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Comparative Study
. 2020 Jan;44(1):77-83.
doi: 10.1007/s00264-019-04405-y. Epub 2019 Sep 13.

Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

Luxme Mahendira  1 , Caroline Jones  2   3 , Angelo Papachristos  2   3 , James Waddell  2   3   4 , Laurence Rubin  5   6   7
Affiliations
Comparative Study

Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis

Luxme Mahendira et al. Int Orthop. 2020 Jan.

Abstract

Objective: To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact.

Methods: We prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined.

Results: Five patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered "de facto" surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management.

Conclusion: These findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens.

Keywords: Advanced clinician practitioner; Advanced practice physcial therapist; Arthritis; Comprehensive non-surgical management; Health economics; Models of care; Multidiscplinary medical management; Osteoarthritis; Total knee arthroplasty; WOMAC.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Average change in WOMAC score form baseline to end of two years
Fig. 2
Fig. 2
Tertiles by baseline WOMAC scores
Fig. 3
Fig. 3
The average surgical costs
See this image and copyright information in PMC

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