Page 16 - The value of total hip and knee arthroplasties for patients

Chapter 1
Characteristic symptoms of OA of the hip and/or knee include pain and stiffness. In addition, patients may suffer from reduced joint mobility, reduced muscle strength and joint instability. It should be noted that radiographic abnormalities do not always correlate with the severity of symptoms. Some patients experience little pain in the presence of severe structural joint changes, whereas other patients report severe pain with milder structural joint changes.10 The severity of radiographic OA has been found to explain <20% of the variance in pain intensity.9,11
Given the discrepancy between radiographic severity and clinical symptoms, it is generally acknowledged that by adequate history taking and physical examination alone a confident clinical diagnosis of hip or knee OA can be made.12
The symptoms of hip or knee OA may eventually lead to a decline in daily
activities and societal participation. According to the International Classification of
Functioning, Disability and Health (ICF) the consequences of hip and knee OA in
terms of functioning on the level of body functions and structures and activities
and participation are influenced by contextual factors, including both personal
and environmental factors. (table 2). For OA specifically, an ICF Core Set has been
defined, capturing those aspects of the ICF that are most relevant for patients with OA.13,14
Non-surgical management of hip and knee OA
The initial treatment of hip and knee OA is non-surgical, with education and exercise constituting the cornerstone of the management. Indeed, the Dutch Orthopaedic Association (NOV; Nederlandse Orthopaedische Vereniging) advocates the provision of adequate non-surgical care before surgery is being considered.15,16 Currently, several national and international guidelines on the core non-surgical treatment of hip and knee OA are available, examples being the sets of recommendations or standards of care issued by EULAR (European League Against Rheumatism)17, OARSI (Osteoarthritis Research Society International)18, EUMUSCNET (European Musculoskeletal Conditions Surveillance and Information Network)19, NICE (National Institute for Health and Care Excellence)20, and NOV (Nederlandse Orthopaedische Vereniging)21.
Despite the availability of multiple professional guidelines, there is underuse of non- surgical treatment options, so that planned, tailored strategies to enhance the uptake among the health care providers involved have been proposed.22,23
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