ab22205

Treatment of osteoarthritis of the hip and knee: A comparison of nsaid use in patients for whom surgery was and was not recommended

J.E. Pope, K. McCrea, A. Stevens, J.M. Ouimet

Department of Medicine, Division of Rheumatology, University of Western Ontario, London, Canada.

ABSTRACT
Objective
To determine if NSAID use was different between OA (hip and/or knee) patients treated surgically to those treated medically.

Methods
We conducted a case control study, in which cases (n = 433) had had a total joint replacement within a two-year period, while controls (n = 195) had seen a rheumatologist or orthopedic surgeon, and not been recommended for surgery. Current and previous NSAID use was surveyed.

Results
Cases were older than controls (70 vs. 64 years, p < 0.0001), and were more likely to have OA in the hips (45% vs. 21%, p < 0.0001), to have severe OA (p < 0.0001), and to be male (42% vs. 28%, p < 0.0008). Potential confounding variables were statistically adjusted using logistic regression. Although disease duration was similar in cases and controls (9.8 years), cases had tried fewer NSAIDs (1.3 ± 0.05 vs. 2.3 ± 0.08 in controls, p < 0.0001). Cases were less likely to have taken any NSAID (86% vs. 94% of controls; OR 0.40, p < 0.007) or to have had intra-articular steroids (OR 0.19, p < 0.0001). Two or more NSAIDs were used (ever) in 38% of cases vs. 70% of controls (p < 0.0001); and 3 or more NSAIDs in 5% vs. 38% (p < 0.0001). Women were less apt to have obtained total joint replacements (OR 0.62, p < 0.0001), including TKRs even when adjusting for severity of OA.

Conclusions
NSAIDs are used less by orthopedic surgeons than rheumatologists in our centre. Some subjects were offered a joint replacement without even a failure of medical management. The reasons for differences in prescribing trends are unknown. Referral biases may exist.

Key words
Osteoarthritis, NSAIDs, treatment, orthopedic surgery.

This work was funded in part from a grant from the Victoria Campus, London Health Sciences Centre (LHSC) Research Development Fund.
Please address correspondence and reprint requests to: Dr. Janet E. Pope, St. Joseph's Health Centre, 268 Grosvenor Street, PO Box 5777, London, ON N6A 4V2, Canada.
E-mail: janet.pope@sjhc.london.on.ca