Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis

Gustavo Gonçalves Arliani; Juliana Munhoz Vergara; Isaias Duarte Mesquita Júnior; Victor Otávio Oliveira; Paulo Henrique Schmidt Lara; Gabriel Ferraz Ferreira

doi:10.1055/s-0040-1722576

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis

Rev Bras Ortop (Sao Paulo). 2021 Mar 31;57(3):409-414. doi: 10.1055/s-0040-1722576. eCollection 2022 Jun.

Authors

Gustavo Gonçalves Arliani¹, Juliana Munhoz Vergara¹, Isaias Duarte Mesquita Júnior¹, Victor Otávio Oliveira¹, Paulo Henrique Schmidt Lara¹, Gabriel Ferraz Ferreira¹

Affiliation

¹ Departamento de Ortopedia e Traumatologia, Instituto Prevent Senior, São Paulo, SP, Brasil.

Abstract

Objective To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation. Methods The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis. Results Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests ( p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases. Conclusion Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Keywords: clinical protocols; magnetic resonance imaging; osteoarthritis, knee.

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