Closing The Treatment Gap For Patients Not Yet Ready For Surgery
In our last blog, we outlined the typical roadmap for most patients with knee osteoarthritis and provided some guidance on what to expect at each stop along the way.
As we showed, nearly all patients begin their journey with lifestyle changes and conservative (non-surgical) interventions like physical therapy, which is typically followed by other treatments if their symptoms don’t improve or get worse. The final stop on the roadmap is a knee replacement, but not all patients get to this point because they are either not suitable candidates or don’t want to undergo the invasive, irreversible procedure.
This underscores an important problem in the management of knee osteoarthritis that’s called a treatment gap. The treatment gap in knee osteoarthritis is the period of time after a patient has exhausted all conservative treatment options without success and before a knee replacement surgery is indicated or desired.
There are very few—if any—effective therapies available for patients who fall in this gap, leaving them to often endure an extended period of pain and disability until surgery is eventually recommended. Many healthcare providers believe these patients represent a pressing issue and require a better set of options.
Age is the biggest contributing factor
Knee osteoarthritis is often regarded as a disorder that affects older individuals, and this is somewhat accurate, as the average age that patients begin noticing symptoms is 58–61 years. But older adults are not the only age group that experiences knee osteoarthritis, as the condition can develop much earlier in life.
Nearly 40% of all knee osteoarthritis patients are under the age of 55, with the bulk of younger individuals landing in the 35–55 age group. Unfortunately, the earlier symptoms begin to emerge, the greater the likelihood for poor outcomes and for the patient to fall into the treatment gap.
The primary reason is the limited average lifespan of the implants that are used in these procedures. When a patient undergoes a knee replacement surgery, the surgeon removes damaged bone or cartilage from the knee and inserts a surgical implant. Although this leads to positive outcomes in most patients (90-95%), the implants usually only last for about 15-25 years.
Over time, every implant will eventually fail, at which point the patient will need to undergo a second surgery called a revision. Revision surgery can often be more complicated than the original procedure, and outcomes are typically worse, with higher rates of complications. Therefore, many surgeons try to avoid performing knee replacement surgery on patients that are under the age of 60–65, since the risk for revision is about 35% in patients between the ages of 50–54 versus about 4% in those over the age of 70.
Instead, they believe that a patient should ideally only undergo one knee replacement in their lifetime, and the later in life this is done, the less likely they are to need a revision. Surgeons may also not recommend a knee replacement to patients who are obese, frequently exercise intensely, or who work jobs that place excessive loads on the knees, since the risk for failure is also high in these groups.
More effective treatment strategies are needed to close the gap
As you can see, the treatment gap is made up of patients who have unsuccessfully tried a variety of conservative interventions but are not candidates for a knee replacement due to their age or other reasons. Recent research suggests that about 20% of patients with knee osteoarthritis fall into this treatment gap, which equates to about 3.6 million Americans. It’s estimated that most patients remain in this treatment gap for an average of 20 years, but for even longer if the patient is extremely young.
As the population continues to age and more individuals are diagnosed with knee osteoarthritis, the treatment gap will also continue to expand, and the number of those in this group is expected to increase to 5 million by 2025. Most surgeons are aware of this problem and agree that there is a need for more effective management strategies to address those who fall within the treatment gap. The current consensus is that the conservative (and minimally invasive) therapies available now can only provide relief for a finite period of time and usually fail to do so in the long term.
Therefore, the single biggest goal is to essentially “close this gap” by identifying new interventions that can potentially delay surgery for several years or more in younger patients who are not yet ready for surgery. This highlights an urgent need to develop and study treatments that can accomplish this task by offering patients a safe, effective, and noninvasive therapy to postpone their surgery either temporarily or indefinitely.
Wearable Robotic Orthosis for Pain Relief and Improved Mobility
Ascend is a smart knee orthosis designed to provide relief from knee pain and intuitively support everyday mobility. The customized, lightweight, and comfortable design reduces burden on the knee and adjusts to users as needed, enabling a confident, active and healthy lifestyle.
Smart sensor technology provides support when performing common motions like walking, kneeling, standing, sitting, and going up or down steps. Ascend provides a safe, non-invasive and non-surgical option for pain relief and mobility constraints related to osteoarthritis, knee instability, and/or weak quadriceps.
To learn more about knee pain or Ascend, visit www.ascend.health or call us at (415) 481-6400 or email us at hello@ascend.health
Medical Disclaimer: Ascend is registered with the FDA as a Class I medical device. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers.