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Intervention more likely if MRI ordered by orthopedic surgeon than by PCP

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Among patients reporting knee sprains and strains, recent study data showed arthroscopic intervention was more likely if an MRI was ordered by an orthopedic surgeon as opposed to a primary care physician.

“Further, orthopedic surgeons were less likely to order knee MRIs in situations where plain radiographs usually suffice — such as advanced osteoarthritis,” researcher, Justin Roberts, MD, said in a press release issued by the American Academy of Orthopaedic Surgeons. “As the U.S. faces major health care reform, efforts to reduce unnecessary imaging and referral costs become all the more essential.”

Roberts and colleagues conducted a chart review of 1,592 new patients with ICD-9 codes for meniscal or unspecified knee sprains and strains at their outpatient office between Jan. 1, 2010, and Dec. 31, 2011. Patients were divided into groups based on whether their initial evaluation was conducted respectively by a primary care physician (PCP) or by a staff orthopedic surgeon at the researchers’ clinic. The PCP group comprised 727 patients with a mean age of 45.1 years, and the staff surgeon group comprised 845 patients with a mean age of 56.5 years.

Although there was no significant difference observed in the rate at which MRIs were ordered between orthopedic surgeons (25%) and PCPs (24.8%), arthroscopic intervention was significantly more likely from the former (41.2%) than the latter (31.4%).

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In addition to being more likely than PCPs to order MRIs for younger patients who were more likely to benefit from arthroscopic treatment, orthopedic surgeons also ordered MRIs more often for patients with acute symptoms (39.3% and 22.2%, respectively) and patients with a history of trauma (49.3% and 36.2%, respectively), according to the researchers.

In situations such as patients with advanced osteoarthritis, PCPs ordered an MRI at a rate of 9.2%, significantly higher than the rate observed in orthopedic surgeons (4.3%).

“Significantly more patients with primary care physician-ordered MRIs went on to receive total knee replacements than those with orthopedic surgeon-ordered MRIs,” Roberts said.

References: www.aaos.org.

Roberts TT, et al. J Bone Joint Surg Am. 2015;doi:10.2106/JBJS.N.00947.

Disclosure: The researchers report no relevant financial disclosures.