The American Academy of Orthopaedic Surgeons (AAOS) recently released their Guidline on the Treatment of Osteoarthritis of the Knee. AAOS' guidlines join those made by the Osteoarthritis Research Society International (OARSI) guidlines released in February of this year. AAOS makes recommendations on topics ranging from lifestyle modifications to, of course, surgical interventions. However, there were a couple of recommendations/statements that stood out to me.
The first was they recommend AGAINST the prescribing of Glucosamine, Chondroitin, or hydrochloride. I would have to say that my observation in the clinic that greater than 50% of my patients over the age of 50 are taking one or all of these. I haven't read any studies that show a strong benefit from any of these. However, they are marketed hard. Will like to know if there are any side effects from long term use of these.
The last issue I wold like to discuss is AAOS', in my opinion, obvious choice to avoid the term/word "PHYSICAL THERAPY". This is in stark contrast to OARSI's recommendation which specifically recommends physical therapy. AAOS recommends many treatments used by physical therapists and education routinely provided by physical therapists. However, at no time does the 265 page document use the terms "physical therapy "or "physical therapist" in reference to it's recommendations. The did have 2 PT's on the review board (one the president of the orthopaedic section of the APTA) and get the nod of acceptance from the APTA. However, I feel this is just a continuation of, specifically, orthopaedic surgeons refusal to aknowldedge the importance of our profession instead of something the own and direct as just a small aspect of their patient's recovery.
Besides the hypocrisy of direct access for PT's (may go to a massage therapist with a certificate for back pain w/o MD ok but not a PT with a doctoral degree), this concerted effort by orthopaedic surgeons in general to make sure PT's stay subservient gives me the most angst in my professional life. In the end, our working together and respecting each others discrete knowledge for orthopaedic patients should be paramount. Instead, it's unilateraly ignored and buried.
Good recommendations and good information for us all to read. Hope future editions of these recommendations can include the recommendation skirted through out - the referral to a physical therapist.
Jason Harris
