JBJS | Commentary

The Journal of Bone & Joint Surgery, Volume 82, Issue 9

Evidence-Based Orthopaedics | September 01, 2000

Commentary

Nizar N. Mohomed, M.D., Sc.D.

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Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

The Journal of Bone & Joint Surgery. 2000; 82:1324-a-1324

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Introduction

Introduction | References

Osteoarthritis of the knee is one of the most commonly reported causes of long-term disability¹. The prevalence of osteoarthritis is higher in women than in men and increases with age. No known cure exists for it. Therefore, the goal of medical and surgical management is to reduce pain and physical disability.

This study by Deyle and colleagues clearly shows the efficacy of manual physical therapy and exercise in relieving pain and reducing physical disability from knee osteoarthritis. The effect size reported for the intervention is larger than that of previous studies and is comparable with that seen following total knee arthroplasty². Furthermore, the positive effects of physical therapy seem to persist to 1 year. The study findings recommend the use of physical therapy as a first-line option in the management of patients with knee osteoarthritis.

Three issues must be kept in mind when interpreting these results. First, because of the design of the study, we cannot determine which components of the physical therapy and exercise program were actually effective in improving patient outcomes. Second, because the natural history of knee osteoarthritis is poorly understood, it is possible that the positive benefits of physical therapy seen to 1 year may be confounded by the natural variation in knee joint symptoms. Finally, evidence exists that delaying total knee arthroplasty beyond a critical threshold may compromise the outcomes in the long term. Fortin and colleagues reported that preoperative WOMAC scores were predictive of postoperative WOMAC scores².

Physical therapy and exercise should be used early in the course of knee osteoarthritis when it is likely to have the greatest benefit. Definitive surgery should not be delayed when it is indicated.

Nizar N. Mohomed, M.D., Sc.D.

Toronto Western Hospital

University of Toronto

Toronto, Ontario, Canada

References

Introduction | References

Badley EM: The effect of osteoarthritis on disability and health care use in Canada. J Rheumatol Suppl.,1995.43: 19-22, 4319 1995 [PubMed]

Fortin PR; Clarke AE; Joseph L; and et al.: Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum.,1999.42: 1722-8, 421722 1999 [PubMed]

Topics

Badley EM: The effect of osteoarthritis on disability and health care use in Canada. J Rheumatol Suppl.,1995.43: 19-22, 4319 1995 [PubMed]

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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Nizar N. Mohomed; Commentary. The Journal of Bone & Joint Surgery. 2000 Sep;82(9):1324-a-1324.

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