Comprehensive physiotherapy could save millions by avoiding joint replacement surgery

Australians suffering moderate-to-severe knee osteoarthritis (OA) who take part in a structured physiotherapy program could avoid or delay joint replacement surgery and save the health system between AUD$303 to $690 million per year, according to new research led by School of Public Health and Preventive Medicine researchers.

More than 56,000 Australians are estimated to live with severe knee OA, and this is projected to increase significantly over the next few years given population ageing and rising rates of obesity. The symptoms can have profound impacts on quality of life and the ability to undertake daily activities at work and home.

Most Australians with OA receive care that falls short of guideline-recommendations, and many proceed to surgery without appropriate first-line therapy; data suggests that as many as one in four joint replacement surgeries are unwarranted, and that up to 20 per cent of knee replacement recipients are dissatisfied with the outcome.

Associate Professor Ilana AckermanThe research team, led by musculoskeletal epidemiologist A/Prof Ilana Ackerman, assessed the national use of a physiotherapy-led program evaluated in a previously published Danish randomised control trial. The program involves 12 weeks of treatment consisting of exercise therapy, education, use of insoles, dietary advice and pain relief medication where appropriate, delivered before resorting to surgery.

They found that if 34 to 68 per cent of Australians were to avoid surgery as a result of the program, this would translate to health system savings in the order of $AUD303million–690 million in 2019. Only 1 in 12 program recipients would need to avoid surgery for the program to generate savings.

And the savings aren’t just financial; avoiding the trauma of surgery means patients aren’t faced with lengthy recoveries including rehabilitation, and the risks associated with surgery, including complications with anaesthetics and post-surgical infections.

A/Prof Ackerman said, “Paying for comprehensive physiotherapy care for people before they decide to undergo surgery would lead to savings for the Australian health system even if just 8% of participants avoided surgery. The savings would obviously be far greater if more people avoided surgery, which we expect would be the case. This is a win for both individual patients and the health system overall."

The Australian Physiotherapy Association (APA) welcomed the study results, and APA National President Phil Calvert reiterated the need for non-surgical management for Australians considering total knee replacements for their OA. “While this particular data modelling is new, the concept of successful physio treatment prior to surgery is not. Our health system needs to keep up to date with what the research is clearly showing, and that is funding for physio treatment before people even consider costly surgical options.”

The modelling was performed by A/Prof Zanfina Ademi (CCRET), and the research team included Prof Danny Liew (CCRET) and collaborators from La Trobe University and Denmark.

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