Centre for Allied Health Research and Education, Cabrini Health, Malvern, Victoria, Australia.
Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia.
Musculoskeletal Care. 2021 Dec;19(4):524-532. doi: 10.1002/msc.1549. Epub 2021 Mar 12.
Delivery of recommended treatments for hip and knee osteoarthritis (OA) is known to be discordant with guideline recommendations. However, professional views related to OA management across medical and surgical disciplines are not well understood. The aim of this study was to explore the views of medical professionals about management of hip and knee OA.
Qualitative study. Semistructured individual interviews were conducted with orthopaedic surgeons, rheumatologists and general practitioners routinely involved in the management of OA. Interviews were audiotaped, transcribed, member-checked, coded and thematically analysed.
Fifteen medical professionals were interviewed. Three main themes were: (i) recognition of the importance of nonsurgical management of hip and knee OA, focussed on self-management, exercise-therapy, weight management and analgesia; (ii) joint replacement being considered the 'last resort' for end stage disease not responding to nonsurgical management; and (iii) determination of management 'success' through patient perceptions was more common than the use of validated instruments. Views on management broadly converged across disciplines, except for the role of joint replacement, considered an adjunct in the overall management of OA by rheumatologists and as a definitive cure by orthopaedic surgeons.
Aligning with current guidelines, medical professionals recognised the importance of nonsurgical management focussed on exercise-therapy for hip and knee OA, and concurred that joint replacement surgery should be a last resort. A focus on patient education was less prominent, which along with implementation of validated outcome measures in routine medical practice, may require greater health system support.
髋膝关节骨关节炎（OA）的推荐治疗方法与指南建议不一致。然而，医学和外科领域的专业人员对 OA 管理的看法尚不清楚。本研究旨在探讨医疗专业人员对髋膝关节 OA 管理的看法。
定性研究。对经常参与 OA 管理的骨科医生、风湿病学家和全科医生进行半结构化的个人访谈。对访谈进行录音、转录、成员检查、编码和主题分析。
共采访了 15 名医疗专业人员。三个主要主题是：（i）认识到非手术治疗髋膝关节 OA 的重要性，重点是自我管理、运动疗法、体重管理和镇痛；（ii）关节置换被认为是对非手术治疗无反应的终末期疾病的“最后手段”；（iii）通过患者的感知来确定管理“成功”比使用经过验证的工具更为常见。除了关节置换的作用外，各学科之间的管理观点大致趋同，风湿病学家认为关节置换是 OA 整体管理的辅助手段，而骨科医生则认为关节置换是一种明确的治疗方法。
与当前指南一致，医疗专业人员认识到以运动疗法为重点的非手术治疗对髋膝关节 OA 的重要性，并一致认为关节置换手术应作为最后的手段。对患者教育的重视程度较低，这与在常规医疗实践中实施经过验证的结果测量方法一起，可能需要更大的卫生系统支持。
