Background/Purpose: St. Michael’s Hospital (SMH) is a tertiary care facility located in Toronto, serving a diverse social, economic and cultural urban population. In 2008, a multidisciplinary osteoarthritis (MOA) clinic was established at SMH.  The majority of referrals are received in the clinic from orthopaedic surgeons in patients contemplating knee replacement surgery. The team (Rheumatologist, Advanced Practitioner) designs and implements a comprehensive treatment plan. 

Purpose:   To complete a qualitative review of all of the patients who attended clinic and who subsequently went on to require a total knee arthroplasty.

Methods:   A retrospective chart review was completed on all patients who attended the OA clinic between January 2011 and April 2012.  During this time period there were 329 patients who attended clinic of which 24 went on to require a total knee arthroplasty (TKA).  The charts of the patients who went on to a TKA were reviewed in detail and analyzed to determine if there are key criteria that determine who will subsequently elect to have a joint replacement.  This project is designed as part of a continuous quality improvement initiative.

Results:   In the 16 months that this data was obtained there was 329 patients who attended clinic of which 24 went on to require a total knee arthroplasty.  All of the patients completed a WOMAC, an MDHAQ, x-rays as well as a complete physical exam.  All of the patients had x-rays that demonstrated OA.  The majority of patients had x-ray evidence of moderate to severe arthritis.  Table showing the mean of results:

 

	General Cohort	Arthroplasty  Group
WOMAC total, mean	41.3	49.8
MDHAQ pain	5.9	8
Global health	4.9	7
fatigue	4.8	5.4
ACR function	2	3

Discussion:  The results from this project provide information with respect to actual clinical situations.  A significant number of patients that attended the clinic had x-ray evidence of moderate to severe arthritis yet less than 10% went on to require an arthroplasty.  There were some subtle differences between the two patient groups and it was the intent of this review to examine in more detail the criteria that patients feel is crucial in opting for surgical intervention. 

Conclusion:   The results show that the decision to proceed to surgery is multifactorial with pain and decreased function being the key criteria in patients’ decision making process.  Interestingly, patients who perceived their general health as negatively impacted were more likely to proceed with surgery.

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/reducing-the-need-for-total-knee-arthroplasty-the-experience-of-a-multidisciplinary-osteoarthritis-clinic/