Osteoarthritis of either the knee or hip is characterized by a long period of progressively increasing pain and disability that may eventually result in the need for joint replacement surgery after several years. Before considering surgical intervention, clinical guidelines recommend utilizing non-surgical treatment options first, of which there are many choices available to a patient. Is there a way to know what approach may be best for a typical knee or hip osteoarthritis patient?
In a study published in 2018, researchers recruited 206 patients who met the American College of Rheumatology’s clinical criteria for diagnosing knee and/or hip osteoarthritis, had no prior history of rheumatoid arthritis or prior hip or knee joint replacement at the time of study enrollment, had not initiated opioid or corticosteroid intervention within the previous month, and were able to complete the proposed course of intervention and two-year follow-up period. The participants were then randomly assigned to one of four treatment groups: 1) usual care alone; 2) usual care plus supervised exercises; 3) usual care plus manual therapy; and 4) usual care plus combined supervised exercises and manual therapy. The members in the exercise and/or manual therapy groups received ten treatment sessions initially followed by two “booster” sessions four and thirteen months later. Usual care for all four groups was provided by each patient’s medical provider on an ongoing basis.
The researchers’ goal was to identify which approach performed best based on a combination of cost effectiveness and clinical effectiveness using the Western Ontario and McMaster (WOMAC) osteoarthritis index, which takes into account pain, stiffness, and physical function. At the conclusion of the study, the research team found that participants in groups 2, 3, and 4 (the manual therapy and/or exercise groups) not only experienced greater improvements in their WOMAC scores, but these approaches also offered the greatest cost savings with respect to both healthcare spending and related expenditures/lost productivity.
The findings of the study highlight the importance of pursuing a multimodal approach that includes manual therapies and supervised exercise in the management of conditions like knee or hip osteoarthritis. Not only can these interventions reduce pain and improve function, but they enact a lower cost on the healthcare system overall, which frees up resources to help more patients. Doctors of chiropractic are well-versed in the conservative management of osteoarthritic conditions with the goal of helping patients carry out their normal life, work, and leisure activities, pushing their need for joint replacement as far into the future as possible.