Research streams

To improve the evidence-based treatment of patients with severe osteoarthritis.

OPUS is working towards its’ mission by focusing on five streams that have been designed to improve
and streamline the OA journey. This is a more personalised approach to produce better patient
outcomes rather than a ‘one size fits all’ management program for all people with OA.

Stream one

Which patients would benefit the most from surgery and who will not?

At least $158 million is being spent each year on surgeries that have no meaningful clinical benefit, and unnecessarily place patients with knee osteoarthritis (OA) at risk of harm. Despite this, most general practice referrals for people with knee OA are to orthopaedic surgeons for arthroscopic or total joint replacement (TJR) surgery.

The referral rate for non-surgical options is low, despite a strong evidence base. The aim of this stream is to improve clinical understanding of patients’ needs, risks and knowledge of total knee replacement surgery to optimise OA outcomes and clinical care. This understanding will guide the development of a predictive tool that identifies the potential outcomes for each patient before total joint replacement surgery.

  • O’Brien P, et al. What are the patient factors that impact on decisions to progress to total knee replacement? A qualitative study involving patients with knee osteoarthritis. BMJ Open. 2019; 9:e031310.
  • Bunzli, S, et al. Misconceptions and the acceptance of evidence-based non-surgical interventions for knee osteoarthritis. Clinical Orthopaedics and Related Research. 2019, 477(9) 1975-1983

Stream two

How can we align patient expectations with patient satisfaction?

What we have also come to learn is that meeting patient and surgeon expectations is an important part of surgical success and satisfaction. Through a series of carefully planned scenarios, Stream Two is aligning both patients and surgeon perspectives to make the most appropriate decision for patient treatment options. By studying the trade-offs that both groups accept to reach the goal of satisfying surgery, we can inform patient decision-making as well as allowing surgeons to better communicate what TJR can offer each patient.

  • Szawlowski SChoong PFMLi J, et al. How do surgeons’ trade-off between patient outcomes and risk of complications in total knee arthroplasty? a discrete choice experiment in Australia
  • Wall, L. ‘Attitudes of patients and surgeons towards sham surgery trials: A protocol for a scoping review of attributes to inform a discrete choice experiment’. BMJ Open. Accepted 14.02.20

Stream three

What are the most effective alternatives for patients?

For some, surgery is not an appropriate solution to their joint disease. We have to uncover suitable and safe alternatives to help resolve their symptoms and functional disabilities. From Cognitive Functional Therapy, to research into emotional responses to pain and qualitative research into patient satisfaction, Stream Three is working to develop novel solutions which combine mind and body therapies to allow patients to regain control over their symptoms and to adjust in a realistic way to their limitations. Although successful for those who are not suitable for surgery, this approach is also turning out to be an excellent preoperative initiative to optimise post-operate recovery. During this journey, our teams have also developed a new paradigm of understanding that describes how patients perceive different levels of post-operative outcomes and how these can be managed supportively and sensitively.

  • Caneiro JP et al. Three steps to changing the narrative about knee osteoarthritis care: a call to action. Br J Sports Med. 2019, Sep 4.
  • Caneiro JP et al. It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2019, Oct 1.
  • Klem, N.R. et al. Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review. Osteoarthritis and Cartilage Open. 2020, p.100032.
  • Caneiro JP. Infographic. Roadmap to managing a person with musculoskeletal pain irrespective of body region. Br J Sports Med. 2020 Jan 20.
  • Klem, N.R. “What Influences Patient Satisfaction after TKA? A Qualitative Investigation“ Clinical Orthopaedics and Related Research. In press, accepted 14 Apr 2020.

Stream four

Can we reduce readmissions, complications and length of stay?
Can we accelerate recovery while satisfying patient safety and meeting expectations?

Stream Four aims to improve recovery in the first few days after total joint replacement (TJR) surgery, through developing a multidisciplinary care bundle to optimise patient care. It also aims to increase physical activity after recovery from TJR surgery. It has been observed that physical activity does not increase from pre-surgery levels in the four years post-surgery for TJR patients. Additionally, no studies have investigated TJR patients’ knowledge of physical activity guidelines or their perceptions of the importance of physical activity in TJR recovery. Therefore, this stream also endeavours to identify barriers to the uptake of physical activity post-TJR by qualitatively exploring patients’ beliefs and perceptions of physical activity.

  • Wallis JA, et al. The experience of living with knee osteoarthritis: A systematic review of qualitative studies. BMJ Open, 2019, 9:e030060,
    impact factor 2.376.
  • Taylor NF, et al. 2019. Qualitative Research and Osteoarthritis of the Knee. In Enhancing Healthcare and Rehabilitation: The Impact of
    Qualitative Research. CRCPress, Boca Raton Fl. Ch 8: pp104-140.
  • Hawke LJ, et al. Effectiveness of behavioural interventions on physical activity levels after hip or knee joint replacement: a systematic review. Disability and Rehabilitation. 2019, doi.org/10.1080/0963828 .2019.160 3328
  • Hawke LJ, et al. Physical activity levels after hip and knee joint replacement surgery: An observational study. Clinical Rheumatology. 2019, 38(3): 665-674.

Stream five

Will our interventions cut costs to give meaningful policy changes?

Total knee replacements (TKR) are being performed in ever increasing numbers largely because they have a proven track record of successfully relieving pain and restoring function in advanced knee arthritis. However, there are drawbacks – the high costs of surgery, complications, and the increasing demand on resources. There is a well-documented complication profile, and approximately one in five patients are unsatisfied following surgery.

This stream aims to assess both qualitative patient-centred metrics and cost metrics to evaluate the ‘value’ of TKR surgery. We have research projects examining cost-effectiveness of surgery through computer navigation in TKR operations, evaluating patient quality-of-life measures and pre-operative opioid use.

  • Tew, M., Dowsey, M. M., Choong, A., Choong, P. F., & Clarke, P. Co-Morbidities and Sex Differences in Long-Term Quality-of-Life Outcomes among
    Patients with and without Diabetes after Total Knee Replacement: Five-Year Data from Registry Study. Journal of Clinical Medicine. 2020 9(1), 19.
  • Tew, M.; Dalziel, K; Dowsey, M.M.; Choong, P.F.; Clarke, P. Exploring the Impact of Quality of Life on Survival: A Case Study in Total Knee Replacement Surgery. Medical Decision Making. 2020 (Under review)

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