surgical consultation and undergoing TKA, and conservative management options tried before clinic referral. RESULTS: Of the 327 patients, 172 (52.6%) were referred to the surgeon, of whom 76% underwent TKA. Options used before referral were medications (92.0%), injections (41.3%), and physiotherapy (34.9%). Patients referred to the surgeon, compared with those who were not, were more likely to have met all referral criteria (86.5% vs 33.3%, P < 0.001), tried 3 or more options (70.9% vs 49.7%, P < 0.01), used injections (58.7% vs 32.3%, P < 0.001), scored higher on the Hip-Knee Priority Tool (45 vs 24, P < 0.001), and had been referred by a physician who practices sport medicine (88.2% vs 46.2%, P < 0.001). CONCLUSIONS: Orthopedic surgical screening by trained physicians using standardized tools halved the number of surgical consultations. Few conservative management options were tried before referral, indicating the need to enhance presurgical care for patients with knee OA.
Authors: Laura Churchill; Samuel J Malian; Bert M Chesworth; Dianne Bryant; Steven J MacDonald; Jacquelyn D Marsh; J Robert Giffin Journal: Can J Surg Date: 2016-12 Impact factor: 2.089