MANAGEMENT OF OSTEOARTHRITIS OF THE KNEE BY PRIMARY-CARE PHYSICIANS

Background: Most patients with osteoarthritis (OA) are treated by prim ary care physicians (in this article, primary care physicians are fami ly physicians and general internists). Objective: To describe and comp are the self-reported practice patterns of family physicians and gener al internists for the evaluation and management of severe OA of the kn ee, including factors that might influence referral for total knee rep lacement. Design, getting, and Participants: A survey was developed an d mailed to randomly selected community family physicians and general internists practicing in Indiana. Main Outcome Measurer Self-reported physician practice patterns regarding OA of the knee. Results: Physica l examination was the most common method of evaluating OA of the knee. Family physicians were more likely to examine for crepitation, joint stability, and quadriceps muscle strength than were general internists (P<.05). Patients with OA of the knee treated by family physicians we re more likely to receive nonsteroidal anti-inflammatory drugs or oral corticosteroids and were less likely to receive aspirin, acetaminophe n, or narcotics compared with patients treated by general internists. Six patient characteristics were rated as positive factors favoring a referral for possible total knee replacement, 8 characteristics were r ated as negative, and 5 were rated as not a factor in the decision abo ut referral. Conclusions: Results from this study suggest that additio nal research is needed to determine the evaluative techniques for OA o f the knee that provide the most useful information for management dec isions, the management techniques that maximize patient outcomes, and the criteria that should be used to select patients who would benefit most from referral for possible total knee replacement.