Division of Rheumatology, Unity Health-Saint Michael's Hospital, 30 Bond Street, Bond Wing 3-061, Toronto, Ontario, M5B 1W8, Canada.
Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
Int Orthop. 2020 Jan;44(1):77-83. doi: 10.1007/s00264-019-04405-y. Epub 2019 Sep 13.
To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact.
We prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined.
Five patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered "de facto" surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management.
These findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens.
评估膝关节骨关节炎（OAK）的管理和成本，OAK 是一种由骨骼和软骨退化引起的进行性关节疾病，对个人和社会都有重大影响。
我们前瞻性分析了在两年时间内转诊到我们多学科 OA 项目的 OAK 患者的临床结果和可量化的累积直接成本。评估了 131 名患者。所有患者均表现出中度至重度 OAK 的放射学标准。记录并分析了西部安大略省麦克马斯特大学骨关节炎指数（WOMAC）、最小临床重要改善（MCII）和 BMI 的变化。确定了所有患者在两年时间内的所有医疗和手术直接成本。
在两年的研究期间，有 5 名患者接受了全关节置换术。在整个组中，在两年的随访时间点，WOMAC 评分总体显著改善。根据基线 WOMAC 评分将组分为三分位，46%的患者达到 MCII。对于基线 BMI>30 的个体，体重显著减轻。由于所有患者在转诊时都被视为“事实上”的手术候选者，因此与手术管理相比，每例患者的直接成本可节省 9551.10 美元，或者整个组可节省 1203438.60 美元。
这些发现支持对有严重 OAK 的患者进行多学科医学管理的好处。这种方法在临床上是有益的，并可能节省大量成本。这种护理模式可以显著改善这种高发性疾病的长期预后，并减轻社会和经济负担。
