Observational study of the impact of an individualized multidisciplinary chronic care program for hip and knee osteoarthritis treatment on willingness for surgery

Aim: To determine the impact of an osteoarthritis-specific multidisciplinary conservative care program (OACCP) on willingness for surgery (WFS) and to identify changes and factors in our cohort that influence and predict willingness for surgery. Methods: Consecutive OACCP participants with hip or knee OA, with WFS (willing, unsure or unwilling) data for at least two appointments were included. The proportions of unwilling versus willing/unsure patients at baseline and last appointment were compared using McNemar's test. Logistic regression was used to analyze baseline age, gender, main language, educational status, living situation, number of comorbidities, index joint, non-index joint osteoarthritis, completion of program, baseline and change in pain, function, depression, body mass index and 6-min walk test (6MWT) for association with changing WFS. Results: At baseline 203/409 were unwilling for surgery while by final appointment 234/409 were unwilling (P = 0.002). Of the 206 initially willing/unsure participants, 63/206 (30.6%) became unwilling by final appointment. Index joint, completion of program, baseline and change in pain, self-reported function and 6MWT were independently associated with becoming unwilling. Final model from multivariate logistic regression analysis regarding becoming unwilling included baseline pain (P < 0.001), change in pain (P < 0.001), completion of program (P < 0.001) and age (P = 0.004). Conclusion: A conservative OA-specific treatment program that improves pain and function can reduce willingness for surgery among participants with hip or knee OA. The strongest determinants of this reduction in willingness were baseline and change in pain, completion of the program and participant age.