New Clinical Care Standard sets the benchmark for treating knee osteoarthritis

UNDER EMBARGO to 5am, Friday 19 May 2017

Surgery should be considered a last resort for the treatment of knee osteoarthritis, under a new clinical care standard released today by the Australian Commission on Safety and Quality in Health Care and which is designed to help patients get the best care.

Knee osteoarthritis is a common condition most often seen in people over 45. Eventually it causes a wearing away of the lining inside the knee, causing significant pain and disability for some people, and making it hard to do everyday tasks such as walking upstairs.

The Commission’s new Osteoarthritis of the Knee Clinical Care Standard highlights less invasive but effective options as the gold standard for high-quality care, including the use of pain-relieving medicines and encouragement for patients to lose weight and do more exercise in the first instance.

Only when a patient’s symptoms fail to respond to these non-surgical treatments should knee replacement surgery be considered under the new standard, which has been endorsed by nine leading health, medical and consumer organisations including Arthritis Australia, the Australian Rheumatology Association, the Australian Physiotherapy Association and NPS MedicineWise.

About 2.1 million Australians are living with osteoarthritis, with that number expected to climb as our population ages. Australia spends an estimated $5.7 billion each year treating musculoskeletal conditions, and osteoarthritis accounts for nearly one-third of this spending. Patients who are overweight have double the risk of developing knee osteoarthritis, and obese patients have four times the risk.

The Commission’s Clinical Director Dr Robert Herkes said about 70% of knee replacements were carried out on patients whose weight was contributing to their osteoarthritis.

“But fewer than 8% of Australians incorporate weight loss as part of their osteoarthritis treatment,” Dr Herkes said. “It is crucial that clinicians provide patient education and help patients with knee osteoarthritis develop a tailored self-management plan to set realistic goals for reducing pain and to improve their participation in day-to-day activities.”

One effect of the new standard is to discourage the use of arthroscopy for patients with knee osteoarthritis. Knee arthroscopy – a procedure that involves doctors inserting a camera and surgical instruments inside a patient’s knee joint to clear out debris – is costly, may cause harm, and has repeatedly been shown to bring minimal benefit to patients with osteoarthritis, and yet it remains a common form of treatment.

When a patient’s symptoms fail to respond to more conservative management, knee replacement rather than arthroscopy can be considered, the new standard says. Osteoarthritis of the knee can be diagnosed by a GP, usually without X-rays, MRIs or other tests, as changes in the knee joint detected in imaging are common regardless of whether people have knee symptoms.

The new standard is to be launched today (Friday 19 May) by Commission Chair Professor Villis Marshall AC at the General Practice Conference and Exhibition in Sydney. ABC national medical reporter Sophie Scott will introduce the event, which will also feature a panel discussion involving clinical experts and a patient with the condition.

The Osteoarthritis of the Knee Clinical Care Standard aims to guide clinicians in best-practice primary care management of osteoarthritis of the knee. This includes timely comprehensive assessment, conservative treatment and appropriate patient review, which can help patients avoid unnecessary testing and surgery.


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About the Australian Commission on Safety and Quality in Health Care
The Australian Commission on Safety and Quality in Health Care is an Australian Government agency that leads and coordinates national improvements in the safety and quality of health care based on the best available evidence. By working in partnership with patients, consumers, clinicians, managers, policy makers and health care organisations, our aim is to achieve a sustainable, safe and high-quality health system. The Commission has an ongoing program of significant national activities with outcomes that are demonstrating direct patient benefit as well as creating essential underpinnings for ongoing improvement.

The Commission aims to use its role as the national body for safety and quality in health care in Australia to ensure that the health system is better informed, supported and organised to deliver safe and high-quality care.

About Clinical Care Standards
A clinical care standard comprises a small number of nationally agreed quality statements that describe the care health professionals and health services should be providing to patients for a specific clinical condition or defined part of a clinical pathway in line with current best evidence.

Indicators developed in conjunction with the clinical care standards help health services review the performance of their organisation and make improvements in the care they provide.

The Commission develops clinical care standards in partnership with clinicians, researchers and consumers. Clinical guidelines form the evidence base for the clinical care standards. The Commission has previously released clinical care standards on antimicrobial stewardship, acute coronary syndromes, acute stroke, delirium, and hip fracture. Further clinical care standards are planned, with preparations under way for standards on heavy menstrual bleeding and venous thromboembolism.