Primary Care Research

Primary care physicians vary widely in how they evaluate and manage osteoarthritis of the knee

Most patients with osteoarthritis (OA) of the knee are treated by primary care physicians (PCPs). These doctors vary widely in how they evaluate and manage severe OA of the knee, concludes the Total Knee Replacement Patient Outcomes Research Team (PORT). The PORT was supported by the Agency for Health Care Policy and Research (HS06432) and led by Deborah A. Freund, Ph.D., of Indiana University. For this study, the researchers mailed a questionnaire to a random sample of 300 family physicians (70 responded) and 300 general internists (72 responded) in Indiana.

The most often used techniques for evaluating severe OA of the knee were examination for crepitation (crackling sound in the knee), assessment of knee range of motion, and a check for pedal pulses. Only 17 percent of PCPs used standing knee x-rays, compared with 60 percent who used non-weight-bearing x-rays. Standing knee x-rays reportedly provide more important diagnostic information. Family physicians were significantly more likely to examine for crepitation, joint stability, and quadriceps muscle strength (a strong quadriceps takes pressure off the knee joint) than were general internists.

The most frequent method of managing severe OA of the knee was drug therapy. Nonsteroidal antiinflammatory drugs (NSAIDs) were the most commonly prescribed medication, despite their higher cost and debatable superiority over pure analgesics such as aspirin or acetaminophen. General internists were significantly more likely than family physicians to prescribe aspirin, acetaminophen, or narcotics. Family physicians were more likely than general internists to prescribe NSAIDs or oral corticosteroids and to inject corticosteroids intra-articularly. Instruction or referral for weight loss was the second most common management method (reflecting the known relationship between obesity and OA of the knee), followed by referral for physical therapy. Few patients were referred to an orthopedic surgeon for evaluation for possible knee replacement or knee arthroscopy. PCPs did not differ significantly in their referral rates.

See "Management of osteoarthritis of the knee by primary care physicians," by Lorrie A. Mamlin, M.P.H., Catherine A. Melfi, Ph.D, Michael L. Parchman, M.D., and others, in the Archives of Family Medicine 7, pp. 563-567, 1998.

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