Dr. Geoffrey Van Thiel: How surgeons can keep patients from postponing care for knee pain


It's common for patients to put off getting treatment for knee pain, and surgeons can address the issue head-on, according to Geoffrey Van Thiel, MD, an orthopedic surgeon at Ortho Illinois and team physician with the Chicago Blackhawks Medical Network.

Note: Responses were lightly edited for style and clarity. Click here to view Becker's coverage of the Vericel survey findings.

Question: Why are orthopedic surgeons concerned about patients delaying treatment for knee pain? What are the risks of delaying treatment, in terms of costs and outcomes?

Dr. Geoffrey Van Thiel: For healthcare providers and orthopedic surgeons alike, it's important to know what factors are preventing patients from seeking care and why patients are waiting so long to get treatment for their knee pain. According to Vericel's recent survey findings, it takes on average three years for people to finally seek treatment from a healthcare provider after they start experiencing knee pain.

Patients who wait too long to get treatment — especially if it is related to their damaged knee cartilage — can find themselves with more serious concerns down the line and limited treatment options. This can not only affect patients' health and medical costs, but also can impact the amount of time and money hospitals and healthcare providers spend treating those patients who do not get their knee pain taken care of when they first experience it.

Q: Vericel's recent survey showed that the most common reasons patients delay treatment for knee pain are believing they can live with the pain (30 percent), cost of treatment (30 percent), being too busy (29 percent), putting others' needs before their own (26 percent), and being used to their knee pain (24 percent). How do you address those causes of delays?

GVT: It's important that doctors, orthopedic surgeons and other healthcare professionals talk with their patients about the potential effects of postponing treatment. For patients with knee cartilage damage especially, it's important they understand that cartilage injuries do not heal on their own and are often chronic and may get worse as time goes on. Knowledge is the first step to finding a path to recovery. While some patients can be scared to visit their doctor because they worry about what comes next, it's crucial that patients seek medical attention when they experience symptoms related to knee pain. Once the issue is identified, doctors can discuss the available treatment options with their patients — answering any questions or concerns a patient has relating to cost, recovery time or effectiveness of their repair procedure.

Q: Vericel's survey showed pain medications were used to treat knee pain over half of the time. Is that problematic in light of the ongoing opioid crisis? How is the opioid crisis affecting prescribing practices and treatment modalities?

GVT: Pain medications to treat knee pain are absolutely problematic. The opioid crisis has brought attention to the risks of narcotic-based pain management, but even chronic anti-inflammatory use can have significant medical complications. These two facts have made a multimodal approach to joint pain essential. Things like therapy can help alleviate joint pain, and surgery in the right situation can both increase activity and decrease chronic pain medication use. Cartilage problems are a major reason for knee pain, and knee pain is a significant source of dysfunction, as illustrated in the survey.

As a physician, the opioid crisis has definitely influenced prescribing practices and treatment modalities. We are more conscientious about prescribing narcotic pain medication for chronic and postoperative pain. This has resulted in the exploration of other pain-control regimens with each patient and a continued focus on how we can correct the underlying problem. The Vericel survey is a wake-up call to the number of patients that are dealing with significant knee pain and will help to shape our approach to these cartilage patients.

Q: Where do orthopedic surgeons have the greatest opportunity to ensure patients get back to doing the things they love after knee surgery?

GVT: Orthopedic surgeons can provide support in the recovery and rehabilitation stages to ensure patients get back to doing the things they love. For example, the rehabilitation processes are designed for patients by their physician to ensure a smooth and efficient recovery. The commitment patients make to the rehabilitation program will play a key role in their return to activity, but physicians play just as important of a role during the recovery process. This includes everything from helping the patient restore mobility, build strength, return to independent movement and daily activities, and eventually get them back to a full active lifestyle. As with any type of surgery, recovery time varies greatly, as no two patients are alike; however, working with a physician post-surgery can ensure patients are making an effective, efficient recovery.

Q: What are some treatment protocols Ortho Illinois has implemented that other orthopedic practices can learn from?

GVT: Ortho Illinois, along with many other orthopedic practices, [has] been exploring and implementing many different protocols across all specialties to help decrease narcotic pain medication use. Generally speaking, there have been two initiatives that have been very successful. The first is management of patient expectations. We have changed the focus in postoperative patients from "you should have no pain" to "you will have some pain, but we can help manage this." Educating patients that pain is normal and okay helps them expect and cope with this ahead of time. We have found this to be successful in the reduction of narcotic consumption. The second is chronic pain management through a specialist. Patients that require ongoing pain management are now referred to a specialist that we work with to manage this pain. This allows us to monitor a patient's pain and their medication use. This also puts pain in the hands of a specialist that is equipped to offer a comprehensive multimodal approach.

Interested in participating in future Becker's Q&As? Email Angie Stewart: astewart@beckershealthcare.com.

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