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New gold standard preventative management for knee osteoarthritis might be overlooked as surgery is “cheaper”?

Medicine, Physiotherapy, Podiatry

The Australian Physiotherapy Association (APA) endorsed a new Osteoarthritis of the Knee Clinical Care Standard.

The standard includes encouraging patients to lose weight and do more exercise, as well as using pain relieving medicines.

Referral to an orthopaedic surgeon and knee replacement surgery would only be considered when a patient’s symptoms no longer respond to these more conservative management options.

APA member Associate Professor Ilana Ackerman said, “By making relatively simple lifestyle changes like modifying their diet, increasing their physical activity and commencing an appropriate exercise program – with a focus on improving knee strength and muscle control – people with knee osteoarthritis can achieve reductions in their pain and improvements in overall quality of life.”

However, the APA said that following the recommended conservative management options utilised by physiotherapists would risk the run out of cover under current Medicare and private health insurer funding models. This may force patients to take the cheaper option of having surgery rather than being active in avoiding it.

The APA believes that both Medicare and private health insurance systems need to undergo significant change to make sure patients can get this standard of care. The APA is calling for review of the current funding model philosophy that rewards acute needs and illness-focused health care, rather than patient-centred, preventive health management.

Presently, there are various treatment options for osteoarthritis, including mesenchymal stem cells (MSCs). According to a report in a 2016 issue ot Australia and New Zealand Journal of Surgery (ANZJS), the peer-review publication of the Royal Australasian College of Surgeons (RACS), patients have reported improvement in symptoms using this method.

According to the RACS, implantation of MSCs might be a viable treatment alternative and some Australian clinics are reportedly using MSC therapy to treat advanced knee osteoarthritis, although the National Health and Medical Research Council has so far not recommended the use of MSCs for the treatment of knee osteoarthritis. The report says that patients need to make their own informed decisions and medical practitioners have a responsibility to ensure that patients understand the potential risks prior to any treatment.

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