There has been a major change in the medical profession’s approach to treating one of Australia’s most widespread and debilitating diseases: less surgery and more exercise.
Osteoarthritis of the knee is a scourge for many Australians who have clocked up a few years, and more than two million people are estimated to be afflicted.
Its prevalence sharply increases over the age of 45, affecting more women than men. The waiting lists for surgery are long.
Until now it was common to attribute the cause to natural wear and tear of the knee joint, and the solution was scans followed by knee replacement surgery.
But the 2024 Osteoarthritis of the Knee Clinical Care Standard, released last week by the Australian Commission on Safety and Quality in Health Care (ACSQHC), heads down a new path, replacing medical intervention with a person-centred solution – physical activity.
This won't be news to those bike riders already heading down this path, and living healthy active lives into their advanced years.
The new clinical care standard does not pull any punches: no more talk about the myth of wear and tear; imaging and surgery are mostly ineffective and unnecessary; exercise and weight management will ease symptoms and improve function; no opioid pain killers; surgery as last resort.
Another way of putting this is that a lack of physical activity and being overweight will lead to osteoarthritis in the knee, while physical activity and a healthy weight will reverse its impact.
The guidelines state: "A patient with knee osteoarthritis is advised that being active can help manage knee pain and improve function. The patient is offered advice on physical activity and exercise that is tailored to their priorities and preferences. The patient is encouraged to set exercise and physical activity goals and is recommended services or programs to help them achieve their goals.”
Patients will be told that nine out of 10 people with knee osteoarthritis can manage without needing joint replacement surgery.
Clinicians are told to reassure the patient that exercise will not cause damage and is not a risky activity.
"Advise them that physical activity and exercise will help to manage their pain and improve their function. Provide advice on exercise that is specific to the patient’s needs, preferences, and clinical context. Tailor appropriate exercise goals and activities to a sufficient dosage and duration to improve fitness and strength and minimise pain.
"Encourage patients to set realistic and achievable physical activity goals, such as gradually increasing participation in an activity they enjoy, including muscle strengthening activities, incidental activity, and sport. Tailor exercises to provide opportunities for the patient to have positive experiences or an experience of increasing function or mastery."
The guidelines state that knee osteoarthritis is a major contributor to disability and lost productivity and is the main reason for knee replacement surgery.
People with knee osteoarthritis often have difficulty walking, climbing stairs, standing from a sitting position, getting in and out of cars, and a range of other every day activities.
These limitations can further hinder physical activity and their participation in work, leisure, cultural, and social activities, and can contribute to psychological distress, including clinical depression.
People who are overweight have double the risk of developing knee osteoarthritis and for people with obesity the risk is fourfold.
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