Article Text

SP0017 A stepped care approach towards hip and knee osteoarthritis in primary care
  1. S. Bierma-Zeinstra
  1. General practice/Orthopedics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands


The management of hip and knee osteoarthritis has been reported to be non-optimal despite existing guidelines. To facilitate guideline implementation and improve utilization of non-surgical treatment options we developed an evidence-based, multidisciplinary, patient-centered, stepped care strategy.

A Dutch multidisciplinary steering group developed the strategy in three subsequent stages: 1) consensus among steering group members based on existing national guidelines; 2) written consultation of representatives of patient organizations and professional associations involved in osteoarthritis care; 3) consensus of the final draft after discussion during a conference with representatives from the above mentioned disciplines.

The final stepped care strategy provides guidance to the timing of non-surgical treatment modalities. It recommends that more advanced options should only be considered if options listed in previous steps failed to produce satisfactory results. The first step treatment options can be offered to all patients (education, life style advice, and acetaminophen). The second step (exercise therapy, dietary therapy, and non-steroidal anti-inflammatory drugs or other pain medication) and third step treatment options (multidisciplinary care, intra-articular injections, and transcutaneous electrical nerve stimulation) can be considered for people with persisting complaints.

Based on a consensus procedure we developed a multidisciplinary, patient-centered, stepped care strategy for patients with hip or knee osteoarthritis, which provides a framework for health care providers and patients to discuss the optimal timing of the various treatment options.

Disclosure of Interest None Declared

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.