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Sample records for hip osteoarthritis patients

  1. Pelvic Incidence in Patients with Hip Osteoarthritis

    PubMed Central

    Raphael, Ibrahim J.; Rasouli, Mohammad R.; Kepler, Christopher K.; Restrepo, Santiago; Albert, Todd J.; Radcliff, Kris E.

    2016-01-01

    Background: Hip osteoarthritis (OA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. This study aims to test the hypothesis if pelvic incidence varies in patients with and without osteoarthritis. We assessed the relationship between spinopelvic alignment as measured by pelvic incidence (PI) and the presence of hip OA. Methods: We collected supine pelvis CT scans of 1,012 consecutive patients not known to have hip OA. Our first group consisted of 95 patients with moderate to severe hip OA as per radiology reports. The second group included 87 patients with no evidence of hip OA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5° or less between both groups. Two trained physicians independently measured the PI to account for inter-observer reliability. Results: Patients with moderate to severe hip OA had a mean PI of 56.5°±12.8°. The mean PI for patients without hip OA was 57.2°±7.5°. An independent samples t-test revealed no significant difference between the PI values of the two groups. Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. Conclusion: There was no difference in PI angle of hip OA patients and “healthy” patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature. It appears that hip OA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of hip arthritis. CT scan seems to be a reliable and accurate way of assessing pelvic incidence. PMID:27200390

  2. Hip Surgery Candidates: A Comparative Study of Hip Osteoarthritis and Prior Hip Fracture Patient Characteristics

    PubMed Central

    Marks, Ray

    2008-01-01

    Aim: To assess similarities and differences in patient-related characteristics before and after surgery for painful disabling hip osteoarthritis among elderly subgroups with and without a trauma history. Method: First, a cohort of 1000 hospitalized patients were assessed for trends in: perceived duration of the condition, pain intensity, functional performance ability, walking distance, body mass, and comorbidity characteristics among other factors. Then, the most salient of these patient-related characteristics were compared between 42 cases of hip osteoarthritis without a trauma history and 42 cases with a trauma history matched for age and gender, using medical records and standard data recording and analysis procedures. Results: Hip osteoarthritis cases with a prior hip fracture history had a longer duration of disability, and were more impaired functionally before surgery (p < 0.05) than those with no such history. They also had lower leg muscle strength and used more assistive devices. Conclusion: Patients undergoing hip replacement surgery for painful hip osteoarthritis who have a hip fracture history are likely to be more impaired and disabled than those with no such history. PMID:19478931

  3. Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement

    PubMed Central

    Czyżewska, Anna; Walesiak, Katarzyna; Krawczak, Karolina; Cabaj, Dominika; Górecki, Andrzej

    2014-01-01

    Introduction The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not. Material and methods Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery. Results Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05). Conclusions Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery. PMID:25395951

  4. HIP osteoarthritis and work.

    PubMed

    Harris, E Clare; Coggon, David

    2015-06-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment. PMID:26612242

  5. HIP OSTEOARTHRITIS AND WORK

    PubMed Central

    Harris, E Clare; Coggon, David

    2016-01-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by elimination or redesign of processes and use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age, and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment. PMID:26612242

  6. Total hip arthroplasty in young patients with osteoarthritis.

    PubMed

    Daras, Mariza; Macaulay, William

    2009-03-01

    Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis. PMID:19377644

  7. Body mass indices in patients with disabling hip osteoarthritis

    PubMed Central

    Marks, Ray; Allegrante, John P

    2002-01-01

    Hip osteoarthritis (OA) is a degenerative joint disease that results in substantial morbidity. The disease may be preventable in some instances by reducing risk factors associated with the disease. We undertook a study to determine whether being overweight or obese, a health risk that applies to younger and older age groups, is commonly associated with hip joint OA. The body mass indices (BMIs) of 1021 males and females ranging in age from 23 to 94 years and requiring surgery for end-stage hip joint OA were analyzed to find the prevalence of high body weights at the time of surgery. Being overweight was defined as having a BMI of 25–29.9 kg/m2 and being obese as having a BMI >30 kg/m2. BMIs indicative of overweight were recorded for 68% of the patients surveyed. Of 35 patients aged 30–39 years, 53.3% had BMIs >25, with a mean of 28.8, which nearly reaches the lower limit defined for obesity. On average, patients who had had previous surgery and complications warranting reimplantation of new surgical devices had BMIs in the obese range. Our findings suggest that a high percentage of patients with end-stage hip OA are overweight, including younger adults and those with symptoms of 3–6 months' duration. Moreover, patients whose BMIs are in the obese range may be at increased risk for removal and reimplantation of their prosthesis. PMID:11879546

  8. Postural stability disorders in patients with osteoarthritis of the hip.

    PubMed

    Truszczyńska, Aleksandra; Rąpała, Kazimierz; Gmitrzykowska, Elżbieta; Trzaskoma, Zbigniew; Drzał-Grabiec, Justyna

    2014-01-01

    The osteoarthritis of the hip dominant symptom is pain that leads to disability and to postural and gait disorders. The aim of this study was to analyze postural stability and its impact on disability and pain. The study population consisted of 60 patients and control group of 30. Group 1 (n=30) included patients with unilateral coxarthrosis, aged 56.2 (±12.3) years, BMI 25.17 (±2.87) kg/m2. There were 16 men (53.3%). The mean age of patients in group 2 (n=30) with bilateral coxarthrosis was 62.3 (±12.1) years; the mean BMI was 24.87 (±2.06) kg/m2. There were 15 men in this group (50%). The patients were evaluated using the WOMAC, the Harris Hip Score, VAS and the Biodex Balance System. Both study groups had stability index results different than the control group. There was a significant correlation between the stability indexes and BMI. VAS correlated with the M-L plane variance. In group 2, there were significant differences related to disability for the disability scales for all measured parameters. Balance disorder is a basic parameter found in coxathrosis. There is a statistically significant correlation between balance disorders and BMI, VAS and functional scales. PMID:24708175

  9. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

    PubMed Central

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. Results A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). Conclusions 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  10. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    PubMed

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-01-01

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (p<0.001), increased ranges of motion and muscle strength, and reduced use of medicines (NASAIDs) (p<0.001). A correlation was found between the degree of degenerative deforming lesions and the effects of the treatment process (p<0.01). CONCLUSIONS 1. The rehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR. PMID:27455419

  11. Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education.

    PubMed

    Wainwright, Thomas William; Immins, Tikki; Middleton, Robert Gordon

    2015-01-01

    A 71-year-old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his general practitioner to CHAIN (Cycling against Hip PAIN), a 6 week programme developed to aid self-management of hip osteoarthritis through exercise, education and advice, as defined by the National Institute for Health and Care Excellence (NICE) guidelines. Significant improvements were seen in Oxford hip score, the Hip disability and Osteoarthritis Outcome Score (HOOS) - function score, sit-to-stand test, timed up and go test, pain scores and hip flexion. There was also a weight loss of 2.1 kg. The man reported 'an amazing difference' in his affected hip and leg, and improved fitness. Many clinicians would have questioned the man's suitability for the programme due to his coexisting medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise. PMID:25678618

  12. Outcome of Arthroscopy in Patients with Advanced Osteoarthritis of the Hip

    PubMed Central

    Daivajna, Sachin; Bajwa, Ali; Villar, Richard

    2015-01-01

    Hip arthroscopy has continued to expand its horizons in treating many conditions other than femoroacetabular impingement (FAI). However, the results of hip arthroscopy are known to be poor if the degree of articular cartilage damage is significant. We wanted to assess, whether the procedure might have a role in the management of young and active patients with advanced osteoarthritis (OA) and whether it should be offered as a treatment modality. 77 consecutive patients with Tönnis grade 2 and 3 osteoarthritis of the hip who had undergone hip arthroscopy were included in the study. Patients' medical notes, plain radiographs and outcome scores (modified Harris hip score (mHHS), non-arthritic hip score (NAHS)) preoperatively and postoperatively at six weeks, six months, one year and annually thereafter, were analysed. 77 patients consisted of 63 men and 14 women with mean follow-up of 2.8 years (2.2 to 4.2) and mean age at surgery of 43 years (19 to 64). The mean preoperative mHHS and NAHS scores were 58 (28 to 87) and 64 (27 to 93) respectively. The mean improvements in both the mHHS and NAHS scores were significant (p = 0.003 and p = 0.0001 for mHHS at one and two years, p = 0.002 and p = 0.0003 for NAHS at one and two years, respectively). There were 34 patients (44%) who required a total hip replacement at mean of 18 months (6 to 48) after hip arthroscopy. We conclude that hip arthroscopy improves outcome scores in 56% of patients with severe OA of the hip (Tönnis grade 2 and 3) for at least two years after surgery. We thus consider the procedure to be a reasonable option for patients with hip OA, although success of the procedure will be less than if undertaken for certain other conditions. PMID:25635392

  13. Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

    PubMed Central

    McMinn, D J W; Snell, K I E; Daniel, J; Treacy, R B C; Pynsent, P B

    2012-01-01

    Objectives To examine mortality and revision rates among patients with osteoarthritis undergoing hip arthroplasty and to compare these rates between patients undergoing cemented or uncemented procedures and to compare outcomes between men undergoing stemmed total hip replacements and Birmingham hip resurfacing. Design Cohort study. Setting National Joint Registry. Population About 275 000 patient records. Main outcome measures Hip arthroplasty procedures were linked to the time to any subsequent mortality or revision (implant failure). Flexible parametric survival analysis methods were used to analyse time to mortality and also time to revision. Comparisons between procedure groups were adjusted for age, sex, American Society of Anesthesiologists (ASA) grade, and complexity. Results As there were large baseline differences in the characteristics of patients receiving cemented, uncemented, or resurfacing procedures, unadjusted comparisons are inappropriate. Multivariable survival analyses identified a higher mortality rate for patients undergoing cemented compared with uncemented total hip replacement (adjusted hazard ratio 1.11, 95% confidence interval 1.07 to 1.16); conversely, there was a lower revision rate with cemented procedures (0.53, 0.50 to 0.57). These translate to small predicted differences in population averaged absolute survival probability at all time points. For example, compared with the uncemented group, at eight years after surgery the predicted probability of death in the cemented group was 0.013 higher (0.007 to 0.019) and the predicted probability of revision was 0.015 lower (0.012 to 0.017). In multivariable analyses restricted to men, there was a higher mortality rate in the cemented group and the uncemented group compared with the Birmingham hip resurfacing group. In terms of revision, the Birmingham hip resurfacings had a similar revision rate to uncemented total hip replacements. Both uncemented total hip replacements and Birmingham hip

  14. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study

    PubMed Central

    Nevitt, Michael C; Niu, Jingbo; Clancy, Mary M; Lane, Nancy E; Link, Thomas M; Vlad, Steven; Tolstykh, Irina; Jungmann, Pia M.; Felson, David T; Guermazi, Ali

    2015-01-01

    Study question Is there concordance between hip pain and radiographic hip osteoarthritis? Methods In this diagnostic test study, pelvic radiographs were assessed for hip osteoarthritis in two cohorts: the Framingham Osteoarthritis Study (community of Framingham, Massachusetts) and the Osteoarthritis Initiative (a multicenter longitudinal cohort study of osteoarthritis in the United States). Using visual representation of the hip joint, participants reported whether they had hip pain on most days and the location of the pain: anterior, groin, lateral, buttocks, or low back. In the Framingham study, participants with hip pain were also examined for hip pain with internal rotation. The authors analysed the agreement between radiographic hip osteoarthritis and hip pain, and for those with hip pain suggestive of hip osteoarthritis they calculated the sensitivity, specificity, positive predictive value, and negative predictive value of radiographs as the diagnostic test. Study answer and limitations In the Framingham study (n=946), only 15.6% of hips in patients with frequent hip pain showed radiographic evidence of hip osteoarthritis, and 20.7% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of radiographic hip osteoarthritis for hip pain localised to the groin was 36.7%, specificity 90.5%, positive predictive value 6.0%, and negative predictive value 98.9%. Results did not differ much for hip pain at other locations or for painful internal rotation. In the Osteoarthritis Initiative study (n=4366), only 9.1% of hips in patients with frequent pain showed radiographic hip osteoarthritis, and 23.8% of hips with radiographic hip osteoarthritis were frequently painful. The sensitivity of definite radiographic hip osteoarthritis for hip pain localised to the groin was 16.5%, specificity 94.0%, positive predictive value 7.1%, and negative predictive value 97.6%. Results also did not differ much for hip pain at other locations. What this

  15. Selective type II fibre muscular atrophy in patients with osteoarthritis of the hip.

    PubMed

    Sĭrca, A; Susec-Michieli, M

    1980-01-01

    The size and the distribution of type I and tye II fibres was determined in the gluteus maximus (21 cases), gluteus medius (56 cases) and tensor faciae latae (27 cases) muscles of patients with osteoarthritis of the hip. The patients were of both sexes, aged between 37 and 64 years (younger group) and between 65 and 78 years (older group). Autopsy material of the two comparable age groups and of a group of "normal" adults (aged 22-44 years) served as controls. It was shown statistically that the diameter of both types of fibres and the relative number of type II fibres diminished with progressing age. In patients with osteoarthritis the degree of the selective atrophy of type II fibres was significantly higher than in the control groups. The atrophy is interpreted as a consequence of diminished muscular activity. No neurogenic lesions were detected either in the muscles of the patients or in those of the control groups. PMID:6444440

  16. Strength and pain are related to different measures of functional ability in patients with end-stage hip osteoarthritis

    PubMed Central

    Zeni, Joseph; Abujaber, Sumayah; Pozzi, Federico; Raisis, Leo

    2014-01-01

    Objective Performance tests and self-reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance-based tests and self-reported questionnaires of functional ability of individuals with end-stage hip osteoarthritis. Methods Fifty-six patients scheduled to undergo unilateral total hip arthroplasty were included in this cross sectional analysis. Subjects completed the Hip Outcome Survey (HOS) and pain in the affected hip was quantified on a scale from 0–10. Performance-based tests included the Six Minute Walk (6MW), Timed Up and Go (TUG), and Stair Climbing Test (SCT). Isometric strength of the hip abductors and knee extensors was collected. Hierarchical linear regressions were created to determine the contributions of pain, knee extensor strength, and hip strength for each outcome measure (TUG, 6MW, SCT, HOS). Height and BMI were entered first, followed by pain, then knee extensor strength, then hip abduction strength. Results Greater pain significantly predicted lower HOS scores, but hip strength did not significantly improve the model. Hip pain was also significantly related to TUG, SCT and 6MW values, but hip and knee strength explained additional variance for these performance-based measures. Conclusions Self-report and performance-based measures capture different aspects of disability and are influenced by different underlying impairments. Both types of outcome measures should be used in studies that evaluate functional changes in patients with hip osteoarthritis. PMID:24664893

  17. Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

    PubMed Central

    2010-01-01

    Background Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR). Methods We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery. Results Internal consistency reliability (Cronbach's α) was >0.80 for the BPI, the WOMAC and five of the eight SF-36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales. Conclusions The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36. PMID:21143926

  18. Validation of a proposed WOMAC short form for patients with hip osteoarthritis

    PubMed Central

    2011-01-01

    Background The aims of this study were to propose a Spanish Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) short form based on previously shortened versions and to study its validity, reliability, and responsiveness for patients with hip osteoarthritis undergoing total hip replacement (THR). Methods Prospective observational study of two independent cohorts (788 and 445 patients, respectively). Patients completed the WOMAC and the Short Form (SF)-36 questionnaires before THR and 6 months afterward. Patients received the questionnaires by mailing, and two reminder letters were sent to patients who had not replied the questionnaire. Based on two studies from the literature, we selected the two shortened domains, the pain domain composed of three items and the function domain composed of eight items. Thus, we proposed an 11-items WOMAC short form. A complete validation process was performed, including confirmatory factor analysis (CFA) and Rasch analysis, and a study of reliability, responsiveness, and agreement measured by the Bland-Altman approach. Results The mean age was about 69 years and about 49% were women. CFA analyses confirmed the two-factor model. The pain and function domains fit the Rasch model. Stability was supported with similar results in both cohorts. Cronbach's alpha coefficients were high, 0.74 and 0.88. The highest correlations in convergent validity were found with the bodily pain and physical function SF-36 domains. Significant differences were found according to different pain and function severity scales, supporting known-groups validity. Responsiveness parameters showed large changes (effect sizes, 2.11 and 2.29). Agreement between the WOMAC long and short forms was adequate. Conclusions Since short questionnaires result in improved patient compliance and response rates, it is very useful to have a shortened WOMAC version with the same good psychometric properties as the original version. The Spanish WOMAC short form

  19. Physical Exercise and Weight Loss for Hip and Knee Osteoarthritis in Very Old Patients: A Systematic Review of the Literature

    PubMed Central

    Quintrec, Jean-Laurent Le; Verlhac, Bernard; Cadet, Christian; Bréville, Philippe; Vetel, Jean M; Gauvain, Jean B; Jeandel, Claude; Maheu, Emmanuel

    2014-01-01

    Background : Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients. Methods : Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles. Results : We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients. Physical exercise (8 trials): was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation. Aquatic exercise (5 trials): was as effective as land-based exercise. Weight loss (2 trials): only patients under diet + exercise had significant improvement on symptoms. Conclusion : Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis. PMID:25489352

  20. Neuromuscular exercise prior to joint arthroplasty in patients with osteoarthritis of the hip or knee.

    PubMed

    Villadsen, Allan

    2016-04-01

    Osteoarthritis (OA) is a degenerative joint disease affecting the whole joint and peri-articular structures like the muscles. The hallmark of OA is cartilage loss. The main symptoms are pain and decreased physical function leading to a reduced quality of life. OA ranks eight in leading causes of disability worldwide and it generates a heavy economic burden for society. The prevalence of OA increases with age and 10-18% aged above 60 years are affected. Currently there is no cure for OA and the various treatment modalities aim at addressing symptoms, i.e. reducing pain, improving physical function and preventing further progression of the disease. Exercise has proven to be a viable treatment option with regard to reducing pain and improving physical function in patients with mild to moderate knee OA and is today regarded a cornerstone in the treatment. The documentation is less clear for hip OA. Patients with severe OA of the hip or knee are treated with total joint arthroplasty (TJA). Although, in general, it is a very successful procedure, there are still challenges to overcome in this patient group, as approximately 10% of those having hip arthroplasty and 20% of those having knee arthroplasty have persistent symptoms. The evidence on the efficacy of exercise prior to TJA is sparse. It is based on insufficiently powered trials and with interventions of questionable validity. Two recent systematic reviews and meta-analyses reach conflicting conclusions and highlight the need for high quality trials with sufficient sample sizes. In this dissertation, I wanted to evaluate the effects of an individualised neuromuscular exercise programme (NEMEX-TJR) when administered prior to joint arthroplasty in patients with severe OA of the hip or knee joint. This intervention was previously found to be feasible with regard to pain level during exercise and it was possible to progress the training level in this patient group. The main question asked was: Does the addition of

  1. Mesenchymal Stem Cell Alterations in Bone Marrow Lesions in Patients With Hip Osteoarthritis

    PubMed Central

    Campbell, T. Mark; Churchman, Sarah M.; Gomez, Alejandro; McGonagle, Dennis; Conaghan, Philip G.; Ponchel, Frederique

    2016-01-01

    Objective In patients with osteoarthritis (OA), bone marrow lesions (BMLs) are intimately linked to disease progression. We hypothesized that aberrant multipotential stromal cell (also known as mesenchymal stem cell [MSC]) responses within bone tissue contributes to BML pathophysiology. The aim of this study was to investigate BML and non‐BML native subchondral bone MSCs for numeric, topographic, in vitro functional, and gene expression differences. Methods Ex vivo 3T magnetic resonance imaging (MRI) of the femoral heads of 20 patients with hip OA was performed. MRI‐determined BML and non‐BML regions were excised and enzymatically treated to extract cells and quantify MSCs using flow cytometry and colony‐forming unit–fibroblast (CFU‐F) assay. Immunohistochemical analysis was performed to determine in vivo CD271+ MSC distribution. Culture‐expanded CD271+ cells were analyzed for tripotentiality and gene expression. Results BML regions were associated with greater trabecular bone area and cartilage damage compared with non‐BML regions. The proportion of CD45−CD271+ MSCs was higher in BML regions compared with non‐BML regions (median difference 5.6‐fold; P < 0.001); the CFU‐F assay showed a similar trend (median difference 4.3‐fold; P = 0.013). Immunohistochemistry revealed CD271+ cell accumulation in bone adjacent to cartilage defects and areas of osteochondral angiogenesis. BML MSCs had lower proliferation and mineralization capacities in vitro and altered expression of TNFSF11/RANKL and CXCR4/stromal cell–derived factor 1 receptor. OA MSCs showed up‐regulated transcripts for CXCR1 and CCR6 compared with MSCs derived from healthy or osteoporotic bone. Conclusion This study is the first to show numeric and topographic alterations in native MSCs in the diseased bone of patients with hip OA. Given the associated functional perturbation of MSCs, these data suggest that subchondral bone MSC manipulation may be an OA treatment target. PMID

  2. Adaptation and validation of the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire for use in patients with osteoarthritis in Spain.

    PubMed

    Gonzalez Sáenz de Tejada, Marta; Escobar, Antonio; Herdman, Michael; Herrera, Carmen; García, Lidia; Sarasqueta, Cristina

    2011-12-01

    This study aims to adapt and validate the Spanish version of the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire. The OAKHQOL was adapted into Spanish using a forward-backward translation methodology. The Spanish version was then validated in a prospective, mixed-design study of 759 patients with hip or knee osteoarthritis (OA). Patients completed the OAKHQOL, Short Form 36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index, and the EQ-5D. The internal consistency was evaluated using Cronbach's alpha. Convergent validity was assessed by examining correlations between the OAKHQOL and other patient-reported instruments; known groups' validity was assessed by determining the capacity of the OAKHQOL to discriminate between patients with different levels of disease severity measured using the Lequesne Index. Test-retest reliability was evaluated by calculating the intraclass correlation coefficient (ICC) for all OAKHQOL domains in 409 stable patients with OA. Responsiveness was evaluated by calculating effect sizes among 129 patients undergoing hip or knee replacement. Cronbach's alpha for the five domains of the OAKHQOL ranged from 0.60 to 0.93 while ICCs ranged from 0.75 to 0.81 for all domains except the two social domains. Statistically significant differences (p < 0.001) were observed between patients with different degrees of disease severity on all domains except "social support". The instrument showed convergent validity among hypothesized domains (p < 0.001). Results of the study supported that the Spanish version OAKHQOL questionnaire was a valid instrument to measure health-related quality of life in patients with OA of the lower limb. PMID:21947701

  3. Imaging the hip joint in osteoarthritis: A place for ultrasound?

    PubMed

    Sudula, S N

    2016-05-01

    Osteoarthritis has traditionally been imaged with conventional radiographs; this has been regarded as the reference technique in osteoarthritis for a long time. However, in recent years, innovative imaging techniques such as ultrasonography have been used to obtain a better understanding of this disease. This is mainly due to tremendous technical advances and progressive developments of ultrasound equipment occurring over the past decade. Ultrasonography has been demonstrated to be a valuable imaging technique in the diagnosis and management of osteoarthritis of the hip joint. Application of this imaging methodology for osteoarthritis has improved the understanding of the disease process and may aid in the assessment of the efficacy of future therapies. The execution of ultrasound-guided procedures with safety and reliability has a relevant significance in patient management of osteoarthritis of the hip joint. This paper reviews the use of ultrasound as an imaging technique for the evaluation and treatment of osteoarthritis hip joint. PMID:27482280

  4. [Cross cultural adaptation of the lequesne algofunctional indices for german speaking patients with osteoarthritis of the hip and the knee].

    PubMed

    Ludwig, F J; Melzer, Ch; Grimmig, H; Daalmann, H H

    2002-08-01

    The Lequesne Algofunctional Index is a widespread international instrument and recommended by the World Health Organization (WHO) for outcome measurement in hip and knee diseases. Up to now there has been no German version of the questionnaire fulfilling the guidelines for cross-cultural adaptation and providing satisfactory metric quality. Based on these guidelines, we developed the German version of the Lequesne Algofunctional Index regarding osteoarthritis of the hip and knee joints presented in this article. All of the questions it contains have been worded as whole sentences, questions concerning walking performance have been substantiated by examples. In testing of the metric outcome (hip: n = 112; knee: n = 83), both questionnaires showed an excellent reliability (IKK > 0,88). As a validity criterion, the correlation with the WOMAC score was tested. We received a Spearman coefficient between 0,63 and 0,81, indicating a high correlation. Time needed to fill in the Lequesne score was 2 min. in patients, physicians took 1,2 min. to evaluate the questionnaire. Regarding the questionnaires handed back, the Lequesne score showed better results than the WOMAC index. Sensitivity, measured by the "standardized response mean", was good in both regions for the total score. Comparing the data received on pain-related questions, the WOMAC score however showed a better sensitivity. The German version of the Lequesne Algofunctional Index is a suitable outcome instrument to measure the intensity of pain, walking capacity and activity of daily life in patients with osteoarthritis of hip and knee joints. PMID:12168149

  5. A Blended Intervention for Patients With Knee and Hip Osteoarthritis in the Physical Therapy Practice: Development and a Pilot Study

    PubMed Central

    Kloek, Corelien; Snippe, Harm Wouter; Dekker, Joost; de Bakker, Dinny; Veenhof, Cindy

    2016-01-01

    Background Blended care, a combination of online and face-to-face care, is seen as a promising treatment option. However, actual use of blended interventions in practice is disappointing. Objective The objective of this study was two folded. The first aim was to develop a blended exercise therapy intervention for patients with knee and hip osteoarthritis that matches the values of the users and that can be implemented in the daily routine of physical therapists. The second aim was to investigate the feasibility through interviews and a pilot study. Methods In this paper, we employed the first 3 steps of the CeHRes road map to develop a blended intervention for patients with knee and hip osteoarthritis. We used interviews, a focus group and discussions with stakeholders to explore the needs, values, and requirements with respect to our to-be-developed blended intervention, which we called e-Exercise. The first version of e-Exercise was tested in a pilot study. Feasibility outcomes, including recruitment rates within each practice, website usage (assignments completed and website visits), and user satisfaction, were measured. In addition, therapists and patients from the pilot study were interviewed to investigate users’ experiences. Results The study captured important information about stakeholders’ needs and perspectives. Based on our findings, we created a first version and attuned the application’s content, functionality, and structure. Patients and, to lesser extent, physical therapists were satisfied with the e-Exercise intervention. Eight patients were recruited by 8 physical therapists. Of the 8 patients, 6 completed more than 7 of 12 modules. Conclusions This study outlines the development and feasibility of a blended exercise therapy intervention for patients with knee and hip osteoarthritis. E-Exercise offers an alternative approach in the physical therapy treatment of knee and hip osteoarthritis. This study provides valuable information to conduct

  6. Progressive Change in Joint Degeneration in Patients with Knee or Hip Osteoarthritis Treated with Fentanyl in a Randomized Trial

    PubMed Central

    Fujii, Tatsuya; Takana, Koshi; Orita, Sumihisa; Inoue, Gen; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Gou; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Yamauchi, Kazuyo; Toyone, Tomoaki; Nakamura, Junichi; Kishida, Shunji; Takahashi, Kazuhisa

    2014-01-01

    Purpose Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids. Materials and Methods Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated. Results Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group. Conclusion Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol. PMID:25048500

  7. Femoroacetabular impingement and osteoarthritis of the hip

    PubMed Central

    Zhang, Charlie; Li, Linda; Forster, Bruce B.; Kopec, Jacek A.; Ratzlaff, Charles; Halai, Lalji; Cibere, Jolanda; Esdaile, John M.

    2015-01-01

    Objective To outline the clinical presentation, physical examination findings, diagnostic criteria, and management options of femoroacetabular impingement (FAI). Sources of information PubMed was searched for relevant articles regarding the pathogenesis, diagnosis, treatment, and prognosis of FAI. Main message In recent years, FAI has been increasingly recognized as a potential precursor and an important contributor to hip pain in the adult population and idiopathic hip osteoarthritis later in life. Femoroacetabular impingement is a collection of bony morphologic abnormalities of the hip joint that result in abnormal contact during motion. Cam-type FAI relates to a non-spherical osseous prominence of the proximal femoral neck or head-neck junction. Pincer-type FAI relates to excessive acetabular coverage over the femoral head, which can occur owing to several morphologic variants. Patients with FAI present with chronic, deep, or aching anterior groin pain most commonly in the sitting position, or during or after activity. Patients might also experience occasional sharp pains during activity. A thorough history should be taken that includes incidence of trauma and exercise frequency. A physical examination should be performed that includes a full hip, low back, and abdominal examination to assess for alternate causes of anterior groin pain. Diagnosis of FAI should be confirmed with radiography. Femoroacetabular impingement can be managed conservatively with rest, modification of activities, medications, and physiotherapy, or it can be treated surgically. Conclusion Femoroacetabular impingement is an important cause of anterior groin pain. Early recognition and intervention by the primary care provider might be critical to alleviating morbidity and preventing FAI progression. PMID:26668284

  8. A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study

    PubMed Central

    Grahn, Daniel; Dahlberg, Jakob E; Thorstensson, Carina A

    2016-01-01

    Background Chronic conditions are the leading cause of disability throughout the world and the most expensive problem facing the health care systems. One such chronic condition is osteoarthritis (OA), a frequent cause of major disability. Objective To describe the effect on joint pain for the first users of a newly developed Web-based osteoarthritis self-managing program, Joint Academy, and to examine whether these patients would recommend other OA patients to use the program. Methods Patients with clinically established knee or hip OA according to national and international guidelines were recruited from an online advertisement. A trained physiotherapist screened the eligible patients by scrutinizing their answers to a standardized questionnaire. The 6-week program consisted of eight 2- to 5-minute videos with lectures about OA, effects of physical activity, self-management, and coping strategies. In addition, exercises to improve lower extremity physical function were introduced in daily video activities. During the course of the program, communication between physiotherapist and patients was based on an asynchronous chat. After 6 weeks, patients were able to continue without support from the physiotherapist. Patients reported their current pain weekly by using a numeric rating scale (range 0-10; 0=no pain, 10=worst possible pain) as long as they were in the program. In addition, after 6 weeks patients answered the question “What is the probability that you would recommend Joint Academy to a friend?” Results The eligible cohort consisted of 53 individuals (39 women; body mass index: mean 27, SD 5; age: mean 57, SD 14 years). With the continued use of the program, patients reported a constant change in pain score from mean 5.1 (SD 2.1) at baseline to mean 3.6 (SD 2.0) at week 12. Six patients participated for 30 weeks (mean 3.2, SD 2.1). Overall, the patients would highly recommend Joint Academy to other OA patients, suggesting that the platform may be useful

  9. Low validity of the Sensewear Pro3 activity monitor compared to indirect calorimetry during simulated free living in patients with osteoarthritis of the hip

    PubMed Central

    2014-01-01

    Background To validate physical activity estimates by the Sensewear Pro3 activity monitor compared with indirect calorimetry during simulated free living in patients diagnosed with osteoarthritis of the hip pre or post total hip arthroplasty. Methods Twenty patients diagnosed with hip osteoarthritis (10 pre- and 10 post total hip arthroplasty; 40% female; age: 63.3 ± 9.0; BMI: 23.7 ± 3.7). All patients completed a 2 hour protocol of simulated free living with 8 different typical physical activity types. Energy consumption (kcal/min) was estimated by the Sense Wear pro3 Armband activity monitor and validated against indirect calorimetry (criterion method) by means of a portable unit (Cosmed K4b2). Bias and variance was analyzed using functional ANOVA. Results Mean bias during all activities was 1.5 Kcal/min 95%CI [1.3; 1.8] corresponding to 72% (overestimation). Normal gait speed showed an overestimation of 2.8 Kcal/min, 95%CI [2.3; 3.3] (93%) while an underestimation of -1.1 Kcal/min, 95%CI [-1.8; -0.3] (-25%) was recorded during stair climb. Activities dominated by upper body movements showed large overestimation with 4.37 Kcal/min, 95%CI [3.8; 5.1] (170%) being recorded during gardening. Both bias and variance appeared to be dependent on activity type. Conclusion The activity monitor generally overestimated the energy consumption during common activities of low to medium intensity in the patient group. The size and direction of the bias was highly dependent on the activity type which indicates the activity monitor is of limited value in patients with hip osteoarthritis and that the results do not express the real energy expenditure. PMID:24552503

  10. Identifying compositional and structural changes in spongy and subchondral bone from the hip joints of patients with osteoarthritis using Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Buchwald, Tomasz; Niciejewski, Krzysztof; Kozielski, Marek; Szybowicz, Mirosław; Siatkowski, Marcin; Krauss, Hanna

    2012-01-01

    Raman microspectroscopy was used to examine the biochemical composition and molecular structure of extracellular matrix in spongy and subchondral bone collected from patients with clinical and radiological evidence of idiopathic osteoarthritis of the hip and from patients who underwent a femoral neck fracture, as a result of trauma, without previous clinical and radiological evidence of osteoarthritis. The objectives of the study were to determine the levels of mineralization, carbonate accumulation and collagen quality in bone tissue. The subchondral bone from osteoarthritis patients in comparison with control subject is less mineralized due to a decrease in the hydroxyapatite concentration. However, the extent of carbonate accumulation in the apatite crystal lattice increases, most likely due to deficient mineralization. The alpha helix to random coil band area ratio reveals that collagen matrix in subchondral bone is more ordered in osteoarthritis disease. The hydroxyapatite to collagen, carbonate apatite to hydroxyapatite and alpha helix to random coil band area ratios are not significantly changed in the differently loaded sites of femoral head. The significant differences also are not visible in mineral and organic constituents' content in spongy bone beneath the subchondral bone in osteoarthritis disease.

  11. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

    PubMed Central

    2012-01-01

    Background Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries. Methods Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Results Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives. Conclusions Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes

  12. Hip arthroscopy and osteoarthritis: Where are the limits and indications?

    PubMed Central

    Mella, Claudio; Villalón, Ignacio E.; Núñez, Álvaro; Paccot, Daniel; Díaz-Ledezma, Claudio

    2015-01-01

    The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage. PMID:27163082

  13. Osteoarthritis of the hip: an occupational disease in farmers.

    PubMed Central

    Croft, P.; Coggon, D.; Cruddas, M.; Cooper, C.

    1992-01-01

    OBJECTIVE--To test the hypothesis that farmers are at high risk of hip osteoarthritis and to investigate possible causes for such a hazard. DESIGN--Cross sectional survey. SETTING--Five rural general practices. SUBJECTS--167 male farmers aged 60-76 and 83 controls from mainly sedentary jobs. All those without previous hip replacement underwent radiography of the hip. MAIN OUTCOME MEASURES--Hip replacement for osteoarthritis or radiological evidence of hip osteoarthritis. RESULTS--Prevalence of hip osteoarthritis was higher in farmers than controls and especially in those who had farmed for over 10 years (odds ratio 9.3, 95% confidence interval 1.9 to 44.5). The excess could not be attributed to any one type of farming, and heavy lifting seems the likely explanation. CONCLUSIONS--Manual handling in agriculture should be limited where possible. Consideration should be given to making hip osteoarthritis a prescribed industrial disease in farmers. There may be wider implications for the prevention of hip osteoarthritis in the general population. PMID:1606427

  14. Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

    PubMed

    Yildirim, Tugrul; Guclu, Berk; Karaguven, Dogac; Kaya, Alper; Akan, Burak; Cetin, Ilker

    2015-01-01

    Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes. PMID:25907395

  15. Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study

    PubMed Central

    Jackson, K A; Glyn-Jones, S; Batt, M E; Arden, N K; Newton, J L

    2015-01-01

    Objective Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. Methods This Dephi study used online surveys to gain concordance of expert opinion in a structured process of ‘rounds’. In this study, we asked ‘What outcome measures are useful in predicting hip OA in activity-related hip pain?’ The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. Results The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. Conclusions We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further

  16. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales

    PubMed Central

    Jameson, Simon S.; Mason, James; Baker, Paul N.; Gregg, Paul J.; Deehan, David J.; Reed, Mike R.

    2015-01-01

    Background Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis. Methods and Findings Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing); the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs), costs and risk of repeat (revision) surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index) (9159 linked episodes) and competing risks modelling of implant survival (79,775 procedures). Cost of implants and ancillary equipment were obtained from National Health Service procurement data. Results EQ5D score improvements (at 6 months) were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001), when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001) for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003) and resurfacing implants, HR = 3.46, p<0.001), with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524) and highest with cementless implants (£1928 to £4285). Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long

  17. FEMORAL ANTEVERSION AND THE NECK-SHAFT ANGLE: RELATIONSHIP WITH HIP OSTEOARTHRITIS

    PubMed Central

    Labronici, Pedro José; de Oliveira Castro, Gabriel Novaes Pillar; Neto, Sérgio Ricardo; Gomes, Hermann Costa; Hoffmann, Rolix; de Azevedo Neto, Justino Nóbrega; Franco, José Sergio; de Noronha Rocha, Tito Henrique; Alves, Sergio Delmonte

    2015-01-01

    Objective: To compare the existence of agreement between measurements of anteversion of the femoral neck and the degrees of osteoarthritis and abnormality of the neck-shaft angle in patients with unilateral idiopathic hip osteoarthritis, among three evaluators. Methods: Forty-two patients with unilateral hip osteoarthritis were evaluated by means of simple radiography and computed tomography. Results: It was observed that there was no significant variation in femoral anteversion between the diseased and healthy hips. There was strongest agreement between observers 1 and 2 in relation to both the diseased hips (cases) and the healthy hips (controls). Moreover, no significant agreement was found between observers 1 and 3 (p = 0.13) and between observers 2 and 3 (p = 0.12), in relation to the neck-shaft angle of the control hips. Conclusion: Although there was no relationship between femoral anteversion and the neck-shaft angle in the patients with unilateral hip osteoarthritis, the present study showed that there was also no relationship with these angular deviations. PMID:27026989

  18. Total hip replacement in osteoarthritis: the role of bone metabolism and its complications

    PubMed Central

    Bottai, Vanna; Dell'Osso, Giacomo; Celli, Fabio; Bugelli, Giulia; Cazzella, Niki; Cei, Elena; Guido, Giulio; Giannotti, Stefano

    2015-01-01

    Summary Osteoarthritis is one of the most common joint disorder. For treatment of hip symptomatic osteoarthritis, when conservative medical therapy has failed, total hip arthroplasty (THA) is a successful orthopaedic procedures that reduces pain and improves function and quality of life. Incidence of osteoarthritis is constantly increasing with raising life expectancy. This aging process also has led to an increasing number of patients with osteoporosis who need hip replacement for osteoarthritis. Osteoporosis have 3 major potential complications in total hip arthroplasty: perioperative fracture, an increased risk of periprosthetic fracture, and late aseptic loosening. The purpose of the present study was to examine the effects of osteoporosis on total hip replacement procedure outcome and highlight the importance of adequate study of calcium-phosphorus metabolism in patient candidate for hip surgery, and the need to start a suitable therapy to recover the bone mass before surgery. Bone quality of the hip joint has become an important risk factor limiting the durability of THA. PMID:26811704

  19. Primary osteoarthritis of the hip: a genetic disease caused by European genetic variants.

    PubMed

    Hoaglund, Franklin T

    2013-03-01

    Primary osteoarthritis of the hip is a separate phenotype that occurs at a rate of 3% to 6% in the populations of the world with European ancestry. In all non-European populations, there is a consistent rarity of primary osteoarthritis that suggests a different etiology for these few patients. Family, sibling, and twin studies prove primary osteoarthritis to be a genetic disease with a 50% heritability caused by European genetic variants. The genetic basis is reinforced by the lower rate of primary osteoarthritis in American minorities consistent with their degree of European gene admixture. Whether the mechanism of degeneration of primary osteoarthritis may be secondary through a morphologic deformity, such as femoroacetabular impingement, remains unknown. The virtual absence of the disease in non-Europeans indicates that the European gene component is necessary for the expression of this separate phenotype of osteoarthritis. PMID:23467870

  20. Osteoarthritis

    MedlinePlus

    Osteoarthritis is the most common form of arthritis. It causes pain, swelling, and reduced motion in your ... it affects your hands, knees, hips or spine. Osteoarthritis breaks down the cartilage in your joints. Cartilage ...

  1. The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis

    PubMed Central

    Williams, Nefyn H; Amoakwa, Elvis; Burton, Kim; Hendry, Maggie; Lewis, Ruth; Jones, Jeremy; Bennett, Paul; Neal, Richard D; Andrew, Glynne; Wilkinson, Clare

    2010-01-01

    Background The pain and disability of hip and knee osteoarthritis can be improved by exercise, but the best method of encouraging this is not known. Aim To develop an evidence-based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity. Design of study Systematic review of reviews and guidelines, then focus groups. Setting Four general practices in North East Wales. Method Evidence-based messages were developed from a systematic review, synthesised into patient-centred messages, and then incorporated into a narrative. A draft booklet was examined by three focus groups to improve the phrasing of its messages and discuss its usefulness. The final draft was examined in a fourth focus group. Results Six evidence-based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, while moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues. Conclusion The booklet was readable, credible, and useful to end-users. A randomised controlled trial is planned, to test whether the booklet influences beliefs about osteoarthritis and exercise. PMID:20132695

  2. Phase 1, placebo-controlled, dose escalation trial of chicory root extract in patients with osteoarthritis of the hip or knee

    PubMed Central

    2010-01-01

    Background Extracts of chicory root have anti-inflammatory properties in vitro and in animal models of arthritis. The primary objective of this investigator-initiated, Phase 1, placebo-controlled, double blind, dose-escalating trial was to determine the safety and tolerability of a proprietary bioactive extract of chicory root in patients with osteoarthritis (OA). Secondary objectives were to assess effects on the signs and symptoms of this disorder. Methods Individuals greater than 50 years of age with OA of the hip or knee were eligible for trial entry. A total of 40 patients were enrolled in 3 cohorts and were treated with escalating chicory doses of 600 mg/day, 1200 mg/day and 1800 mg/day for 1 month. The ratio of active treatment to placebo was 5:3 in cohorts 1 and 2 (8 patients) each and 16:8 in cohort 3 (24 patients). Safety evaluations included measurement of vital signs and routine lab tests at baseline and the end of the treatment period. Efficacy evaluations at baseline and final visits included self-assessment questionnaires and measurement of the 25-foot walking time. Results In the highest dose cohort, 18 patients who completed treatment per protocol were analyzed for efficacy. In this group, 13 patients showed at least 20% improvement in the defined response domains of pain, stiffness and global assessment: 9 of 10 (90%) patients randomized to active treatment with chicory and 4 of 8 (50%) patients randomized to placebo (P = 0.06). In general, the treatment was well-tolerated. Only one patient who was treated with the highest dose of chicory had to discontinue treatment due to an adverse event. Conclusions The results of this pilot study suggest that a proprietary bioactive extract of chicory root has a potential role in the management of OA and merits further investigation. Clinicaltrials.gov identifier: NCT 01010919. PMID:20618964

  3. Pharmacologic treatment of hand-, knee- and hip-osteoarthritis.

    PubMed

    Bobacz, Klaus

    2013-05-01

    Osteoarthritis (OA) is a joint disease of high prevalence and affects > 90 % of the population, depending on several risk factors. Symptomatic OA is less frequent, but requires an individually tailored therapeutic regimen consisting of non-pharmacological and pharmacological treatment modalities. Pharmacologic therapy, however, is mainly limited to analgetic and anti-inflammatory agents; structure modifying remedies do not exist. The therapeutic approach to hand-, knee- and hip-OA is basically similar and differs only at some minor points. Generally, topical agents or paracetamol are recommended as first-line agents. If unsuccessful oral non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2-selctive inhibitors should be introduced. Tramadol is an option in the case patients will not respond satisfactorily to NSAIDs. Glucosamine and chondroitine sulphate are no longer recommended in knee and hip OA, but chondroitine might be efficient in treating hand OA. Oral NSAIDs should be prescribed with caution due to potential side effects. Opioids are not recommended as their benefits are outweighed by an increased risk for serious adverse events. PMID:23715933

  4. Investigation of association between hip morphology and prevalence of osteoarthritis

    PubMed Central

    Zeng, Wei-Nan; Wang, Fu-You; Chen, Cheng; Zhang, Ying; Gong, Xiao-Yuan; Zhou, Kai; Chen, Zhi; Wang, Duan; Zhou, Zong-Ke; Yang, Liu

    2016-01-01

    The cause of hip osteoarthritis (OA) remains unclear, morphologic abnormality of hip was thought to be a contributing factor to hip OA. The hypothesis was that there were subtle anatomical morphology differences of the hip between normal and OA subjects; the objective of this study was to explore these anatomical differences which are predisposing to hip OA based on CT 3D reconstruction. Ninety-three normal subjects (186 hips) and 66 mild-to-moderate hip OA subjects (132 hips) were recruited in this study. Three parameters of the head-neck relationship were assessed: translation, rotation and concavity. Translation was the potential translational movements of femoral head related to the neck’s axis. Rotation was described by the physeal scar to evaluate the rotation tendency of femoral head related to the neck at the head-neck junction. Concavity was used to assess the sphericity of the head as it joins the neck. The femoral neck anteversion angle and some parameters of the acetabulum: anteversion, inclination and CE angle were measured too. By comparison, it was found that OA subjects had less femoral head sphericity, head-neck junction concavity, acetabular and femoral neck anteversion angle; but greater acetabular coverage. These characteristics increased the risk of hip OA in OA subjects. PMID:27002423

  5. [Osteoarthritis].

    PubMed

    Yamamoto, Seizo

    2014-10-01

    Osteoarthritis (OA) is the most common cause of arthritis, and is associated with significant pain and disability. Epidemiological study showed a large number of the eldery in Japan suffered OA, especially OA of the knee. Rapid diagnosis and conservative treatments those includes patient education, weight loss, exercise, physical and occupational therapy are effective at early stage. Pharmacologic treatment are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) including cyclooxygenase-2 (COX-2) selective agents. Surgery of the joint arthroplasty significantly reduces knee and hip pain, and restores the functions of the patient at the end stage. PMID:25509795

  6. Relationship between pelvic incidence and osteoarthritis of the hip

    PubMed Central

    Weinberg, D. S.; Bohl, M. S.; Liu, R. W.

    2016-01-01

    Objectives Sagittal alignment of the lumbosacral spine, and specifically pelvic incidence (PI), has been implicated in the development of spine pathology, but generally ignored with regards to diseases of the hip. We aimed to determine if increased PI is correlated with higher rates of hip osteoarthritis (HOA). The effect of PI on the development of knee osteoarthritis (KOA) was used as a negative control. Methods We studied 400 well-preserved cadaveric skeletons ranging from 50 to 79 years of age at death. Each specimen’s OA of the hip and knee were graded using a previously described method. PI was measured from standardised lateral photographs of reconstructed pelvises. Multiple regression analysis was performed to determine the relationship between age and PI with HOA and KOA. Results The mean age was 60.2 years (standard deviation (sd) 8.1), and the mean PI was 46.7° (sd 10.7°). Multiple regression analysis demonstrated a significant correlation between increased PI and HOA (standardised beta = 0.103, p = 0.017). There was no correlation between PI and KOA (standardised beta = 0.003, p = 0.912). Conclusion Higher PI in the younger individual may contribute to the development of HOA in later life. Cite this article: Dr J. J. Gebhart. Relationship between pelvic incidence and osteoarthritis of the hip. Bone Joint Res 2016;5:66–72. DOI: 10.1302/2046-3758.52.2000552. PMID:26912384

  7. Effects of osteoarthritis on radiographic measures of laxity and congruence in hip joints of Labrador Retrievers.

    PubMed

    Gold, Randi M; Gregor, Thomas P; Huck, Jennifer L; McKelvie, Pamela J; Smith, Gail K

    2009-06-15

    OBJECTIVE- To determine effects of hip joint osteoarthritis on radiographic measures of hip joint laxity and congruence. DESIGN- Longitudinal study. ANIMALS- 40 Labrador Retrievers. PROCEDURES- Dogs were assigned to 2 groups based on radiographic evidence of osteoarthritis. Dogs in the osteoarthritis group were free of osteoarthritis at initial radiographic evaluation (t(1)) and developed osteoarthritis by a subsequent radiographic evaluation (t(2)). Dogs in the nonosteoarthritis group had no radiographic osteoarthritis at either evaluation. Hip joint laxity was quantified by use of the distraction index (DI) from a distraction radiographic view and use of the Norberg angle (NA) from a ventrodorsal hip-extended radiographic view. The compression index (CI) from a compression radiographic view was used as a measure of joint congruence (concentricity). RESULTS- Hip joint laxity (NA or DI) did not change over time in the nonosteoarthritis group. Mean hip joint laxity (NA and DI) for the osteoarthritis group was greater at t(1) than for the nonosteoarthritis group. With the onset of osteoarthritis, mean NA decreased significantly and mean CI increased significantly, but mean DI remained unchanged. CONCLUSIONS AND CLINICAL RELEVANCE- No radiographic evidence for compensatory hip joint tightening associated with osteoarthritis was detected. Hip-extended radiography revealed that hip joints got looser with osteoarthritis and NA decreased. Hip joint laxity (DI) on distraction radiographs was unchanged by the onset of osteoarthritis and remained constant in the osteoarthritis and nonosteoarthritis groups at both evaluations. However, the CI increased with osteoarthritis, as reflected in nonzero indices (incongruence). The CI may be a valid marker for early hip joint osteoarthritis. PMID:19527128

  8. Effects of Nordic walking on pelvis motion and muscle activities around the hip joints of adults with hip osteoarthritis

    PubMed Central

    Homma, Daisuke; Jigami, Hirofumi; Sato, Naritoshi

    2016-01-01

    [Purpose] Increased compensatory pelvic movement is remarkable in limping patients with hip osteoarthritis (OA). However, a method of improving limping has not been established. The purpose of this study was to identify the effects of two types of Nordic walking by analyzing the pelvic movement and muscle activities of adults with hip OA. [Subjects and Methods] Ten patients with OA of the hip performed Japanese-style Nordic walking (JS NW), European-style Nordic walking (ES NW), and Ordinary walking (OW), and the muscle activities around the hip joint and pelvic movements were analyzed. [Results] The pelvic rotation angle was significantly larger in ES NW than in JS NW. In the stance phase, hip abductor muscle activity was significantly decreased in JS NW compared to both OW and ES NW. In the swing phase, rectus abdominis muscle activity was significantly increased in both JS NW and ES NW compared to OW and lumbar erector spinae activity was significantly lower in JS NW than in OW. [Conclusion] JS NW style may reduce the compensatory pelvic rotation in patients with hip OA. JS NW might be better for joint protection and prevention of secondary disorders of the hip in OA patients. PMID:27190455

  9. A computer-based image analysis method for assessing the severity of hip joint osteoarthritis

    NASA Astrophysics Data System (ADS)

    Boniatis, Ioannis; Costaridou, Lena; Cavouras, Dionisis; Panagiotopoulos, Elias; Panayiotakis, George

    2006-12-01

    A computer-based image analysis method was developed for assessing the severity of hip osteoarthritis (OA). Eighteen pelvic radiographs of patients with verified unilateral hip OA, were digitized and enhanced employing custom developed software. Two ROIs corresponding to osteoarthritic and contralateral-physiological radiographic Hip Joint Spaces (HJSs) were determined on each radiograph. Textural features were extracted from the HJS-ROIs utilizing the run-length matrices and Laws textural measures. A k-Nearest Neighbour based hierarchical tree structure was designed for classifying hips into three OA severity categories labeled as "Normal", "Mild/Moderate", and "Severe". Employing the run-length features, the overall classification accuracy of the hierarchical tree structure was 86.1%. The utilization of Laws' textural measures improved the system classification performance, providing an overall classification accuracy of 94.4%. The proposed method maybe of value to physicians in assessing the severity of hip OA.

  10. "Feeling better" or "feeling well" in usual care of hip and knee osteoarthritis pain: determination of cutoff points for patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) at rest and on movement in a national multicenter cohort study of 2414 patients with painful osteoarthritis.

    PubMed

    Perrot, Serge; Bertin, Philippe

    2013-02-01

    Patient-reported outcome measures are being developed for more relevant assessments of pain management. The patient acceptable symptom state (PASS) ("feeling well") and the minimal clinically important improvement (MCII) ("feeling better") have been determined in clinical trials, but not in daily pain management. We carried out a national multicenter cohort study of patients over the age of 50years with painful knee osteoarthritis (KOA) or hip osteoarthritis (HOA) who had visited their general practitioner and required treatment for more than 7days. Overall, 2414 patients (50.2% men, mean age 67.3years, body mass index 27.9kg/m(2), 33.5% with HOA) were enrolled by 1116 general practitioners. After 7days of treatment, PASS was estimated on a numerical rating scale as 4 at rest and 5 on movement, for both HOA and KOA, above the PASS threshold in clinical trials. In KOA, PASS was more frequently reached in men and younger people with less pain at rest and on movement, and in patients specifically seeking an improvement during sport activities. In HOA, PASS was most frequently reached in patients with low levels of pain at risk and in nonobese patients. MCII was -1 numerical rating scale point after 7days of usual treatment. This improvement is smaller than that recorded in randomized controlled trials, and was the same for both sites, both at rest and on movement. In conclusion, patient-reported outcome values in daily practice differ from those in clinical trials, and their determinant factors may depend on the site of osteoarthritis. Assessments of the treatment of painful osteoarthritis should be adapted to the characteristics and daily life of the patient, to personalize patient management. PMID:23265687

  11. Evaluation of the patient with hip pain.

    PubMed

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. PMID:24444505

  12. OARSI Clinical Trials Recommendations for Hip Imaging in Osteoarthritis

    PubMed Central

    Gold, Garry E.; Cicuttini, Flavia; Crema, Michel D.; Eckstein, Felix; Guermazi, Ali; Kijowski, Richard; Link, Thomas M.; Maheu, Emmanuel; Martel-Pelletier, Johanne; Miller, Colin G.; Pelletier, Jean-Pierre; Peterfy, Charles G.; Potter, Hollis G.; Roemer, Frank W.; Hunter, David. J

    2015-01-01

    Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/ techniques (including guidance on positioning for radiography, sequence/protocol recommendations/ hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/ control procedures; measurement methods; measurement performance (reliability, responsiveness, and validity); recommendations for trials; and research recommendations. PMID:25952344

  13. Osteoarthritis

    MedlinePlus

    ... causes pain, swelling, and reduced motion in your joints. It can occur in any joint, but usually it affects your hands, knees, hips ... spine. Osteoarthritis breaks down the cartilage in your joints. Cartilage is the slippery tissue that covers the ...

  14. Uncemented total hip arthroplasty in osteoarthritis of hip secondary to low and high dislocated hips: A mid-term follow-up study

    PubMed Central

    Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric

    2016-01-01

    Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2™ at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. PMID:27433063

  15. Grading and quantification of hip osteoarthritis severity by analyzing the spectral energy distribution of radiographic hip joint space

    NASA Astrophysics Data System (ADS)

    Boniatis, I.; Costaridou, L.; Panagiotopoulos, E.; Panayiotakis, G.

    2009-08-01

    An image analysis system is proposed for the assessment of hip osteoarthritis (OA) severity. Sixty four hips (18 normal, 46 osteoarthritic), corresponding to 32 patients of unilateral or bilateral hip OA were studied. Employing custom developed software, 64 Region Of Interest (ROI) images of Hip Joint Spaces (HJSs) were delineated on patients' digitized radiographs. The Fourier spectrum of each HJS-ROI was computed and expressed in polar coordinates. Spectral signatures, quantifying the radial and angular distribution of HJS spectral energy were formed. Signature descriptors were generated and utilized in the design of a two-level hierarchical decision tree, used for the grading of the severity of the disease. Accordingly, at Level 1, implemented by a multiple classifier system, the discrimination between normal and osteoarthritic hips was performed. At Level 2, the hips that had been successfully characterized as osteoarthritic at Level 1, were further characterized as of ``Mild / Moderate'' or ``Severe'' OA, by the Bayes classifier. A signature descriptors based regression model was designed, so as to quantify OA-severity. The system graded OA reliably, given that the accomplished classification accuracies for Level 1 and Level 2 were 98.4% and 100%, respectively. OA-severity values, expressed by HJS-narrowing, correlated highly (r = 0.9, p < 0.001) with values predicted by the model. The system may contribute to OA-patient management.

  16. A morphological descriptors-based pattern recognition system for the characterization of hip osteoarthritis severity from X-ray images

    NASA Astrophysics Data System (ADS)

    Boniatis, I.; Costaridou, L.; Cavouras, D.; Panagiotopoulos, E.; Panayiotakis, G.

    2007-10-01

    A pattern recognition system is proposed for the characterization of hip osteoarthritis (OA) severity. Sixty-four (64) hips, corresponding to 32 unilateral and bilateral OA patients were studied. Employing the Kellgren and Lawrence scale, hips were grouped into three OA severity categories: "Normal", "Mild/Moderate", and "Severe". Utilizing custom-developed software, 64 ROIs, corresponding to patients' radiographic Hip Joint Spaces (HJSs), were determined on digitized radiographs. A Probabilistic Neural Network classifier was designed employing morphological descriptors of the HJS-ROIs. The classifier discriminated successfully between (i) normal and OA hips (92.2% accuracy) and (ii) hips of "Mild/Moderate" OA and of "Severe" OA (91.3% accuracy). The proposed system could contribute in assessing hip OA severity.

  17. Unilateral hip osteoarthritis: Its effects on preoperative lower limb muscle activation and intramuscular coordination patterns.

    PubMed

    Schmidt, André; Stief, Felix; Lenarz, Katharina; Froemel, Dara; Lutz, Frederick; Barker, John; Meurer, Andrea

    2016-03-01

    The objective of this study was to test if patients with unilateral hip osteoarthritis (OA) show greater muscle activity asymmetry between their affected and non-affected limbs than healthy controls between their left and right limbs. Seventeen patients with unilateral hip OA (7 females, 10 males) and 17 age-matched healthy controls (7 females, 10 males) participated in this study. Both groups performed instrumented gait analysis at comparable speeds. Muscle activity was recorded simultaneously for the tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL), semitendinosus (ST), tensor fasciae latae (TFL), and gluteus medius (GLM) muscles. In hip OA patients, EMG data showed greater activity of the TA muscle in the non-affected limb, and greater TFL muscle activity in the affected limb. Compared to healthy controls, greater asymmetries between paired limbs were observed for the TA and GM muscles. Finally, the TFL muscle of the affected limb contributed more to the total limb muscle activity than did the non-affected limb. The observed alterations in TA and GM muscle activity in hip OA patients may be due to the greater peak braking and peak vertical forces measured in the non-affected limb. Contrary to this, greater TLF muscle activity of the affected limb indicates the demands put on stabilizing the hip during stance phase. Further studies are necessary to test whether leg length discrepancy affects muscle activation alterations between the affected and non-affected limb in unilateral hip OA patients. PMID:26979904

  18. Differential Genetic Regulation of Canine Hip Dysplasia and Osteoarthritis

    PubMed Central

    Zhang, Zhiwu; Zhao, Keyan; Zhu, Lan; Guo, Gang; Friedenberg, Steve G.; Hunter, Linda S.; Vandenberg-Foels, Wendy S.; Hornbuckle, William E.; Krotscheck, Ursula; Corey, Elizabeth; Moise, Nancy S.; Dykes, Nathan L.; Li, Junya; Xu, Shangzhong; Du, Lixin; Wang, Yachun; Sandler, Jody; Acland, Gregory M.; Lust, George; Todhunter, Rory J.

    2010-01-01

    Background Canine hip dysplasia (HD) is a common polygenic trait characterized by hip malformation that results in osteoarthritis (OA). The condition in dogs is very similar to developmental dysplasia of the human hip which also leads to OA. Methodology/Principal Findings A total of 721 dogs, including both an association and linkage population, were genotyped. The association population included 8 pure breeds (Labrador retriever, Greyhounds, German Shepherd, Newfoundland, Golden retriever, Rottweiler, Border Collie and Bernese Mountain Dog). The linkage population included Labrador retrievers, Greyhounds, and their crosses. Of these, 366 dogs were genotyped at ∼22,000 single nucleotide polymorphism (SNP) loci and a targeted screen across 8 chromosomes with ∼3,300 SNPs was performed on 551 dogs (196 dogs were common to both sets). A mixed linear model approach was used to perform an association study on this combined association and linkage population. The study identified 4 susceptibility SNPs associated with HD and 2 SNPs associated with hip OA. Conclusion/Significance The identified SNPs included those near known genes (PTPRD, PARD3B, and COL15A1) reported to be associated with, or expressed in, OA in humans. This suggested that the canine model could provide a unique opportunity to identify genes underlying natural HD and hip OA, which are common and debilitating conditions in both dogs and humans. PMID:20949002

  19. Pain Management in the Elderly: Transdermal Fentanyl for the Treatment of Pain Caused by Osteoarthritis of the Knee and Hip

    PubMed Central

    2014-01-01

    This study was designed to evaluate the utility of transdermal fentanyl (transdermal fentanyl, TDF) for the treatment of pain due to osteoarthritis (osteoarthritis, OA) of the knee and hip, which was not adequately controlled by nonopioid analgesics or weak opioids. WOMAC is a reliable, valid, and responsive multidimensional, self-administrated outcome measure designed specifically to evaluate patients with OA of the knee or hip. TDF significantly increased pain control and improved functioning and quality of life. Metoclopramide appeared to be of limited value in preventing nausea and vomiting. PMID:24527441

  20. Characterization of the Cartilage DNA Methylome in Knee and Hip Osteoarthritis

    PubMed Central

    Rushton, Michael D; Reynard, Louise N; Barter, Matt J; Refaie, Ramsay; Rankin, Kenneth S; Young, David A; Loughlin, John

    2014-01-01

    Objective The aim of this study was to characterize the genome-wide DNA methylation profile of chondrocytes from knee and hip cartilage obtained from patients with osteoarthritis (OA) and hip cartilage obtained from patients with femoral neck fracture, providing the first comparison of DNA methylation between OA and non-OA hip cartilage, and between OA hip and OA knee cartilage. Methods The study was performed using the Illumina Infinium HumanMethylation450 BeadChip array, which allows the annotation of ∼480,000 CpG sites. Genome-wide methylation was assessed in chondrocyte DNA extracted from 23 hip OA patients, 73 knee OA patients, and 21 healthy hip control patients with femoral neck fracture. Results Analysis revealed that chondrocytes from the hip cartilage of OA patients and healthy controls have unique methylation profiles, with 5,322 differentially methylated loci (DMLs) identified between the 2 groups. In addition, a comparison between hip and knee OA chondrocytes revealed 5,547 DMLs between the 2 groups, including DMLs in several genes known to be involved in the pathogenesis of OA. Hip OA samples were found to cluster into 2 groups. A total of 15,239 DMLs were identified between the 2 clusters, with an enrichment of genes involved in inflammation and immunity. Similarly, we confirmed a previous report of knee OA samples that also clustered into 2 groups. Conclusion We demonstrated that global DNA methylation using a high-density array can be a powerful tool in the characterization of OA at the molecular level. Identification of pathways enriched in DMLs between OA and OA-free cartilage highlight potential etiologic mechanisms that are involved in the initiation and/or progression of the disease and that could be therapeutically targeted. PMID:24838673

  1. Association of hip and pelvic geometrywith tibiofemoral osteoarthritis: Multicenter Osteoarthritis Study (MOST)

    PubMed Central

    Boissonneault, A; Lynch, JA; Wise, BL; Segal, NA; Gross, KD; Murray, DW; Nevitt, MC; Pandit, HG

    2014-01-01

    Objective Lateral tibiofemoral osteoarthritis (OA) is overall less common than medial tibiofemoral OA, but it is more prevalent in women. This may be explained by sex differences in hip and pelvic geometry. The aim of this study is to explore sex differences in hip and pelvic geometry and determine if such parameters are associated with the presence of compartment-specific knee OA. Methods This case-control study reports on 1,328 hips/knees from 664 participants and is an ancillary to the Multicenter Osteoarthritis Study (MOST). Of the 1,328 knees, 219 had lateral OA, 260 medial OA, and 849 no OA. Hip and pelvic measurements were taken from full-limb radiographs on the ipsilateral side of the knee of interest. After adjusting for covariates, means were compared between sexes and also between knees with medial and lateral OA versus no OA using separate regression models. Results Women were shown to have a reduced femoral offset (mean 40.9 mm vs. 45.9 mm; p=0.001) and more valgus neck-shaft angle (mean 128.4° vs. 125.9°; p<0.001) compared to men. Compared to those with no OA, knees with lateral OA were associated with a reduced femoral offset (p=0.012), increased height of hip centre (p=0.003), more valgus neck-shaft angle (p=0.042), and increased abductor angle (p=0.031). Knees with medial OA were associated with a more varus neck-shaft angle (p=0.043) and a decreased abductor angle (p=0.003). Conclusion These data suggest anatomical variations at the hip and pelvis are associated with compartment-specific knee OA and may help to explain sex differences in patterns of knee OA. PMID:24971867

  2. Prevalence of hip symptoms and radiographic and symptomatic hip osteoarthritis in African-Americans and Caucasians: The Johnston County Osteoarthritis Project

    PubMed Central

    Jordan, Joanne M.; Helmick, Charles G.; Renner, Jordan B.; Luta, Gheorghe; Dragomir, Anca D.; Woodard, Janice; Fang, Fang; Schwartz, Todd A.; Nelson, Amanda E.; Abbate, Lauren M.; Callahan, Leigh F.; Kalsbeek, William D.; Hochberg, Marc C.

    2010-01-01

    Objective To report contemporary estimates of the prevalence of hip-related osteoarthritis (OA) outcomes in African-Americans and Caucasians aged ≥ 45 years. Methods Weighted prevalence estimates and their corresponding 95% confidence intervals for hip symptoms, radiographic hip OA, symptomatic hip OA, and severe radiographic hip OA were calculated using SUDAAN® for age, race, and sex subgroups among 3,068 participants (33% African-Americans, 38% men) in the baseline examination (1991–1997) of The Johnston County Osteoarthritis Project, a population-based study of OA in North Carolina. Radiographic hip OA was defined as Kellgren-Lawrence radiographic grade ≥ 2, moderate/severe radiographic hip OA as grades 3 and 4, and symptomatic hip OA as hip symptoms in a hip with radiographic OA. Results Hip symptoms were present in 36%; 28% had radiographic hip OA; nearly 10% had symptomatic hip OA; and 2.5% had moderate/severe radiographic hip OA. Prevalence of all 4 outcomes was higher in older individuals; most outcomes were higher for women and African-Americans. Conclusion These hip-related outcomes were common in this population, and African-Americans did not have a lower prevalence as previous studies have suggested. Increasing public and health system awareness of the relatively high prevalence of these outcomes, which can be disabling, may help to decrease their impact and ultimately prevent them. PMID:19286855

  3. A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

    PubMed Central

    Takasago, Tomoya; Goto, Tomohiro; Tsutsui, Takahiko; Kondo, Kenji; Hamada, Daisuke; Tonogai, Ichiro; Wada, Keizo; Sairyo, Koichi

    2015-01-01

    A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA), secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient's hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients. PMID:26504606

  4. [Treatment of patients with osteoarthritis].

    PubMed

    Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

    2014-01-01

    The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. PMID:24467960

  5. Generalized Vibratory Deficits in Osteoarthritis of the Hip

    PubMed Central

    SHAKOOR, NAJIA; LEE, KRISTEN J.; FOGG, LOUIS F.; BLOCK, JOEL A.

    2013-01-01

    Objective Lower extremity sensory deficits, including reduced proprioception, joint kinesthesia, and, recently, vibratory sense, have been described in subjects with osteoarthritis (OA) of the knee. However, comparable deficits in OA of the hip have not previously been evaluated. Vibratory perception threshold (VPT) is a reliable measure used to assess sensory deficits and is amenable to testing multiple body sites. This study examined VPT at the upper and lower extremities of subjects with hip OA compared with subjects without hip OA. Methods Fourteen subjects with symptomatic and radiographic hip OA were compared with 13 age-matched controls without hip OA. VPT was assessed using a biothesiometer. Five sites in the lower extremity and 1 site in the upper extremity (radial head) were evaluated and compared between OA and control subjects. Results VPT was significantly reduced at all 6 testing sites of the OA subjects compared with controls (P < 0.05 for all sites). VPT scores (mean ± SEM volts) for OA subjects and controls were as follows: first metatarsophalangeal joint (13.5 ± 1.4 versus 7.4 ± 0.7), medial malleolus (18.1 ± 2.6 versus 11.2 ± 1.7), lateral malleolus (20.9 ± 2.4 versus 10.6 ± 1.5), medial femoral condyle (22.8 ± 2.9 versus 12.6 ± 1.3), lateral femoral condyle (26.7 ± 2.6 versus 16.2 ± 1.9), and radial head (10.2 ± 0.8 versus 7.5 ± 0.6). Conclusion To our knowledge, this is the first study to evaluate sensory deficits in hip OA and to demonstrate that there is vibratory sense loss at both the upper and lower extremities in these subjects compared with controls. The noted generalized deficits may have significant implications in the neuromechanical pathophysiology of OA. PMID:18759259

  6. Pain threshold correlates with functional scores in osteoarthritis patients

    PubMed Central

    Kuni, Benita; Wang, Haili; Rickert, Markus; Ewerbeck, Volker; Schiltenwolf, Marcus

    2015-01-01

    Background and purpose Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement. Patients and methods We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined. Results Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0–10) vs. 7.8 (4–10) (p = 0.003) for the affected knee; 4.5 (2–10) vs. 6.8 (4–10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA. Interpretation Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization. PMID:25323797

  7. Prevalence of osteoporosis in patients awaiting total hip arthroplasty

    PubMed Central

    Domingues, Vitor Rodrigues; de Campos, Gustavo Constantino; Plapler, Pérola Grimberg; de Rezende, Márcia Uchôa

    2015-01-01

    Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study. PMID:26327793

  8. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia.

    PubMed

    Argenson, J-N; Ryembault, E; Flecher, X; Brassart, N; Parratte, S; Aubaniac, J-M

    2005-09-01

    Using radiography and computer tomography (CT) we studied the morphology of 83 hips in 69 Caucasian adults with osteoarthritis secondary to developmental dysplasia of the hip (DDH). A previously published series of 310 hips with primary osteoarthritis was used as a control group. According to the Crowe classification, 33 of the dysplastic hips were graded as class I, 27 as class II and 23 as class III or class IV. The intramedullary femoral canal had reduced mediolateral and anteroposterior dimensions in all groups compared with the control group. Only in Crowe class II hips was the femoral neck-shaft angle increased. The proximal femur had more anteversion in all the developmental dysplasia of the hip groups, ranging from 2 degrees to 80 degrees. Templated measurement of acetabular dimensions for plain radiography closely matched measurements taken by CT. The results of our study confirm the observations previously confined to the Japanese population. PMID:16129740

  9. Osteoarthritis

    MedlinePlus

    ... Read More Ankle replacement Arthritis Chronic Elbow replacement Hip joint replacement Knee joint replacement Knee microfracture surgery Overweight Shoulder arthroscopy Shoulder replacement Spinal fusion Systemic Patient ... replacement - discharge Elbow replacement - discharge Hip or knee replacement - after - what to ask your ...

  10. Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis.

    PubMed

    Deasy, Margaret; Leahy, Edmund; Semciw, Adam Ivan

    2016-08-01

    Study Design Systematic review with meta-analysis. Background A complete understanding of impairments associated with knee osteoarthritis would optimize exercise interventions for people with knee osteoarthritis. Our current understanding of hip strength deficits in this population is based on studies with conflicting findings and small samples. There is a need to systematically review and pool current evidence. Objectives To determine whether hip strength deficits exist in people with symptomatic knee osteoarthritis. Methods Electronic databases (MEDLINE, CINAHL, Embase, the Cochrane Library, and PsycINFO) were searched through February 2016. Studies comparing hip strength in people diagnosed with symptomatic knee osteoarthritis to healthy control participants were included in the review. A meta-analysis with random effects was applied to relevant data from included studies and a modified Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the quality of evidence for each pooled analysis. Results Five studies were included in the review. Meta-analysis revealed moderate-quality evidence of weaker isometric and isokinetic hip abduction strength in people with knee osteoarthritis (moderate difference: 7% to 24% weaker) and very low-quality evidence of no difference in isometric hip adduction strength. There was very low- to moderate-quality evidence of weaker isokinetic hip strength in the remaining planes of motion (moderate to large differences: 14% to 55% weaker). Conclusion Significant hip strength deficits exist in people with knee osteoarthritis. Hip strength assessment should be considered in clinical practice and may assist with directing targeted management strategies. Level of Evidence Symptom prevalence, level 1a-. J Orthop Sports PhysTher 2016;46(8):629-639. Epub3 Jul 2016. doi:10.2519/jospt.2016.6618. PMID:27374011

  11. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

    PubMed Central

    2010-01-01

    Background There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders. Methods Separate focus groups and interviews were conducted with patients (THA or TKA within past year) and three health professional groups: allied health professionals (AHPs), orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes. Results Eleven focus groups and eight interviews took place in six sites. Patients (n = 32) varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44) represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1) Let's talk (issues related to patient-health professional and inter-professional communication); 2) Expecting the unexpected (observations about unanticipated recovery experiences); 3) It's attitude that counts (the importance of the patient's positive attitude and participation in recovery); 4) It takes all kinds of support (along the continuum of care); 5) Barriers to recovery (at patient, provider and system levels), and 6) Back to normal (reflecting diversity of expected outcomes). Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA. Conclusion Results will inform subsequent phases of guideline development and ensure stakeholders

  12. Osteoarthritis of the hip or knee: which coexisting disorders are disabling?

    PubMed

    Reeuwijk, Kerstin G; de Rooij, Mariëtte; van Dijk, Gabriella M; Veenhof, Cindy; Steultjens, Martijn P; Dekker, Joost

    2010-07-01

    Exercise therapy is generally recommended in osteoarthritis (OA) of the hip or knee. However, coexisting disorders may bring additional impairments, which may necessitate adaptations to exercise for OA of the hip or knee. For the purpose of developing an adapted protocol for exercise therapy in OA patients with coexisting disorders, information is needed on which specific coexisting disorders in OA are associated with activity limitations and pain. To describe the relationship between specific coexisting disorders, activity limitations, and pain in patients with OA of the hip or knee, a cross-sectional cohort study among 288 older adults (50-85 years of age) with OA of hip or knee was conducted. Subjects were recruited from three rehabilitation centers and two hospitals. Demographic data, clinical data, information about coexisting disorders (i.e., comorbidity and other disorders), activity limitations (WOMAC: physical functioning domain), and pain (visual analogue scale (VAS)) were collected by questionnaire. Statistical analysis included descriptive statistics and multivariate regression analysis. Coexisting disorders associated with activity limitations were chronic back pain or hernia, arthritis of the hand or feet, and other chronic rheumatic diseases (all musculoskeletal disorders); diabetes and chronic cystitis (non-musculoskeletal disorders); hearing impairments in a face-to-face conversation, vision impairments in long distances, and dizziness in combination with falling (all sensory impairments); and overweight and obesity. Coexistent disorders associated with pain were arthritis of the hand or feet, other chronic rheumatic diseases (musculoskeletal disorders), and diabetes (non-musculoskeletal disorder). Specific disorders coexisting next to OA and associated with additional activity limitations and pain were identified. These coexisting disorders need to be addressed in exercise therapy and rehabilitation for patients with OA of the hip or knee. PMID

  13. Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult indian patients with osteoarthritis of the hip or knee: A 4-week, double-blind, randomized, comparative, multicenter study

    PubMed Central

    Goregaonkar, Arvind; Mathiazhagan, K.J.; Shah, Ravindra R.; Kapoor, Paramjeet Singh; Taneja, Praveen; Sharma, Akhilesh; Bolmall, Chandrashekhar; Baliga, Vidyagauri P.

    2009-01-01

    Background: Reports of cardiovascular adverse events (AEs) associated with the use of cyclooxygenase-2 inhibitors for the treatment of osteoarthritis (OA) have prompted the quest for a better-tolerated NSAID. Objective: The aim of this study was to compare the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with OA of the hip or knee. Methods: This 4-week, double-blind, randomized, comparative, multicenter study was undertaken to compare oral lornoxicam and diclofenac in patients with OA. Patients who met the selection criteria were enrolled consecutively from the outpatient clinics of each of the participating hospitals in India. Participants completed the Western Ontario and McMasters Individual Osteoarthritis Index (WOMAC-OA), WOMAC Composite Index (WOMAC-CI) (for pain, stiffness, and physical function), and a 10-cm visual analog scale (VAS) (0–10 where 0 = no pain and 10 = worst possible pain or severe or excruciating pain) at each study visit (weeks 0 [baseline], 2, and 4 [or at early termination]). Patients' and physicians' global assessments of arthritis control were measured at each study visit when laboratory and clinical AEs were also monitored. The primary end points were the WOMAC-OA, the WOMAC-CI, and VAS scores for pain among the patients who completed the study. Results: Of the 273 patients (159 men, 114 women; mean [SD] age, 44.73 [10.72] years; range, 28–68 years) enrolled in the study, 13 (7 in the lornoxicam group and 6 in the diclofenac group) were lost to follow-up and their effectiveness and tolerability results were not included in the study analysis. Over the 4-week study period, both drugs provided significant (P < 0.05) sustained relief of OA symptoms compared with baseline. Compared with baseline, the mean pain score (WOMAC-CI) decreased 90.6% (13.88 [4.47] vs 1.30 [1.49]; P < 0.05) in the lornoxicam group and 88.9% (14.15 [4.56] vs 1.57 [1.49]; P < 0.05) in the diclofenac group

  14. Muscle Impairments in Patients With Knee Osteoarthritis

    PubMed Central

    Alnahdi, Ali H.; Zeni, Joseph A.; Snyder-Mackler, Lynn

    2012-01-01

    Context: Muscle impairments associated with knee osteoarthritis (OA) are the primary underlying cause of functional limitations. Understanding the extent of muscle impairments, its relationship with physical function and disease progression, and the evidence behind exercise therapy that targets muscle impairments is crucial. Evidence Acquisition: An electronic search for relevant articles using MEDLINE and CINHAL databases up to September 2011 was performed. In addition to the electronic search, retrieved articles were searched manually for relevant studies. Results: Quadriceps, hamstrings, and hip muscles are significantly impaired in subjects with knee OA compared with age-matched controls. Muscle strength, especially quadriceps, is a major determinant of both performance-based and self-reported physical function. Whether stronger quadriceps is protective against knee OA onset and progression is not clear. Exercise therapy, including global and targeted resistance training, is effective in reducing pain and improving function in subjects with knee OA. Conclusions: Subjects with knee OA have significant muscle impairments. These muscle impairments affect physical function and should be targeted in therapy. Further research is needed to explore the relationship between quadriceps strength and knee OA initiation and progression and to determine the optimal exercise prescription that augments outcomes in this patient population. PMID:23016099

  15. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

    PubMed Central

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-01-01

    Background and purpose There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  16. The Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

    PubMed Central

    Royer, Nathaniel K.

    2012-01-01

    Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement (FAI) have been recently implicated as risk factors for hip osteoarthritis (OA). The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search using PubMed, Embase and Central was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and FAI and hip OA and preliminary evidence suggests that AD is a risk factor for OA, however these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA. PMID:22108232

  17. Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis

    NASA Astrophysics Data System (ADS)

    Karagülle, Mine; Kardeş, Sinan; Dişçi, Rian; Gürdal, Hatice; Karagülle, Müfit Zeki

    2016-01-01

    Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study

  18. Successful staged hip replacement in septic hip osteoarthritis in osteopetrosis: a case report

    PubMed Central

    2012-01-01

    Background Osteopetrosis is a rare, inherited, bone disorder, characterized by osteosclerosis, obliteration of the medullary cavity and calcified cartilage. The autosomal dominant form is compatible with a normal life span, although fractures often result from minimal trauma, due to the pathologic nature of bone. Osteomyelitis is common in patients with osteopetrosis because of a reduced resistance to infection, attributed to the lack of marrow vascularity and impairment of white cell function. Only one case of osteomyelitis of the proximal third of the femur has been previously reported, treated with several repeated debridements and finally with femoral head resection. Here we present for the first time a case of a staged implant of a cementless total hip prosthesis for the treatment of a septic hip in femoral neck nonunion in osteopetrosis. Case presentation A 36-years-old woman, affected by autosomal dominant osteopetrosis was referred to our department because of a septic hip arthritis associated with femoral neck septic non-union, with draining fistulas. The infection occurred early after a plate osteosynthesis for a closed perthrocanteric fracture of the femur and persisted in spite of osteosynthesis removal, surgical debridement and external fixation. In our hospital the patient underwent accurate debridement, femoral head and greater trochanter resection, preparation of the diaphyseal intramedullary canal and implant of an antibiotic-loaded cement spacer. The spacer was exchanged after one month, due to infection recurrence and four months later, a cementless total hip arthroplasty was implanted, with no clinical and laboratory signs of infection recurrence at two years follow-up. Conclusions In case of hip septic arthritis and proximal femur septic non-union, femoral head resection may not be the only option available and staged total hip arthroplasty can be considered. PMID:22472060

  19. Associations between Pressure-Pain Threshold, Symptoms, and Radiographic Knee and Hip Osteoarthritis: The Johnston County Osteoarthritis Project

    PubMed Central

    Goode, Adam P.; Shi, Xiaoyan A.; Gracely, Richard H.; Renner, Jordan B.; Jordan, Joanne M.

    2014-01-01

    Objective To determine the association between generalized evoked pressure pain sensitivity with distal pressure-pain threshold (PPT) and the presence, severity, or number of involved knee/hip joints with radiographic osteoarthritis (rOA) or related symptoms. Methods Data for these cross-sectional analyses come from the second follow-up (2008–11) of the Johnston County Osteoarthritis Project (n=1,602). Pressure-pain threshold measurements were averaged over two trials from both the left and right trapezius. Outcomes of radiographic knee and hip OA were both defined by a Kellgren-Lawrence score of 2–4 and site-specific symptoms were ascertained at clinical interview. Associations were determine with multiple logistic regression models, and two-way interactions were tested at p<0.05. Results The sample was 67.2% female and 31.0% African American. Participants’ mean age was 67.9 (SD 9.0); mean body mass index was 31.5 (SD 7.1); mean Center for Epidemiologic Studies Depression Scale score was 6.5 (SD 7.4); and mean total PPT was 3.6kg (SD 0.7). Significant associations were found between PPT and self-reported knee/hip symptoms. No significant associations were found between PPT and presence, severity, or number of joints with knee and hip rOA without accompanying symptoms. No significant interactions were found with demographic or clinical characteristics. Conclusion Pressure-pain threshold was significantly associated with self-reported single and multi-joint symptoms. In contrast, after adjustment, PPT measured at the trapezius was not associated with asymptomatic knee or hip rOA. As such, PPT may prove to be a useful indicator of rOA pain processing and of why individuals respond favorably and others do not to treatments targeting rOA. PMID:24643946

  20. Arthroscopic Treatment of Subchondral Bony Cyst in Early Osteoarthritis of the Hip Joint Using Allogeneic Bone Graft: A Report of Two Cases

    PubMed Central

    Lee, Gi-Soo; Kang, Chan; Lee, Jung-Bum; Noh, Chang-Kyun

    2015-01-01

    Subchondral bony cyst, large solitary or multiple cysts in acetabular dome usually exacerbate progression to degenerative osteoarthritis in the hip joint. But it can be treated through arthroscopic intervention. We report two cases that treated by arthroscopic curettage and bone graft for subchondral bony cysts in early osteoarthritis of the hip joint, and it may delay progression to moderate osteoarthritis.

  1. Pain Coping Strategies in Osteoarthritis Patients.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1987-01-01

    Investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic pain. Patients completed various questionnaires. Medical status variables were also used. The Pain Control and Rational Thinking factor derived from the Coping Strategies Questionnaire proved to…

  2. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime

    PubMed Central

    Murphy, Louise B; Helmick, Charles G.; Schwartz, Todd A; Renner, Jordan B; Tudor, Gail; Koch, Gary G; Dragomir, Anca D; Kalsbeek, William D; Luta, Gheorghe; Jordan, Joanne M

    2010-01-01

    Summary Objective To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). Design We analyzed data from the Johnston County Osteoarthritis Project (a longitudinal population-based study of OA in North Carolina, United States [n=3,068]). The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ≥2 (anterior-posterior pelvis x-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). Results Lifetime risk of symptomatic hip OA was 25.3% (95% confidence interval [CI] = 21.3–29.3). Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. Conclusion The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk. PMID:20713163

  3. [Avocado/soybean unsaponifiables in the treatment of knee and hip osteoarthritis].

    PubMed

    Angermann, Peter

    2005-08-15

    Avocado/soybean unsaponifiables (ASU) is an extract prepared from avocado and soybean oil. The product has been approved as a prescription drug in France for several years and has now been introduced in Denmark as a food supplement. ASU has been examined in vitro and in animal studies that have showed an anti-inflammatory effect and a stimulatory effect on proteoglycan synthesis in chondrocytes. Four randomized, double-blind, placebo-controlled clinical trials have been published. These studies indicate that ASU has an effect on the symptoms of knee and hip osteoarthritis but not on the structural changes caused by osteoarthritis. PMID:16109242

  4. The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis—A Cross-Sectional Study

    PubMed Central

    Rosenlund, Signe; Holsgaard-Larsen, Anders; Overgaard, Søren; Jensen, Carsten

    2016-01-01

    Background The Gait Deviation Index summarizes overall gait ‘quality’, based on kinematic data from a 3-dimensional gait analysis. However, it is unknown which clinical outcomes may affect the Gait Deviation Index in patients with primary hip osteoarthritis. The aim of this study was to investigate associations between Gait Deviation Index as a measure of gait ‘quality’ and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis. Method Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m2) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the ‘Physical Function Short-form of the Hip disability and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL). Results Mean Gait Deviation Index was positively associated with hip abduction strength (p<0.01, r = 0.40), hip flexion strength (p = 0.01, r = 0.37), HOOS-Physical Function (p<0.01, r = 0.41) HOOS-QOL (p<0.01, r = 0.41), and negatively associated with HOOS-Pain after walking (p<0.01, r = -0.45). Adjusting the analysis for walking speed did not affect the association. Conclusion Patients with the strongest hip abductor and hip flexor muscles had the best gait ‘quality’. Furthermore, patients with higher physical function, quality of life scores and lower pain levels demonstrated better gait ‘quality’. These findings indicate that interventions aimed at improving hip muscle strength and pain management may to a moderate degree improve the overall gait ‘quality’ in patients with primary hip OA. PMID:27065007

  5. An innovative care model coordinated by a physical therapist and nurse practitioner for osteoarthritis of the hip and knee in specialist care: a prospective study.

    PubMed

    Voorn, Veronique M A; Vermeulen, Henricus M; Nelissen, Rob G H H; Kloppenburg, Margreet; Huizinga, Tom W J; Leijerzapf, Nicolette A C; Kroon, Herman M; Vliet Vlieland, Thea P M; van der Linden, Henrica M J

    2013-07-01

    The subject of the study is to investigate whether health-related quality of life (HRQoL), pain and function of patients with hip or knee osteoarthritis (OA) improves after a specialist care intervention coordinated by a physical therapist and a nurse practitioner (NP) and to assess satisfaction with this care at 12 weeks. This observational study included all consecutive patients with hip or knee OA referred to an outpatient orthopaedics clinic. The intervention consisted of a single, standardized visit (assessment and individually tailored management advice, to be executed in primary care) and a telephone follow-up, coordinated by a physical therapist and a NP, in cooperation with an orthopaedic surgeon. Assessments at baseline and 10 weeks thereafter included the short form-36 (SF-36), EuroQol 5D (EQ-5D), hip or knee disability and osteoarthritis outcome score (HOOS or KOOS), the intermittent and constant osteoarthritis pain questionnaire (ICOAP) for hip or knee and a multidimensional satisfaction questionnaire (23 items; 4 point scale). Eighty-seven patients (57 female), mean age 68 years (SD 10.9) were included, with follow-up data available in 63 patients (72 %). Statistically significant improvements were seen regarding the SF-36 physical summary component score, the EQ-5D, the ICOAP scores for hip and knee, the HOOS subscale sports and the KOOS subscales pain, symptoms and activities of daily living. The proportions of patients reporting to be satisfied ranged from 79 to 98 % per item. In patients with hip and knee OA pain, function and HRQoL improved significantly after a single-visit multidisciplinary OA management intervention in specialist care, with high patient satisfaction. PMID:23325095

  6. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis.

    PubMed

    Gandhi, Rajiv; Zywiel, Michael G; Mahomed, Nizar N; Perruccio, Anthony V

    2015-01-01

    The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement. PMID:25861476

  7. Depression and the Overall Burden of Painful Joints: An Examination among Individuals Undergoing Hip and Knee Replacement for Osteoarthritis

    PubMed Central

    Gandhi, Rajiv; Zywiel, Michael G.; Mahomed, Nizar N.; Perruccio, Anthony V.

    2015-01-01

    The majority of patients with hip or knee osteoarthritis (OA) report one or more symptomatic joints apart from the one targeted for surgical care. Therefore, the purpose of the present study was to investigate the association between the burden of multiple symptomatic joints and self-reported depression in patients awaiting joint replacement for OA. Four hundred and seventy-five patients at a single centre were evaluated. Patients self-reported joints that were painful and/or symptomatic most days of the previous month on a homunculus, with nearly one-third of the sample reporting 6 or more painful joints. The prevalence of depression was 12.2% (58/475). When adjusted for age, sex, education level, hip or knee OA, body mass index, chronic condition count, and joint-specific WOMAC scores, each additional symptomatic joint was associated with a 19% increased odds (odds ratio: 1.19 (95% CI: 1.08, 1.31, P < 0.01)) of self-reported depression. Individuals reporting 6 or more painful joints had 2.5-fold or greater odds of depression when compared to those patients whose symptoms were limited to the surgical joint. A focus on the surgical joint alone is likely to miss a potentially important determinant of postsurgical patient-reported outcomes in patients undergoing hip or knee replacement. PMID:25861476

  8. Early MRI and intraoperative findings in rapidly destructive osteoarthritis of the hip: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Fukushima, Mana; Matsumoto, Tadami

    2015-01-01

    Introduction The pathophysiology of rapidly destructive hip osteoarthritis (OA) of the hip is still unclear. Also, there have been only few reports on the initial stage of the disease. We report a case of an initial-stage rapidly destructive hip OA, documented by magnetic resonance imaging and intraoperative findings. Presentation of case A 77-year-old woman reported left hip pain without any antecedent trauma. Initial radiographs showed no obvious abnormality. After 4 months of conservative therapy, radiographs showed progressive joint-space narrowing and T1-weighted magnetic resonance images revealed a bone-marrow edema pattern not only on the femoral head but also on the lateral side of the acetabulum. Then during total hip arthroplasty, we found extensive inversion of the anterosuperior portion of the acetabular labrum, and the location was mostly consistent with the bone-marrow edema lesions in the femoral head and acetabulum. Discussion Several theories for the etiology of rapidly destructive hip OA have been proposed, including idiopathic chondrolysis, abnormal immunoreaction, intra-articular deposition of hydroxyapatite crystals, and subchondral insufficiency fracture. One of the reasons rapidly destructive hip OA is still considered idiopathic is the lack of reports regarding the initial stage of the disease. Our report is the first to demonstrate magnetic resonance imaging for initial-stage disease with intraoperative findings before collapse of the femoral head. Conclusion Inversion of the acetabular labrum may be a mechanism of rapidly destructive hip OA. PMID:25603485

  9. Osteoarthritis

    MedlinePlus

    ... thumb joint also is commonly affected by osteoarthritis. Knees The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make ...

  10. Management of the 'young' patient with hip disease.

    PubMed

    Ritterman, Scott A; Rubin, Lee E

    2013-03-01

    Although hip arthritis typically affects older patients, there is a rapidly growing population of "young" patients experiencing debilitating symptoms from hip disease. Most commonly, osteoarthritis and avascular necrosis affect this population, but a variety of other primary structural and metabolic causes can also occur. The expectations of these younger patients are often distinct from geriatric patients, and the challenges in optimizing their care are unique in this demanding population. Selection of the implant, bearing surface, and surgical technique can all impact the success and longevity of total hip replacement. A consideration for respecting the native bone stock is an important consideration that can potentially reduce some of the future challenges of revision arthroplasty in this young population. PMID:23641435

  11. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

    PubMed

    Chong, Elaine W; Wang, Yuanyuan; Robman, Liubov D; Aung, Khin Zaw; Makeyeva, Galina A; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M; Guymer, Robyn H

    2015-01-01

    Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur may be

  12. Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study

    PubMed Central

    Chong, Elaine W.; Wang, Yuanyuan; Robman, Liubov D.; Aung, Khin Zaw; Makeyeva, Galina A.; Giles, Graham G.; Graves, Stephen; Cicuttini, Flavia M.; Guymer, Robyn H.

    2015-01-01

    Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003–2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001–2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00–1.49). Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25–12.02). The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured neck of femur

  13. Microhardness of human cancellous bone tissue in progressive hip osteoarthritis.

    PubMed

    Tomanik, Magdalena; Nikodem, Anna; Filipiak, Jarosław

    2016-12-01

    Bone tissue is a biological system in which the dynamic processes of, among others, bone formation or internal reconstruction will determine the spatial structure of the tissue and its mechanical properties. The appearance of a factor disturbing the balance between biological processes, e.g. a disease, will cause changes in the spatial structure of bones, thus affecting its mechanical properties. One of the bone diseases most common in an increasingly ageing population is osteoarthritis, also referred to as degenerative joint disease. It is estimated that in 2050 about 1300 million people will show symptoms of OA. The appearance of a pathological stimulus disturbs the balance of the processes of degradation and synthesis of articular cartilage, chondrocytes and the extracellular matrix, and the subchondral bone layer. As osteoarthritis progresses, study of the epiphysis reveals increasingly widespread changes of the articular surface and the internal structure of bone tissue. In this paper, the authors point out the differences in the mechanical properties of cancellous bone tissue forming the proximal epiphysis of the femoral bone during the progressive stages of OA. In order to determine microproperties of bone trabeculae, specimens from different stages of the disease (N=9) were subjected to microindentation testing, which made it possible to determine the material properties of bone tissue, such as microhardness HV and Young׳s modulus E. In addition, mechanical tests were supplemented with Raman spectroscopy, which determine the degree of bone mineralization, and measurements of structural properties based on analysis using microCT. The conducted tests were used to establish both quantitative and quantitative description of changes in the structural and mechanical properties connected with reorganization of trabeculae making up the bone in the various stages of osteoarthritis. The proposed description will supplement existing knowledge in the literature about

  14. Validation of a screening questionnaire for hip and knee osteoarthritis in old people

    PubMed Central

    Quintana, José M; Arostegui, Inmaculada; Escobar, Antonio; Lafuente, Iratxe; Arenaza, Juan C; Garcia, Isidoro; Aguirre, Urko

    2007-01-01

    Background To develop a sensitive and specific screening tool for knee and hip osteoarthritis in the general population of elderly people. Methods The Knee and Hip OsteoArthritis Screening Questionnaire (KHOA-SQ) was developed based on previous studies and observed data and sent to 11,002 people aged 60 to 90 years, stratified by age and gender, who were selected by random sampling. Algorithms of the KHOA-SQ were created. Respondents positive for knee or hip OA on the KHOA-SQ were invited to be evaluated by an orthopedic surgeon. A sample of 300 individuals negative for knee or hip OA on the KHOA-SQ were also invited for evaluation. Sensitivity and specificity were determined for the KHOA-SQ, as well as for KHOA-SQ questions. Classification and Regression Tree analysis was used to find alternative screening algorithms from the questionnaire. Results Of 11,002 individuals contacted, 7,577 completed the KHOA-SQ. Of 1,115 positive for knee OA, on the KHOA-SQ, 710 (63.6%) were diagnosed with it. For hip OA, 339 of the 772 who screened positive (43.9%) were diagnosed it. Sensitivity for the hip algorithm was 87.4% and specificity 59.8%; for the knee, sensitivity was 94.5% and specificity 43.8%. Two alternative algorithms provided lower specificity. Conclusion The KHOA-SQ offers high sensitivity and moderate specificity. Although this tool correctly identifies individuals with knee or hip OA, the high false positive rate could pose problems. Based on our questions, no better algorithm was found. PMID:17716378

  15. Hand, hip and knee osteoarthritis in a Norwegian population-based study - The MUST protocol

    PubMed Central

    2013-01-01

    Background Knowledge about the prevalence and consequences of osteoarthritis (OA) in the Norwegian population is limited. This study has been designed to gain a greater understanding of musculoskeletal pain in the general population with a focus on clinically and radiologically confirmed OA, as well as risk factors, consequences, and management of OA. Methods/Design The Musculoskeletal pain in Ullensaker STudy (MUST) has been designed as an observational study comprising a population-based postal survey and a comprehensive clinical examination of a sub-sample with self-reported OA (MUST OA cohort). All inhabitants in Ullensaker municipality, Norway, aged 40 to 79 years receive the initial population-based postal survey questionnaire with questions about life style, general health, musculoskeletal pain, self-reported OA, comorbidities, health care utilisation, medication use, and functional ability. Participants who self-report OA in their hip, knee and/or hand joints are asked to attend a comprehensive clinical examination at Diakonhjemmet Hospital, Oslo, including a comprehensive medical examination, performance-based functional tests, different imaging modalities, cardiovascular assessment, blood and urine samples, and a number of patient-reported questionnaires including five OA disease specific instruments. Data will be merged with six national data registries. A subsample of those who receive the questionnaire has previously participated in postal surveys conducted in 1990, 1994, and 2004 with data on musculoskeletal pain and functional ability in addition to demographic characteristics and a number of health related factors. This subsample constitutes a population based cohort with 20 years follow-up. Discussion This protocol describes the design of an observational population-based study that will involve the collection of data from a postal survey on musculoskeletal pain, and a comprehensive clinical examination on those with self-reported hand, hip and

  16. The Content of the 14 Metals in Cancellous and Cortical Bone of the Hip Joint Affected by Osteoarthritis.

    PubMed

    Zioła-Frankowska, Anetta; Kubaszewski, Łukasz; Dąbrowski, Mikołaj; Kowalski, Artur; Rogala, Piotr; Strzyżewski, Wojciech; Łabędź, Wojciech; Uklejewski, Ryszard; Novotny, Karel; Kanicky, Viktor; Frankowski, Marcin

    2015-01-01

    The aim of the study was to determine the content of particular elements Ca, Mg, P, Na, K, Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femur bone tissue (cancellous and cortical bone) of 96 patients undergoing total hip replacement for osteoarthritis using ICP-AES and FAAS analytical techniques. The interdependencies among these elements and their correlations depended on factors including age, gender, place of residence, tobacco consumption, alcohol consumption, exposure to environmental pollution, physical activity, and type of degenerative change which were examined by statistical and chemometric methods. The factors that exerted the greatest influence on the elements in the femoral head and neck were tobacco smoking (higher Cr and Ni content in smokers), alcohol consumption (higher concentrations of Ni, Cu in people who consume alcohol), and gender (higher Cu, Zn, and Ni concentrations in men). The factors influencing Pb accumulation in bone tissue were tobacco, alcohol, gender, and age. In primary and secondary osteoarthritis of the hip, the content and interactions of elements are different (mainly those of Fe and Pb). There were no significant differences in the concentrations of elements in the femoral head and neck that could be attributed to residence or physical activity. PMID:26357659

  17. The Content of the 14 Metals in Cancellous and Cortical Bone of the Hip Joint Affected by Osteoarthritis

    PubMed Central

    Zioła-Frankowska, Anetta; Kubaszewski, Łukasz; Dąbrowski, Mikołaj; Kowalski, Artur; Rogala, Piotr; Strzyżewski, Wojciech; Łabędź, Wojciech; Uklejewski, Ryszard; Novotny, Karel; Kanicky, Viktor; Frankowski, Marcin

    2015-01-01

    The aim of the study was to determine the content of particular elements Ca, Mg, P, Na, K, Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femur bone tissue (cancellous and cortical bone) of 96 patients undergoing total hip replacement for osteoarthritis using ICP-AES and FAAS analytical techniques. The interdependencies among these elements and their correlations depended on factors including age, gender, place of residence, tobacco consumption, alcohol consumption, exposure to environmental pollution, physical activity, and type of degenerative change which were examined by statistical and chemometric methods. The factors that exerted the greatest influence on the elements in the femoral head and neck were tobacco smoking (higher Cr and Ni content in smokers), alcohol consumption (higher concentrations of Ni, Cu in people who consume alcohol), and gender (higher Cu, Zn, and Ni concentrations in men). The factors influencing Pb accumulation in bone tissue were tobacco, alcohol, gender, and age. In primary and secondary osteoarthritis of the hip, the content and interactions of elements are different (mainly those of Fe and Pb). There were no significant differences in the concentrations of elements in the femoral head and neck that could be attributed to residence or physical activity. PMID:26357659

  18. Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study

    PubMed Central

    2011-01-01

    Background There is emerging evidence for a beneficial effect of meat consumption on the musculoskeletal system. However, whether it affects the risk of knee and hip osteoarthritis is unknown. We performed a prospective cohort study to examine the relationship between meat consumption and risk of primary hip and knee replacement for osteoarthritis. Methods Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry. Results There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement. Conclusion A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted. PMID:21235820

  19. Comparative analysis of gene expression profiles of hip articular cartilage between non-traumatic necrosis and osteoarthritis.

    PubMed

    Wang, Wenyu; Liu, Yang; Hao, Jingcan; Zheng, Shuyu; Wen, Yan; Xiao, Xiao; He, Awen; Fan, Qianrui; Zhang, Feng; Liu, Ruiyu

    2016-10-10

    Hip cartilage destruction is consistently observed in the non-traumatic osteonecrosis of femoral head (NOFH) and accelerates its bone necrosis. The molecular mechanism underlying the cartilage damage of NOFH remains elusive. In this study, we conducted a systematically comparative study of gene expression profiles between NOFH and osteoarthritis (OA). Hip articular cartilage specimens were collected from 12 NOFH patients and 12 controls with traumatic femoral neck fracture for microarray (n=4) and quantitative real-time PCR validation experiments (n=8). Gene expression profiling of articular cartilage was performed using Agilent Human 4×44K Microarray chip. The accuracy of microarray experiment was further validated by qRT-PCR. Gene expression results of OA hip cartilage were derived from previously published study. Significance Analysis of Microarrays (SAM) software was applied for identifying differently expressed genes. Gene ontology (GO) and pathway enrichment analysis were conducted by Gene Set Enrichment Analysis software and DAVID tool, respectively. Totally, 27 differently expressed genes were identified for NOFH. Comparing the gene expression profiles of NOFH cartilage and OA cartilage detected 8 common differently expressed genes, including COL5A1, OGN, ANGPTL4, CRIP1, NFIL3, METRNL, ID2 and STEAP1. GO comparative analysis identified 10 common significant GO terms, mainly implicated in apoptosis and development process. Pathway comparative analysis observed that ECM-receptor interaction pathway and focal adhesion pathway were enriched in the differently expressed genes of both NOFH and hip OA. In conclusion, we identified a set of differently expressed genes, GO and pathways for NOFH articular destruction, some of which were also involved in the hip OA. Our study results may help to reveal the pathogenetic similarities and differences of cartilage damage of NOFH and hip OA. PMID:27374150

  20. Activity Increase Despite Arthritis (AÏDA): design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis [ISRCTN24554946

    PubMed Central

    Williams, Nefyn H; Amoakwa, Elvis; Burton, Kim; Hendry, Maggie; Belcher, John; Lewis, Ruth; Hood, Kerenza; Jones, Jeremy; Bennett, Paul; Edwards, Rhiannon T; Neal, Richard D; Andrew, Glynne; Wilkinson, Clare

    2009-01-01

    Background Hip and knee osteoarthritis is a common cause of pain and disability, which can be improved by exercise interventions. However, regular exercise is uncommon in this group because the low physical activity level in the general population is probably reduced even further by pain related fear of movement. The best method of encouraging increased activity in this patient group is not known. A booklet has been developed for patients with hip or knee osteoarthritis. It focuses on changing disadvantageous beliefs and encouraging increased physical activity. Methods/Design This paper describes the design of a Phase II randomised controlled trial (RCT) to test the effectiveness of this new booklet for patients with hip and knee osteoarthritis in influencing illness and treatment beliefs, and to assess the feasibility of conducting a larger definitive RCT in terms of health status and exercise behaviour. A computerised search of four general medical practice patients' record databases will identify patients older than 50 years of age who have consulted with hip or knee pain in the previous twelve months. A random sample of 120 will be invited to participate in the RCT comparing the new booklet with a control booklet, and we expect 100 to return final questionnaires. This trial will assess the feasibility of recruitment and randomisation, the suitability of the control intervention and outcome measurement tools, and will provide an estimate of effect size. Outcomes will include beliefs about hip and knee pain, beliefs about exercise, fear avoidance, level of physical activity, health status and health service costs. They will be measured at baseline, one month and three months. Discussion We discuss the merits of testing effectiveness in a phase II trial, in terms of intermediate outcome measures, whilst testing the processes for a larger definitive trial. We also discuss the advantages and disadvantages of testing the psychometric properties of the primary outcome

  1. Cross-cultural adaptation and validation of the Turkish version of the Hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS).

    PubMed

    Yilmaz, Ozlem; Gul, Ebru Demir; Bodur, Hatice

    2014-01-01

    The purpose of this study is to adapt the Hip disability and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) to Turkish language and to evaluate the psychometric properties of the Turkish version in patients with primary hip osteoarthritis. After the translation from the source language (English) to the target language (Turkish), synthesis, back translation, revision, and pretest stages were done. Next, 50 patients with primary hip osteoarthritis were asked to fill out the Turkish version of the HOOS-PS two times with one week interval. Internal consistency was tested using the Cronbach's alpha coefficient, and test-retest reliability was assessed by calculating the intra-class correlation coefficient (ICC). Construct validity was investigated by comparing the results of the HOOS-PS and WOMAC, Lequesne questionnaries using Spearman's rank correlation coefficient. Internal consistency was good with a Cronbach's alpha of 0.778 (>0.7) and ICC was 0.911 (>0.7). Both scores verify that the Turkish HOOS-PS is a reliable tool. Spearman's rank correlation coefficients between the HOOS-PS and overall WOMAC (r = 0.653), WOMAC physical functions (r = 0.626), WOMAC pain (r = 0.629) subscales, overall Lequesne (r = 0.650), and Lequesne daily living activities (r = 0.620) subscales were high (r > 0.6), and moderate correlations were found between the HOOS-PS and WOMAC stiffness (r = 0.511), Lequesne pain (r = 0.569), and Lequesne-walking distance (r = 0.578) subscales (0.6 > r > 0.2), thus providing proof for the validity of the Turkish form. The Turkish HOOS-PS was found to be reliable and valid for patients with primary hip osteoarthritis. PMID:24026527

  2. Usefulness of postoperative hip irradiation in the prevention of heterotopic bone formation in a high risk group of patients

    SciTech Connect

    MacLennan, I.; Keys, H.M.; Evarts, C.M.; Rubin, P.

    1984-01-01

    Heterotopic ossification is a complication of total hip arthroplasty in 14 to 30% of patients. Significant functional impairment will occur in up to 28% of patients with ectopic bone. The high risk group includes those with preexisting heterotopic bone in either hip, those suffering from hypertrophic osteoarthritis or ankylosing spondylitis and patients who have had multiple procedures on the hip. Fifty-eight patients (67 hips) were irradiated after surgical removal of ectopic bone (53 hips) or received radiation prophylaxis of heterotopic ossification (14 hips). Ninety-five percent of patients had either no bone visible or insignificant amounts of ectopic bone visible on postoperative hip X-rays. Only 5% of patients showed significant persistence of ectopic bone. Postoperative hip function was dramatically improved compared to preoperative function in all patients treated. The importance of early commencement of irradiation is emphasized.

  3. Investigation of Association Between Hip Osteoarthritis Susceptibility Loci and Radiographic Proximal Femur Shape

    PubMed Central

    Thiagarajah, Shankar; Wilkinson, J. Mark; Panoutsopoulou, Kalliope; Day‐Williams, Aaron G.; Cootes, Timothy F.; Wallis, Gillian A.; Loughlin, John; Arden, Nigel; Birrell, Fraser; Carr, Andrew; Chapman, Kay; Deloukas, Panos; Doherty, Michael; McCaskie, Andrew; Ollier, William E. R.; Rai, Ashok; Ralston, Stuart H.; Spector, Timothy D.; Valdes, Ana M.; Wallis, Gillian A.; Mark Wilkinson, J.; Zeggini, Eleftheria

    2015-01-01

    Objective To test whether previously reported hip morphology or osteoarthritis (OA) susceptibility loci are associated with proximal femur shape as represented by statistical shape model (SSM) modes and as univariate or multivariate quantitative traits. Methods We used pelvic radiographs and genotype data from 929 subjects with unilateral hip OA who had been recruited previously for the Arthritis Research UK Osteoarthritis Genetics Consortium genome‐wide association study. We built 3 SSMs capturing the shape variation of the OA‐unaffected proximal femur in the entire mixed‐sex cohort and for male/female‐stratified cohorts. We selected 41 candidate single‐nucleotide polymorphisms (SNPs) previously reported as being associated with hip morphology (for replication analysis) or OA (for discovery analysis) and for which genotype data were available. We performed 2 types of analysis for genotype–phenotype associations between these SNPs and the modes of the SSMs: 1) a univariate analysis using individual SSM modes and 2) a multivariate analysis using combinations of SSM modes. Results The univariate analysis identified association between rs4836732 (within the ASTN2 gene) and mode 5 of the female SSM (P = 0.0016) and between rs6976 (within the GLT8D1 gene) and mode 7 of the mixed‐sex SSM (P = 0.0003). The multivariate analysis identified association between rs5009270 (near the IFRD1 gene) and a combination of modes 3, 4, and 9 of the mixed‐sex SSM (P = 0.0004). Evidence of associations remained significant following adjustment for multiple testing. All 3 SNPs had previously been associated with hip OA. Conclusion These de novo findings suggest that rs4836732, rs6976, and rs5009270 may contribute to hip OA susceptibility by altering proximal femur shape. PMID:25939412

  4. Subject-specific musculoskeletal modelling in patients before and after total hip arthroplasty.

    PubMed

    Wesseling, Mariska; De Groote, Friedl; Meyer, Christophe; Corten, Kristoff; Simon, Jean-Pierre; Desloovere, Kaat; Jonkers, Ilse

    2016-11-01

    The goal of this study was to define the effect on hip contact forces of including subject-specific moment generating capacity in the musculoskeletal model by scaling isometric muscle strength and by including geometrical information in control subjects, hip osteoarthritis and total hip arthroplasty patients. Scaling based on dynamometer measurements decreased the strength of all flexor and abductor muscles. This resulted in a model that lacked the capacity to generate joint moments required during functional activities. Scaling muscle forces based on functional activities and inclusion of MRI-based geometrical detail did not compromise the model strength and resulted in hip contact forces comparable to previously reported measured contact forces. PMID:27123960

  5. Effects of sulfur bath on hip osteoarthritis: a randomized, controlled, single-blind, follow-up trial: a pilot study

    NASA Astrophysics Data System (ADS)

    Kovács, Csaba; Bozsik, Ágnes; Pecze, Mariann; Borbély, Ildikó; Fogarasi, Andrea; Kovács, Lajos; Tefner, Ildikó Katalin; Bender, Tamás

    2016-06-01

    The effects of balneotherapy were evaluated in patients with osteoarthritis of the hip. This randomized, controlled, investigator-blinded study enrolled outpatients with hip osteoarthritis according to ACR criteria. In addition to home exercise therapy, one patient group received balneotherapy for 3 weeks on 15 occasions. The mineral water used in this study is one of the mineral waters with the highest sulfide ion content (13.2 mg/L) in Hungary. The control group received exercise therapy alone. The WOMAC Likert 3.1 index and the EQ-5D quality of life self-administered questionnaire were completed three times during the study: prior to first treatment, at the end of the 3-week treatment course, and 12 weeks later. The main endpoint was achievement of Minimal Clinically Important Improvement (MCII) at 12 weeks, defined as ≥7.9 points in a normalized WOMAC function score. The intention to treat analysis included 20 controls and 21 balneotherapy patients. At 12 weeks, 17 (81 %) balneotherapy group patients had Minimal Clinically Important Improvement and 6 (30 %) of controls (p = 0.001). Comparing the results of the two groups at the end of treatment, there was a significant difference in the WOMAC stiffness score only, whereas after 12 weeks, the WOMAC pain, stiffness, function, and total scores also showed a significant difference in favor of the balneotherapy group. The difference between the two groups was significant after 12 weeks in point of EQVAS score, too. The results of our study suggest that the combination of balneotherapy and exercise therapy achieves more sustained improvement of joint function and decreases in pain than exercise therapy alone.

  6. Hip Osteoarthritis in Dogs: A Randomized Study Using Mesenchymal Stem Cells from Adipose Tissue and Plasma Rich in Growth Factors

    PubMed Central

    Cuervo, Belen; Rubio, Monica; Sopena, Joaquin; Dominguez, Juan Manuel; Vilar, Jose; Morales, Manuel; Cugat, Ramón; Carrillo, Jose Maria

    2014-01-01

    Purpose: The aim of this study was to compare the efficacy and safety of a single intra-articular injection of adipose mesenchymal stem cells (aMSCs) versus plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in dogs with hip osteoarthritis (OA). Methods: This was a randomized, multicenter, blinded, parallel group. Thirty-nine dogs with symptomatic hip OA were assigned to one of the two groups, to receive aMSCs or PRGF. The primary outcome measures were pain and function subscales, including radiologic assessment, functional limitation and joint mobility. The secondary outcome measures were owners’ satisfaction questionnaire, rescue analgesic requirement and overall safety. Data was collected at baseline, then, 1, 3 and 6 months post-treatment. Results: OA degree did not vary within groups. Functional limitation, range of motion (ROM), owner’s and veterinary investigator visual analogue scale (VAS), and patient’s quality of life improved from the first month up to six months. The aMSCs group obtained better results at 6 months. There were no adverse effects during the study. Our findings show that aMSCs and PRGF are safe and effective in the functional analysis at 1, 3 and 6 months; provide a significant improvement, reducing dog’s pain, and improving physical function. With respect to basal levels for every parameter in patients with hip OA, aMSCs showed better results at 6 months. PMID:25089877

  7. Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk

    PubMed Central

    Williams, Paul T.

    2013-01-01

    Purpose Running and other strenuous sports activities are purported to increase osteoarthritis (OA) risk, more so than walking and less-strenuous activities. Analyses were therefore performed to test whether running, walking, and other exercise affect OA and hip replacement risk, and to assess BMI’s role in mediating these relationships. Methods Proportional hazards analyses of patients’ report of having physician-diagnosed OA and hip replacement vs. exercise energy expenditure (metabolic equivalents, METs). Results 74,752 runners reported 2004 OA and 259 hip replacements during 7.1-year follow-up, while the 14,625 walkers reported 695 OA and 114 hip replacements over 5.7 years. Compared to running <1.8 METhr/d, the risks for OA and hip replacement decreased: 1) 18.1% (P=0.01) and 35.1% (P=0.03), respectively, for 1.8 to 3.6 METhr/d run; 2) 16.1% (P=0.03) and 50.4% (P=0.002), respectively, for 3.6 to 5.4 METhr/d run; and 3) 15.6% (P=0.02) and 38.5% (P=0.01), respectively, for ≥5.4 METhr/d run, suggesting that the risk reduction mostly occurred by 1.8 METhr/d. Baseline BMI was strongly associated with both OA (5.0% increase per kg/m2, P=2x10−8) and hip replacement risks (9.8% increase per kg/m2, P=4.8x10−5), and adjustment for BMI substantially diminished the risk reduction from running ≥1.8 METhr/d for OA (from 16.5%, P=0.01 to 8.6%, P=0.21) and hip replacement (from 40.4%, P=0.005 to 28.5%, P=0.07). The reductions in OA and hip replacement risk by exceeding 1.8 METhr/d did not differ significantly between runners and walkers. Other (non-running) exercise increased the risk of OA by 2.4% (P=0.009) and hip replacement by 5.0% per METhr/d (P=0.02), independent of BMI. Conclusions Whereas other exercise increased OA and hip replacement risk, running significantly reduced their risk due, in part, to running’s association with lower BMI. PMID:23377837

  8. The rate of joint replacement in osteoarthritis depends on the patient's socioeconomic status.

    PubMed

    Wetterholm, Malin; Turkiewicz, Aleksandra; Stigmar, Kjerstin; Hubertsson, Jenny; Englund, Martin

    2016-06-01

    Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skåne, Sweden. We included all residents aged ≥ 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups. PMID:26982799

  9. Rehabilitation and treatment of a recreational golfer with hip osteoarthritis: a case report

    PubMed Central

    Howell, Emily R.

    2012-01-01

    Objective: This case study reviews the conservative chiropractic treatment of hip osteoarthritis (OA) and the prescription of a rehabilitation program for a recreational golfer. Clinical features: A 49-year-old registered nurse/ college instructor presented with a five year history of left hip OA and pain, recent right hip pain and occasional low back stiffness. Once her symptoms improved, a golf-specific functional rehabilitation program was prescribed in preparation for the upcoming golf season. Intervention and Outcome: The initial treatment included ultrasound, soft tissue and myofascial therapy, mobilizations, acupuncture and home advice. Rehabilitative exercises included core and scapular stability exercises, general conditioning, golf specific stretches, functional swinging, proprioceptive and strengthening exercises, and referral to a swing coach. The positive outcomes included increased ranges of motion, decreased pain, as well as improvements in golf driving distance and endurance. Summary: Conservative management and golf-specific rehabilitation prescription appears to be beneficial for hip OA and recreational golf performance in this case. PMID:22997470

  10. Knee and hip radiographic osteoarthritis features: differences on pain, function and quality of life.

    PubMed

    Pereira, Duarte; Severo, Milton; Santos, Rui A; Barros, Henrique; Branco, Jaime; Lucas, Raquel; Costa, Lúcia; Ramos, Elisabete

    2016-06-01

    The association between radiographic osteoarthritis (OA) and symptoms is inconsistent and variable according to each joint. The purpose of this study is to understand the relation between radiographic OA features, pain, function and quality of life, in knee and hip joints. A cross-sectional study was performed using information from EPIPorto cohort. Data was obtained by interview using a structured questionnaire on social, demographic, behavioural and clinical data. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Quality of life was evaluated with Short Form 36 (SF-36) and function disability with the Lequesne knee and hip indexes. Radiographic knees and hips were classified using the Kellgren-Lawrence score (KL 0-4). Linear regression and proportional odds ratios estimated the association between radiographic features, pain, function and quality of life. In our study, symptomatic OA (KL ≥ 2 plus joint pain) was 26.0 % in knee and 7.0 % hip joints. In knee, the increase on radiographic score increased the odds to have a higher pain frequency score [1.58 (95 % CI = 1.27, 1.97)] and was associated [adjusted β (95 % CI)] with worst general health [-3.05 (-5.00, -1.09)], physical function [-4.92 (-7.03, -2.80)], role-physical [-4.10 (-8.08, -0.11)], bodily pain [-2.96 (-5.45, -0.48)] and limitations in activities of daily living [0.48 (0.08, 0.89)]. Regarding hip, no significant associations were found between the severity of radiographic lesions and these measures. Radiographic lesions in knee were associated with higher complaints, as far as pain and functional limitations are concerned, compared with hip. PMID:26445941

  11. Early detection of aging cartilage and osteoarthritis in mice and patient samples using atomic force microscopy

    NASA Astrophysics Data System (ADS)

    Stolz, Martin; Gottardi, Riccardo; Raiteri, Roberto; Miot, Sylvie; Martin, Ivan; Imer, Raphaël; Staufer, Urs; Raducanu, Aurelia; Düggelin, Marcel; Baschong, Werner; Daniels, A. U.; Friederich, Niklaus F.; Aszodi, Attila; Aebi, Ueli

    2009-03-01

    The pathological changes in osteoarthritis-a degenerative joint disease prevalent among older people-start at the molecular scale and spread to the higher levels of the architecture of articular cartilage to cause progressive and irreversible structural and functional damage. At present, there are no treatments to cure or attenuate the degradation of cartilage. Early detection and the ability to monitor the progression of osteoarthritis are therefore important for developing effective therapies. Here, we show that indentation-type atomic force microscopy can monitor age-related morphological and biomechanical changes in the hips of normal and osteoarthritic mice. Early damage in the cartilage of osteoarthritic patients undergoing hip or knee replacements could similarly be detected using this method. Changes due to aging and osteoarthritis are clearly depicted at the nanometre scale well before morphological changes can be observed using current diagnostic methods. Indentation-type atomic force microscopy may potentially be developed into a minimally invasive arthroscopic tool to diagnose the early onset of osteoarthritis in situ.

  12. Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis.

    PubMed

    Zwartele, Rob; Peters, Anil; Brouwers, Johannes; Olsthoorn, Paul; Brand, Ronald; Doets, Cornelis

    2008-10-01

    The aim of this study was to assess the outcome of primary cementless total hip arthroplasty in rheumatoid arthritis patients and to compare the results with osteoarthritis patients. Sixty-four patients (77 hips) with rheumatoid arthritis and 120 patients (135 hips) with osteoarthritis had a conical-shaped Zweymueller threaded cup and a tapered, rectangular Zweymueller stem implanted and were assessed after an average of 12.5 years. The endpoints for survival analysis were failure of one or both components due to radiographic loosening or revision. Revision was defined as exchange of cup, stem or both. When the PE-insert or the ceramic ball head were exchanged leaving cup and stem in place, e.g. for PE-wear or dislocation, this was not considered a revision but a re-intervention. No differences were found in survival rates; however, in the rheumatoid arthritis group there was an increased rate of malposition of the cup, avulsions of the greater trochanter, and increased bone resorption in the trochanteric region. This study shows that despite altered biomechanical properties of rheumatoid bone, mechanical stability and osseous integration of cementless prosthesis are not compromised and, although a higher complication rate did occur, long-term survival is excellent. PMID:17609955

  13. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome

    PubMed Central

    Putnis, S.E; Wartemberg, G.K; Khan, W.S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  14. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome.

    PubMed

    Putnis, S E; Wartemberg, G K; Khan, W S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  15. Association between genetic variants of DVWA and osteoarthritis of the knee and hip: a comprehensive meta-analysis

    PubMed Central

    Zhang, Rui; Yao, Jianfeng; Xu, Peng; Ji, Baohu; Voegeli, Géraldine; Hou, Weikun; Li, Hui; Wang, Yi; Kelsoe, John R; Ma, Jie

    2015-01-01

    Recently, double von Willebrand factor domain A (DVWA) gene, a previously unknown gene, was revealed to contain several single nucleotide polymorphisms (SNPs) that showed consistent association with knee osteoarthritis (OA) in Japanese and Chinese cohorts. However, subsequent studies failed to confirm this result in several different populations. To deal with the issues raised by inconsistent results among those studies, we investigated the association between DVWA and OA using meta-analytic techniques, combining all published data up to December 2014. 10 independent samples from 4 teams contributed data for a possible association between SNP rs7639618 and knee or hip OA. The total number of cases and controls of this SNP was respectively 4,142 versus 6,575 for knee OA, and 2,325 versus 2,914 for hip OA. A trend of significant association was observed in the combined population with knee OA (P=0.06), and a significant difference was identified between patients with knee OA and controls for the G-allele of rs7639618 (P=0.02). Together with the reported functional studies, our results indicate that DVWA may have a small but strong effect on the susceptibility to knee OA, at least in Asian population. Further functional studies are needed to determine the underlying variation of DVWA and to relate this to the pathophysiology of OA. PMID:26309605

  16. The Pathophysiology of Primary Hip Osteoarthritis may Originate from Bone Alterations

    PubMed Central

    Kamimura, Mikio; Nakamura, Yukio; Ikegami, Shota; Mukaiyama, Keijiro; Uchiyama, Shigeharu; Kato, Hiroyuki

    2013-01-01

    Objectives: The aim of this study was to investigate whether bone alterations detected by hip magnetic resonance imaging (MRI) were associated with subsequent primary hip OA. Methods: We enrolled 7 patients with hip joint pain from their first visit, at which hip joints were classified as grade 0 or I on the Kellgren-Lawrence grading scale. Plain radiographs and magnetic resonance imaging (MRI) were performed on all cases, and pain was assessed with the Denis pain scale. Average age, height, weight, body mass index, bone mineral density (L1-4), central edge angle, Sharp’s angle, and acetabular hip index were calculated. Results: Within two months of the onset of pain, 4 of the 7 cases showed broad bone signal changes, while 3 cases showed local signal changes in the proximal femur on hip MRI. Three to 6 months after the onset of pain, in all patients whose pain was much improved, plain radiographs showed progression to further-stage OA. Conclusion: Our findings suggest that bone abnormalities in the proximal femur might be involved in the pathogenesis of primary hip OA. PMID:24358070

  17. Hip arthropathy in a patient with primary hemochromatosis: MR imaging findings with pathologic correlation.

    PubMed

    Papakonstantinou, Olympia; Mohana-Borges, Aurea V R; Campell, Loretta; Trudell, Debra; Haghighi, Parviz; Resnick, Donald

    2005-03-01

    Arthropathy is a major clinical manifestation in primary hemochromatosis, typically affecting the metacarpophalangeal joints. Hip arthropathy is not uncommon, with radiologic features resembling osteoarthritis or calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. We describe the MR imaging findings of the hip in a patient with severe hip arthropathy and primary hemochromatosis and correlate them with the histopathologic findings. MR imaging showed severe degenerative changes, with large subchondral cysts and subchondral sclerosis in the femoral head and acetabulum. There was conspicuous correlation between MR imaging and pathologic findings of the resected femoral head. However, MR imaging failed to reveal intra-articular iron. PMID:15316682

  18. Are cam and pincer deformities as common as dysplasia in Japanese patients with hip pain?

    PubMed

    Mori, R; Yasunaga, Y; Yamasaki, T; Nakashiro, J; Fujii, J; Terayama, H; Ohshima, S; Ochi, M

    2014-02-01

    In Japan, osteoarthritis (OA) of the hip secondary to acetabular dysplasia is very common, and there are few data concerning the pathogeneses and incidence of femoroacetabular impingement (FAI). We have attempted to clarify the radiological prevalence of painful FAI in a cohort of Japanese patients and to investigate the radiological findings. We identified 176 symptomatic patients (202 hips) with Tönnis grade 0 or 1 osteoarthritis, whom we prospectively studied between August 2011 and July 2012. There were 61 men (65 hips) and 115 women (137 hips) with a mean age of 51.8 years (11 to 83). Radiological analyses included the α-angle, centre-edge angle, cross-over sign, pistol grip deformity and femoral head neck ratio. Of the 202 hips, 79 (39.1%) had acetabular dysplasia, while 80 hips (39.6%) had no known aetiology. We found evidence of FAI in 60 hips (29.7%). Radiological FAI findings associated with cam deformity were the most common. There was a significant relationship between the pistol grip deformity and both the α-angle (p < 0.001) and femoral head-neck ratio (p = 0.024). Radiological evidence of symptomatic FAI was not uncommon in these Japanese patients. PMID:24493180

  19. Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review.

    PubMed

    Arnold, John B; Walters, Julie L; Ferrar, Katia E

    2016-06-01

    Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative

  20. Risk of Severe Knee and Hip Osteoarthritis in Relation to Level of Physical Exercise: A Prospective Cohort Study of Long-Distance Skiers in Sweden

    PubMed Central

    Michaëlsson, Karl; Byberg, Liisa; Ahlbom, Anders; Melhus, Håkan; Farahmand, Bahman Y.

    2011-01-01

    Background To complete long-distance ski races, regular physical exercise is required. This includes not only cross-country skiing but also endurance exercise during the snow-free seasons. The aim of this study was to determine whether the level of physical exercise is associated with future risk of severe osteoarthritis independent of previous diseases and injuries. Methodology/Principal Findings We used a cohort that consisted of 48 574 men and 5 409 women who participated in the 90 km ski race Vasaloppet at least once between 1989 and 1998. Number of performed races and finishing time were used as estimates of exercise level. By matching to the National Patient Register we identified participants with severe osteoarthritis, defined as arthroplasty of knee or hip due to osteoarthritis. With an average follow-up of 10 years, we identified 528 men and 42 women with incident osteoarthritis. The crude rate was 1.1/1000 person-years for men and 0.8/1000 person-years for women. Compared with racing once, participation in ≥5 races was associated with a 70% higher rate of osteoarthritis (multivariable-adjusted hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.33 to 2.22). The association was dose-dependent with an adjusted HR of 1.09, 95% CI 1.05 to 1.13 for each completed race. A faster finishing time, in comparison with a slow finishing time, was also associated with an increased rate (adjusted HR 1.51, 95% CI 1.14 to 2.01). Contrasting those with 5 or more ski races and a fast finish time to those who only participated once with a slow finish time, the adjusted HR of osteoarthritis was 2.73, 95% CI 1.78 to 4.18. Conclusions/Significance Participants with multiple and fast races have an increased risk of subsequent arthroplasty of knee and hip due to osteoarthritis, suggesting that intensive exercise may increase the risk. PMID:21479136

  1. Inflammatory response to therapeutic gold bead implantation in canine hip joint osteoarthritis.

    PubMed

    Lie, K-I; Jæger, G; Nordstoga, K; Moe, L

    2011-11-01

    Inflammatory changes associated with periarticular pure gold bead implants were studied in dogs involved in a clinical trial investigating motor dysfunction and chronic pain owing to hip joint dysplasia and osteoarthritis. Gold beads were percutaneously implanted via a needle into different locations surrounding the greater trochanter of the femur. Nine dogs with implants were necropsied. In all examined animals, characteristic histologic lesions were observed in the tissue surrounding the gold implants--namely, a fibrous capsule composed of concentric fibroblasts intermixed with a variable number of inflammatory cells and a paucicellular innermost layer of collagen with a few fibrocyte-like cells in empty lacunae. Lymphocytes dominated the inflammatory infiltrate, with rarely observed macrophages present in close proximity to the implant site. No giant cells were observed. Immunohistochemistry showed mixed populations of lymphocytes, both CD3 positive (T cells) and CD79a positive (B cells), which in some cases formed lymphoid follicles. Diffuse inflammatory changes were present to a minor extent in the perimysium and surrounding fascia. The inflammation observed in dogs is similar to that observed with gold implants in humans. It is possible that the clinically beneficial effect of gold beads for chronic osteoarthritis depends on sustained localized inflammation with localized release of soluble mediators. The encapsulation of the implant by a paucicellular and poorly vascularized fibrous capsule may help prevent an exaggerated inflammatory reaction by sequestering the gold bead from the surrounding tissue. PMID:20861497

  2. Osteoarthritis

    MedlinePlus Videos and Cool Tools

    ... with the aging process. Osteoarthritis is a chronic disease causing the deterioration of the cartilage within a ... is roughened and becomes worn down. As the disease progresses, the cartilage becomes completely worn down and ...

  3. Osteoarthritis

    MedlinePlus Videos and Cool Tools

    ... osteoarthritis include loss of flexibility, limited movement, and pain and swelling within the joint. The condition results ... the margins of the joint. Part of the pain results from these bone spurs, which can restrict ...

  4. Effects of naproxcinod on blood pressure in patients with osteoarthritis.

    PubMed

    White, William B; Schnitzer, Thomas J; Bakris, George L; Frayssinet, Hayet; Duquesroix, Brigitte; Weber, Michael

    2011-05-01

    Nonsteroidal anti-inflammatory drugs are associated with increases in blood pressure (BP), particularly in patients treated with antihypertensive therapy. Naproxcinod is a nitric oxide-donating cyclooxygenase inhibitor in development for osteoarthritis (OA). Thus, we characterized the effects of naproxcinod on BP in an integrated safety analysis of 3 pivotal trials of patients with OA of the hip or knee involving 2,734 patients. The changes from baseline in the systolic BP after 13 weeks of therapy with naproxcinod (375 and 750 mg), naproxen 500 mg (equipotent to naproxcinod 750 mg), or placebo twice daily were evaluated in all patients and in the subgroup taking renin-angiotensin system inhibitors. Heterogeneity testing showed no treatment-by-study interaction. The effects of naproxcinod 750 mg on the systolic BP was not different from placebo (mean change from baseline vs placebo -0.4 mm Hg, 95% confidence interval -1.6 to 0.8). Naproxen increased the systolic BP relative to placebo (mean change from baseline vs placebo +1.4 mm Hg, 95% confidence interval 0.1 to 2.7). In the renin-angiotensin system inhibitor-treated patients, the effect of naproxcinod 750 mg compared to naproxen 500 mg in the changes from baseline in the systolic BP was -4.3 mm Hg (95% confidence interval -8.5 to -0.0). In conclusion, naproxcinod had effects on BP similar to that of placebo in patients with OA. These results imply that naproxcinod would be less likely to alter systolic BP control in patients with OA than a conventional nonsteroidal anti-inflammatory drug, particularly in those treated with renin-angiotensin system inhibitor agents. PMID:21371681

  5. Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture

    PubMed Central

    Uppal, Harmeeth S.; Copeland, Marilyn E.; Crist, Brett D.; Volgas, David A.

    2015-01-01

    The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P < .01) and less obese (P < .01) but were otherwise very similar. An extensive comorbidity review revealed that the 2 cohorts were similar, with the exception of an increased incidence of dementia (P = .012) or glaucoma (P = .04) in HIP patients and of peripheral neuropathy (P = .014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P < .001). HIP patients were also less likely to be discharged directly home from the hospital (P < .001). Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip. PMID:26246950

  6. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials

    PubMed Central

    2012-01-01

    Background Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. Methods / Design One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the

  7. Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study

    PubMed Central

    Wang, Yuanyuan; Simpson, Julie Anne; Wluka, Anita E; Teichtahl, Andrew J; English, Dallas R; Giles, Graham G; Graves, Stephen; Cicuttini, Flavia M

    2009-01-01

    Introduction Total joint replacement is considered a surrogate measure for symptomatic end-stage osteoarthritis. It is unknown whether the adipose mass and the distribution of adipose mass are associated with the risk of primary knee and hip replacement for osteoarthritis. The aim of the present investigation was to examine this in a cohort study. Methods A total of 39,023 healthy volunteers from Melbourne, Australia were recruited for a prospective cohort study during 1990 to 1994. Their body mass index, waist circumference, and waist-to-hip ratio were obtained from direct anthropometric measurements. The fat mass and percentage fat were estimated from bioelectrical impedance analysis. Primary knee and hip replacements for osteoarthritis between 1 January 2001 and 31 December 2005 were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for primary joint replacement associated with each adiposity measure. Results Comparing the fourth quartile with the first, there was a threefold to fourfold increased risk of primary joint replacement associated with body weight (HR = 3.44, 95% confidence interval (CI) = 2.83 to 4.18), body mass index (HR = 3.44, 95% CI = 2.80 to 4.22), fat mass (HR = 3.51, 95% CI = 2.87 to 4.30), and percentage fat (HR = 2.99, 95% CI = 2.46 to 3.63). The waist circumference (HR = 2.77, 95% CI = 2.26 to 3.39) and waist-to-hip ratio (HR = 1.46, 95% CI = 1.21 to 1.76) were less strongly associated with the risk. Except for the waist-to-hip ratio, which was not significantly associated with hip replacement risk, all adiposity measures were associated with the risk of both knee and hip joint replacement, and were significantly stronger risk factors for knee. Conclusions Risk of primary knee and hip joint replacement for osteoarthritis relates to both adipose mass and central adiposity. This relationship

  8. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    PubMed Central

    Jørgensen, R. Wejnold; Dippmann, C.; Dahl, L.; Stürup, J.

    2016-01-01

    Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies. PMID:27583059

  9. Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine

    PubMed Central

    Murray, Kelvin J.; Azari, Michael F.

    2015-01-01

    Osteoarthritis (OA) is an extremely common condition that creates substantial personal and health care costs. An important recognised risk factor for OA is excessive or abnormal mechanical joint loading. Leg length discrepancy (LLD) is a common condition that results in uneven and excessive loading of not only knee joints but also hip joints and lumbar motion segments. Accurate imaging methods of LLD have made it possible to study the biomechanical effects of mild LLD (LLD of 20mm or less). This review examines the accuracy of these methods compared to clinical LLD measurements. It then examines the association between LLD and OA of the joints of the lower extremity. More importantly, it addresses the largely neglected association between LLD and degeneration of lumbar motion segments and the patterns of biomechanical changes that accompany LLD. We propose that mild LLD may be an important instigator or contributor to OA of the hip and lumbar spine, and that it deserves to be rigorously studied in order to decrease OA’s burden of disease. PMID:26500356

  10. Health service utilization patterns of primary care patients with osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Szecsenyi, Joachim; Laux, Gunter; Wensing, Michel

    2007-01-01

    Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully. PMID:17956605

  11. [Rehabilitation of the patients with osteoarthritis].

    PubMed

    Sidorov, V D; Pershin, S B

    2015-01-01

    Under the term "osteoarthritis" (OA) is currently meant a clinical syndrome resulting from the combined effect of articular pain and disordered functional activity leading to the deterioration of the quality of life of the patients. The principal objective of rehabilitation of the patients presenting with GA in which all patients with this condition are in need practically after each next aggravation of the pathological process is to relive pain syndrome and restore the functional ability of the joints lost or deteriorated after each exacerbation in order to eventually improve the quality of life of the patients experiencing the constantly progressing degenerative process in the musculoskeletal system. The effectiveness of pain alleviation, the degree of improvement'of the joint functional activity and the general condition of the patient are considered as the criteria for the assessment of the effectiveness of the rehabilitative treatment. These criteria have been chosen in accordance with the recommendations of the OMERACT international working group (outcome measures in rheumatology). In addition, the quality of life associated with the health status and the adverse effects of the rehabilitative measures were estimated. Bearing in mind comorbidity in the patients presenting with OA, one of the main challenges is the development of the scientifically sound rationale for the application of non-pharmacological technologies of physical therapy, remedial gymnastics and massage for the prevention and elimination of an aggravation of the secondary aseptic inflammatory process associated with OA and the subsequent rehabilitative treatment for the restoration of the lost locomotory stereotype and the quality of life of the patients. One of the effective methods of physical therapy used for the treatment and rehabilitation of the patients presenting with GA is hyperbaric gaseous cryotherapy. This method makes use of the heat rejection phenomenon to which the organism

  12. Dysplasia of the contralateral hip in patients with unilateral late-detected congenital dislocation of the hip: 50 years' follow-up of 48 patients.

    PubMed

    Terjesen, T

    2014-09-01

    The aim of this study was to investigate the incidence of dysplasia in the 'normal' contralateral hip in patients with unilateral developmental dislocation of the hip (DDH) and to evaluate the long-term prognosis of such hips. A total of 48 patients (40 girls and eight boys) were treated for late-detected unilateral DDH between 1958 and 1962. After preliminary skin traction, closed reduction was achieved at a mean age of 17.8 months (4 to 65) in all except one patient who needed open reduction. In 25 patients early derotation femoral osteotomy of the contralateral hip had been undertaken within three years of reduction, and later surgery in ten patients. Radiographs taken during childhood and adulthood were reviewed. The mean age of the patients was 50.9 years (43 to 55) at the time of the latest radiological review. In all, eight patients (17%) developed dysplasia of the contralateral hip, defined as a centre-edge (CE) angle < 20° during childhood or at skeletal maturity. Six of these patients underwent surgery to improve cover of the femoral head; the dysplasia improved in two after varus femoral osteotomy and in two after an acetabular shelf operation. During long-term follow-up the dysplasia deteriorated to subluxation in two patients (CE angles 4° and 5°, respectively) who both developed osteoarthritis (OA), and one of these underwent total hip replacement at the age of 49 years. In conclusion, the long-term prognosis for the contralateral hip was relatively good, as OA occurred in only two hips (4%) at a mean follow-up of 50 years. Regular review of the 'normal' side is indicated, and corrective surgery should be undertaken in those who develop subluxation. PMID:25183584

  13. Assessment of quality of life in patients with knee osteoarthritis

    PubMed Central

    Kawano, Marcio Massao; Araújo, Ivan Luis Andrade; Castro, Martha Cavalcante; Matos, Marcos Almeida

    2015-01-01

    ABSTRACT OBJECTIVE : To assess the quality of life of knee osteoarthritis patients using the SF-36 questionnaire METHODS : Cross-sec-tional study with 93 knee osteoarthritis patients. The sample was categorized according to Ahlbӓck score. All individuals were interviewed with the SF-36 questionnaire RESULTS : The main finding of the study is related to the association of edu-cation level with the functional capacity, functional limitation and pain. Patients with higher education level had better functional capacity when they were compared to patients with basic level of education CONCLUSION : Individuals with osteoarthritis have a low perception of their quality of life in functional capacity, functional limitation and pain. There is a strong association between low level of education and low perception of quality of life. Level of Evidence IV, Clinical Case Series. PMID:27057143

  14. A Case Series of Total Hip Arthroplasty Using Cementless Hip Stem Customized for Patients of a Specific Race: 10- to 15-Year Results.

    PubMed

    Tsukada, Sachiyuki; Wakui, Motohiro

    2016-01-01

    We report a minimum of 10-year results of patients undergoing total hip arthroplasty (THA) using the cementless BiCONTACT N stem, which was developed to fit the femur in a specific race in which the predominant etiology of hip diseases was developmental dysplasia. A total of 108 hips were evaluated with a mean follow-up of 11.9 ± 1.4 years. The etiology for THA was secondary osteoarthritis due to developmental dysplasia in 90.3% of patients. No evidence of aseptic loosening of the BiCONTACT N stem was observed. The survivorship with the end point as revision surgery for any reason was 94.4% (95% confidence interval 88.7%-97.3%) at 15.0 years postoperatively. BiCONTACT N stem may be an effective alternative for patients with developmental dysplasia of the hip. PMID:26321076

  15. Total Hip Arthroplasty for the Paralytic and Non-paralytic Side in Patient with Residual Poliomyelitis

    PubMed Central

    Sonohata, Motoki; Kitajima, Masaru; Kawano, Shunsuke; Mawatari, Masaaki

    2016-01-01

    Background: Total hip arthroplasty (THA) for poliomyelitis is a problematic procedure due to difficulty in positioning the cup of the prosthesis in the true acetabulum and the risk of dislocation after THA due to the low muscle tone. Methods: We herein present a case of bilateral hip pain with a history of poliomyelitis. Radiograph showed bilateral hip osteoarthritis caused by hip dysplasia due to residual poliomyelitis in right hip joint or developing dysplasia of the hip joint in left hip joint. THA was performed to bilateral hip joints. Results: Six years after bilateral THA, bilateral hip pain significantly improved. Additionally, the muscle strength on the paralyzed right side partially improved. However, the muscle strength on the non-paralyzed left side did not significantly improve. No complications related to the surgery were observed. Conclusion: Promising early results were obtained for THA in our patient with residual poliomyelitis. However, surgeons should pay attention to the potential development of complications concerning THA that may arise due to the residual poliomyelitis. PMID:27347238

  16. Variant Alleles of the WNT Antagonist FRZB Are Determinants of Hip Shape and Modify the Relationship between Hip Shape and Osteoarthritis

    PubMed Central

    Baker-LePain, Julie C.; Lynch, John A.; Parimi, Neeta; McCulloch, Charles E.; Nevitt, Michael C.; Corr, Maripat; Lane, Nancy E.

    2011-01-01

    Objectives (1) To test whether single nucleotide polymorphisms (SNPs) of the FRZB gene are associated with hip shape. (2) To determine whether FRZB variant alleles affect the relationship between hip shape and radiographic hip osteoarthritis (RHOA). Methods A nested case-control study of Caucasian women aged ≥ 65 years in the Study of Osteoporotic Fractures (SOF) was performed. Cases (n = 451) demonstrated incident RHOA during follow-up (mean 8.0 ± 0.4 years). Controls (n = 601) had no RHOA at baseline or follow-up. Statistical shape modeling (SSM) of digitized hip radiographs was used to assess proximal femur shape, and center-edge angle and acetabular depth were used to assess acetabular shape. The association of the rs288326 and rs7775 FRZB variant alleles with hip shape was analyzed using linear regression. The effect of these alleles on the relationship between hip shape and RHOA was analyzed using logistic regression with and without interaction terms. Results The rs288326 and rs7775 alleles were associated with shape of the proximal femur (SSM Mode 2). There was a significant interaction between the rs288326 SNP and proximal femur shape (Mode 2) in predicting RHOA (p for interaction = 0.022). Among subjects with the rs288326 variant allele, there were increasing odds of RHOA with increasing quartiles of proximal femur shape Mode 2 (OR for 4th quartile of Mode 2 = 2.5, 95% confidence interval 1.2–5.3; p for linear trend = 0.02). Conclusions The rs288326 and rs7775 FRZB SNPs are associated with the shape of the proximal femur. The presence of the rs288326 SNP alters the relationship between proximal femur shape and incident RHOA. Together, these findings suggest that FRZB may serve an important role in determining hip shape and may modify the relationship between hip shape and OA. PMID:22544526

  17. Comparative, double-blind, controlled study of intra-articular hyaluronic acid (Hyalubrix®) injections versus local anesthetic in osteoarthritis of the hip

    PubMed Central

    2009-01-01

    Introduction Comparison of intra-articular bacterial-derived hyaluronic acid (Hyalubrix®) (HA) with local analgesia (mepivacaine) for osteoarthritis (OA) of the hip. Methods A pilot prospective, double-blind, 6-month randomized trial of 42 patients with hip OA. HA or mepivacaine was administered twice (once a month) under ultrasound guidance. Efficacy measurements included the Lequesne's algofunctional index, a visual analog scale for pain, concomitant use of analgesia, patient and physician global measurement, and safety. Results Patients in the HA group exhibited a significantly reduced Lequesne's algofunctional index 3 and 6 months after treatment (P < 0.001) and significantly reduced visual analog scale pain scores 3 and 6 months after treatment (P < 0.05) compared with the local anesthetic group. All primary and secondary measures were significantly improved versus baseline, but other than the above were not different from each other at 3 or 6 months. Adverse effects were minimal. Conclusions This comparative study suggests a beneficial effect and safety of intra-articular HA in the management of hip OA. Trial registration number ISRCTN39397064. PMID:20003205

  18. Asymmetric loading and bone mineral density at the asymptomatic knees of subjects with unilateral hip osteoarthritis

    PubMed Central

    Shakoor, Najia; Dua, Anisha; Thorp, Laura; Mikolaitis, Rachel A.; Wimmer, Markus A.; Foucher, Kharma C.; Fogg, Louis F.; Block, Joel A.

    2011-01-01

    Objective The contralateral knee of those with unilateral endstage hip OA is known to be at greater risk for endstage knee OA compared to the ipsilateral, same side knee. Likewise, in endstage hip OA, this contralateral knee is known to have increased dynamic joint loads compared to the ipsilateral knee. Here, we study a population with unilateral hip OA, who are asymptomatic at the knees, for early asymmetries in knee loading. Methods Data from 62 subjects with unilateral hip OA were evaluated. Subjects underwent gait analyses for evaluation of dynamic knee loads as well as dual energy X-ray absorptiometry for evaluation of bone mineral density (BMD) at both knees. Differences between knees were compared. Results Peak dynamic knee loads were significantly higher at the contralateral knee compared to the ipsilateral knee (2.46±0.71 vs 2.23±0.81 %BW*ht, p=0.029). Similarly, medial compartment tibial BMD was significantly higher at the contralateral knee compared to the ipsilateral knee (0.897±0.208 vs 0.854±0.206 gm/c2, p=0.033). Interestingly, there was a direct correlation between contralteral:ipsilateral dynamic knee load and contralateral:ipsilateral medial compartment tibial BMD (Spearman’s rho= 0.287, p=0.036). Conclusions This study demonstrates that at the contralateral knees of patients with unilateral hip OA, which are at higher risk of developing progressive symptomatic OA compared to the ipsilateral knees, loading and structural asymmetries appear early in the disease course, while the knees are still asymptomatic. These early biomechanical asymmetries may have corresponding long term consequences, providing further support for the potential role of loading in OA onset and progression. PMID:22127702

  19. [Treatment of hip fractures in elderly patients].

    PubMed

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program. PMID:25919823

  20. Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients

    PubMed Central

    Dettmer, Marius; Pourmoghaddam, Amir; Kreuzer, Stefan W.

    2015-01-01

    Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n = 52, age 48.9 ± 6.1 years) who had received hip resurfacing (HR) with a cohort of patients (n = 73, age 48.2 ± 6.6 years) who had received neck-preserving, short-stem implant total hip arthroplasty (THA). Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year) in both groups (p < 0.0001, η2 = 0.69); there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4 min ± 17.8) than MiniHip surgery (62.5 min ± 14.8), U = 85.0, p < 0.0001, η2 = 0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs. PMID:26101669

  1. Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis—A prospective study

    PubMed Central

    Sansone, Mikael; Ahldén, Mattias; Jonasson, Pall; Thomeé, Christoffer; Swärd, Leif; Collin, David; Baranto, Adad; Karlsson, Jón; Thomeé, Roland

    2016-01-01

    Osteoarthritis (OA) of the hip is a common cause of hip pain. The arthroscopic management of patients with femoro-acetabular impingement (FAI) has been reported to yield good outcomes. The purpose of this study was to report on outcome following the arthroscopic treatment of patients with FAI in the presence of mild to moderate OA. Seventy-five patients undergoing arthroscopic surgery for FAI, all with preoperative radiological signs of mild to moderate OA were prospectively included in this study. A 2-year follow-up, using web-based patient-reported outcome measures, including the International Hip Outcome Tool (iHOT-12), Copenhagen Hip and Groin Outcome (HAGOS), EQ-5D, Hip Sports Activity Scale (HSAS) for physical activity level and a visual analogue scale (VAS) for overall hip function, was performed, complemented by a radiographic evaluation. At follow-up (mean 26 months, SD 5), five patients (7%) had undergone total hip arthroplasty, leaving 70 patients for the analysis. Preoperative scores compared with those obtained at the 2-year follow-up revealed significant improvements (P < 0.0001) for all measured outcomes; the iHOT-12 (42 versus 65), VAS for global hip function (48 versus 68), HSAS (2.5 versus 3), EQ5D index (0.62 versus 0.76), EQ VAS (69 versus 75) and different HAGOS subscales (54 versus 72, 47 versus 67, 56 versus 75, 40 versus 61, 33 versus 56, 31 versus 55). At follow-up, 56 (82%) patients reported that they was satisfied with the outcome of surgery. Arthroscopic treatment for patients with FAI in the presence of mild to moderate OA resulted in statistically significant and clinically relevant improvements in outcome measures related to pain, symptoms, function, physical activity level and quality of life in the majority of patients. PMID:27026820

  2. Unilateral total hip replacement patients with symptomatic leg length inequality have abnormal hip biomechanics during walking

    PubMed Central

    Li, Junyan; McWilliams, Anthony B.; Jin, Zhongmin; Fisher, John; Stone, Martin H.; Redmond, Anthony C.; Stewart, Todd D.

    2015-01-01

    Background Symptomatic leg length inequality accounts for 8.7% of total hip replacement related claims made against the UK National Health Service Litigation authority. It has not been established whether symptomatic leg length inequality patients following total hip replacement have abnormal hip kinetics during gait. Methods Hip kinetics in 15 unilateral total hip replacement patients with symptomatic leg length inequality during gait was determined through multibody dynamics and compared to 15 native hip healthy controls and 15 ‘successful’ asymptomatic unilateral total hip replacement patients. Finding More significant differences from normal were found in symptomatic leg length inequality patients than in asymptomatic total hip replacement patients. The leg length inequality patients had altered functions defined by lower gait velocity, reduced stride length, reduced ground reaction force, decreased hip range of motion, reduced hip moment and less dynamic hip force with a 24% lower heel-strike peak, 66% higher mid-stance trough and 37% lower toe-off peak. Greater asymmetry in hip contact force was also observed in leg length inequality patients. Interpretation These gait adaptions may affect the function of the implant and other healthy joints in symptomatic leg length inequality patients. This study provides important information for the musculoskeletal function and rehabilitation of symptomatic leg length inequality patients. PMID:25900447

  3. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis

    PubMed Central

    Wang, W. J.; Liu, F.; Zhu, Y.W.; Sun, M.H.; Qiu, Y.

    2016-01-01

    Objectives Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Methods Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test. Results Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p < 0.001) compared with controls. In addition, patients with FI of 10° (n = 23) showed reduced lumbar lordosis and significant forward spinal inclination compared with controls, whereas those with FI > 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP. Conclusions The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population. Cite this article: W. J. Wang, F. Liu

  4. Pre-operative ambulatory measurement of asymmetric lower limb loading during walking in total hip arthroplasty patients

    PubMed Central

    2013-01-01

    Background Total hip arthroplasty is a successful surgical procedure to treat hip osteoarthritis. Clinicians use different questionnaires to assess the patient’s pain and functional capacity. Furthermore, they assess the quality of gait in a very global way. This clinical evaluation usually shows significant improvement after total hip arthroplasty, however, does not provide objective, quantifiable information about the movement patterns underlying the functional capacity, which can currently only be obtained in a gait laboratory. Instrumented force shoes can quantify gait velocity, ground reaction forces and the gait pattern easily in an outpatient setting. The main goal of this study was to investigate how mobility characteristics during walking, relate to gait velocity and questionnaire outcomes of patients with hip osteoarthritis in an outpatient setting. Methods 22 patients with primary osteoarthritis of the hip selected for a total hip arthroplasty participated in this study. For each patient the Harris Hip Score, the Traditional Western Ontario and the McMaster Universities osteoarthritis index were administered. Subsequently, the patients were instructed to walk through the corridor while wearing instrumented shoes. The gait velocity estimated with the instrumented force shoes was validated measuring the time required to walk a distance of 10 m using a stopwatch and a measuring tape as a reference system. A regression analysis between spatial, temporal, ground reaction force parameters, including asymmetry, and the gait velocity and the questionnaires outcomes was performed. Results The velocity estimated with the instrumented shoes did not differ significantly from the velocity measured independently. Although gait parameters correlated significantly with velocity, symmetry index parameters were not correlated with velocity. These symmetry index parameters show significant inter-limb asymmetry during walking. No correlation was found between any of the

  5. Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis: Synthesis of the Literature Using Behavior Change Theory.

    PubMed

    Dobson, Fiona; Bennell, Kim L; French, Simon D; Nicolson, Philippa J A; Klaasman, Remco N; Holden, Melanie A; Atkins, Lou; Hinman, Rana S

    2016-05-01

    Exercise is recommended for hip and knee osteoarthritis (OA). Patient initiation of, and adherence to, exercise is key to the success of managing symptoms. This study aimed to (1) identify modifiable barriers and facilitators to participation in intentional exercise in hip and/or knee OA, and (2) synthesize findings using behavior change theory. A scoping review with systematic searches was conducted through March 2015. Two reviewers screened studies for eligibility. Barriers and facilitators were extracted and synthesized according to the Theoretical Domains Framework (TDF) by two independent reviewers. Twenty-three studies (total of 4633 participants) were included. The greatest number of unique barriers and facilitators mapped to the Environmental Context and Resources domain. Many barriers were related to Beliefs about Consequences and Beliefs about Capabilities, whereas many facilitators were related to Reinforcement. Clinicians should take a proactive role in facilitating exercise uptake and adherence, rather than trusting patients to independently overcome barriers to exercise. Strategies that may be useful include a personalized approach to exercise prescription, considering environmental context and available resources, personalized education about beneficial consequences of exercise and reassurance about exercise capability, and use of reinforcement strategies. Future research should investigate the effectiveness of behavior change interventions that specifically target these factors. PMID:26945211

  6. An Implementation Study of Two Evidence-Based Exercise and Health Education Programmes for Older Adults with Osteoarthritis of the Knee and Hip

    ERIC Educational Resources Information Center

    de Jong, O. R. W.; Hopman-Rock, M.; Tak, E. C. M. P.; Klazinga, N. S.

    2004-01-01

    Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in randomized controlled trials (RCTs). We report on an implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis (OA) of the knee or hip. Three types of…

  7. Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

    PubMed Central

    Mannava, Sandeep; Howse, Elizabeth A.; Stone, Austin V.; Stubbs, Allston J.

    2015-01-01

    Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases. PMID:26759783

  8. Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study

    PubMed Central

    2013-01-01

    Background According to Antonovsky’s salutogenic concept, a strong sense of coherence is associated with physical and psychological health. The goal of this study was to analyze the association of Antonovsky’s sense of coherence with physical and psychosocial health components in patients with hip and knee osteoarthritis before and after in- and outpatient rehabilitation. Methods Prospective cohort study with 335 patients, 136 (41%) with hip and 199 (59%) with knee osteoarthritis. The outcome was measured by Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Sense of Coherence (SOC-13). Baseline scores of the SF-36 and WOMAC scales and the observed effect sizes after rehabilitation were correlated with the baseline SOC-13. These correlations of the SF-36 scales were compared to the Factor Score Coefficients for the Mental Component Summary of SF-36, which quantify the factor load on the psychosocial dimension. Predictive impact of the baseline SOC-13 for the SF-36 and WOMAC scales (baseline scores and effect sizes) was then determined by multivariate linear regression controlled for possible confounders. Results At baseline, the SOC-13 correlated with the WOMAC scores between r = 0.18 (stiffness) and r = 0.25 (pain) and with the SF-36 scores between r = 0.10 (physical functioning) and r = 0.53 (mental health). The correlation of these SF-36 correlation coefficients to the Factor Score Coefficient of the SF-36 Mental Component Summary was r = 0.95. The correlations for the effect sizes (baseline → discharge) with the baseline SOC-13 global score were all negative and varied between r = 0.00 (physical functioning) and r = −0.19 (social functioning). In the multivariate linear regression model, the explained variance of the SF-36 scores by the baseline SOC-13 increased continuously from physical to psychosocial health dimensions (from 12.9% to 29.8%). This gradient was consistently

  9. Multimodal Analgesia in the Hip Fracture Patient.

    PubMed

    Fabi, David W

    2016-05-01

    Hip fracture is one of the most common injuries among the elderly and, because the population is aging, it is expected to remain a major clinical challenge and public health problem for the foreseeable future. The clinical importance of early mobilization and prompt participation in physical therapy after hip fracture surgery is now widely recognized. Because postoperative pain can impair mobility and delay physical therapy, much attention is now being paid to finding more effective ways of controlling pain after hip fracture. Oversedation with opioid drugs inhibits communication between the patient and the health care team, can delay ambulation and rehabilitation therapy, and may increase the probability of the patient requiring a skilled nursing facility, which adds further cost to the overall health care system. Multiple pain pathways contribute to the perception of postoperative pain, and although opioids are highly effective in blocking nociceptive pain through inhibition of the mu receptors, they do not block other pain pathways. Multimodal analgesia involves the use of several anesthetic and analgesic modalities that are strategically combined to block pain perception at different sites in the peripheral and central nervous systems. This balanced, multifaceted approach provides more effective control of postoperative pain than opioid drugs alone, allows lower doses of opioids to be used as part of the multimodal regimen (thereby reducing the risk of opioid-related adverse events and complications), and may facilitate more rapid recovery and improve certain outcome measures related to recovery time. One prospective randomized study evaluating the clinical value of multimodal pain management in elderly patients undergoing bipolar hip hemiarthroplasty found that a multimodal regimen, including preemptive pain medication and intraoperative periarticular injections, reduced pain on postoperative days 1 and 4, and reduced overall opioid use. This article describes

  10. Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

    PubMed Central

    Flecher, Xavier; Pearce, Oliver; Parratte, Sebastien; Aubaniac, Jean-Manuel

    2009-01-01

    THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D’Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%–97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%–97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19690930

  11. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review

    PubMed Central

    Santaguida, Pasqualina L.; Hawker, Gillian A.; Hudak, Pamela L.; Glazier, Richard; Mahomed, Nizar N.; Kreder†, Hans J.; Coyte, Peter C.; Wright, James G.

    2008-01-01

    Background Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. Methods We searched 4 bibliographic databases (MEDLINE 1980–2001, CINAHL 1982–2001, EMBASE 1980–2001, HealthStar 1998–1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Results Sixty-four of 14 276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Conclusion Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these

  12. Curved versus Straight Stem Uncemented Total Hip Arthroplasty Osteoarthritis Multicenter trial (CUSTOM): design of a prospective blinded randomised controlled multicentre trial

    PubMed Central

    van Beers, Loes W A H; van Oldenrijk, Jakob; Scholtes, Vanessa A B; Geerdink, Carel H; Niers, Bob B A M; Runne, Wouter; Bhandari, Mohit; Poolman, Rudolf W

    2016-01-01

    Introduction Answering the demands of an increasingly young and active patient population, recent developments in total hip arthroplasty (THA) have shifted towards minimising tissue damage. The Collum Femoris Preserving (CFP) stem was developed to preserve the trochanteric region of the femur, which potentially preserves the insertion of the gluteus musculature. This might accelerate early postoperative rehabilitation and improve functional outcome. Currently the functional results of the CFP stem have not been compared with conventional straight stems in a randomised controlled trial (RCT). The primary purpose of this trial is to compare the functional result of CFP stem THA with conventional uncemented straight stem THA, measured by the Dutch Hip disability and Osteoarthritis Outcome Score (HOOS) at 3-month follow-up. Methods A prospective blinded multicentre RCT will be performed. We aim to recruit 150 patients. The patients will be randomly allocated to a THA with a straight or a curved stem. All patients, research assistants, clinical assessors and investigators will be blinded for the type of prosthesis for 5 years. Clinical assessments and roentgenograms will be taken preoperative, at 6 weeks after surgery, at 1, 2, 3, 4 and 5 years after surgery. Patient reported outcome measures (PROMs) will be obtained at the same follow-up moments. In addition, the PROMs will also be sent to the patients at 3 and 6 months after surgery. The HOOS at 3-month follow-up will be our primary outcome. Ethics and dissemination This trial will be performed in accordance with the Declaration of Helsinki. A local ethics committee has approved this trial. Written informed consent will be obtained from all participating patients. All serious adverse events will be reported to the ethics committee. Results Results will be submitted for publication to an orthopaedics related journal. Trial registration number NTR1560. PMID:27009147

  13. Hip fractures in extremely old patients

    PubMed Central

    Kapicioglu, Mehmet; Ersen, Ali; Saglam, Yavuz; Akgul, Turgut; Kizilkurt, Taha; Yazicioglu, Onder

    2014-01-01

    Aims The purpose of this study was to report a less seen age-group (>90) of hip fractures and to assess the predictors of functional loss, complications and mortality. Methods Thirty-two patients at a mean age of 92.8 (±2.7) were treated in a single institution and reported at a mean follow-up of 2.02 (±1.35) years. Results Mortality was similar between proximal femoral nailing (PFN) and bipolar cemented hemiarthroplasty (BCH) in first year (p = 0.17) but significantly high in following years in BCH (p = 0.035) and patients with cardiac disease (p = 0.054). Conclusion Hip fractures are challenging in extremely old patients and associated with increased mortality and disability. PMID:25264408

  14. Routine functional assessment for hip fracture patients.

    PubMed

    Pedersen, Tonny J; Lauritsen, Jens M

    2016-08-01

    Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4 months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new mobility score were scored immediately after admission. Outcome defined as mortality, residential status, and independent walking ability was assessed at 4 months. Results - 3 of the assessment instruments, namely Barthel-20, Barthel-100, and new mobility score, correlated with outcome at 4 months post-fracture and were valid predictors. Thresholds were estimated. We found no evidence that Barthel-100, with its finer granularity, performs better than Barthel-20 as a predictor. Interpretation - Our findings indicate that pre-fracture scores of Barthel-20 and new mobility score have predictive ability, and further investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted. PMID:27329799

  15. Total hip arthroplasty revision in elderly patients.

    PubMed

    Gasbarra, Elena; Perrone, Fabio Luigi; Celi, Monica; Rao, Cecilia; Feola, Maurizio; Cuozzo, Nicola; Tarantino, Umberto

    2013-10-01

    In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality. PMID:24046034

  16. Pelvic irradiation does not increase the risk of hip replacement in patients with gynecological cancer

    PubMed Central

    Dybvik, Eva; Furnes, Ove; D. Fosså, Sophie; Trovik, Clement; Lie, Stein Atle

    2014-01-01

    Background and purpose — Long-term survivors of cancer can develop adverse effects of the treatment. 60% of cancer patients survive for at least 5 years after diagnosis. Pelvic irradiation can cause bone damage in these long-term survivors, with increased risk of fracture and degeneration of the hip. Patients and methods — Analyses were based on linkage between the Cancer Registry of Norway (CRN) and the Norwegian Arthroplasty Register (NAR). All women who had been exposed to radiation for curative radiotherapy of gynecological cancer (40–60 Gy for at least 28 days) were identified in the CRN. Radiotherapy had been given between 1998 and 2006 and only patients who were irradiated within 6 months of diagnosis were included. The control group contained women with breast cancer who had also undergone radiotherapy, but not to the pelvic area. Fine and Gray competing-risk analysis was used to calculate subhazard-rate ratios (subHRRs) and cumulative incidence functions (CIFs) for the risk of having a prosthesis accounting for differences in mortality. Results — Of 962 eligible patients with gynecological cancer, 26 (3%) had received a total hip replacement. In the control group without exposure, 253 (3%) of 7,545 patients with breast cancer had undergone total hip replacement. The 8-year CIF for receiving a total hip replacement was 2.7% (95% CI: 2.6–2.8) for gynecological cancer patients and 3.0% (95% CI: 2.95–3.03) for breast cancer patients; subHRR was 0.80 (95% CI: 0.53–1.22; p = 0.3). In both groups, the most common reason for hip replacement was idiopathic osteoarthritis. Interpretation — We did not find any statistically significantly higher risk of undergoing total hip replacement in patients with gynecological cancer who had had pelvic radiotherapy than in women with breast cancer who had not had pelvic radiotherapy. PMID:25238432

  17. Serum Collagen Type II Cleavage Epitope and Serum Hyaluronic Acid as Biomarkers for Treatment Monitoring of Dogs with Hip Osteoarthritis

    PubMed Central

    Vilar, José M.; Rubio, Mónica; Spinella, Giuseppe; Cuervo, Belén; Sopena, Joaquín; Cugat, Ramón; Garcia-Balletbó, Montserrat; Dominguez, Juan M.; Granados, Maria; Tvarijonaviciute, Asta; Ceron, José J.; Carrillo, José M.

    2016-01-01

    The aim of this study was to evaluate the use of serum type II collagen cleavage epitope and serum hyaluronic acid as biomarkers for treatment monitoring in osteoarthritic dogs. For this purpose, a treatment model based on mesenchymal stem cells derived from adipose tissue combined with plasma rich in growth factors was used. This clinical study included 10 dogs with hip osteoarthritis. Both analytes were measured in serum at baseline, just before applying the treatment, and 1, 3, and 6 months after treatment. These results were compared with those obtained from force plate analysis using the same animals during the same study period. Levels of type II collagen cleavage epitope decreased and those of hyaluronic acid increased with clinical improvement objectively verified via force plate analysis, suggesting these two biomarkers could be effective as indicators of clinical development of joint disease in dogs. PMID:26886592

  18. OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group

    PubMed Central

    GOSSEC, LAURE; PATERNOTTE, SIMON; BINGHAM, CLIFTON O.; CLEGG, DANIEL O.; COSTE, PHILIPPE; CONAGHAN, PHILIP G.; DAVIS, AILEEN M.; GIACOVELLI, GIAMPAOLO; GUNTHER, KLAUS-PETER; HAWKER, GILLIAN; HOCHBERG, MARC C.; JORDAN, JOANNE M.; KATZ, JEFFREY N.; KLOPPENBURG, MARGREET; LANZAROTTI, ARTURO; LIM, KEITH; LOHMANDER, L. STEFAN; MAHOMED, NIZAR N.; MAILLEFERT, JEAN FRANCIS; MANNO, REBECCA L.; MARCH, LYN M.; MAZZUCA, STEVEN A.; PAVELKA, KAREL; PUNZI, LEONARDO; ROOS, EWA M.; ROVATI, LUCIO C.; SHI, HELEN; SINGH, JASVINDER A.; SUAREZ-ALMAZOR, MARIA E.; TAJANA-MESSI, ELEONORA; DOUGADOS, MAXIME

    2012-01-01

    Objective To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of “need for joint replacement surgery,” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA). Methods New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons’ indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA. Results In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%–12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0–100) + physical function (0–100) > 80]. Conclusion These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define “nonresponders” to disease-modifying drugs in OA clinical trials. PMID:21807799

  19. Hip dysplasia in the skeletally mature patient.

    PubMed

    Goldstein, Rachel Y; Kaye, Ian David; Slover, James; Feldman, David

    2014-01-01

    Abnormal hip development causes one-quarter to one-half of all hip disease. Dysplastic hips typically share characteristic anatomic abnormalities. The dysplastic acetabulum is typically shallow, lateralized, and anteverted with insufficient coverage anteriorly, superiorly, and laterally. The dysplastic proximal femur has a small femoral head with excessive femoral neck anteversion and a short neck with an increased neck shaft angle. These characteristic changes result in intraarticular pathology leading to hip arthritis. A variety of treatment options exist based on the degree of dysplasia and the amount of concomitant hip arthritis. Treatment options include hip arthroscopy, acetabular or femoral osteotomies, hip arthrodesis, and total hip arthroplasty. PMID:25150325

  20. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty

    PubMed Central

    Harris, Kristina; Dawson, Jill; Gibbons, Elizabeth; Lim, Chris R; Beard, David J; Fitzpatrick, Raymond; Price, Andrew J

    2016-01-01

    Objectives To identify patient-reported outcome measures (PROMs) that have been developed and/or used with patients undergoing hip or knee replacement surgery and to provide a shortlist of the most promising generic and condition-specific instruments. Methods A systematic review of the literature was performed to identify measures used in patients undergoing hip and knee replacement and extract and evaluate information on their methodological quality. Results Thirty-two shortlisted measures were reviewed for the quality of their measurement properties. On the basis of the review criteria, the measures with most complete evidence to date are the Oxford Hip Score (OHS) (for patients undergoing hip replacement surgery) and the Oxford Knee Score (OKS), with OKS-Activity and Participation Questionnaire (for patients undergoing knee replacement surgery). Conclusion A large number of these instruments lack essential evidence of their measurement properties (eg, validity, reliability, and responsiveness) in specific populations of patients. Further research is required on almost all of the identified measures. The best-performing condition-specific PROMs were the OKS, OHS, and Western Ontario and McMaster Universities Osteoarthritis Index. The best-performing generic measure was the Short Form 12. Researchers can use the information presented in this review to inform further psychometric studies of the reviewed measures. PMID:27524925

  1. Automatic assessment of volume asymmetries applied to hip abductor muscles in patients with hip arthroplasty

    NASA Astrophysics Data System (ADS)

    Klemt, Christian; Modat, Marc; Pichat, Jonas; Cardoso, M. J.; Henckel, Joahnn; Hart, Alister; Ourselin, Sebastien

    2015-03-01

    Metal-on-metal (MoM) hip arthroplasties have been utilised over the last 15 years to restore hip function for 1.5 million patients worldwide. Althoug widely used, this hip arthroplasty releases metal wear debris which lead to muscle atrophy. The degree of muscle wastage differs across patients ranging from mild to severe. The longterm outcomes for patients with MoM hip arthroplasty are reduced for increasing degrees of muscle atrophy, highlighting the need to automatically segment pathological muscles. The automated segmentation of pathological soft tissues is challenging as these lack distinct boundaries and morphologically differ across subjects. As a result, there is no method reported in the literature which has been successfully applied to automatically segment pathological muscles. We propose the first automated framework to delineate severely atrophied muscles by applying a novel automated segmentation propagation framework to patients with MoM hip arthroplasty. The proposed algorithm was used to automatically quantify muscle wastage in these patients.

  2. Radiographic measures of settlement phenomenon in patients with medial compartment knee osteoarthritis.

    PubMed

    Dong, Tianhua; Chen, Wei; Zhang, Fei; Yin, Bing; Tian, Ye; Zhang, Yingze

    2016-06-01

    In this study, we proposed for the first time the theory of "settlement phenomenon" in tibial plateau and carefully explored the role of settlement of tibial plateau in the occurrence and progression of medial compartment knee osteoarthritis (OA) through investigating the relationship between the degree of settlement and the radiographic severity of OA. One hundred twenty-seven patients with knee medial compartment OA were recruited and examined with weight-bearing radiographs of the entire lower limb. The radiographic severity of OA was evaluated using the Kellgren and Lawrence (KL) grading methods. The settlement value, hip-knee-ankle angle, minimum medial joint space width, and condylar plateau angle were measured at the same time. The settlement value increases with the upgrading of KL grades (r = 0.352, P < 0.001) and is significantly correlated with the changes of hip-knee-ankle angle, minimum medial joint space width, and condylar plateau angle (r = -0.527, -0.271, and 0.415, P < 0.001, respectively). These results suggest that the settlement of tibial plateau could be an evaluable indicator of medial compartment knee OA and be used in the early diagnosis and progression of OA. PMID:26712497

  3. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis

    PubMed Central

    Ebrahimzadeh, Mohammad H; Makhmalbaf, Hadi; Birjandinejad, Ali; Keshtan, Farideh Golhasani; Hoseini, Hosein A; Mazloumi, Seyed Mahdi

    2014-01-01

    Background: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. Methods: We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. Results: Reliability testing resulted in a Cronbach’s alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) . Conclusions: The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis. PMID:25207315

  4. Medical problems in hip fracture patients.

    PubMed

    Chong, Carol Pei Wei; Savige, Judith A; Lim, Wen Kwang

    2010-11-01

    Increasing number of older patients are admitted to hospital with hip fractures. This review evaluates the common medical problems that arise as a consequence of having a hip fracture. Older patients with fractures commonly have co-morbidities that require evaluation prior to and after surgery. Joint acute orthopaedic-geriatric units have been established to provide comprehensive orthopaedic and medical care with some studies showing a reduction in postoperative complications and mortality. Recommendations surrounding the care of the older orthopaedic patient include early surgical fixation, the use of prophylactic antibiotics and thromboembolic prophylaxis, good perioperative pain control to improve ambulation, delirium detection and management to decrease the risk complications, such as institutionalisation, the avoidance of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery. Physicians are well placed to manage these patients with orthopaedic surgeons during the perioperative period. Sufficient evidence exists for most recommendations for fracture patients, but further research is needed in most areas. PMID:20049603

  5. A meta-analysis of genome-wide association studies identifies novel variants associated with osteoarthritis of the hip

    PubMed Central

    Evangelou, Evangelos; Kerkhof, Hanneke J; Styrkarsdottir, Unnur; Ntzani, Evangelia E; Bos, Steffan D; Esko, Tonu; Evans, Daniel S; Metrustry, Sarah; Panoutsopoulou, Kalliope; Ramos, Yolande F M; Thorleifsson, Gudmar; Tsilidis, Konstantinos K; Arden, Nigel; Aslam, Nadim; Bellamy, Nicholas; Birrell, Fraser; Blanco, Francisco J; Carr, Andrew; Chapman, Kay; Day-Williams, Aaron G; Deloukas, Panos; Doherty, Michael; Engström, Gunnar; Helgadottir, Hafdis T; Hofman, Albert; Ingvarsson, Thorvaldur; Jonsson, Helgi; Keis, Aime; Keurentjes, J Christiaan; Kloppenburg, Margreet; Lind, Penelope A; McCaskie, Andrew; Martin, Nicholas G; Milani, Lili; Montgomery, Grant W; Nelissen, Rob G H H; Nevitt, Michael C; Nilsson, Peter M; Ollier, William ER; Parimi, Neeta; Rai, Ashok; Ralston, Stuart H; Reed, Mike R; Riancho, Jose A; Rivadeneira, Fernando; Rodriguez-Fontenla, Cristina; Southam, Lorraine; Thorsteinsdottir, Unnur; Tsezou, Aspasia; Wallis, Gillian A; Wilkinson, J Mark; Gonzalez, Antonio; Lane, Nancy E; Lohmander, L Stefan; Loughlin, John; Metspalu, Andres; Uitterlinden, Andre G; Jonsdottir, Ingileif; Stefansson, Kari; Slagboom, P Eline; Zeggini, Eleftheria; Meulenbelt, Ingrid; Ioannidis, John PA; Spector, Tim D; van Meurs, Joyce B J; Valdes, Ana M

    2014-01-01

    Objectives Osteoarthritis (OA) is the most common form of arthritis with a clear genetic component. To identify novel loci associated with hip OA we performed a meta-analysis of genome-wide association studies (GWAS) on European subjects. Methods We performed a two-stage meta-analysis on more than 78 000 participants. In stage 1, we synthesised data from eight GWAS whereas data from 10 centres were used for ‘in silico’ or ‘de novo’ replication. Besides the main analysis, a stratified by sex analysis was performed to detect possible sex-specific signals. Meta-analysis was performed using inverse-variance fixed effects models. A random effects approach was also used. Results We accumulated 11 277 cases of radiographic and symptomatic hip OA. We prioritised eight single nucleotide polymorphism (SNPs) for follow-up in the discovery stage (4349 OA cases); five from the combined analysis, two male specific and one female specific. One locus, at 20q13, represented by rs6094710 (minor allele frequency (MAF) 4%) near the NCOA3 (nuclear receptor coactivator 3) gene, reached genome-wide significance level with p=7.9×10−9 and OR=1.28 (95% CI 1.18 to 1.39) in the combined analysis of discovery (p=5.6×10−8) and follow-up studies (p=7.3×10−4). We showed that this gene is expressed in articular cartilage and its expression was significantly reduced in OA-affected cartilage. Moreover, two loci remained suggestive associated; rs5009270 at 7q31 (MAF 30%, p=9.9×10−7, OR=1.10) and rs3757837 at 7p13 (MAF 6%, p=2.2×10−6, OR=1.27 in male specific analysis). Conclusions Novel genetic loci for hip OA were found in this meta-analysis of GWAS. PMID:23989986

  6. How do metal ion levels change over time in hip resurfacing patients? A cohort study.

    PubMed

    Savarino, Lucia; Cadossi, Matteo; Chiarello, Eugenio; Fotia, Caterina; Greco, Michelina; Baldini, Nicola; Giannini, Sandro

    2014-01-01

    Metal-on-metal hip resurfacing (MOM-HR) is offered as an alternative to traditional hip arthroplasty for young, active adults with advanced osteoarthritis. Nevertheless, concerns remain regarding wear and corrosion of the bearing surfaces and the resulting increase in metal ion levels. We evaluated three cohorts of patients with Birmingham hip resurfacing (BHR) at an average follow-up of 2, 5, and 9 years. We asked whether there would be differences in ion levels between the cohorts and inside the gender. Nineteen patients were prospectively analyzed. The correlation with clinical-radiographic data was also performed. Chromium, cobalt, nickel, and molybdenum concentrations were measured by atomic absorption spectrophotometry. Chromium and cobalt levels demonstrated a tendency to decrease over time. Such tendency was present only in females. An inverse correlation between chromium, implant size, and Harris hip score was present at short term; it disappeared over time together with the decreased ion levels. The prospective analysis showed that, although metal ion levels remained fairly constant within each patient, there was a relatively large variation between subjects, so mean data in this scenario must be interpreted with caution. The chronic high exposure should be carefully considered during implant selection, particularly in young subjects, and a stricter monitoring is mandatory. PMID:25580456

  7. How Do Metal Ion Levels Change over Time in Hip Resurfacing Patients? A Cohort Study

    PubMed Central

    Savarino, Lucia; Cadossi, Matteo; Chiarello, Eugenio; Fotia, Caterina; Greco, Michelina; Baldini, Nicola; Giannini, Sandro

    2014-01-01

    Metal-on-metal hip resurfacing (MOM-HR) is offered as an alternative to traditional hip arthroplasty for young, active adults with advanced osteoarthritis. Nevertheless, concerns remain regarding wear and corrosion of the bearing surfaces and the resulting increase in metal ion levels. We evaluated three cohorts of patients with Birmingham hip resurfacing (BHR) at an average follow-up of 2, 5, and 9 years. We asked whether there would be differences in ion levels between the cohorts and inside the gender. Nineteen patients were prospectively analyzed. The correlation with clinical-radiographic data was also performed. Chromium, cobalt, nickel, and molybdenum concentrations were measured by atomic absorption spectrophotometry. Chromium and cobalt levels demonstrated a tendency to decrease over time. Such tendency was present only in females. An inverse correlation between chromium, implant size, and Harris hip score was present at short term; it disappeared over time together with the decreased ion levels. The prospective analysis showed that, although metal ion levels remained fairly constant within each patient, there was a relatively large variation between subjects, so mean data in this scenario must be interpreted with caution. The chronic high exposure should be carefully considered during implant selection, particularly in young subjects, and a stricter monitoring is mandatory. PMID:25580456

  8. Arthroscopy provides symptom relief and good functional outcomes in patients with hip synovial chondromatosis

    PubMed Central

    Ferro, Fernando P.; Philippon, Marc J.

    2015-01-01

    The purpose of this study was to evaluate clinical presentation, associated pathology and clinical outcomes after arthroscopic treatment of hip synovial chondromatosis (SC). A prospective data registry was queried for patients with SC diagnosis from 2005 to 2012. Surgical indications were intra-articular pain after failure of conservative treatment, labral pathology, chondral damage or loose bodies. All patients had femoroacetabular impingement based on radiographic findings. Patient-centered outcomes were collected before and after surgery. Standard hip arthroscopy techniques were used to address associated pathology. Twenty-three patients met the inclusion criteria. Eleven were males. Mean age was 43.7 years. Mean center-edge angle was 33.7 and alpha angle 73. Radiographs were diagnostic in five patients (23.8%). Magnetic resonance imaging identified loose bodies in 14 (66%). Most patients had an uncountable amount of loose bodies in the central and peripheral compartments. The most common associated pathology was a labral tear (100%) and acetabular cartilage injury (85%). All patients had improvement in range of motion. The average Modified Harris Hip score improved from 62 (pre-op) to 84.8 (post-op). Short-Form 12-PCS improved from 41 to 53. Western Ontario and McMaster Osteoarthritis Index improved from 27.1 to 7.2. Median overall satisfaction was 9.5 (out of 10). Hip arthroscopy with thorough removal of loose bodies and subtotal synovectomy, coupled with an aggressive and early rehabilitation program, was effective in ameliorating symptoms associated with from hip SC, yielding high levels of patient satisfaction and functional outcomes, in a 2.5 year follow-up time. Level of evidence: IV (case series) PMID:27011848

  9. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

    PubMed Central

    Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti

    2016-01-01

    Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions

  10. Variation in use of non-surgical treatments among osteoarthritis patients in orthopaedic practice in the Netherlands

    PubMed Central

    Hofstede, Stefanie N; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J; van Bodegom-Vos, Leti

    2015-01-01

    Objectives National and international evidence-based guidelines for hip and knee osteoarthritis (OA) recommend to start with non-surgical treatments, followed by surgical intervention if a patient does not respond sufficiently to non-surgical treatments, but there are indications that these are not optimally used. The aim of this study was to assess the extent to which all recommended non-surgical treatments were used by patients with hip or knee OA who receive(d) a total hip or knee replacement, as reported by patients and orthopaedic surgeons. Setting We performed two cross-sectional internet-based surveys among patients and orthopaedic surgeons throughout the Netherlands. Participants 195 OA patients either have undergone total knee arthroplasty or total hip arthroplasty no longer than 12 months ago or being on the waiting list for surgery with a confirmed date within 3 months and 482 orthopaedic surgeons were invited to participate. Primary and secondary outcome measures The use of recommended non-surgical treatments including education about OA/treatment options, lifestyle advice, dietary therapy, physical therapy, acetaminophen, NSAIDs and glucocorticoid injections. Results 174 OA patients (93%) and 172 orthopaedic surgeons (36%) completed the surveys. Most recommended non-surgical treatments were given to the majority of patients (eg, 80% education about OA, 73% physical therapy, 72% acetaminophen, 80% NSAIDs). However, only 6% of patients and 10% of orthopaedic surgeons reported using a combination of all recommended treatments. Dietary therapy was used least frequently. Only 11% of overweight and 30% of obese participants reported having received dietary therapy and 28% of orthopaedic surgeons reported to prescribe dietary therapy to overweight patients. Conclusions While most recommended non-surgical treatments were used frequently as single therapy, the combination is used in only a small percentage of OA patients. Especially, use of dietary therapy

  11. Patient-specific Analysis of Cartilage and Labrum Mechanics in Human Hips with Acetabular Dysplasia

    PubMed Central

    Henak, Corinne R; Abraham, Christine L; Anderson, Andrew E; Maas, Steve A; Ellis, Benjamin J; Peters, Christopher L; Weiss, Jeffrey A

    2014-01-01

    BACKGROUND Acetabular dysplasia is a major predisposing factor for development of hip osteoarthritis, and may result from alterations to chondrolabral loading. Subject-specific finite element (FE) modeling can be used to evaluate chondrolabral mechanics in the dysplastic hip, thereby providing insight into mechanics that precede osteoarthritis. OBJECTIVE To evaluate chondrolabral contact mechanics and congruency in dysplastic hips and normal hips using a validated approach to subject-specific FE modeling. METHODS FE models of ten subjects with normal acetabula and ten subjects with dysplasia were constructed using a previously validated protocol. Labrum load support, and labrum and acetabular cartilage contact stress and contact area were compared between groups. Local congruency was determined at the articular surface for two simulated activities. RESULTS The labrum in dysplastic hips supported 2.8 to 4.0 times more of the load transferred across the joint than in normal hips. Dysplastic hips did not have significantly different congruency in the primary load-bearing regions than normal hips, but were less congruent in some unloaded regions. Normal hips had larger cartilage contact stress than dysplastic hips in the few regions that had significant differences. CONCLUSIONS The labrum in dysplastic hips has a far more significant role in hip mechanics than it does in normal hips. The dysplastic hip is neither less congruent than the normal hip, nor subjected to elevated cartilage contact stresses. This study supports the concept of an outside-in pathogenesis of osteoarthritis in dysplastic hips and that the labrum in dysplastic hips should be preserved during surgery. PMID:24269633

  12. The impact of nurse prescribing on patients with osteoarthritis.

    PubMed

    Creedon, Rena; Weathers, Elizabeth

    2011-08-01

    Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing. PMID:21841633

  13. International trends in arthroscopic hip preservation surgery—are we treating the same patient?

    PubMed Central

    Erickson, Brandon J.; Cvetanovich, Gregory L.; Frank, Rachel M.; Bhatia, Sanjeev; Bush-Joseph, Charles A.; Nho, Shane J.; Harris, Joshua D.

    2015-01-01

    The goal of this study was to perform a systematic review and meta-analysis of the entire arthroscopic hip preservation literature to answer the question, ‘Across the world, are we treating the same patient?’ There are significant differences in arthroscopic hip preservation publications, subjects and techniques based on both continent and country published. A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available databases. Therapeutic clinical outcome investigations reporting arthroscopic hip preservation were eligible for inclusion. All study, subject and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student's t-tests, one-way analysis of variance, chi-squared and two-proportion Z-tests. There were 134 studies included in the analysis (10 752 subjects; 11 007 hips; 51% female; mean 37.6 years of age; mean 27.2 months length of follow-up), which had a low Modified Coleman Methodology Score (mean 32.4; poor). North America published the largest number of studies (58%) and the most subjects (55%) and hips (56%). Australia (22%) and Europe (18%) operated on subjects with some amount of osteoarthritis most commonly. North America (2.7%) and Europe (2.0%) operated on subjects with dysplasia or borderline dysplasia most commonly. The Modified Harris Hip Score was the most frequently utilized outcome score (24% of studies). The quantity and quality of arthroscopic hip preservation literature is significantly increasing with time. Several significant differences in study, subject and surgical technique demographics between continents and countries were identified. Deficiencies in use of clinical outcome scores and definitions of treated pathologies preclude complete subject comparisons and serve as an impetus for future study quality improvements. PMID:27011812

  14. [Degenerative rupture of the hip abductors. Missed diagnosis with therapy-resistant trochanteric pain of the hips and positive Trendelenburg sign in elderly patients].

    PubMed

    Aepli-Schneider, N; Treumann, T; Müller, U; Schmid, L

    2012-01-01

    The cases of four elderly patients with persistent trochanteric pain and tears of the gluteus medius and/or gluteus minimus tendons detected in magnetic resonance imaging (MRI) are presented. There was no history of local trauma in any patient but three patients had a positive Trendelenburg sign. Magnetic resonance imaging showed either an obvious discontinuity of the affected tendon or an increased T2 signal above, or less specifically lateral to the greater trochanter. The presence of an elongated tendon on MRI is most likely indicative of a partial rupture of the tendon. Pain and local tenderness over the lateral aspect of the hip in clinical examination is commonly attributed to trochanteric bursitis or trochanteric pain syndrome. Partial or complete tears of the gluteus medius and/or gluteus minimus tendons are thought to represent an unusual finding. However, the true incidence and the clinical significance of hip abductor degeneration and rupture remain to be determined. More studies are needed to examine the prevalence of ruptures in asymptomatic patients, to evaluate the subsequent risk for developing osteoarthritis of the hip (caused by impaired protective reflexes originating from proprioceptive nerve endings in muscle spindles) and to determine the risk for falls related to weakness of hip abduction. Furthermore, no data exist regarding the success rate of conservative treatment. Tears of the gluteus medius and minimus tendons in the elderly population are likely to be a more common cause of pain in the greater trochanteric region than previously thought. In patients who do not respond to conservative treatment, weakness of hip abduction (positive Trendelenburg sign) and new limping should point to the possibility of hip abductor ruptures. The most useful examination technique for diagnosis is MRI. PMID:22286357

  15. Pain sensitivity profiles in patients with advanced knee osteoarthritis.

    PubMed

    Frey-Law, Laura A; Bohr, Nicole L; Sluka, Kathleen A; Herr, Keela; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Zimmerman, M Bridget; Rakel, Barbara A

    2016-09-01

    The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a "low pressure pain" group, an "average pain" group, and 3 "high pain" sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease. PMID:27152688

  16. Patient-adapted treatment for prosthetic hip joint infection.

    PubMed

    Baker, Richard P; Furustrand Tafin, Ulrika; Borens, Olivier

    2015-01-01

    Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach. PMID:26044528

  17. The genetic influence on radiographic osteoarthritis is site specific at the hand, hip and knee

    PubMed Central

    Li, Q.; Spector, T. D.; Williams, F. M. K.

    2009-01-01

    Objective. To identify whether a shared genetic influence accounts for the occurrence of OA at different skeletal sites. Methods. Multivariate modelling of data on prevalent radiographic OA at the hand (DIP, PIP and CMC joints), hip and knee joints assessed in 992 monozygotic and dizygotic female twin participants from the TwinsUK Registry. Results. OA at all the five joint sites was heritable. Genetic influences were strongly correlated among joints in the hand; however, there was little evidence of common genetic pathways to account for the co-occurrence of OA at the hand, hip and knee. Conclusions. While genetic influences are important in explaining the variation in occurrence of OA at the hand, hip and knee, there is no evidence that common or shared genetic factors determine the occurrence of disease across all these skeletal sites. The findings suggest that there are important aetiological differences in the disease that are site-specific in women. These results have implications for the design of studies examining the genetic basis of OA as well as for strategies aimed at preventing and treating the disease. PMID:19153142

  18. Surgical treatments for osteoarthritis.

    PubMed

    de l'Escalopier, Nicolas; Anract, Philippe; Biau, David

    2016-06-01

    There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures. PMID:27185463

  19. Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions

    PubMed Central

    Rahmann, Ann E

    2010-01-01

    Expert opinion considers the referral of people with osteoarthritis (OA) for physiotherapy to be a core component of managing the functional disability and pain of the disease. Clinical guidelines for the physiotherapy management of people with OA focus on three main areas: exercise, pain relief, and specific manual therapy techniques. Land-based group and individual physiotherapy exercise programs, as well as manual therapy, have demonstrated a distinct benefit in favor of physiotherapy intervention. Similarly, both general and specific aquatic physiotherapy exercise programs have shown positive outcomes for people with OA. This review will focus primarily on therapeutic exercise to improve strength and fitness and reduce pain in people with hip or knee OA. An overview of the principles of hydrodynamics relevant to aquatic exercise is also included to facilitate an understanding of effective aquatic exercise programs. The issue of compliance with exercise programs will also be discussed. Clinicians will, therefore, gain an understanding of the benefits of land-based and aquatic exercise for people with OA. PMID:24198550

  20. Fat embolism in patients with fractured hips.

    PubMed

    Sevitt, S

    1972-04-29

    Fat embolism was assessed at necropsy and correlated with clinical findings in the patients who died among 854 with fractured hips admitted to hospital between 1967 and August 1971. Sixteen cases of clinical importance were found, eight of which were judged to have been fatal or to have seriously contributed to death. Frequencies were as follows: 2.4 to 3.3% among 424 patients with subcapital fractures; 0.7 to 0.8% in the 405 with trochanteric fractures; 4.1 to 7% among subjects treated without operation, representing 30% of those who died within seven days; and 0.9 to 1.1% among patients treated by pinning, nailing, or nail-plating. The higher frequency in the conservatively treated group is probably related to selection of poor-risk subjects. Fat embolism was found in 6.8 to 8.0% of those with subcapital fractures treated by primary Thompson's arthroplasty which utilizes acrylic cement, and in none of those given Moore's prostheses for which cement is not used. Study of a larger group after Moore's prosthesis is required to establish its lack of special risk. Fat embolism accounted for all the deaths within seven days of Thompson's arthroplasty and for most within 14 days; it was clearly related to surgery in some cases.A possible explanation of the hazard of Thompson's arthroplasty is that fat globule entry is enhanced by a rise of intramedullary pressure due to proximal occlusion of the reamed marrow cavity. A controlled trial of the effect of venting the marrow cavity on the frequency of fat embolism is warranted. It is possible that the acrylic monomer may also contribute to venous entry of medullary fat. The higher-age group of those with subcapital fractures and associated chronic cardiac and pulmonary disease might make them more susceptible to fat embolization than those in whom arthroplasty is also carried out for chronic hip disease. PMID:5022012

  1. Fat Embolism in Patients with Fractured Hips

    PubMed Central

    Sevitt, Simon

    1972-01-01

    Fat embolism was assessed at necropsy and correlated with clinical findings in the patients who died among 854 with fractured hips admitted to hospital between 1967 and August 1971. Sixteen cases of clinical importance were found, eight of which were judged to have been fatal or to have seriously contributed to death. Frequencies were as follows: 2·4 to 3·3% among 424 patients with subcapital fractures; 0·7 to 0·8% in the 405 with trochanteric fractures; 4·1 to 7% among subjects treated without operation, representing 30% of those who died within seven days; and 0·9 to 1·1% among patients treated by pinning, nailing, or nail-plating. The higher frequency in the conservatively treated group is probably related to selection of poor-risk subjects. Fat embolism was found in 6·8 to 8·0% of those with subcapital fractures treated by primary Thompson's arthroplasty which utilizes acrylic cement, and in none of those given Moore's prostheses for which cement is not used. Study of a larger group after Moore's prosthesis is required to establish its lack of special risk. Fat embolism accounted for all the deaths within seven days of Thompson's arthroplasty and for most within 14 days; it was clearly related to surgery in some cases. A possible explanation of the hazard of Thompson's arthroplasty is that fat globule entry is enhanced by a rise of intramedullary pressure due to proximal occlusion of the reamed marrow cavity. A controlled trial of the effect of venting the marrow cavity on the frequency of fat embolism is warranted. It is possible that the acrylic monomer may also contribute to venous entry of medullary fat. The higher-age group of those with subcapital fractures and associated chronic cardiac and pulmonary disease might make them more susceptible to fat embolization than those in whom arthroplasty is also carried out for chronic hip disease. PMID:5022012

  2. Can we identify patients with high risk of osteoarthritis progression who will respond to treatment? A focus on epidemiology and phenotype of osteoarthritis.

    PubMed

    Bruyère, Olivier; Cooper, Cyrus; Arden, Nigel; Branco, Jaime; Brandi, Maria Luisa; Herrero-Beaumont, Gabriel; Berenbaum, Francis; Dennison, Elaine; Devogelaer, Jean-Pierre; Hochberg, Marc; Kanis, John; Laslop, Andrea; McAlindon, Tim; Reiter, Susanne; Richette, Pascal; Rizzoli, René; Reginster, Jean-Yves

    2015-03-01

    Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis. PMID:25701074

  3. Patient-Perceived Quality of Life after Total Hip Arthroplasty: Elective versus Traumatological Surgery

    PubMed Central

    Aprato, Alessandro; Massè, Alessandro; Caranzano, Francesco; Matteotti, Renato; Pautasso, Patrick; Daghino, Walter; Kain, Michael; Governale, Giorgio

    2011-01-01

    Purpose. The aim was to evaluate and compare patient's health-related quality of life after THA for osteoarthritis and femoral neck fracture. The postoperative outcome was retrospectively evaluated in patients who underwent THA with an intracapsular femoral neck fracture (Group A) or with an hip osteoarthritis (Group B). Methods. Length discrepancy was measured on postoperative X-rays. Study groups were compared as to age, results of WOMAC and SF-36 tests, limb length discrepancy (LLD) by independent group t-test. Correlations between LLD and results obtained atWOMAC test were performed. 117 patients were enrolled. The 2 groups were similar as to age, type of implanted stem and sex. Mean follow up was 2,4 years for group A and 2,3 years for group B. Results. WOMAC score was found higher in group A in all items examinated. Correlation tests did not indicate a statistically significant linear relationship between LLD and WOMAC score in both groups. Conclusions. Patients who received THA for arthritis have better perception of quality of life than traumatologic patients. Although LLD should always be strongly considered by the surgeons performing a THA, LLD alone can't be considered as an indicator of patient dissatisfaction or clinical bad result after a 2-year followup. PMID:24977070

  4. Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow-up

    PubMed Central

    Grotle, Margreth; Hagen, Kare B; Natvig, Bard; Dahl, Fredrik A; Kvien, Tore K

    2008-01-01

    Background Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years. Methods A total of 1854 people aged 24–76 years in 1994 participated in a Norwegian study on musculoskeletal pain in both 1994 and 2004. Participants with OA or rheumatoid arthritis in 1994 and those above 74 years in 1994 were excluded, leaving n = 1675 for the analyses. The main outcome measure was OA diagnosis at follow-up based on self-report. Obesity was defined by a body mass index (BMI) of 30 and above. Results At 10-years follow-up the incidence rates were 5.8% (CI 4.3–7.3) for hip OA, 7.3% (CI 5.7–9.0) for knee OA, and 5.6% (CI 4.2–7.1) for hand OA. When adjusting for age, gender, work status and leisure time activities, a high BMI (> 30) was significantly associated with knee OA (OR 2.81; 95%CI 1.32–5.96), and a dose-response relationship was found for this association. Obesity was also significantly associated with hand OA (OR 2.59; 1.08–6.19), but not with hip OA (OR 1.11; 0.41–2.97). There was no statistically significant interaction effect between BMI and gender, age or any of the other confounding variables. Conclusion A high BMI was significantly associated with knee OA and hand OA, but not with hip OA. PMID:18831740

  5. Patient Blood Management in Hip Replacement Arthroplasty

    PubMed Central

    Lee, Jong Hee

    2015-01-01

    Perioperative blood transfusions are common in total hip arthroplasty because of preoperative anemia and perioperative blood loss. Perioperative anemia and the need for allogeneic blood transfusion are related with increased morbidity. To reduce perioperative allogeneic blood transfusion, keeping the preoperative hemoglobin level above 12.0 g/dL is important in orthopedic patients. By using the anti-fibrinolytic agent or perioperative cell salvage, reduce intraoperative blood loss is very important for the reduction of perioperative blood loss. As a transfusion trigger, low hemoglobin is another important target to reduce the transfusion rate. Because blood management is closely connected with prognosis, it has become a new challenge in orthopedic surgery. PMID:27536627

  6. Patient injuries in primary total hip replacement.

    PubMed

    Helkamaa, Teemu; Hirvensalo, Eero; Huhtala, Heini; Remes, Ville

    2016-06-01

    Background and purpose - Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods - We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results - We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume ≥ 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of < 400), the relative risks (RRs) of patient injury for any reason, due to technical errors, or because of cup malposition were 2-fold (95% CI: 1.6-3.1), 4-fold (95% CI: 2.3-6.2), and 9-fold (95% CI: 3-28), respectively, compared to high-volume hospitals. Interpretation - Our study provides the first comprehensive nationwide data on THR-related patient injury types. Hospital volume was associated with the quality and quantity of errors detected. An annual hospital volume of ≥ 400 primary THRs was established as a protective factor against patient injuries. PMID:26808350

  7. Patient injuries in primary total hip replacement

    PubMed Central

    Helkamaa, Teemu; Hirvensalo, Eero; Huhtala, Heini; Remes, Ville

    2016-01-01

    Background and purpose Although the results of primary total hip replacements (THRs) are generally excellent, sometimes serious complications arise. Some of these severe complications are considered to be patient injuries. We analyzed primary THR-related patient injuries in a nationwide setting. Patients and methods We evaluated all the primary THR-related patient injury claims in Finland between 2008 and 2010. We used the original medical records and 2 nationwide registries, the Care Register for Social Welfare and Health Care and the Patient Injury Claim Register. Results We identified 563 claims, 44% of which were compensated (n = 250). Of these 250 compensated claims, 79% were considered to be avoidable (treatment injuries) and 21% were severe unexpected infections (with a preoperative infection risk of less than 2%). The most common type of technical error was cup malposition (31%). High-volume hospitals (with an annual primary THR volume ≥ 400) had a lower patient injury rate. In lower-volume hospitals (with an annual primary THR volume of < 400), the relative risks (RRs) of patient injury for any reason, due to technical errors, or because of cup malposition were 2-fold (95% CI: 1.6–3.1), 4-fold (95% CI: 2.3–6.2), and 9-fold (95% CI: 3–28), respectively, compared to high-volume hospitals. Interpretation Our study provides the first comprehensive nationwide data on THR-related patient injury types. Hospital volume was associated with the quality and quantity of errors detected. An annual hospital volume of ≥ 400 primary THRs was established as a protective factor against patient injuries. PMID:26808350

  8. Patient preference and willingness to pay for knee osteoarthritis treatments

    PubMed Central

    Posnett, John; Dixit, Sanjeev; Oppenheimer, Brooks; Kili, Sven; Mehin, Nazanin

    2015-01-01

    Purpose To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments. Patients and methods A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. Results Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). Conclusion OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician. PMID:26089650

  9. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty

    PubMed Central

    Piscitelli, Prisco; Iolascon, Giovanni; Innocenti, Massimo; Civinini, Roberto; Rubinacci, Alessandro; Muratore, Maurizio; D’Arienzo, Michele; Leali, Paolo Tranquilli; Carossino, Anna Maria; Brandi, Maria Luisa

    2013-01-01

    Summary Background Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from “painful prosthesis”, which currently represents a clinical problem. Methods A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. Conclusions The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention. PMID:24133526

  10. Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis.

    PubMed

    Lubowitz, James H

    2015-11-01

    Systematic review of overlapping meta-analyses shows that platelet-rich plasma improves knee pain and function in patients with knee osteoarthritis. Ultimately, biologics hold promise for chondroprotection in addition to symptomatic relief. PMID:26542203

  11. Total Hip Arthroplasty in Patient with the Sequelae of Legg-Calvé-Perthes Disease

    PubMed Central

    Lim, Young Wook; Kim, Myung Jin; Lee, Yong Suk

    2014-01-01

    Purpose Patients who have secondary hip osteoarthritis as sequelae of Legg-Calvé-Perthes disease (LCPD) are severe deformities of femoral head and acetabulum. A few studies have presented that the clinical results and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD were not satisfactory. In this study, we reported the radiographic and clinical outcomes of THA in patients with sequelae of LCPD. Materials and Methods Between March 2007 and May 2012, 23 hips (23 patients) underwent cementless THA and were followed up at least 2 years after surgery. There were 11 male patients and 12 female patients with an average age of 49.2 years old (range, 25 to 69 years old), and the average follow up period was 40.8 months (range, 24 to 84 months). The clinical and radiological evaluations were performed. Results The Harris hip score improved from 48.3 points preoperatively to 92.4 points at the time of the last follow-up. The shortening of affected limb was improved from -1.6 cm to 0.2 cm. The complications included one case of sciatic nerve palsy that developed after extensive lengthening of lower extremity, three cases of intraoperative femur fractures. There was no component loosening. Conclusion Fractures and motor nerve palsies may be more frequent in this population. Careful preoperative planning should be performed to overcome the technical pitfalls. If overcoming this early complication, the clinical and radiological evaluations showed excellent outcomes at average 40-month follow-ups.

  12. Biomechanical Analysis of Stair Descent in Patients with Knee Osteoarthritis

    PubMed Central

    Igawa, Tatsuya; Katsuhira, Junji

    2014-01-01

    [Purpose] The purposes of this study were to investigate the lower extremity joint kinematics and kinetics of patients with the knee osteoarthritis (knee OA) during stair descent and clarify the biomechanical factors related to their difficulty in stair descent. [Subjects and Methods] Eight healthy elderly persons and four knee OA patients participated in this study. A 3-D motion analysis system and force plates were employed to measure lower extremity joint angles, ranges of motion, joint moments, joint powers, and ratios of contribution for the joint powers while descending stairs. [Results] Knee joint flexion angle, extension moment, and negative power during the early stance phase in the knee OA group were smaller than those in the healthy subjects group. However, no significant changes in these parameters in the ankle joint were observed between the two subject groups. [Conclusion] Knee OA patients could not use the knee joint to absorb impact during the early stance phase of stair descent. Hence, they might compensate for the roles played by the intact knee joint by mainly using ipsilateral ankle kinematics and kinetics. PMID:24926119

  13. Treatment strategies for osteoarthritis patients with pain and hypertension.

    PubMed

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-08-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  14. Treatment Strategies for Osteoarthritis Patients with Pain and Hypertension

    PubMed Central

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-01-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  15. Premature development of erosive osteoarthritis of hands in patients with chronic renal failure.

    PubMed Central

    Duncan, I J; Hurst, N P; Sebben, R; Milazzo, S C; Disney, A

    1990-01-01

    The prevalence of grade III or IV osteoarthritis was determined in 210 patients with chronic renal failure, of whom 94 were receiving chronic haemodialysis and 116 had functioning renal transplants. The prevalence of grade III or IV osteoarthritis was three times greater in patients under 65 than in a control population, and all but two affected patients also had erosion of subchondral bone in at least one affected joint. The excess of osteoarthritis was apparent in both the transplant recipients and those receiving haemodialysis. Over the age of 65 there was no significant difference in prevalence. Metabolic bone disease, including osteopenia, might contribute to the development of erosive osteoarthritis in chronic renal failure. Images PMID:2383060

  16. BLEEDING OF FEMORAL HEAD DURING TOTAL HIP ARTHROPLASTY FOR OSTEOARTHROSIS

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Sotomayor, Marco Yánez; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Objective: To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty. Methods: One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB). Results: We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05). Conclusions: The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study. PMID:26981036

  17. [Symptoms. Localizations: knee, hip, hands, spine, other localizations].

    PubMed

    Pérez Martín, Álvaro

    2014-01-01

    The symptoms of osteoarthritis vary widely from patient to patient, depending especially on the localization on the disease. There is a poor correlation between radiological involvement and pain. In general, symptom onset is gradual and symptoms increase slowly but progressively. The most commonly affected joints are the knees, hips, hands, and spine. The main signs and symptoms are pain, stiffness, joint deformity, and crepitus. Pain is mechanical and its causes are multifactorial; in the initial phases, pain usually manifests in self-limiting episodes but may subsequently be almost constant. The criteria of the American college of Rheumatology for the classification of osteoarthritis of the knee, hip and hands are an aid to classification and standardization but are not useful for diagnosis. Hip osteoarthritis usually produces inguinal pain in the internal and anterior sections of the muscle extending to the knee and, with progression, tends to limit mobility. Knee osteoarthritis is more frequent in women and is usually associated with hand osteoarthritis and obesity. In hand osteoarthritis, the most commonly affected joints are the distal interphalangeal joints, followed by the proximal interphalangeal joints and the trapeziometacarpal joints; the development of Heberden and Bouchard nodes is common; involvement of the trapeziometacarpal joint is called rhizarthrosis and is one of the forms of osteoarthritis that produces the greatest limitation on hand function. Osteoarthritis of the spine affects the facet joints and the vertebral bodies. Other, less frequent, localizations are the foot, elbow and shoulder, which are generally secondary forms of osteoarthritis. PMID:24467955

  18. Patient reported outcomes in hip arthroplasty registries.

    PubMed

    Paulsen, Aksel

    2014-05-01

    PROs are used increasingly in orthopedics and in joint registries, but still many aspects of use in this area have not been examined in depth. To be able to introduce PROs in the DHR in a scientific fashion, my studies were warranted; the feasibility of four often used PROs (OHS, HOOS, EQ-5D and SF-12) was examined in a registry context. Having the PROs in the target language is an absolute necessity, so I translated, cross-culturally adapted and validated a Danish language version of an often used PRO (OHS), since this PRO had no properly developed Danish language version. To minimize data loss and to maximize the data quality I validated our data capture procedure, an up to date AFP system, by comparing scannable, paper-based PROs, with manual single-key- and double-key entered data. To help further registry-PRO studies, I calculated the number of patients needed to discriminate between subgroups of age, sex, diagnosis, and prosthesis type for each of four often used PROs (OHS, HOOS, EQ-5D and SF-12), and to simplify the clinical interpretation of PRO scores and PRO change scores in PRO studies, I estimated MCII and PASS for two often used PROs (EQ-5D and HOOS). The feasibility study included 5,747 THA patients registered in the DHR, and I found only minor differences between the disease-specific and the generic PROs regarding ceiling and floor effects as well as discarded items. The HOOS, the OHS, the SF-12, and the EQ-5D are all appropriate PROs for administration in a hip registry. I found that group sizes from 51 to 1,566 were needed for subgroup analysis, depending on descriptive factors and choice of PRO. The AFP study included 200 THA patients (398 PROs, 4,875 items and 21,887 data fields), and gave excellent results provided use of highly structured questionnaires. OMR performed equally as well as manual double-key entering, and better than single-key entering. The PRO translation and validation study included 2,278 patients (and 212 patients for the test

  19. Total Hip Arthroplasty in Patient with Aplastic Anemia

    PubMed Central

    Lim, Young Wook; Kim, Seung Chan; Kwon, Soon Yong; Park, Do Joon

    2016-01-01

    Purpose Patients with aplastic anemia (AA) are now living longer and therefore are at increased risk for the development of osteonecrosis of the hip. However, studies on the results of total hip arthroplasty (THA) are lacking. The purpose of this study is to present the result of THA in patients with AA. Materials and Methods We retrospectively reviewed the data for a group of 29 patients (45 hips) with AA who presented to our institution for THA between May 2008 and May 2012. All hips were replaced because of osteonecrosis of the femoral head. A specific prospective protocol was followed for the perioperative transfusion of platelets and blood. The clinical and radiographic evaluations were done, and the minimum follow-up period was 3 years (mean, 49.2 months; range, 36 to 84 months). Results Three hips had excessive perioperative bleeding and hematoma formation, and then hematoma evacuations were done; one hip was finally revised because of infection of acetabular component. One patient with poorly controlled AA died due to delayed infection on the hip joint. All hips showed stable fixation, and the mean Harris hip score was improved from 54.2 points (range, 42 to 69 points) preoperatively to 90.8 points (range, 73 to 97 points) at the time of the latest follow-up. Conclusion In the present study, the durability of implant fixation was maintained and the clinical results demonstrated a sustained increase in function of the hip. Postoperatively, paying attention to bleeding and infection should be needed. PMID:27536640

  20. Effects of administration of adipose-derived stromal vascular fraction and platelet-rich plasma to dogs with osteoarthritis of the hip joints.

    PubMed

    Upchurch, David A; Renberg, Walter C; Roush, James K; Milliken, George A; Weiss, Mark L

    2016-09-01

    OBJECTIVE To evaluate effects of simultaneous intra-articular and IV injection of autologous adipose-derived stromal vascular fraction (SVF) and platelet-rich plasma (PRP) to dogs with osteoarthritis of the hip joints. ANIMALS 22 client-owned dogs (12 placebo-treated [control] dogs and 10 treated dogs). PROCEDURES Dogs with osteoarthritis of the hip joints that caused signs of lameness or discomfort were characterized on the basis of results of orthopedic examination, goniometry, lameness score, the Canine Brief Pain Inventory (CBPI), a visual analogue scale, and results obtained by use of a pressure-sensing walkway at week 0 (baseline). Dogs received a simultaneous intraarticular and IV injection of SVF and PRP or a placebo. Dogs were examined again 4, 8, 12, and 24 weeks after injection. RESULTS CBPI scores were significantly lower for the treatment group at week 24, compared with scores for the control group. Mean visual analogue scale score for the treatment group was significantly higher at week 0 than at weeks 4, 8, or 24. Dogs with baseline peak vertical force (PVF) in the lowest 25th percentile were compared, and the treatment group had a significantly higher PVF than did the control group. After the SVF-PRP injection, fewer dogs in the treated group than in the control group had lameness confirmed during examination. CONCLUSIONS AND CLINICAL RELEVANCE For dogs with osteoarthritis of the hip joints treated with SVF and PRP, improvements in CBPI and PVF were evident at some time points, compared with results for the control group. PMID:27580105

  1. Electromyographic power spectrum of jaw muscles during clenching in unilateral temporomandibular joint osteoarthritis patients.

    PubMed

    Park, I H; McCall, W D; Chung, J W

    2012-09-01

    The relationship between temporomandibular joints (TMJ) osteoarthritis and masticatory muscle disorders is poorly understood. The data are sparse, the results are conflicting, and electromyographic (EMG) power spectrum analysis has not been used. The aims of this study were to compare the differences in EMG power spectrum during, and pressure pain thresholds (PPTs) before and after, sustained clenching in patients with unilateral TMJ osteoarthritis and healthy control subjects. Nineteen patients with unilateral TMJ osteoarthritis without masticatory muscle pain and 20 control subjects were evaluated. We measured EMG amplitudes at maximum voluntary contraction, median frequency from the EMG power spectrum during sustained clenching at 70% and PPTs before and after the clenching in both temporalis and masseter muscles. There were no significant differences in PPT decrease between muscles or between groups during sustained clenching. There were no significant differences in maximum voluntary contraction EMG activity ratios of affected to unaffected sides between groups, or of masseter to temporalis muscles between affected and unaffected side of patients with TMJ osteoarthritis. Median frequencies decreased from the beginning to the end of the sustained clench, and the interaction between group and clench was significant: the median frequency decrease was larger in the osteoarthritis group. Our results suggested that masticatory muscles of patients with unilateral TMJ osteoarthritis are more easily fatigued during sustained clenching than normal subjects. PMID:22672238

  2. Knee motion variability in patients with knee osteoarthritis: the effect of self-reported instability

    PubMed Central

    Gustafson, Jonathan A.; Robinson, Megan E.; Fitzgerald, G. Kelley; Tashman, Scott; Farrokhi, Shawn

    2015-01-01

    Background Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. Methods Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. Findings The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03). Interpretation The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation. PMID:25796536

  3. Current concepts in osteoarthritis

    PubMed Central

    de Rezende, Márcia Uchôa; de Campos, Gustavo Constantino; Pailo, Alexandre Felício

    2013-01-01

    Osteoarthritis (OA), the most common form of joint disease, affects mainly the hips, knees, hands and feet, leading to severe disability and loss of quality of life, particularly in the elderly population. Its importance grows every year with the aging of the population, with a large increase in the elderly population compared to younger patients. The progressive understanding of the pathophysiology of OA, the perception that the process is not purely mechanical and / or aging, and clarification of the inflammatory pathways involved led recently to the clinical application of various drugs and other measures. This update aims to expose the current concepts on the pathophysiology and treatment of OA. PMID:24453655

  4. The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery.

    PubMed

    González Della Valle, A; Sharrock, N; Barlow, M; Caceres, L; Go, G; Salvati, E A

    2016-01-01

    We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology. PMID:26733642

  5. Effectiveness of diclofenac versus acetaminophen in primary care patients with knee osteoarthritis: [NTR1485], DIPA-Trial: design of a randomized clinical trial

    PubMed Central

    2010-01-01

    Background Osteoarthritis is the most frequent chronic joint disease which causes pain and disability of especially hip and knee. According to international guidelines and the Dutch general practitioners guidelines for non-traumatic knee symptoms, acetaminophen should be the pain medication of first choice for osteoarthritis. However, of all prescribed pain medication in general practice, 90% consists of non-steroidal anti-inflammatory drugs compared to 10% of acetaminophen. Because general practitioners may lack evidence showing a similar efficacy of acetaminophen and non-steroidal anti-inflammatory drugs, we present the design of a randomized open-label trial to investigate the efficacy of a non-steroidal anti-inflammatory drug (diclofenac) compared with acetaminophen in new consulters with knee osteoarthritis in general practice. Methods/Design Patients aged 45 years or older consulting their general practitioner with non-traumatic knee pain, meeting the clinical American College of Rheumatology criteria, and with a pain severity score of 2 or higher (on a 0-10 scale), will be randomly allocated to either diclofenac (maximum daily dose of 150 mg) or acetaminophen (maximum daily dose of 3000 mg) for 2 weeks and, if required, an additional 1-2 weeks, with a total follow-up period of 12 weeks. The primary outcomes are knee pain measured with a daily diary, and pain and function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, and at 3, 6, 9, and 12-weeks follow-up. Secondary outcomes are patients' perceived recovery, quality of life, medical, patient, and productivity costs, compliance to therapy, co-interventions, and adverse reactions. Discussion The successful completion of this trial would lead to a better understanding of which medication should be used in the treatment of primary care patients with mild knee osteoarthritis. Trial registration Dutch trial registry NTR1485. PMID:20067607

  6. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    PubMed Central

    Fenstad, Anne M; Dale, Håvard; Havelin, Leif; Hallan, Geir; Overgaard, Søren; Pedersen, Alma B; Kärrholm, Johan; Garellick, Göran; Pulkkinen, Pekka; Eskelinen, Antti; Mäkelä, Keijo; Engesæter, Lars B; Fevang, Bjørg-Tilde

    2015-01-01

    Background and purpose Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year period, and compared it with that in THR patients with osteoarthritis (OA). Patients and methods We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery. Results RA patients had a 1.3 times (95% CI 1.0–1.6) higher risk of revision for infection. After 2001, this risk increased more for RA patients than for OA patients. During the first 3 months and from 8 years postoperatively, the risk of revision for infection was higher in RA patients with THRs fixated with antibiotic-loaded cement than in corresponding OA patients. Interpretation We found a slightly higher overall risk of revision for infection in RA patients than in OA patients, but this difference was only present after 2001. In THRs with antibiotic-loaded cement, the risk of very early and late infections leading to revision was higher in RA patients than in OA patients. PMID:25782042

  7. Current Challenges in Pain Management in Hip Fracture Patients.

    PubMed

    Sanzone, Anthony G

    2016-05-01

    The high incidence of hip fracture, together with considerable associated morbidity, mortality, and cost of care, makes this injury a major clinical challenge. Of particular importance is the pain associated with hip fracture, which can have potentially severe consequences and may lead to delayed recovery. The prevailing opioid-dependent model of analgesia, however, presents multiple drawbacks and risks that can compromise outcomes in the hip fracture population. The pain management process has essential preoperative, intraoperative, and postoperative components, yet data on the comparative effectiveness of different pain management interventions in patients undergoing surgery for hip fracture are not clear cut. A Cochrane database review that included 83 different pain management studies indicated that there are not enough well-designed studies to show unequivocally which pain management approaches work well after hip fracture surgery. Yet a growing body of data on certain interventions, such as nerve blocks and multimodal analgesia, supports consideration of these options. PMID:27101319

  8. An Unusual Cause of Fever in a Patient with Total Hip Replacement.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-01-01

    Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment. PMID:27014530

  9. An Unusual Cause of Fever in a Patient with Total Hip Replacement

    PubMed Central

    Vaishya, Raju; Vijay, Vipul

    2016-01-01

    Pyrexia of unknown origin (PUO) in a patient with acquired immunodeficiency syndrome (AIDS) is a challenging clinical problem despite recent advances in the diagnostic modalities. The diagnosis of the cause of fever is especially difficult in the postoperative period as the focus remains on the operative site. We present an unusual cause of PUO in a patient with advanced HIV disease during an immediate postoperative period following total hip arthroplasty (THA) for osteoarthritis (OA) of the left hip. The fever started on the eighth postoperative day, and after an extensive workup to rule out infection it was found that the patient was allergic to sulfa drugs. The fever subsided after discontinuation of trimethoprim/sulfamethoxazole. Fever in an immunocompromised patient should not be attributed only to infection. A high index of suspicion along with careful history making is required to diagnose drug fever. An early diagnosis of drug fever can reduce hospital stay and the costs of investigations and treatment. PMID:27014530

  10. Patients’ values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences

    PubMed Central

    Zhang, Yuqing; Tikkinen, Kari A O; Agoritsas, Thomas; Ayeni, Olufemi R; Alexander, Paul; Imam, Maha; Yoo, Daniel; Tsalatsanis, Athanasios; Djulbegovic, Benjamin; Thabane, Lehana; Schünemann, Holger; Guyatt, Gordon H

    2014-01-01

    Introduction Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients’ symptoms and improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients’ values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients’ VP. Methods and analysis We will perform a multinational, structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy. We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences. Eligible patients will be randomly assigned (1 : 1) to either a short or a long format of health scenarios of THA and HA. We will determine each patient's VP using a trade-off and anticipated regret exercises. Our primary outcomes for the combined surveys will be: (1) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA, (2) patients’ satisfaction with the amount of information provided in the health scenarios used to elicit their VPs. Ethics and dissemination The protocol has been approved by the Hamilton Integrated Research Ethics Board (HIREB13-506). We will disseminate our study findings through peer-reviewed publications and conference presentations, and make them

  11. Contemporary Concepts in the Young Adult Hip Patient: Periacetabular Osteotomy for Hip Dysplasia.

    PubMed

    Coobs, Benjamin R; Xiong, Ao; Clohisy, John C

    2015-07-01

    The Bernese periacetabular osteotomy, as originally described by Dr. Reinhold Ganz, is an effective treatment for symptomatic acetabular dysplasia in the pre-arthritic young adult hip. This technique has experienced several recent modifications in an attempt to optimize the clinical outcomes of these patients. We will review the clinical presentation of acetabular dysplasia, indications for surgery, contemporary refinements in technique and clinical results following periacetabular osteotomy. In well-selected patients, this reconstructive osteotomy should be considered safe and effective in alleviating pain and improving hip function. PMID:25865812

  12. Early results of the Acclaim total elbow replacement in patients with primary osteoarthritis.

    PubMed

    Naqui, S Z; Rajpura, A; Nuttall, D; Prasad, P; Trail, I A

    2010-05-01

    This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged > or = 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4). Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved. This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged > or = 65 years with primary osteoarthritis of the elbow. PMID:20436004

  13. Hip Arthroplasty in Obese Patients: Rising Prevalence–Standard Procedures?

    PubMed Central

    Skutek, Michael; Wirries, Nils; von Lewinski, Gabriela

    2016-01-01

    We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed. PMID:27433302

  14. Hip Arthroplasty in Obese Patients: Rising Prevalence-Standard Procedures?

    PubMed

    Skutek, Michael; Wirries, Nils; von Lewinski, Gabriela

    2016-06-27

    We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed. PMID:27433302

  15. Hip Dysplasia in the Young Adult.

    PubMed

    Gala, Luca; Clohisy, John C; Beaulé, Paul E

    2016-01-01

    Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip. An increase in mechanical stress on the cartilage matrix with failure of the acetabular labrum represents the major pathomechanism of degeneration. Because the prevalence of associated femoral deformities is high (>50%), the structural anatomy of the dysplastic hip must be assessed in multiple planes using radiographs and, if needed, advanced imaging modalities. Acetabular osteotomy (periacetabular and/or rotational) is the most commonly used procedure for the treatment of the majority of dysplastic hips in adults. Modern total hip replacement remains an excellent option for the more arthritic joints. Difficulties can arise from anatomical abnormalities and previous operations. PMID:26738905

  16. Hip Injuries and Disorders

    MedlinePlus

    ... or falling can all sometimes lead to hip injuries. These include Strains Bursitis Dislocations Fractures Certain diseases also lead to hip injuries or problems. Osteoarthritis can cause pain and limited ...

  17. Hip fracture surgery

    MedlinePlus

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  18. Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients

    PubMed Central

    Argoff, Charles E; Gloth, F Michael

    2011-01-01

    Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide solution (D-DMSO), are approved in the US for the treatment of osteoarthritis pain. Topical NSAIDs have shown efficacy and safety in knee (DSG, D-DMSO) and hand (DSG) osteoarthritis. Analyses of data from randomized controlled trials of DSG in hand and knee osteoarthritis demonstrate significant improvement of pain and function in both younger patients (<65 years) and older patients (≥65 years) and suggest good safety and tolerability. However, long-term safety data in older patients are limited. Topical NSAIDs can ease medication administration and help address barriers to pain management in older patients, such as taking multiple medications and inability to swallow, and are a valuable option for long-term care providers. PMID:22076115

  19. Estrogens, cartilage, and osteoarthritis.

    PubMed

    Richette, Pascal; Corvol, Maïté; Bardin, Thomas

    2003-08-01

    A role for estrogens in osteoarthritis is consistent with the larger increases in women than in men in the incidence and prevalence of hip, knee, and finger osteoarthritis after 50 years of age. Furthermore, hormone replacement therapy for the menopause seems to be associated with a decrease in the prevalence of symptoms and radiological alterations related to hip and knee osteoarthritis. The two estrogen receptors alpha and beta (ERalpha and Erbeta) have been identified in normal and osteoarthritic cartilage, indicating that cartilage can respond to estrogens. Finally, in vivo experiments in animals and in vitro studies have shed light on the mechanisms by which estrogens may influence chondrocyte metabolism. PMID:12951307

  20. Are Hip-Specific Items Useful in a Quality of Life Questionnaire for Patients with Hip Fractures?

    ERIC Educational Resources Information Center

    Yao, Kai-Ping Grace; Lee, Hsin-Yi; Tsauo, Jau-Yih

    2009-01-01

    Researchers measure the significance of hip fracture by the patient's impairment. The patient's quality of life (QOL) is usually also substantially affected. However, there is no specific quality of life (QOL) questionnaire for patients with hip fractures. This study was designed to determine whether adding a new set of specific questions about…

  1. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  2. Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: A randomized, controlled trial

    PubMed Central

    Broderick, Joan E.; Keefe, Francis J.; Bruckenthal, Patricia; Junghaenel, Doerte U.; Schneider, Stefan; Schwartz, Joseph E.; Kaell, Alan T.; Caldwell, David S.; McKee, Daphne; Reed, Shelby; Gould, Elaine

    2014-01-01

    A multisite, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners provided a 10-session intervention, pain coping skills training (PCST), in patients’ doctors’ offices (N = 129 patients); the control group received usual care (N = 127 patients). Primary outcomes assessed at baseline, posttreatment, 6-month follow-up, and 12-month follow-up were: pain intensity, physical functioning, psychological distress, self-efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary ITT and secondary per-protocol analyses were conducted. Attrition was within the expected range: 11% at posttreatment and 29% at 12-month follow-up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared with the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self-efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self-efficacy, were maintained through the 12-month follow-up; effects for self-efficacy degraded over time. Per-protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more vs less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of nurse practitioner delivery of PCST for chronic osteoarthritis pain. PMID:24865795

  3. Development of a Decision Support System to Predict Physicians' Rehabilitation Protocols for Patients with Knee Osteoarthritis

    ERIC Educational Resources Information Center

    Hawamdeh, Ziad M.; Alshraideh, Mohammad A.; Al-Ajlouni, Jihad M.; Salah, Imad K.; Holm, Margo B.; Otom, Ali H.

    2012-01-01

    To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee…

  4. Elderly patients with a hip fracture: the risk for delirium.

    PubMed

    Schuurmans, Marieke J; Duursma, Sijmen A; Shortridge-Baggett, Lillie M; Clevers, Gert-Jan; Pel-Littel, Ruth

    2003-05-01

    This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised. PMID:12764718

  5. Less invasive modified Spitzy shelf procedure for patients with dysplasia of the hip.

    PubMed

    Okanoue, Yusuke; Kawakami, Teruhiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Ikeuchi, Masahiko

    2015-05-01

    The shelf procedure for developmental dysplasia of the hip (DDH) is a simpler technique compared with periarticular acetabular osteotomies. However, the most commonly used approach involves the exposure of a large section of the outer iliac surface via a long skin incision and is relatively invasive. We have developed a mini one-incision technique for shelf procedure using bioabsorbable material, based on a modified Spitzy method. In the present report, we describe this procedure and outcomes. For the procedure, the patients are positioned in the lateral position and a 6-8-cm skin incision is made. The interval between the gluteus medius and the tensor fascia lata is developed without any muscle splitting. Thereafter, image intensification is used for accurate positioning of a slot for the new shelf, and a bone graft for the new shelf is obtained from the internal cortex of the iliac wing. The patient is then positioned with the hip in flexion; through the same sliding skin incision, the bone graft is impacted into the slot, and bioabsorbable screws or plates are implanted to cover and stabilise the new shelf. Cancellous bone chips are packed into the triangular space surrounded by the outer iliac surface, the new shelf, and the bioabsorbable screws or plate. We performed this procedure in 9 patients (12 hips). No progression of osteoarthritis was observed during the follow-up period (mean 28 months). The advantages of this procedure include the small, single, skin incision and minimal removal of the gluteus medius from the outer iliac surface. Based on our results, we believe that this procedure could be effective for the treatment of DDH. PMID:25205470

  6. Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial

    PubMed Central

    2014-01-01

    Background: A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among patients with a hip fracture. Methods: Patients aged 45 years or older who, during weekday, daytime working hours, received a diagnosis of a hip fracture requiring surgery were randomly assigned to receive accelerated or standard care. Our feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. The main clinical outcome, assessed by data collectors and adjudicators who were unaware of study group allocations, was a major perioperative complication (i.e., a composite of death, preoperative myocardial infarction, myocardial injury after noncardiac surgery, pulmonary embolism, pneumonia, stroke, and life-threatening or major bleeding) within 30 days of randomization. Results: Of patients eligible for inclusion, 80% consented and were randomly assigned to groups (30 to accelerated care and 30 to standard care) at 2 centres in Canada and 1 centre in India. All patients completed 30-day follow-up. The median time from diagnosis to surgery was 6.0 hours in the accelerated care group and 24.2 hours in the standard care group (p < 0.001). A major perioperative complication occurred in 9 (30%) of the patients in the accelerated care group and 14 (47%) of the patients in the standard care group (hazard ratio 0.60, 95% confidence interval 0.26–1.39). Interpretation: These results show the feasibility of a trial comparing accelerated and standard care among patients with hip fracture and support a definitive trial. Trial registration: ClinicalTrials.gov, no. NCT01344343. PMID:24246589

  7. A knee monitoring device and the preferences of patients living with osteoarthritis: a qualitative study

    PubMed Central

    Papi, Enrica; Belsi, Athina; McGregor, Alison H

    2015-01-01

    Objectives To identify perspective of patients with osteoarthritis, in particular design requirements and mode of use, of wearable technology to support the rehabilitation pathway. This study is part of a user-centred design approach adopted to develop a rehabilitation tool for patients with osteoarthritis. Design Qualitative study using a focus group approach; data management via a thematic analysis of patients’ responses. Participants 21 patients with osteoarthritis (age range 45–65 years) participated in 1 of the 4 focus groups. Recruitment continued until data saturation. Setting The study was conducted in a university setting. Results Main determinants of user acceptance of a wearable technology were appearance and comfort during use. Patients were supportive of the use of wearable technologies during rehabilitation and could recognise their benefit as monitors for their progress, incentives to adhere to exercise, and tools for more informed interaction with clinicians. Conclusions This paper should encourage adoption and development of wearable technology to support rehabilitation of patients with osteoarthritis. It is pivotal that technological development takes into account patients’ views in that it should be small, light, discrete, not ‘appear medical’ or challenge the identity of the user. Derived data should be available to patients and clinicians. Furthermore, wearable technologies should be developed to operate in two modes: for exercise guidance and assessment only, and for unobtrusive everyday monitoring. The information obtained from this study should guide the design of new technologies and support their use in clinical practice. PMID:26346873

  8. A rational program of exercise for patients with osteoarthritis.

    PubMed

    Bunning, R D; Materson, R S

    1991-12-01

    This report provides a history of exercise therapy, gives background for and defines relevant terms, and describes common gross manifestations of osteoarthritis (OA). Bias and dogmatism concerning arthritis treatment are examined. Treatment using exercise and physical medicine modalities with reference to recent pertinent literature is reviewed. Human and animal studies demonstrating the efficacy of conditioning and strengthening in the treatment of OA are analyzed critically, and methods to enhance compliance and directions of future exercise research are discussed. PMID:1796304

  9. Properties of the patient administered questionnaires: new scales measuring physical and psychological symptoms of hip and knee disorders.

    PubMed

    Mancuso, Carol A; Ranawat, Amar S; Meftah, Morteza; Koob, Trevor W; Ranawat, Chitranjan S

    2012-04-01

    The Patient Administered Questionnaires (PAQ) incorporate physical and psychological symptoms into one scale and permit more comprehensive self-reports for hip and knee disorders. We tested the psychometric properties of the PAQ-Hip and PAQ-Knee. Correlations between baseline PAQ-Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were .39 to .72 (n = 102), .39 to .69 for score change (n = 68 post-total hip arthroplasty), and most κ values > .60 (n = 50). Correlations between baseline PAQ-Knee and WOMAC were .35 to .64 (n = 100), .62 to .79 for score change (n = 43 post-total knee arthroplasty), and most κ values >.60 (n = 51). For both scales, effect sizes were higher than for the WOMAC, and there was modest correlation between physical and psychological questions, indicating these concepts are not completely interchangeable. Thus, the PAQ scales have strong psychometric properties and are unique compared with existing scales by including physical and psychological symptoms. PMID:21945079

  10. [Follow-up of patients with osteoarthritis. Coordinated management and criteria for referral between healthcare levels].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

    The correct management of osteoarthritis requires an accurate diagnosis, evaluation of its spread and functional repercussions, and the application of comprehensive and effective individually-tailored treatment aimed at relieving pain and improving physical function with a consequent improvement in quality of life; treatment should also aim to prevent or delay disease progression and its effects. In the National Health Service, primary care is the basic level and the first point of access to healthcare; this level guarantees the continuity of care, coordinates patients, and regulates clinical workflow. Family physicians coordinate the healthcare processes related to chronic diseases and are responsible for the management, diagnosis, evaluation, treatment, and follow-up of patients with osteoarthritis. The clinical practice guidelines internationally accepted as the standard of care for the management of osteoarthritis should be adapted by both Spanish health planning strategies and clinical practice guidelines to the Spanish healthcare setting. The comprehensive assessment of osteoarthritis includes evaluation of its effects on the patient's physical function and quality of life; formulating a treatment plan in collaboration with the patient and adapted to his or her comorbidities; providing advice on basic treatments and their risks and benefits; and carrying out an individually-tailored periodic review. Referral criteria are based on diagnostic confirmation, poor treatment response, and surgical evaluation. PMID:24467961

  11. A Walking Education Program for Patients with Osteoarthritis of the Knee: Theory and Intervention Strategies.

    ERIC Educational Resources Information Center

    Allegrante, John P.; And Others

    1993-01-01

    A walking program for osteoarthritis patients promoted adoption by guided practice, reinforcement, and stimulus control; facilitated compliance by behavioral contracting; maintained behavior change through generalization and self-control strategies; and prevented relapse by realignment of normative beliefs and planned relapse techniques. (SK)

  12. Altered Frontal and Transverse Plane Tibiofemoral Kinematics and Patellofemoral Malalignments During Downhill Gait in Patients with Mixed Knee Osteoarthritis

    PubMed Central

    Farrokhi, Shawn; Meholic, Brad; Chuang, Wei-Neng; Gustafson, Jonathan A.; Fitzgerald, G. Kelley; Tashman, Scott

    2015-01-01

    Patients with knee osteoarthritis often present with signs of mixed tibiofemoral and patellofemoral joint disease. It has been suggested that altered frontal and transverse plane knee joint mechanics play a key role in compartment-specific patterns of knee osteoarthritis, but invivo evidence in support of this premise remains limited. Using Dynamic Stereo X-ray techniques, the aim of this study was to compare the frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during the loading response phase of downhill gait in three groups of older adults: patients with medial tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=11); patients with lateral tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=10); and an osteoarthritis-free control group (n=22). Patients with lateral compartment osteoarthritis walked with greater and increasing degrees of tibiofemoral abduction compared to the medial compartment osteoarthritis and the control groups who walked with increasing degrees of tibiofemoral adduction. Additionally, the medial and lateral compartment osteoarthritis groups demonstrated reduced degrees of tibiofemoral internal rotation compared to the control group. Both medial and lateral compartment osteoarthritis groups also walked with increasing degrees of lateral patella tilt and medial patella translation during the loading response phase of downhill gait. Our findings suggest that despite the differences in frontal and transverse plane tibiofemoral kinematics between patients with medial and lateral compartment osteoarthritis, the malalignments of their arthritic patellofemoral joint appears to be similar. Further research is needed to determine if these kinematic variations are relevant targets for interventions to reduce pain and disease progression in patients with mixed disease. PMID:26087880

  13. Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.

    PubMed

    Pulikottil-Jacob, R; Connock, M; Kandala, N-B; Mistry, H; Grove, A; Freeman, K; Costa, M; Sutcliffe, P; Clarke, A

    2015-04-01

    Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient. PMID:25820881

  14. Early Assessment of Delirium in Elderly Patients after Hip Surgery

    PubMed Central

    Lee, Hyo Jin; Hwang, Deuk Soo; Wang, Seong Keun; Chee, Ik Seung; Baeg, Sengmi

    2011-01-01

    Objective This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. Methods This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium. Results Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group. Conclusion Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery. PMID:22216044

  15. Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.

    PubMed

    Nam, Denis; Nunley, Ryan M; Johnson, Staci R; Keeney, James A; Clohisy, John C; Barrack, Robert L

    2015-12-01

    This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE. PMID:26182980

  16. Switching from NSAIDs to paracetamol: a series of n of 1 trials for individual patients with osteoarthritis

    PubMed Central

    Wegman, A; van der Windt, D A W M; de Haan, M; Deville, W; Fo, C; de Vries, T. P G M

    2003-01-01

    Objectives: To investigate for individual patients who have been using NSAIDs regularly, whether paracetamol is as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of pain and disability related to osteoarthritis of the hip or knee. Methods: A series of n of 1 trials were conducted in general practices in Amsterdam and the surrounding area. Each patient was his or her own control and received five pairs of treatments comprising two weeks of an NSAID and two weeks of paracetamol. For each pair, the order of treatments was randomised. Outcome measures were severity of individual main complaints, intensity of pain, satisfaction with drugs, function test, and side effects. Results: Thirteen patients were selected. Six patients did not complete the study. For five patients completing the study little or no difference was found between NSAIDs and paracetamol, for one patient the results favoured the NSAID, and for one patient there was no association between outcome and type of drug. It was recommended that six patients changed to paracetamol; the others continued with NSAIDs. Three months after the end of the study, four of the six patients for whom paracetamol had been recommended were taking NSAIDs for practical reasons or perceived lack of efficacy. Conclusion: The results of the n of 1 trials varied across patients. n of 1 trials can be used to investigate which treatment is best for any specific person, thus avoiding unnecessary prolonged treatment with NSAIDs. However, practical reasons may cause patients to switch from NSAIDs to paracetamol or not. PMID:14644852

  17. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty

    PubMed Central

    Blikman, T; Rienstra, W; van Raaij, T M; ten Hagen, A J; Dijkstra, B; Zijlstra, W P; Bulstra, S K; van den Akker-Scheek, I; Stevens, M

    2016-01-01

    Introduction Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. Ethics and dissemination The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). Trial registration number 2013-004313-41; Pre

  18. Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis

    PubMed Central

    Rogoveanu, OC; Streba, CT; Vere, CC; Petrescu, L; Trăistaru, R

    2015-01-01

    Introduction: Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract. Patients and Methods: 30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena. Results: The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions). Conclusions: The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer. PMID:26664470

  19. Dynamic Frequency Analyses of Lower Extremity Muscles during Sit-To-Stand Motion for the Patients with Knee Osteoarthritis

    PubMed Central

    Suzuki, Kentaro; Yagi, Masahide

    2016-01-01

    Objective Muscle activities during the sit-to-stand motion (STS) are characterized by coordinated movements between hip extensors and knee extensors. However, previous reports regarding the STS and lower extremity muscle activities have focused on some quantitative assessment, but little qualitative research. This study aimed to examine the muscle activities of the lower extremity both quantitatively and qualitatively. Methods Study participants included 13 patients with knee osteoarthritis (knee OA) and 11 age-matched asymptomatic controls. The task was STS from a chair with a height-adjustable seat. EMG activities were acquired using surface electromyogram. The root mean square signals normalized as a percentage of maximum voluntary isometric contraction values (RMS%MVC) and the mean power frequency (MPF) were calculated. Results During STS, knee OA patients had increased RMS%MVC of the vastus medialis and raised MPF of the rectus femoris before buttocks-off. Conclusion These findings suggest that STS of knee OA patients not only increased relative muscle activity of the vastus medialis, but also enlisted the rectus femoris in knee extension to improve muscle contraction force by activating more type II fibers to accomplish buttocks-off. PMID:26807578

  20. Predictors of Gait Speed in Patients after Hip Fracture

    PubMed Central

    Craik, Rebecca L.; Lopopolo, Rosalie; Tomlinson, James D.; Brenneman, Susan K.

    2008-01-01

    ABSTRACT Purpose: Following hip fracture, patients demonstrate greatly reduced walking speeds 1 year later compared with age-matched elders. The purpose of our study was to examine the factors that relate to gait speed in patients after hip fracture. Methods: Forty-two men and women (mean age 79 ± 7.5 years) who sustained a hip fracture participated in this study. Linear regression analysis was used to determine a statistical model that best predicted gait speed, the dependent variable. Gait speed was measured with a computerized gait mat. The independent variables were age, sex, height, weight, time post-fracture, medications, mental status, depression, balance confidence, Medical Outcome Studies, Short Form (SF-36), balance, and lower extremity isometric force. All subjects were discharged from physical therapy services, and measurements were taken, on average, 17 weeks post-fracture. Results: Using stepwise regression, 72% of the variance in gait speed was explained by summed lower extremity strength normalized by body weight, general health (SF-36), and balance confidence (Activities-specific Balance Confidence Scale). Conclusions: Impairments (summed lower extremity strength) and risk factors (perception of general health and balance confidence) are important predictors of gait speed in elders after hip fracture. PMID:20145738

  1. Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers

    PubMed Central

    van Ittersum, M. W.; Groothoff, J. W.; Oostveen, J. C. M.; Oosterveld, F. G. J.; van der Schans, C. P.; Soer, R.; Reneman, M. F.

    2010-01-01

    Objective The prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples’ functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands. Methods Self-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p5 of reference data were calculated. Results Compared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (n = 78) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands. Conclusions Functional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands. PMID:20490537

  2. Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A Mesotherapy Treatment Study

    PubMed Central

    Di Stefano, Alexandra; Dodaj, Ira; Scarcello, Laura; Bellomo, Rosa Grazia

    2015-01-01

    Abstract Background: Pes anserine bursitis strongly affects quality of life in patients with osteoarthritis. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and injections of corticosteroid, with highly variable responses; recovery can take 10 days to 36 months. Mesotherapy is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. The goal is to modulate the pharmacokinetics of the injected substance and prolong the effects at a local level. Objective: To evaluate the effects of mesotherapy with diclofenac for anserine bursitis associated with knee osteoarthritis. Methods: One hundred and seventeen patients with anserine bursitis associated with grade II Kellgren-Lawrence knee osteoarthritis, assessed by clinical, radiographic, and ultrasonographic examination, were evaluated and treated. They were randomly divided into two groups (A, mesotherapy; B, control). Group A completed nine sessions of mesotherapy with sodium diclofenac (25 mg/1 mL; Akis®, IBSA, Lugano, Switzerland), 1 mL for each session, three times per week. Group B received 21 oral administrations of sodium diclofenac (50 mg; Voltaren®, Novartis, Parsippany, NJ), once a day for 3 weeks. Primary outcome measures were pain intensity assessed by visual analogue scale (VAS), along with ability to perform activities of daily living, ability to participate in sports, level of pain, symptoms, and quality of life, as assessed by the Knee injury and Osteoarthritis Outcome Score. These measures were performed before and after the treatment period and at 30 and 90 days' follow up. Results: In both groups pain level decreased significantly after the treatment period. Ultrasonography showed a reduction of the hypoechoic area related to anserine bursitis only in group A. Conclusion: Administration of conventional NSAIDs (diclofenac) by mesotherapy is effective in managing anserine bursitis in knee osteoarthritis in the short term and

  3. Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis

    PubMed Central

    Tsonga, Theano; Michalopoulou, Maria; Malliou, Paraskevi; Godolias, George; Gkasdaris, Grigorios; Soucacos, Panagiotis

    2015-01-01

    Background One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis. Methods An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed. Results The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test. Conclusions Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences

  4. Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis

    PubMed Central

    van der Meijden, Olivier A.; Gaskill, Trevor R.; Millett, Peter J.

    2012-01-01

    The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement. Several palliative and restorative techniques are currently optional. Joint debridement has shown good results and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems promising when humeral osteophytes are present. Currently, microfracture seems the most studied reparative treatment modality available. Other techniques, such as autologous chondrocyte implantation and osteochondral transfers, have reportedly shown potential but are currently mainly still investigational procedures. This paper gives an overview of the currently available joint preserving surgical techniques for glenohumeral osteoarthritis. PMID:22536514

  5. Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.

    PubMed

    Katz, R L; Bourne, R B; Rorabeck, C H; McGee, H

    1992-08-01

    Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem. PMID:1499201

  6. The Patient's View of Nursing Care after Hip Fracture

    PubMed Central

    Hommel, Ami; Kock, Marie-Louise; Persson, Jeanette; Werntoft, Elisabeth

    2012-01-01

    Background. The pathway for patients with a hip fracture described in this study is a fast track. Many studies have focused on prevention of various complications but, so far, the patient's view of nursing care has not been highlighted. Aim. The aim of the study is to illuminate the patient's view on nursing care when treated for a hip fracture. Method. Ten patients were interviewed. A content analysis design was conducted. Findings. From the analysis, four main categories emerged: waiting times; pain/pain relief and mobilisation; attitude/information and sense of security; complications. Conclusion. Patients generally felt satisfied with the nursing provided. The staff created a feeling of security and showed interest and empathy for the patient. However, patients experienced a stressful waiting for surgery, and patients who developed confusion waited more than 24 hours for surgery. Therefore, waiting time must be decreased. Furthermore, patients' descriptions of a variety of pain problem show, for example, that good collaboration between the nurse and physiotherapist is critical for achieving good pain relief before mobilisation. Nursing staff need to be attentive and should elicit the patient's feelings through patient-focused communication in order to relieve anxiety about going home. PMID:22811933

  7. Total hip replacement for developmental dysplasia of hip and postoperative nursing.

    PubMed

    Zong, S J; Wang, F; Hu, S L

    2016-01-01

    This study was designed to determine the clinical effect of total hip replacement for the treatment of developmental dysplasia of the hip (DDH) and analyze the postoperative nursing. Sixty patients (78 hips) aged 18-75 years (average 58.6±2.31 years) who received total hip replacement for treatment of DDH at the Zhengzhou People’s Hospital, Henan, China, from April 2013 to June 2016 were selected as research subjects. Twenty-four patients were male (30 hips) and 36 were female (48 hips). Of the 60 patients, according to Crowe typing, 24 were type I (30 hips), 26 were type II (34 hips), 6 were type III (8 hips) and 4 were type IV (6 hips). According to the Harris hip score system, the score of all hips was 39.46±3.56 points average (18-56 points) before treatment and resulted as 89.60±4.25 points (79-98 points) at the last follow-up, showing a statistically significant difference (P < 0.05). Complications such as wound infection, dislocation, fracture of femoral shaft, femoral nerve and injury of sciatic nerve were not found after treatment. A total of 48 cases (58 hips) obtained excellent curative results (93.33% recovery), 8 cases (14 hips) good (92.31% recovery), and 4 cases (6 hips) medium. Total hip replacement proved to be effective in treating DDH and secondary osteoarthritis. Moreover, soft tissue release and an optimum degree recovery of anatomic form and physiological function of the diseased hip is an important basis for reconstructing the acetabulum and stabilizing acetabulum prosthesis. PMID:27049089

  8. Modern total hip arthroplasty in patients younger than 21 years.

    PubMed

    Kamath, Atul F; Sheth, Neil P; Hosalkar, Harish H; Babatunde, Oladapo M; Lee, Gwo-Chin; Nelson, Charles L

    2012-03-01

    Total hip arthroplasty (THA) is not commonly performed in adolescents. However, it may be the only option for pain control with continued mobility for advanced disease. We report our experience with modern alternative-bearing THA in patients younger than 21 years. Twenty-one THAs (18 patients) were followed. Preoperative and postoperative Harris hip scores were recorded, and radiographs were reviewed. Average follow-up was 49 months (range, 25-89). Underlying etiology was chemotherapy-induced osteonecrosis (33%), steroid-induced osteonecrosis (29%), sickle cell disease (24%), and chronic dislocation (14%). Articulation bearings were ceramic/ceramic (67%), metal/highly cross-linked polyethylene (29%), and metal resurfacing (5%). Mean age was 18 years (range, 13-20). Harris hip scores improved from 43.6 to 83.6 (P < .001). At final follow-up, there was no radiographic loosening; 1 THA was revised for a cracked ceramic liner. At intermediate-term follow-up, clinical and radiographic results are favorable after alternative-bearing THA in patients younger than 21 years. PMID:21723701

  9. Resurfacing hip arthroplasty in neuromuscular hip disorders – A retrospective case series

    PubMed Central

    Tudor, Francois; Ariamanesh, Amir; Potty, Anish; Hashemi-Nejad, Aresh

    2013-01-01

    Background Management of the degenerate hip in patients with neuromuscular conditions should be aimed at improving quality of life and ease of nursing care. Arthroplasty poses a significant challenge with predisposition to dislocation and loosening due to anatomical abnormalities, soft tissue contractures and impaired muscle tone. Methods We present a series of 11 hips (9 patients) following total hip resurfacing arthroplasty for painful osteoarthritis in patients with differing neuromuscular conditions. Patients were assessed clinically and radiographically and also for satisfaction of their carers due to improved ability to provide nursing care. Mean patient age was 33.1 years (range 13–49 years) with mean follow up at publication 63.7 months (41–89 months). All patients were operated by a single surgeon (AHN) and received the required post operative care and physiotherapy. Soft tissue releases were performed when necessary. All hips were assessed clinically and radiographically at 6 weeks and 6 months and 1 year post-operatively. Six month follow-up also included a questionnaire with scoring of care-provider satisfaction. Results Ten hips had good clinical results with improvement in pain and function and radiologically showed no signs of loosening. One hip required revision to proximal femoral excision due to dislocation and loose acetabular component with severe pain. None of the other hips dislocated. Analysis of care provider satisfaction assessing ability to provide personal care, positioning and transferring, comfort, interaction and communication scored excellent to good in 10 patients and satisfactory in one. Conclusion We believe hip resurfacing arthroplasty to be a viable option in the treatment of the complex problem of osteoarthritis in the hips of patients with neuromuscular disease. The improved biomechanics confer greater stability when compared to conventional total hip arthroplasty. Although technically demanding, a successful result has

  10. Public opinion on community-based education and exercise programs for managing hip and knee osteoarthritis-like symptoms: results of a survey

    PubMed Central

    Davis, Aileen M; Palaganas, Marvilyn; Li, Linda C

    2016-01-01

    Introduction In North America, delivery of targeted exercise and education programs by health professionals for people with hip and knee osteoarthritis (OA) poses challenges related to cost and access. Linking the wellness and health sectors could increase program availability. We evaluated if people with OA were willing to participate in programs delivered by trainers in community centers/gyms. Methods We conducted an online survey of the general public in Canada over a period of 2 months. Participants included those aged ≥30 years with self-reported chronic OA-like knee or hip pain. We evaluated access to community/fitness centers, exercise frequency, interest in attending an evidence-based program twice a week for 6 weeks, and willingness to pay. Analyses included descriptive statistics with 95% confidence intervals and chi-square tests to evaluate factors associated with willingness to attend the program. Results After removing duplicate records, 751 respondents completed the survey with 408 likely having hip and/or knee OA and never having received a joint replacement. These 408 respondents had an age range of 30 to ≥75 years and 86% were female. Of the 408, (63.7%) were between 45 and 64 years of age. Only two respondents reported that a community center was >1 hour away. One hundred and fifty-six (38%) reported a current membership, and 203 (50.4%) reported exercise 3 days/wk, 120 (29.8%) <3 days, and 80 (19.9%) reported no exercise. Two hundred and ninety-seven respondents (73.7%) were willing to attend a program, and, of these, 26% were willing to pay $100 Cdn or more. Age, sex, access to a community center/gym, current gym membership, and current frequency of exercise were not significantly associated with willingness to attend a program. Conclusion Almost 75% of respondents with OA, despite one in three having a community center membership, were interested in attending a targeted program delivered in community/fitness centers. A program in the

  11. Hip Resurfacing Implants.

    PubMed

    Cadossi, Matteo; Tedesco, Giuseppe; Sambri, Andrea; Mazzotti, Antonio; Giannini, Sandro

    2015-08-01

    EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Describe the advantages of hip resurfacing. 2. Describe the disadvantages of hip resurfacing. 3. Identify the population in which hip resurfacing is most often indicated. 4. Demonstrate how to properly postoperatively manage patients with metal-on-metal prostheses. Hip resurfacing offers a suitable solution for young patients affected by hip disease who have high function demands and good bone quality. Bone stock preservation, restoration of the normal proximal femur anatomy, the lack of stress shielding, and the possibility of resuming sporting activity are proven advantages of hip resurfacing. However, there are some disadvantages, such as fracture of the femoral neck, onset of neck narrowing, and possible complications due to the metal-on-metal bearings, including pseudotumors, peri-implant osteolysis, and chronic elevation of metal ions in serum levels. Recent data suggest that the ideal candidate for hip resurfacing is an active male, younger than 65 years, with primary or posttraumatic osteoarthritis, and with a femoral head diameter larger than 50 to 54 mm. Based on these selection criteria, the literature reports implant survival to be similar to that of total hip arthroplasty. The current authors' experience confirms a low failure rate and excellent functional outcomes, with metal ion serum levels becoming stable over time in well-functioning implants. Proper surgical technique, correct patient selection, and the right choice of a well-established prosthetic model are essential elements for the long-term success of these implants. PMID:26270748

  12. Knee stabilization in patients with medial compartment knee osteoarthritis

    PubMed Central

    Lewek, Michael D.; Ramsey, Dan K.; Snyder-Mackler, Lynn; Rudolph, Katherine S.

    2005-01-01

    OBJECTIVE Individuals with medial knee osteoarthritis (MKOA) experience knee laxity and instability. Muscle stabilization strategies may influence the long term integrity of the joint. In this study we determined how individuals with medial knee OA respond to a rapid valgus knee movement to investigate the relationship between muscle stabilization strategies and knee instability. METHODS Twenty one subjects with MKOA and genu varum, and 19 control subjects were tested. Subjects stood with the test limb on a moveable platform that translated laterally to rapidly stress the knee’s medial periarticular structures and create a potentially destabilizing feeling at the knee joint. Knee motion and muscle responses were recorded. Subjects rated their knee instability with a self-report questionnaire about knee instability during daily activities. RESULTS Prior to plate movement the OA subjects demonstrated more medial muscle co-contraction (p=0.014). Following plate movement the OA subjects shifted less weight off the test limb (p = 0.013) and had more medial co-contraction (p=0.037). Those without instability had higher VMMH co-contraction than those who reported more instability (p=0.038). Knee stability correlated positively with VMMH co-contraction prior to plate movement (r = 0.459; p = 0.042). CONCLUSION This study demonstrates that individuals with MKOA attempt to stabilize the knee with greater medial muscle co-contraction in response to laxity that appears on only the medial side of the joint. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction and needs to be altered to slow or stop the progression of the OA disease process. PMID:16142714

  13. Editorial Commentary: Love My Surgeon, Love My Surgery: Patient Satisfaction Matters After Hip Arthroscopy.

    PubMed

    Krych, Aaron J

    2016-08-01

    Patient satisfaction following hip arthroscopy is currently underreported and lacks uniformity when published. While current patient reported outcomes are important, they may not reflect overall patient satisfaction because it is complex and multifactorial. However, assessment and documentation of patient satisfaction following hip arthroscopy is critical to demonstrating value and quality. Therefore, it is of pressing importance that the hip arthroscopy community develops an accurate score that is consistent, valid, and reliable. PMID:27495866

  14. Susceptibility to large-joint osteoarthritis (hip and knee) is associated with BAG6 rs3117582 SNP and the VNTR polymorphism in the second exon of the FAM46A gene on chromosome 6.

    PubMed

    Etokebe, Godfrey E; Jotanovic, Zdravko; Mihelic, Radovan; Mulac-Jericevic, Biserka; Nikolic, Tamara; Balen, Sanja; Sestan, Branko; Dembic, Zlatko

    2015-01-01

    Family with sequence similarity 46, member A (FAM46A) gene VNTR and BCL2-Associated Athanogene 6 (BAG6) gene rs3117582 polymorphisms were genotyped in a case-control study with 474 large-joint (hip and knee) osteoarthritis (OA) patients and 568 controls in Croatian population by candidate-gene approach for association with OA. We found that BAG6 rs3117582 SNP genotypes were associated with protection (major allele homozygote) and susceptibility (major-minor allele heterozygote) to OA. BAG6 rs3117582 major allele (A) was associated with reduced risk to OA while the minor allele (C) was associated with increased risk to OA. We identified 6 alleles harboring 2 to 7 repeats making 20 genotypes for FAM46A. A rare FAM46A VNTR genotype comprising VNTR alleles with four and seven repeats (c/f) was associated with increased OA risk in both genders. The genotype with four and six repeats (c/e) was also associated with increased risk to OA in males. A polymorphic FAM46A allele with six repeats (e) was associated with reduced risk to OA in females. Our results suggest association between the FAM46A gene, BAG6 gene and OA in Croatian population, respectively. This is the first study to show associations between these genetic loci and OA. PMID:25231575

  15. Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis

    PubMed Central

    Mesci, Nilgün; Mesci, Erkan; Külcü, Duygu Geler

    2016-01-01

    [Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis.

  16. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties

    PubMed Central

    Matharu, G. S.; Mittal, S.; Pynsent, P. B.; Buckley, C. D.; Revell, M. P.

    2016-01-01

    Objectives T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. Methods In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry. Results The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05). Conclusions Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure. Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52–60

  17. [Clinical use of chondroitin sulfate in patients with osteoarthritis in geriatric practice].

    PubMed

    Zotkin, E G; Kharitonova, T V; Shkireeva, S Iu

    2014-01-01

    The article presents the results of prospective longitudinal study. The aim of the study was to investigate influence of complex therapy with chondroitin sulfate on pain and functional disorders in elderly patients with knee osteoarthritis. The study shows sufficient decreasing of pain, stiffness and functional disorders with complex therapy with chondroitin sulfate in comparison with nonsteroidal anti-inflammatory drugs (NSAID) by the second month of therapy with stable effect the next 2 months. All patients decrease their NSAID intake by the end of the study. Satisfaction of complex therapy was high according to patient's and physician's opinion. PMID:25306673

  18. Greater Step Widths Reduce Internal Knee Abduction Moments in Medial Compartment Knee Osteoarthritis Patients During Stair Ascent.

    PubMed

    Paquette, Max R; Klipple, Gary; Zhang, Songning

    2015-08-01

    Increased step widths have been shown to reduce peak internal knee abduction moments in healthy individuals but not in knee osteoarthritis patients during stair descent. This study aimed to assess effects of increased step widths on peak knee abduction moments and associated variables in adults with medial knee osteoarthritis and healthy older adults during stair ascent. Thirteen healthy older adults and 13 medial knee osteoarthritis patients performed stair ascent using preferred, wide, and wider step widths. Three-dimensional kinematics and ground reaction forces (GRFs) using an instrumented staircase were collected. Increased step width reduced first and second peak knee abduction moments, and knee abduction moment impulse. In addition, frontal plane GRF at time of first and second peak knee abduction moment and lateral trunk lean at time of first peak knee abduction moment were reduced with increased step width during stair ascent in both groups. Knee abduction moment variables were not different between knee osteoarthritis patients and healthy controls. Our findings suggest that increasing step width may be an effective simple gait alteration to reduce knee abduction moment variables in both knee osteoarthritis and healthy adults during stair ascent. However, long term effects of increasing step width during stair ascent in knee osteoarthritis and healthy adults remain unknown. PMID:25781222

  19. Finding the right hip implant for patient and surgeon: the Dutch strategy--empowering patients.

    PubMed

    Poolman, Rudolf W; Verhaar, Jan A N; Schreurs, B Willem; Bom, L Paul A; Nelissen, Rob G H H; Koot, Henk W J; Goosen, Jon H M; Verheyen, Cees C P M

    2015-01-01

    We describe the implementation process of hip prostheses selection in the Netherlands. The recent problems with large head metal-on-metal hip prostheses resulted in substantial damage to the surgeons' credibility and reputation in the media. This led to a true sense of urgency among orthopaedic surgeons to increase their activities to secure patient safety. The board of the Dutch Orthopaedic Association (NOV) in the Netherlands established a Dutch Hip Task Force (DHTF) with the explicit assignment of formulating criteria to classify the quality of total hip implants on the Dutch market based on survivorship. The aim was to offer unequivocal information enabling a balanced choice of total hip prosthesis. The ultimate goal of the NOV is that all implanted total hip prostheses implanted in the Netherlands are based on reliable clinical evidence. The DHTF decided to adapt the principles of the National Institute for Health and Care Excellence (NICE, UK) (www.nice.org.uk). The taskforce uses data from the registries as well as the Orthopaedic Data Evaluation Panel (ODEP). If the ODEP guidelines had been chosen as standard alone, one quarter of our listed hip components would not have been included. In our view this underlines the strength in the Dutch approach where high quality registry data and ODEP ratings are complementary and result in a list of reliable hip prostheses. Most importantly we offer patients insights into the known quality of the implants by sharing the results of our implant review. This will facilitate shared decision making by empowering patients in their knowledge on available hip arthroplasties. PMID:25633758

  20. Avoiding Failure in Hip Arthroscopy: Complications, Pearls, and Pitfalls.

    PubMed

    Burrus, Matthew Tyrrell; Cowan, James B; Bedi, Asheesh

    2016-07-01

    Although most patients have successful outcomes after hip arthroscopy, a minority of patients experience complications that may impact their recovery and long-term benefit. As most of these complications can be minimized by appropriate surgical technique, many tips have been recommended. Additionally, the reasons behind clinical failure postoperatively have been scrutinized, which include, most commonly, incomplete correction of osseous pathomorphology, underappreciated preexisting hip osteoarthritis, and/or an incorrect preoperative diagnosis. Meticulous preoperative planning, evaluation of advanced imaging studies, and proper patient selection will help to reduce the number of postoperative failures and increase the chance of a successful outcome following hip arthroscopy. PMID:27343398

  1. Simultaneous bilateral hip fractures following a simple fall in an elderly patient without predilecting comorbidities.

    PubMed

    van der Zeeuw, Frederique T; Weeda, Víola B; Vrouenraets, Bart C

    2016-01-01

    Simultaneous bilateral hip fractures are rare, mostly being caused by violent forces or in patients with bone metabolism disorders. We present the case of an elderly patient who sustained simultaneous bilateral hip fractures following a simple fall without having any known predilecting comorbidities other than advanced age. Only four cases have been described of elderly patients without comorbidity with simultaneous bilateral hip fractures following low-energy traumas. This rareness potentially leads to misses of this diagnosis. PMID:27161143

  2. Simultaneous bilateral hip fractures following a simple fall in an elderly patient without predilecting comorbidities

    PubMed Central

    van der Zeeuw, Frederique T.; Weeda, Víola B.; Vrouenraets, Bart C.

    2016-01-01

    Simultaneous bilateral hip fractures are rare, mostly being caused by violent forces or in patients with bone metabolism disorders. We present the case of an elderly patient who sustained simultaneous bilateral hip fractures following a simple fall without having any known predilecting comorbidities other than advanced age. Only four cases have been described of elderly patients without comorbidity with simultaneous bilateral hip fractures following low-energy traumas. This rareness potentially leads to misses of this diagnosis. PMID:27161143

  3. Quality of Life and Functional Independence in Patients with Osteoarthritis of the Knee

    PubMed Central

    Araujo, Ivan Luis Andrade; Castro, Martha Cavalcante; Daltro, Carla

    2016-01-01

    Purpose To verify the association between functional independence (FI) and quality of life (QOL) in patients with knee osteoarthritis. Materials and Methods A cross-sectional study composed of 93 patients with knee osteoarthritis was performed. Osteoarthritis was stratified according the classification of Ahlbach. For evaluation of the patient's overall FI, the Barthel index was used. The patient's QOL was measured by means of the Medical Outcomes Study 36–Item Short Form Health Survey (SF-36) questionnaire. Results The mean age of the patients was 60 years (range, 54.0 to 69.5 years) and only 32 patients (34.3%) were found to be independent. Dependent or independent individuals presented difference in all domains of the QOL including physical function (p=0.001), role-physical (p=0.005), bodily pain (p=0.001), general health (p=0.004), vitality (p=0.009), social function (p=0.010), role-emotional (p=0.002) and mental health (p=0.001). Correlation between FI and QOL was different for all domains of the SF-36. Correlation with FI was strongest for physical function (r=0.609, p<0.001), followed by the domains of bodily pain (r=0.410, p<0.001) and mental health (r=0.402, p<0.001). Conclusions Our data demonstrated a strong association of FI with QOL and positive correlations with all QOL domains, indicating the greater the FI is, the higher the QOL is. PMID:27595076

  4. 'Hip' pain.

    PubMed

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  5. Comparison of AIMS2-SF, WOMAC, x-ray and a global physician assessment in order to approach quality of life in patients suffering from osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Koerner, Thorsten; Szecsenyi, Joachim; Laux, Gunter

    2006-01-01

    Background Chronic diseases like osteoarthritis (OA) substantially affect different dimensions of quality of life (QoL). The aim of the study was to reveal possible factors which mainly influence general practitioners (GPs) assessment of patients' QoL. Methods 220 primary care patients with OA of the knee or the hip treated by their general practitioner for at least one year were included. All GPs were asked to assess patients' QoL based on the patients' history, actual examination and existing x-rays by means of a visual analog scale (VAS scale), resulting in values ranging from 0 to 10. Patients were asked to complete the McMaster Universities Osteoarthritis Index (WOMAC) and the Arthritis Impact Measurement Scale2 Short Form (AIMS2-SF) questionnaire. Results Significant correlations were revealed between "GP assessment" and the AIMS2-SF scales "physical" (rho = 0.495) and "symptom" (rho = 0.598) as well as to the "pain" scale of the WOMAC (rho = 0.557). A multivariate ordinal regression analysis revealed only the AIMS2-SF "symptom" scale (coefficient beta = 0.2588; p = 0.0267) and the x-ray grading according to Kellgren and Lawrence as significant influence variables (beta = 0.6395; p = 0.0004). Conclusion The results of the present study suggest that physicians' assessment of patients' QoL is mainly dominated by physical factors, namely pain and severity of x-ray findings. Our results suggest that socioeconomic and psychosocial factors, which are known to have substantial impact on QoL, are underestimated or missed. Moreover, the overestimation of x-ray findings, which are known to be less correlated to QoL, may cause over-treatment while important and promising targets to increase patients' QoL are missed. PMID:16438717

  6. Circulating T helper 9 cells and increased serum interleukin-9 levels in patients with knee osteoarthritis.

    PubMed

    Qi, Changlin; Shan, Yuxing; Wang, Jing; Ding, Fupeng; Zhao, Ding; Yang, Teng; Jiang, Yanfang

    2016-05-01

    The purpose of this study was to examine the roles of T helper 9 (Th9) cells and the serum interleukin (IL)-9 level in the pathogenesis of osteoarthritis (OA). The numbers of IL-9(+)  CD4(+)  CD8(-) T cells, interferon (IFN)-γ+ CD4(+)  CD8(-) T cells, IL-4(+) CD4(+)  CD8(-) T cells, and IL-17A(+ ) CD4(+ ) CD8(-) T cells in 25 OA patients and 13 healthy controls (HC) were examined by flow cytometry. The serum concentrations of IL-9, IL-4, IL-17A, and IFN-γ were also determined. The numbers of CD4(+) CD45RO(+) T cells, Th9 cells, Th1 cells, and Th17 cells in OA patients were significantly higher than those in HCs. Furthermore, serum IL-9, IL-17A, and IFN-γ levels in OA patients were higher than those in HCs. The number of Th9 cells was positively correlated with the number of Th17 cells in OA patients. Furthermore, greater numbers of Th9 cells were positively associated with elevated C-reactive protein, and both Th9 cells and IL-9 levels were positively correlated with the Western Ontario and McMaster Universities Osteoarthritis index in OA patients. Th9 cell numbers and IL-9 levels are correlated with OA patient symptoms and joint functionality and may be a marker of disease activity. PMID:26926842

  7. [Total hip arthroplasty in the treatment of arthrosis with coexistent high developmental hip dislocation].

    PubMed

    Matewski, Dariusz; Szymkowiak, Edward; Gumański, Ryszard

    2008-01-01

    The question if total hip arthroplasty ought to be advised for patients with high developmental hip dislocation is still actual. The subject of hip arthroplasty, as a method of surgical treatment of high developmental hip dislocation, was analyzed on the base of follow up of seven patients, who underwent this procedure. The mean age of patients was 44.5 (+/- 12.6) years. The mean time of follow up was 64.4 (21.6) months. Initial three patients were treated in two stage regime. In first stage, a surgical hip liberalization and skeletal traction through 3 weeks was performed. In 2nd stage we did total hip replacement with simultaneous shortening of the femoral shaft just below the lesser trochanter. In next four patients we performed total hip arthroplasty with simultaneous shortening of the femoral shaft in one stage. Protection of undesirable rotational instability after osteotomy was done by means of different ways of osteotomy fixation describe in paper. Applied surgical treatment allowed for implanting a cup of prosthesis in original place of acetabulum and reduction of the big anteversion of the femoral neck. The hip congruency was improved in all patients. Score in functional Harris hip scale increased from mean value of 50 points before hip arthroplasty to mean value of 85 points after surgery. The symptoms of late consolidation of osteotomy were observed in one patient with transverse osteotomy without anty-rotational fixation. Total hip replacement with simultaneous "Z" shortening osteotomy of the femoral shaft give good such clinical as radiological results in the treatment of hip osteoarthritis in accordance to high developmental hip dislocation. PMID:18847022

  8. Total hip replacement in dancers.

    PubMed

    Buyls, Inge R A E; Rietveld, A B M Boni; Ourila, Tiia; Emerton, Mark E; Bird, H A

    2013-04-01

    A case report of a professional contemporary dancer who successfully returned to the stage after bilateral total hip replacements (THR) for osteoarthritis is presented, together with her own commentary and a retrospective cohort study of total hip replacements in dancers. In the presented cohort, there were no post-operative dislocations or infections, the original pain had been relieved, rehabilitation was objectively normal and all resumed their dance (teaching) activities. Nevertheless, they were disappointed about the prolonged rehabilitation. Due to their high demands as professional dancers, post-operative expectations were too optimistic in view of the usual quick and favourable results of THR in the older and less physically active, general population. In all dancers with unilateral osteoarthritis, the left hip was involved, which may reflect the tendency to use the left leg as standing leg and be suggestive that strenuous physical activity may lead to osteoarthritis. Better rehabilitation guidelines are needed for dancer patients undergoing THR, especially drawing their attention to realistic post-operative expectations. PMID:23588878

  9. Managing osteoarthritis.

    PubMed

    Kodadek, Marie

    2015-01-01

    Osteoarthritis (OA) is a degenerative disease that affects 27 million American women. All body joints can be affected. OA is more prevalent in women than men. Most women, with a diagnosis of OA report discomfort in the knee, hip, back and wrist joints. The discomforts of OA can be managed with life style changes before over the counter medications are introduced. Surgical interventions should be considered as the last treatment choice. Once a medication choice has been introduced, nurses can review methods to women that will improve their ability to continue activities of daily living and decrease the impact of the discomforts of OA. Nurses can be instrumental in the management of OA by providing education about different intervention choices for the management of OA symptoms. PMID:25690818

  10. Repeatability of gait analysis for measuring knee osteoarthritis pain in patients with severe chronic pain.

    PubMed

    Asay, Jessica L; Boyer, Katherine A; Andriacchi, Thomas P

    2013-07-01

    Gait measures are receiving increased attention in the evaluation of patients with knee osteoarthritis (OA). Yet, there remains a need to assess variability of gait analysis in patients with knee osteoarthritis over time and how pain affects variation in these gait parameters. The purpose of this study was to determine if important gait parameters, such as the knee adduction moment, knee flexion moment, peak vertical ground reaction force, and speed, were repeatable in patients with mild-to-moderate knee OA over a trial period of 12 weeks. Six patients were enrolled in this cross-over study design after meeting strict inclusion criteria. Gait tests were conducted three times at 4 week intervals and once after the placebo arm of a randomized treatment sequence; each gait test followed a 2-week period of receiving a placebo for a pain modifying drug. Repeatability for each gait variable was found using intraclass correlation coefficients (ICC) with a two-way random model. This study found that the knee adduction moment was repeatable throughout the four gait tests. However, normalized peak vertical ground reaction force and knee flexion moment were not as repeatable, varying with pain. This suggests that these gait outcomes could offer a more objective way to measure a patient's level of pain. PMID:23508626

  11. Corticospinal and Intracortical Excitability of the Quadriceps in Patients with Knee Osteoarthritis

    PubMed Central

    Kittelson, Andrew J.; Thomas, Abbey C.; Kluger, Benzi M.; Stevens-Lapsley, Jennifer E.

    2015-01-01

    Deficits in voluntary activation of the quadriceps muscle are characteristic of knee osteoarthritis (OA), contributing to the quadriceps weakness that is also a hallmark of the disease. The mechanisms underlying this central activation deficit (CAD) are unknown, although cortical mechanisms may be involved. Here, we utilize transcranial magnetic stimulation (TMS) to assess corticospinal and intracortical excitability in patients with knee osteoarthritis (OA) and in a comparably aged group of healthy older adults, to quantify group differences and to examine associations between TMS measures and pain, quadriceps strength, and CAD. Seventeen patients with knee OA and 20 healthy controls completed testing. Motor evoked potentials (MEPs) were measured at the quadriceps by superficial electromyographic (EMG) recordings. Corticospinal excitability was assessed by measuring resting motor threshold (RMT) to TMS stimulation of the quadriceps representation at primary motor cortex, and intracortical excitability was assessed via paired pulse paradigms for short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). No statistically significant differences between patients with knee OA and healthy controls were found for RMT, SICI or ICF measures (p>0.05). For patients with knee OA, there were significant associations observed between pain and RMT, as well as between pain and ICF. No associations were observed between CAD and measures of corticospinal or intracortical excitability. These data suggest against direct involvement of corticospinal or intracortical pathways within primary motor cortex in the mechanisms of CAD. However, pain is implicated in the neural mechanisms of quadriceps motor control in patients with knee OA. PMID:25183161

  12. Arthroscopic debridement in the treatment of patients with osteoarthritis of the elbow, based on computer simulation.

    PubMed

    Miyake, J; Shimada, K; Oka, K; Tanaka, H; Sugamoto, K; Yoshikawa, H; Murase, T

    2014-02-01

    We retrospectively assessed the value of identifying impinging osteophytes using dynamic computer simulation of CT scans of the elbow in assisting their arthroscopic removal in patients with osteoarthritis of the elbow. A total of 20 patients were treated (19 men and one woman, mean age 38 years (19 to 55)) and followed for a mean of 25 months (24 to 29). We located the impinging osteophytes dynamically using computerised three-dimensional models of the elbow based on CT data in three positions of flexion of the elbow. These were then removed arthroscopically and a capsular release was performed. The mean loss of extension improved from 23° (10° to 45°) pre-operatively to 9° (0° to 25°) post-operatively, and the mean flexion improved from 121° (80° to 140°) pre-operatively to 130° (110° to 145°) post-operatively. The mean Mayo Elbow Performance Score improved from 62 (30 to 85) to 95 (70 to 100) post-operatively. All patients had pain in the elbow pre-operatively which disappeared or decreased post-operatively. According to their Mayo scores, 14 patients had an excellent clinical outcome and six a good outcome; 15 were very satisfied and five were satisfied with their post-operative outcome. We recommend this technique in the surgical management of patients with osteoarthritis of the elbow. PMID:24493190

  13. Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation.

    PubMed

    Chen, Dongyang; Xu, Zhihong; Shi, Dongquan; Qiu, Xusheng; Dai, Jin; Yuan, Tao; Weng, Wenjie; Jiang, Qing

    2011-01-01

    Treatment of high congenital dislocation of the hip (CDH) remains controversial. We report the outcome of hip arthroplasty using a cementless threaded cup and a cementless straight stem in patients with high congenital hip dislocation. Between January 2001 and August 2004, 17 patients with high congenital hip dislocation were treated. During surgery, at least 25% of the cup was anchored in bone. By monitoring somatosensory-evoked potentials (SEPs) of the common peroneal nerve we were able to reduce the femoral head into position in the true acetabulum by releasing soft tissues. A bulk autogenous femoral head bone graft was implanted in 5 patients to achieve at least 75% bony coverage of the acertabular component. Follow-up ranged from 48 months to 91 months with an average of 69.7 months. The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (P<0.001). Radiographic analysis showed bony union of the bone graft in all cases. PMID:21279967

  14. Primary total hip replacement versus hip resurfacing - hospital considerations.

    PubMed

    Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz

    2011-01-01

    Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients. PMID:22035493

  15. General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis.

    PubMed Central

    Memel, D S; Kirwan, J R; Sharp, D J; Hehir, M

    2000-01-01

    BACKGROUND: General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors. AIM: To determine functional disability, psychological morbidity, social situation, and use of health and social services in patients with osteoarthritis and examine GP knowledge of these factors. METHOD: Two hundred patients completed a validated postal questionnaire about functional disability (Health Assessment Questionnaire [HAQ]), mood (Hospital Anxiety and Depression Scale [HAD]), employment status, who they lived with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety. RESULTS: Forty-seven per cent of patients were moderately or severely disabled (HAQ > 1). GPs underestimated functional disability: mean patient HAQ = 1.04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores (kappa = 0.24). There was moderate prevalence of depression and high prevalence of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4.1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kappa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11.9% (95% CI = 6.9%-16.9%), kappa = 0.19. Only 46% of severely disabled patients (HAQ > 2) were receiving disability welfare benefits. GPs were often unaware of welfare benefits received or the involvement of other professionals. CONCLUSION: GPs frequently lack knowledge about functional disability, social factors, and anxiety as well as depression in their patients with osteoarthritis. PMID:11042917

  16. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation

    PubMed Central

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Kim, Dong-Yeol; Zheng, Long

    2015-01-01

    Background Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. Methods From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. Results There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Conclusions Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays

  17. An expert-based job exposure matrix for large scale epidemiologic studies of primary hip and knee osteoarthritis: The Lower Body JEM

    PubMed Central

    2014-01-01

    Background When conducting large scale epidemiologic studies, it is a challenge to obtain quantitative exposure estimates, which do not rely on self-report where estimates may be influenced by symptoms and knowledge of disease status. In this study we developed a job exposure matrix (JEM) for use in population studies of the work-relatedness of hip and knee osteoarthritis. Methods Based on all 2227 occupational titles in the Danish version of the International Standard Classification of Occupations (D-ISCO 88), we constructed 121 job groups comprising occupational titles with expected homogeneous exposure patterns in addition to a minimally exposed job group, which was not included in the JEM. The job groups were allocated the mean value of five experts’ ratings of daily duration (hours/day) of standing/walking, kneeling/squatting, and whole-body vibration as well as total load lifted (kg/day), and frequency of lifting loads weighing ≥20 kg (times/day). Weighted kappa statistics were used to evaluate inter-rater agreement on rankings of the job groups for four of these exposures (whole-body vibration could not be evaluated due to few exposed job groups). Two external experts checked the face validity of the rankings of the mean values. Results A JEM was constructed and English ISCO codes were provided where possible. The experts’ ratings showed fair to moderate agreement with respect to rankings of the job groups (mean weighted kappa values between 0.36 and 0.49). The external experts agreed on 586 of the 605 rankings. Conclusion The Lower Body JEM based on experts’ ratings was established. Experts agreed on rankings of the job groups, and rankings based on mean values were in accordance with the opinion of external experts. PMID:24927760

  18. Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis

    PubMed Central

    Eftekharsadat, Bina; Habibzadeh, Afshin; Kolahi, Babak

    2015-01-01

    Objective: Knee osteoarthritis (OA) is the main cause of pain, physical impairment and chronic disability in older people. Electrotherapeutic modalities such as interferential therapy (IFT) and action potential simulation (APS) are used for the treatment of knee OA. In this study, we aim to evaluate the therapeutic effects of APS and IFT on knee OA. Methods: In this randomized clinical trial, 67 patients (94% female and 6% male with mean age of 52.80 ± 8.16 years) with mild and moderate knee OA were randomly assigned to be treated with APS (n = 34) or IFT (n = 33) for 10 sessions in 4 weeks. Baseline and post-treatment Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscales, visual analogue scale (VAS) and timed up and go (TUG) test were measured in all patients. Results: VAS and WOMAC subscales were significantly improved after treatment in APS and IFT groups (p < 0.001 for all). TUG was also significantly improved after treatment in APS group (p < 0.001), but TUG changes in IFT was not significant (p = 0.09). There was no significant difference in VAS, TUG and WOMAC subscales values before and after treatment as well as the mean improvement in VAS, TUG and WOMAC subscales during study between groups. Conclusion: Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA. PMID:26029268

  19. Leptin Levels Are Negatively Correlated with 2-Arachidonoylglycerol in the Cerebrospinal Fluid of Patients with Osteoarthritis

    PubMed Central

    Nicholson, James; Azim, Syed; Rebecchi, Mario J.; Galbavy, William; Feng, Tian; Reinsel, Ruth; Rizwan, Sabeen; Fowler, Christopher J.; Benveniste, Helene; Kaczocha, Martin

    2015-01-01

    Background There is compelling evidence in humans that peripheral endocannabinoid signaling is disrupted in obesity. However, little is known about the corresponding central signaling. Here, we have investigated the relationship between gender, leptin, body mass index (BMI) and levels of the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in the serum and cerebrospinal fluid (CSF) of primarily overweight to obese patients with osteoarthritis. Methodology/Principal Findings Patients (20 females, 15 males, age range 44-78 years, BMI range 24-42) undergoing total knee arthroplasty for end-stage osteoarthritis were recruited for the study. Endocannabinoids were quantified by liquid chromatography – mass spectrometry. AEA and 2-AG levels in the serum and CSF did not correlate with either age or BMI. However, 2-AG levels in the CSF, but not serum, correlated negatively with CSF leptin levels (Spearman’s ρ -0.48, P=0.0076, n=30). No such correlations were observed for AEA and leptin. Conclusions/Significance In the patient sample investigated, there is a negative association between 2-AG and leptin levels in the CSF. This is consistent with pre-clinical studies in animals, demonstrating that leptin controls the levels of hypothalamic endocannabinoids that regulate feeding behavior. PMID:25835291

  20. Functional Recovery of Older Hip-Fracture Patients after Interdisciplinary Intervention Follows Three Distinct Trajectories

    ERIC Educational Resources Information Center

    Tseng, Ming-Yueh; Shyu, Yea-Ing L.; Liang, Jersey

    2012-01-01

    Purpose To assess the effects of an interdisciplinary intervention on the trajectories of functional recovery among older patients with hip fracture during 2 years after hospitalization. Design and Methods In a randomized controlled trial with 24-month follow-up, 162 patients [greater than or equal to]60 years were enrolled after hip-fracture…

  1. Chronic NSAIDs Use Increases the Risk of a Second Hip Fracture in Patients After Hip Fracture Surgery

    PubMed Central

    Huang, Kuo-Chin; Huang, Tsan-Wen; Yang, Tien-Yu; Lee, Mel S.

    2015-01-01

    Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs) control musculoskeletal pain, but they also cause adverse side effects. The aim of this study is to explore the impact of chronic NSAIDs use on the risk of a second hip fracture (SHFx) after hip fracture surgery. This population-based case-cohort study used the Taiwan National Health Insurance Research Database (NHIRD), which contains data from >99% of the population. From a random sample of 1 million enrollees, we identified 34,725 patients ≥40 years who sustained a first hip fracture and underwent hip fracture surgery between 1999 and 2009. Chronic NSAIDs use is defined as taking NSAIDs for at least 14 days a month for at least 3 months. The main outcome measure is an SHFx. Propensity-score matching was used to control for confounding. Our results revealed that chronic NSAIDs use was a significant risk factor for an SHFx in patients after hip fracture surgery and for adverse side effects that might last for 12 months. Compared with the nonchronic-use cohort (n = 29,764), the adjusted hazard ratio of an SHFx was 2.15 (95% CI: 2.07–2.33) for the chronic-use cohort (n = 4961). The 10-year Kaplan–Meier survival analyses showed that chronic NSAIDs use presented a positive year-postsurgery-dependency effect on the risk of an SHFx in all the selected subgroups of patients (all P ≤ 0.011). In conclusion, chronic NSAIDs use increases the risk of an SHFx after hip fracture surgery. Avoiding chronic NSAIDs use must be emphasized in clinical practice. PMID:26402817

  2. Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty.

    PubMed

    Nam, Denis; Nunley, Ryan M; Sauber, Timothy J; Johnson, Staci R; Brooks, Peter J; Barrack, Robert L

    2015-11-01

    Persistent pain following hip arthroplasty remains a concern, especially in young, active patients. Four hundred twenty patients less than 60 years of age with a pre-symptomatic UCLA score ≥ 6 (196 total hip arthroplasty [THA]; 224 surface replacement arthroplasty [SRA]) completed a pain-drawing questionnaire investigating the location, severity, and frequency of pain around the hip. At a mean of 2.9 years of follow-up, 40% reported pain in at least one location around the hip. There was no difference in the incidence of groin pain between SRA and THA patients (32% vs. 29%, P=0.6), but THA patients had a greater incidence of anterior (25% vs. 8%, P<0.001) and lateral (20% vs. 10%, P=0.01) thigh pain. A high percentage of young, active patients experience persistent pain following hip arthroplasty. PMID:26067707

  3. A healthy patient with bilateral frozen hips preceding bilateral frozen shoulders: a cautionary tale.

    PubMed

    Miller, Abigail R; Arnot, Dean; Wake, Melissa

    2015-01-01

    Adhesive capsulitis of the shoulder (frozen shoulder) is a common disease characterised by spontaneous onset of pain and restriction of movement, followed by 'thawing', with complete or near-complete resolution. Adhesive capsulitis of the hip has been reported in around a dozen patients. This report describes an otherwise-healthy middle-aged woman with apparent sequential resolving adhesive capsulitis of all four ball-and-socket joints over a 9-year period, initially affecting each hip and then each shoulder sequentially. The likely hip diagnosis became clear only retrospectively with development of the second frozen shoulder, 5 years after the first pain. All joints subsequently resolved within the expected timeframe and the patient remains healthy, other than having mild hypertension. This case illustrates that, when hip precedes shoulder involvement, there is the potential for the frozen hip to receive alternate diagnoses for which invasive open hip surgery could unnecessarily be recommended. PMID:26564111

  4. Ochronosis of the knee with secondary osteoarthritis requiring total knee replacement in a patient with cryptogenic organising pneumonia.

    PubMed

    Jasper, Jorrit; Metsaars, Wieneke; Jansen, Joris

    2016-01-01

    Ochronosis is a rare autosomal recessive metabolic disease caused by homogentisic acid oxidase enzyme deficiency. High homogentisic acid levels will eventually result in black deposits in skin, sclerae, connective tissues and urine (alkaptonuria). It can lead to early degeneration of connective tissues and cartilage. Ochronosis can damage normal cartilage, leading to secondary osteoarthritis. The diagnosis is often delayed because of its low prevalence and non-specific early symptoms. In our patient, the secondary osteoarthritis due to ochronosis deposits in the cartilage was treated by total knee arthroplasty, with good clinical outcome. This article reports the first case of ochronosis with secondary osteoarthritis of the knee in a patient previously diagnosed with cryptogenic organising pneumonia (COP). PMID:27207988

  5. Transdermal fentanyl improves pain control and functionality in patients with osteoarthritis: an open-label Canadian trial.

    PubMed

    Choquette, Denis; McCarthy, Timothy G; Rodrigues, Jude F N; Kelly, Allan J; Camacho, Fernando; Horbay, G L A; Husein-Bhabha, Farah A

    2008-05-01

    Current treatment guidelines advocate opioids for arthritis when standard analgesics produce inadequate relief. Efficacy, adverse effects (AEs), dosing regimens, physician expertise and patient preference influence treatment selection. This study assessed transdermal fentanyl (TDF) as a treatment option for osteoarthritis (OA) patients. This prospective, Canadian open-label, 8-week trial assessed the efficacy and safety of TDF in patients with OA of hip or knee with moderate-to-severe target joint pain inadequately controlled using weak opioids. TDF was initiated at 25 mcg/h and titrated to optimal pain control. Rescue acetaminophen 500 mg was allowed (maximum 4 g/day). The main endpoint was improvement in pain control assessment rating (five rating categories); pain intensity (0-10 numerical scale), functionality (WOMAC-OA Index), health-related quality of life (SF-36 Health Survey) and global impression were also evaluated. Eighty-one patients (61% female, mean age 60 years) were enrolled; 62 were evaluable. All had failed on previous weak opioid therapy, primarily codeine or codeine combinations. At treatment end, 65% rated pain control as improved (Pain Control Assessment rating change >or=1 category; p<0.0001); mean change in pain intensity was a reduction of greater than 2 (p<0.0001); almost 50% were maintained on TDF 25 mcg/h with less than 1.3 g/day of rescue acetaminophen. At 1 month and end of treatment, changes in the SF-36 physical global scale and individual sub-scores for the pain index and role-physical scales were highly significant (p<0.0001). Improvement in functionality was noted at 1 month and at end of treatment with significant reductions in total WOMAC score, individual pain, stiffness and physical function sub-scores (p<0.0001). AEs causing discontinuation (n=32) included nausea, dizziness and vomiting. Most treatment-related AEs were mild to moderate in intensity. TDF improved pain control, functionality and health-related quality of life

  6. Acupuncture modulates cortical thickness and functional connectivity in knee osteoarthritis patients.

    PubMed

    Chen, Xiaoyan; Spaeth, Rosa B; Retzepi, Kallirroi; Ott, Daniel; Kong, Jian

    2014-01-01

    In this study, we investigated cortical thickness and functional connectivity across longitudinal acupuncture treatments in patients with knee osteoarthritis (OA). Over a period of four weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before their first, third and sixth treatments. Clinical outcome showed a significantly greater Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (improvement) with verum acupuncture compared to the sham acupuncture. Longitudinal cortical thickness analysis showed that the cortical thickness at left posterior medial prefrontal cortex (pMPFC) decreased significantly in the sham group across treatment sessions as compared with verum group. Resting state functional connectivity (rsFC) analysis using the left pMPFC as a seed showed that after longitudinal treatments, the rsFC between the left pMPFC and the rostral anterior cingulate cortex (rACC), medial frontal pole (mFP) and periaquiduct grey (PAG) are significantly greater in the verum acupuncture group as compared with the sham group. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway. PMID:25258037

  7. Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.

    PubMed

    Lluch, E; Torres, R; Nijs, J; Van Oosterwijck, J

    2014-11-01

    Hyperexcitability of the central nervous system (CNS) has been suggested to play an important role in the chronic pain experienced by osteoarthritis (OA) patients. A systematic review following PRISMA guidelines was performed to evaluate the existing evidence from the literature related to the presence of central sensitization (CS) in patients with OA.Electronic databases PubMed and Web of Science were searched to identify relevant articles using pre-defined keywords regarding CS and OA. Full-text clinical reports addressing studies of CS in human adults with chronic complaints due to osteoarthritis were included and screened for methodological quality by two independent reviewers. From the 40 articles that were initially eligible for methodological quality assessment, 36 articles achieved sufficient scores and therefore were discussed. The majority of these studies were case-control studies and addressed OA of the knee joint. Different subjective and objective parameters considered manifestations of CS, which have been previously reported in other chronic pain conditions such as whiplash or rheumatoid arthritis, were established in subjects with OA pain. Overall results suggest that, although peripheral mechanisms are involved in OA pain, hypersensitivity of the CNS plays a significant role in a subgroup of subjects within this population. Although the majority of the literature provides evidence for the presence of CS in chronic OA pain, clinical identification and treatment of CS in OA is still in its infancy, and future studies with good methodological quality are necessary. PMID:24700605

  8. Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis.

    PubMed

    Yıldırıım, Mustafa Aziz; Uçar, Demet; Öneş, Kadriye

    2015-12-01

    [Purpose] The aim of study was to compare different durations of ultrasound in patients with knee osteoarthritis. [Subjects and Methods] One hundred patients diagnosed with bilateral knee osteoarthritis (OA) were enrolled in this study. Patients were divided into two groups. The first group (G1) received 4 minutes of ultrasound. The second group (G2) received the exact same treatment, but the duration of ultrasound was longer at 8 minutes. Patients in both groups underwent a total of 10 ultrasound over 2 weeks. Following treatment, all patients provided self-evaluations of pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability via the Lequesne index (Leq), and depressive symptoms with the Beck Depression Index (BDI). [Results] There were no significant differences in VAS, WOMAC Leq, and BDI values between groups 1 and 2. After treatment, VAS, WOMAC, Leq, and BDI values improved for both treatment groups. However, following treatment, G2 had significantly greater values for WOMAC functional and total scores than G1. No statistically significant differences were observed for VAS scores while inactive, WOMAC pain and stiffness scores, and BDI values after treatment between both groups. VAS pain scores while active and Leq index values were significantly lower in G1 than G2. [Conclusion] Patients in both groups demonstrated improved functionality, pain and psychological status following a consistent, 2-week regimen of 4-minute or 8-minute treatments with ultrasound. Yet, patients that experienced longer treatment durations of 8 minutes demonstrated better outcomes in pain and the ability to carry out activities of daily living. PMID:26834328

  9. Influence of pain severity on health-related quality of life in Chinese knee osteoarthritis patients

    PubMed Central

    Pang, Jian; Cao, Yue-Long; Zheng, Yu-Xin; Gao, Ning-Yang; Wang, Xue-Zong; Chen, Bo; Gu, Xin-Feng; Yuan, Weian; Zhang, Ming; Liu, Ting; Zhan, Hong-Sheng; Shi, Yin-Yu

    2015-01-01

    Objective: The aim of this cross-sectional study was to examine the relationship among pain and other symptoms intensity, and health-related quality of life (HRQoL) in Chinese patients with knee osteoarthritis (OA). Methods: The study was cross-sectional, descriptive, and correlational. A convenience sample of 466 patients with knee OA was recruited in the study. Age, gender, body mass index (BMI), duration of disease, and Kellgren- Lawrence (KL) scores were recorded. HRQoL and symptoms were assessed using the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster (WOMAC) index in participants. Results: The sample was predominantly female (82%) with mean age 56.56 years and mean BMI 24.53 kg/m2. We found that WOMAC subscale scores significantly negative correlated with the majority of SF-36 subscale scores in knee OA patients (P < 0.05). There were no correlations between BMI, duration of disease, KL score and the vast majority of SF-36 subscale scores in patients (P > 0.05). In addition, there was a significant correlation between age and PCS, gender and MCS in patients (P < 0.05). Regression analysis showed, WOMAC subscale scores significantly negative correlated with the vast majority of SF-36 subscale scores. WOMAC-pain score had the strongest relationship with SF-36 PCS and MCS scores. Conclusions: In summary, pain severity has a greater impact on HRQoL than patient characteristics, other joint symptoms and radiographic severity in Chinese knee OA patients. Relieving of knee symptoms may help to improve patients’ HRQOL. The study provided the evidence that relieving pain should be the first choice of therapy for knee osteoarthritis. PMID:26064371

  10. Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis

    PubMed Central

    Yıldırıım, Mustafa Aziz; Uçar, Demet; Öneş, Kadriye

    2015-01-01

    [Purpose] The aim of study was to compare different durations of ultrasound in patients with knee osteoarthritis. [Subjects and Methods] One hundred patients diagnosed with bilateral knee osteoarthritis (OA) were enrolled in this study. Patients were divided into two groups. The first group (G1) received 4 minutes of ultrasound. The second group (G2) received the exact same treatment, but the duration of ultrasound was longer at 8 minutes. Patients in both groups underwent a total of 10 ultrasound over 2 weeks. Following treatment, all patients provided self-evaluations of pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability via the Lequesne index (Leq), and depressive symptoms with the Beck Depression Index (BDI). [Results] There were no significant differences in VAS, WOMAC Leq, and BDI values between groups 1 and 2. After treatment, VAS, WOMAC, Leq, and BDI values improved for both treatment groups. However, following treatment, G2 had significantly greater values for WOMAC functional and total scores than G1. No statistically significant differences were observed for VAS scores while inactive, WOMAC pain and stiffness scores, and BDI values after treatment between both groups. VAS pain scores while active and Leq index values were significantly lower in G1 than G2. [Conclusion] Patients in both groups demonstrated improved functionality, pain and psychological status following a consistent, 2-week regimen of 4-minute or 8-minute treatments with ultrasound. Yet, patients that experienced longer treatment durations of 8 minutes demonstrated better outcomes in pain and the ability to carry out activities of daily living. PMID:26834328

  11. Validity of a simple Internet-based outcome-prediction tool in patients with total hip replacement: a pilot study.

    PubMed

    Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph; Bischoff-Ferrari, Heike A

    2014-04-01

    We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR. PMID:24585892

  12. Hip instability.

    PubMed

    Smith, Matthew V; Sekiya, Jon K

    2010-06-01

    Hip instability is becoming a more commonly recognized source of pain and disability in patients. Traumatic causes of hip instability are often clear. Appropriate treatment includes immediate reduction, early surgery for acetabular rim fractures greater than 25% or incarcerated fragments in the joint, and close follow-up to monitor for avascular necrosis. Late surgical intervention may be necessary for residual symptomatic hip instability. Atraumatic causes of hip instability include repetitive external rotation with axial loading, generalized ligamentous laxity, and collagen disorders like Ehlers-Danlos. Symptoms caused by atraumatic hip instability often have an insidious onset. Patients may have a wide array of hip symptoms while demonstrating only subtle findings suggestive of capsular laxity. Traction views of the affected hip can be helpful in diagnosing hip instability. Open and arthroscopic techniques can be used to treat capsular laxity. We describe an arthroscopic anterior hip capsular plication using a suture technique. PMID:20473129

  13. Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings.

    PubMed

    Visuri, T I; Pukkala, E; Pulkkinen, P; Paavolainen, P

    2006-02-01

    All patients with total hip arthroplasty (THA) are exposed to soluble or particulate forms of Co and Cr. Adverse effects of these wear products are not known. Data from Nordic registries is used to estimate adverse effects on a large scale, based mostly on metal-on-polyethylene bearings. Cancer incidence was in line with the general population when the patients were operated on for all indications and significantly decreased when the indication was primary osteoarthritis. Stomach cancer and colorectal cancers were significantly reduced and prostate cancer and skin melanoma significantly increased. There was no significant excess of cancer in target organs, i.e. liver, kidney, or haematopoietic cancers. THA patients had reduced mortality and extended life expectancy compared with standard Nordic populations. All-site cancer incidence of the first-generation metal-on-metal McKee-Farrar patients operated on for primary osteoarthritis was in line with the general population after follow-up for up to 28 years. General mortality of these patients was also reduced and they also had an extended life expectancy. Temporary increases in haematopoietic cancers at different follow-up periods were seen in some cohorts. This malignancy deserves a special record linkage monitoring while large numbers of young patients are provided with the second generation of metal-on-metal prostheses. PMID:16669405

  14. Rapid Destruction of the Hip Joint Accompanied by an Enlarged Iliopsoas Bursa in a Healthy Man

    PubMed Central

    Kim, Ju-Oh

    2014-01-01

    Association between enlarged iliopsoas bursa and hip lesions such as osteoarthritis of the hip or femoral head necrosis is infrequently seen. Enlarged iliopsoas bursa with a rapidly destructive arthropathy is claimed to be seen only in patients with rheumatoid arthritis. In this paper, we report a patient with a rapidly destructive arthropathy accompanied by an enlarged iliopsoas bursa that has been misdiagnosed as an infection.

  15. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    PubMed Central

    Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in

  16. Uncemented total hip arthroplasty in young patients with juvenile chronic arthritis.

    PubMed Central

    Kumar, M. N.; Swann, M.

    1998-01-01

    The hip joint is commonly affected in juvenile chronic arthritis (JCA) and involvement is usually bilateral. It is well established that the involvement of the hip in JCA is the most important reason that the patient will lose independence and mobility. The positive gains, both in terms of hip function and the overall functional capability, of the patients of JCA after hip replacement have been shown by several studies. There have been many reports regarding cemented total hip replacement in young patients with JCA. The short-term results have been excellent, but failure rates were considerably higher with further follow-up. To our knowledge there have been no other reports to date of the results of cementless arthroplasty of the hip in this condition. We reviewed the results of 25 primary uncemented total hip replacements (THR) in 16 patients with JCA. The mean postoperative follow-up time was 4.5 years (range 1-19 years). The clinical results were evaluated using the modified Harris hip score. The functional outcome was assessed by a scoring system described by Witt et al. The most significant long-term problem was acetabular loosening (12%) in our series. Images Figure 1 Figure 2 PMID:9682646

  17. Sensitivity to implant materials in patients undergoing total hip replacement.

    PubMed

    Granchi, Donatella; Cenni, Elisabetta; Trisolino, Giovanni; Giunti, Armando; Baldini, Nicola

    2006-05-01

    Sensitivity to implant materials is an unpredictable event, which may contribute to the process leading to the failure of the total hip replacement (THR). The aim of the current study was to investigate the informative power of skin testing in detecting the sensitization to the implant components in patients undergoing THR. A consecutive series of 223 patients was enrolled in the study, including 66 candidates to THR, 53 with stable implant, and 104 with THR loosening. The patch testing was performed by using the most relevant components of cobalt-based alloys (CoCrMo), Ti-based alloys (TiAlV), and bone cements. The frequency of positive patch testing in preimplant patients did not differ from that observed after THR. Patients with CoCrMo-failed implant showed a significant low frequency of nickel-positive skin reaction, while patients with TiAlV-THR had a high incidence of vanadium-positive patch testing. The panel of haptens showed a good performance in the identification of patients known to have a contact dermatitis. With regard to the THR outcome, patch testing was not able to discriminate between stable and failed implant. Sensitivity to at least one hapten, namely bone cement, as well as the positive medical history of hypersensitivity, influenced negatively the THR survival. Our results show the reliability of patch testing for investigating the sensitivity to implant components. The cause-effect relationship between sensitization and negative outcome cannot be established, but the shorter lifespan of THR in patients who have a positive patch testing supports the significant role of this event in contributing to the implant failure. PMID:16265661

  18. Readmission Rates in Patients Who Underwent Total Hip Arthroplasty.

    PubMed

    Elmallah, Randa K; Cherian, Jeffrey J; Amin, Hiral; Jauregui, Julio J; Pierce, Todd P; Mont, Michael A

    2015-11-01

    Readmission rates remain a concern following total hip arthroplasty (THA). This study: 1) evaluated 30-day, 90-day, and total readmission rates after THAs; 2) assessed causes of readmission; 3) determined differences in demographic factors between those who were and were not readmitted; and 4) compared readmission rates to other large-scale studies. We retrospectively reviewed 232 primary THAs (224 patients) using the same prosthesis at 7 institutions. This included 79 men and 145 women who had a mean age of 69 years (range, 44 to 88). Descriptive analyses were used to evaluate readmission, and rates were compared with those from large cohort studies. There were 11 unplanned readmissions (4.7%) in 10 patients during the first 90 days post-discharge. Seven (3%) readmissions were due to surgical and 4 (1.7%) were due to medical reasons. Surgical causes were found in 70% of early (0 to 30 days) readmissions but none of late (60 to 90 days) readmissions. No differences existed in mean age, gender, and body mass index between readmitted patients and the remainder of the population. We observed lower readmission rates when compared with large cohort studies. The positive performance of the prosthesis may have contributed to the lower readmission rates. PMID:26680400

  19. Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy.

    PubMed

    Park, Jae Young; Choi, Young; Cho, Byung Chae; Moon, Sang Young; Chung, Chin Youb; Lee, Kyoung Min; Sung, Ki Hyuk; Kwon, Soon-Sun; Park, Moon Seok

    2016-07-01

    Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP. PMID:27366015

  20. Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy

    PubMed Central

    2016-01-01

    Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP. PMID:27366015

  1. Leg scanning with radioisotope-labeled fibrinogen in patients undergoing hip surgery

    SciTech Connect

    LeMoine, J.R.; Moser, K.M.

    1980-05-01

    To establish whether radioisotope-labeled fibrinogen leg scanning is of value in the context of hip surgery, we propsectively studied 21 consectuvie patients undergoing either total hip replacement (14) or open repair of a hip fracture (seven) with leg scans, contrast phlebography, and ventilation and perfusion lung scans. We found that in eight patients (38%), venous thromboembolism developed postoperatively. Agreement between phlebographic and leg scanning results was excellent. In no patient as venous thrombosis limited to the thigh on the operated-on side, a vital consideration in application of fibrinogen leg scanning to this patient population. Two patients had lung scan changes indicative of embolism; both had thrombi extending into thigh veins. Leg scanning with radioisotope-labeled fibrinogen appears to be a useful method for monitoring patients undergoing hip surgery, if the upper three counting points on the operated-on side are excluded.

  2. Risk factors for hip fracture among elderly patients with Alzheimer's disease.

    PubMed

    Sato, Yoshihiro; Kanoko, Tomohiro; Satoh, Kei; Iwamoto, Jun

    2004-08-30

    Incidence of hip fracture among patients with Alzheimer's disease (AD), especially in elderly patients, is high. To analyze risk factors of hip fracture, we prospectively studied a cohort of elderly female patients with AD. Subjects studied were 225 female patients with AD, and the average age was 76 years old. At baseline, we recorded body mass index (BMI), a score of Mini-Mental State Examination (MMSE) and bone mineral density (BMD), and measured serum concentrations of ionized calcium, intact parathyroid hormone (PTH), pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), intact bone Gla protein (BGP), 25-hydroxyvitamin (25-OHD) and 1, 25-dihydroxyvitamin D (1, 25-[OH]2D). The patients were followed for 2 years. During the 2-year study, hip fractures occurred in 29 patients. We compared baseline variables between the 29 patients with and 176 patients without hip fracture. AD patients with lower BMD, low concentrations of serum ionized calcium and 25-OHD (mean 3.0 ng/ml) with compensatory hyperparathyroidism were found to have an increased risk of hip fracture. Also, concentrations of serum ICTP and BGP were higher in the fracture group than in the nonfracture group. Elderly female AD patients with low BMD and serum 25-OHD concentrations <5 ng/ml with secondary hyperparathyroidism have a high risk of hip fracture, and the risk may be reduced by vitamin D supplementation. PMID:15337610

  3. Evaluation of the Degree of Knee Joint Osteoarthritis in Patients with Early Gray Hair

    PubMed Central

    Kazemi, Behrooz; Ashraf, Alireza; Namazi, Mohammad Reza; Zarei, Fariba; Foruzi, Shima

    2013-01-01

    Background: Osteoarthritis (OA) is the most common form of arthritis and one of the causes of pain and disability. The hair graying characteristic correlates strictly with chronological aging and take places to varying degrees in all individuals, disregarding gender or race. Aims: Comparison of the degrees of clinical and radiologic severity of the knee OA in individuals with early hair graying compared to ordinary individuals. Materials and Methods: A total of 60 patients with knee OA and similar demographic characteristics were enrolled in this study. All patients were classified in to 3 age subgroups in each of the case and control groups (30-40 year, 41-50 year, 51-60 year). In the case group, the patients must had early hair graying, too. Knee OA were classified using the Kellgren-Lawrence (KL) grading scale. Western Ontario McMaster University Osteoarthritis index (WOMAC) was applied to assess clinical severity of the knee OA. Results: The mean ± SD of WOMAC index in the case group was 60.7 ± 15.9 and in the control group was 55.3 ± 15.3 (P = 0.1). The mean rank of KL scale in case group was 35.3 and in the control group was 25.6 (P = 0.02). Conclusion: Even at the same age of OA onset, the rate of progression of radiological findings and the grade of joint destruction in individuals with early hair graying are greater than normal individuals. However, clinical and functional relevant remain unclear. PMID:24403769

  4. Relationships of Fear, Anxiety, and Depression With Physical Function in Patients With Knee Osteoarthritis

    PubMed Central

    Scopaz, Kristen A.; Piva, Sara R.; Wisniewski, Stephen; Fitzgerald, G. Kelley

    2016-01-01

    Objectives To explore whether the psychologic variables anxiety, depression, and fear-avoidance beliefs, and interactions between these variables, are associated with physical function in patients with knee osteoarthritis (OA). We hypothesized lower levels of function would be related to higher anxiety, higher depression, and higher fear-avoidance beliefs, and that high levels of 2 of these factors simultaneously might interact to have a greater adverse effect on physical function. Design Cross-sectional, correlational design. Setting Institutional practice. Participants Subjects included patients with knee OA (N=182; age, mean ± SD, 63.9±8.8y; 122 women). Interventions Not applicable. Main Outcome Measures Self-report measures of function included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the Lower Extremity Function Scale (LEFS), and the Knee Outcome Survey-Activity of Daily Living Scale. The Get Up and Go test was used as a physical performance measure of function. Self-report measures for psychologic variables included the Beck Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Fear Avoidance Belief Questionnaire-Physical Activity Scale modified for the knee. Results Higher anxiety was related to poorer function on the WOMAC physical function. Both high anxiety and fear avoidance beliefs were related to poorer function on the LEFS and Knee Outcome Survey-Activity of Daily Living Scale. There was no association between the psychologic variables and the Get Up and Go test. The anxiety X depression interaction was associated with the LEFS. Conclusions Anxiety and fear-avoidance beliefs are associated with self-report measures of function in patients with knee OA. Depression may influence scores on the LEFS under conditions of low anxiety. PMID:19887210

  5. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    SciTech Connect

    Okuno, Yuji; Korchi, Amine Mohamed; Shinjo, Takuma; Kato, Shojiro

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  6. Gait patterns after intraarticular treatment of patients with osteoarthritis of the Knee - Hyaluronan versus triamcinolone: a prospective, randomized, doubleblind, monocentric study

    PubMed Central

    2009-01-01

    Objective Evaluation of gait performance and muscle activity patterns as well as clinical efficacy and safety after single intraarticular injection with hyaluronan compared with triamcinolone in patients with knee osteoarthritis. Materials and Methods This trial evaluated the influence of a single injection of hyaluronan or triamcinolone on gait pattern and muscle activity. For clinical evaluation a visual analogue scale for pain, Lequesne index, and Knee Society Score were used. Quality of life was assessed with the SF-36. Results The complete analysis was performed in 50 of 60 patients. 26 patients were treated with triamcinolone and 24 with hyaluronan. Hyaluronan treatment led to significant improvement of range of motion at hip and knee. Significant improvement could be either demonstrated for the pain scale, Lequesne and Knee Society score in both groups. Quality of life showed greater improvement in the triamcinolone group. Conclusion Single application of high-viscosity hyaluronan shows superior range of motion and pain reduction as well as improvement in clinical results. Even if there was a lack of significant differences compared to triamcinolone, this therapy classified as safe and effective in the short follow up. PMID:19380288

  7. Epidemiology of traumatic hip dislocation in patients treated in Ceará, Brazil

    PubMed Central

    Lima, Luciana Cascão; do Nascimento, Robson Alves; de Almeida, Victor Monte Tenório; Façanha, Fernando Antônio Mendes

    2014-01-01

    OBJECTIVE: To describe the epidemiological profile of patients with traumatic hip dislocation treated in our Institute from November/2012 to July/2013. METHODS: A descriptive cross-sectional study based on interviews and involving 43 patients who suffered traumatic hip dislocation was conducted. RESULTS: The mean age of patients was 34.4 years old and 90.7% were male. Regarding the mechanism of injury, 95% involved traffic accidents. The posterior dislocation of the hip was the most common injury (93%). Associated lesions were observed in 74.4% of patients, hip fractures being the most frequent. The time span between accident and dislocation reduction was less than 6 hours in 37.2% of patients, between 6 and 12 hours in 32.5% and over 12 hours in 30.3%, ranging from 1 hour to 15 days. A fraction of 90.7% of patients was submitted to closed reduction. CONCLUSION: Traumatic hip dislocation affected mostly young adults, victims of traffic accidents. The posterior dislocation of the hip was the most frequent injury and closed reduction was performed in 90.7% of patients. The time span between accident and dislocation reduction was less than 12 hours in most patients. Level of Evidence III, Study of Nonconsecutive Patients. PMID:25061422

  8. Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age?

    PubMed Central

    Mason, James; Baker, Paul; Gregg, Paul J; Porter, Martyn; Deehan, David J; Reed, Mike R

    2015-01-01

    Background and purpose The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements. Methods We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men). The reference implant comprised a cemented stem with a conventional polyethylene cemented cup and a standard-sized head (28- or 32-mm). Differences in implant survival were assessed using competing-risks models, adjusted for known prognostic influences. Analysis of covariance was used to assess improvement in PROMs (Oxford hip score (OHS) and EQ5D index) in 2014 linked procedures. Results In males, PROMs and implant survival were similar across all types of implants. In females, revision was statistically significantly higher in hard-bearing and/or small-stem cementless implants (hazard ratio (HR) = 4) and resurfacings (small head sizes (< 48 mm): HR = 6; large head sizes (≥ 48 mm): HR = 5) when compared to the reference cemented implant. In component combinations with equivalent survival, women reported significantly greater improvements in OHS with hybrid implants (22, p = 0.006) and cementless implants (21, p = 0.03) (reference, 18), but similar EQ5D index. For men and women, National Health Service (NHS) costs were lowest with the reference implant and highest with a hard-bearing cementless replacement. Interpretation In young women, hybrids offer a balance of good early functional improvement and low revision risk. Fully cementless and resurfacing components are more costly and do not provide any additional benefit for younger patients. PMID:25285617

  9. Tauroursodeoxycholic acid suppresses endoplasmic reticulum stress in the chondrocytes of patients with osteoarthritis.

    PubMed

    Liu, Chao; Cao, Yongping; Yang, Xin; Shan, Pengcheng; Liu, Heng

    2015-10-01

    The main pathogenic events in osteoarthritis (OA) include loss and abnormal remodeling of cartilage extracellular matrix. The present study aimed to evaluate the protective effect of tauroursodeoxycholic acid on chondrocyte apoptosis induced by endoplasmic reticulum (ER) stress. Articular cartilage tissues were collected from 18 patients who underwent total knee arthroplasty and were analyzed histologically. Subsequently, chondrocyte apoptosis was assessed by TUNEL. Quantitative polymerase chain reaction and western blot analysis were employed to evaluate gene and protein expression, respectively, of ER stress markers, including glucose‑regulated protein 78 (GRP78), growth arrest and DNA‑damage‑inducible gene 153 (GADD153) and caspase‑12 along with type II collagen. Chondrocytes obtained from osteoarthritis patients at different stages were cultured in three conditions including: No treatment (CON group), tunicamycin treatment to induce ER stress (ERS group) and tauroursodeoxycholic acid treatment after 4 h of tunicamycin (TDA group); and cell proliferation, apoptosis, function and ER stress level were assessed. Degradation of cartilage resulted in histological damage with more apoptotic cartilage cells observed. Of note, GRP78, GADD153 and caspase‑12 mRNA and protein expression increased gradually from grade I to III cartilage tissue, while type II collagen expression decreased. Tunicamycin induced ER stress, as shown by a high expression of ER stress markers, reduced cell proliferation, increased apoptosis and decreased synthesis of type II collagen. Notably, tauroursodeoxycholic acid treatment resulted in the improvement of tunicamycin‑induced ER stress. These results indicated that ER stress is highly involved in the tunicamycin‑induced apoptosis in chondrocytes, which can be prevented by tauroursodeoxycholic acid. PMID:26238983

  10. Development of a decision support system to predict physicians' rehabilitation protocols for patients with knee osteoarthritis.

    PubMed

    Hawamdeh, Ziad M; Alshraideh, Mohammad A; Al-Ajlouni, Jihad M; Salah, Imad K; Holm, Margo B; Otom, Ali H

    2012-09-01

    To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee OA were entered into the MDSS. Demographic variables in the model were age and sex. Clinical variables entered into the model were height, weight, BMI, affected side, severity of knee OA, and severity of pain. All patients in the study received one of three treatment protocols for patients with knee OA: (a) hot packs, followed by electrotherapy and exercise, (b) ice packs, followed by ultrasound and exercise and (c) exercise alone. The resilient back propagation artificial neural network algorithm was used, with a ten-fold cross-validation. It was estimated that the MDSS is able to accurately predict the treatment prescribed by the physician for 87% of the patients. We developed an artificial neural network-based decision support system that can viably aid physicians in determining which treatment protocol would best match the anthropometric and clinical characteristics of patients with knee OA. PMID:22508428

  11. Real-Time Tracking of Knee Adduction Moment in Patients with Knee Osteoarthritis

    PubMed Central

    Kang, Sang Hoon; Lee, Song Joo; Zhang, Li-Qun

    2014-01-01

    Background The external knee adduction moment (EKAM) is closely associated with the presence, progression, and severity of knee osteoarthritis (OA). However, there is a lack of convenient and practical method to estimate and track in real-time the EKAM of patients with knee OA for clinical evaluation and gait training, especially outside of gait laboratories. New Method A real-time EKAM estimation method was developed and applied to track and investigate the EKAM and other knee moments during stepping on an elliptical trainer in both healthy subjects and a patient with knee OA. Results Substantial changes were observed in the EKAM and other knee moments during stepping in the patient with knee OA. Comparison with Existing Method(s) This is the first study to develop and test feasibility of real-time tracking method of the EKAM on patients with knee OA using 3-D inverse dynamics. Conclusions The study provides us an accurate and practical method to evaluate in real-time the critical EKAM associated with knee OA, which is expected to help us to diagnose and evaluate patients with knee OA and provide the patients with real-time EKAM feedback rehabilitation training. PMID:24361759

  12. Hip arthrosis and surgical intervention: what and when?

    PubMed

    Innocenti, Massimo; Nistri, Lorenzo; Biondi, Marco; Del Prete, Armando; Giorgini, Marco; Macera, Armando; Soderi, Stefano

    2013-01-01

    Osteoarthritis of the hip is a common pathology and involves forms of disability and need for treatments that affect the quality of life of patients and their families, and in general of the whole society. It should be considered as such degenerative joint disease is increasing as the increase in life expectancy and musculoskeletal trauma, the latter responsible for secondary forms of osteoarthritis. The treatment of osteoarthritis of the hip has changed a lot over the years, since the earlier diagnosis and, before, with prevention through proper lifestyle. More in-depth knowledge of the biology of the tissues involved, first of all hyaline cartilage, has lead to non-surgical treatments such as infiltration with hyaluronic acid (viscosupplementation) and autologous growth factors derived from platelets (platelet rich plasma). Surgical therapy with prosthetic replacement is finally a choice to share with the patient based on pain and functional limitation, bearing in mind always the best technology and tribology and the possibility of less invasive surgical access, while recognizing that there are not still eternal prosthesis. Of particular importance then is the age of the patient. There are also other types of surgery (hip arthroscopy, forage) for other pathologies of the hip which can be resolutive, or, in a sense, can delay the arrival to the prosthetic replacement. We will discuss below the decision-making process that leads the surgeon with the patient to the surgery option. PMID:23858310

  13. Reflecting on pain management for patients with osteoarthritis and other rheumatic disorders: there's more to pain management than managing pain

    PubMed Central

    Perret, Danielle; Chang, Eric Y; Pang, Winnie; Shinada, Shuntaro; Panush, Richard S

    2015-01-01

    SUMMARY Medical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that “the practice of medicine is an art, based on science”. This doesn't change. PMID:24654815

  14. Reflecting on pain management for patients with osteoarthritis and other rheumatic disorders: there's more to pain management than managing pain.

    PubMed

    Perret, Danielle; Chang, Eric Y; Pang, Winnie; Shinada, Shuntaro; Panush, Richard S

    2013-07-01

    SUMMARY Medical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that "the practice of medicine is an art, based on science". This doesn't change. PMID:24654815

  15. Hip resurfacing after iliofemoral distraction for type IV developmental dysplasia of the hip a case report.

    PubMed

    Sambri, A; Cadossi, M; Mazzotti, A; Faldini, C; Giannini, S

    2015-01-01

    Osteoarthritis secondary to developmental dysplasia of the hip is a surgical challenge because of the modified anatomy of the acetabulum which is deficient in its shape with poor bone quality, torsional deformities of the femur and the altered morphology of femoral head. Particularly in Crowe type III and IV, additional surgical challenges are present, such as limb-length discrepancy and adductor muscle contractures. This is a bilateral hip dysplasia case where bilateral hip replacement was indicated, on the left side with a resurfacing one and on the other side a two stage procedure using a iliofemoral external fixator to restore equal leg length with a lower risk of complications. This case report shows both the negative clinical outcome of the left and the excellent one of the right hip where the dysplasia was much more severe. Patient selection and implant positioning are crucial in determining long-term results. PMID:27218252

  16. Accuracy of CT-based patient-specific guides for total knee arthroplasty in patients with post-traumatic osteoarthritis.

    PubMed

    Schotanus, M G M; van Haaren, E H; Hendrickx, R P M; Jansen, E J P; Kort, N P

    2015-12-01

    Published clinical trials who studied the accuracy of patient-specific guides (PSG) for total knee arthroplasty exclude patients with articular deformity of the knee joint. We prospectively analysed a series of 30 patients with post-traumatic osteoarthritis of the knee joint with use of PSG. At 1 year post-operative, the achieved biomechanical (HKA) axis and varus/valgus of the femur and tibia components were measured on anterior-posterior (AP) long-standing weight-bearing radiographs. Flexion/extension of the femoral and AP slope of the tibia component was measured on standard lateral radiographs. Percentages >3° deviation of the pre-operative planned HKA axis and individual implant components were considered as outliers. Approved and used implant size, median blood loss (ml) and operation time (min) were obtained from the operation records. Pre- and 1-year post-operative patient-reported outcome measures (PROMs) were performed. Eighty-three per cent of the patients had a HKA axis restored <3° of the pre-operative planned alignment. Varus/valgus outliers were 0.0 and 6.7 % for the femoral and tibial components, respectively. Percentages of outliers of flexion/extension were 36.7 % for the femoral component and 10.0 % for the AP slope of the tibial component. Median blood loss was 300 ml (50-700), while operation time was 67 min (44-144). In 20 % of all cases, the approved implant size was changed into one size smaller. One-year post-operative PROMs improved significantly. We conclude that the accuracy of CT-based PSG is not impaired in patients with post-traumatic osteoarthritis and this modality can restore biomechanical limb alignment. PMID:26265403

  17. The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: a cone-beam CT study.

    PubMed

    Krisjane, Z; Urtane, I; Krumina, G; Neimane, L; Ragovska, I

    2012-06-01

    Osteoarthritis of the temporomandibular joint (TMJ) can be described as non-inflammatory arthritic condition that results in degenerative changes of the joint structures. The aim of this study was to evaluate the skeletal morphology of the TMJ in patients with osteoarthritis with severe skeletal malocclusions (Class II and Class III) and patients with Class I occlusion as controls. Cone beam computed tomography images of 45 Class I, 28 Class II and 44 Class III joints of Caucasian patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex as described in the research diagnostic criteria for temporomandibular disorders (RDC/TMD). In all groups, the most commonly observed features were articular surface flattening and subcortical sclerosis. A combination of features that corresponds to a diagnosis of osteoarthritis was observed in 3% Class I, 43% Class II and 20% Class III patient joints. In conclusion, degenerative TMJ changes were more common in patients with skeletal jaw discrepancies, but wide inter-individual variations can be observed even in patients with clinically similar malocclusions. PMID:22464854

  18. Measuring the impact and distress of osteoarthritis from the patients' perspective

    PubMed Central

    Pallant, Julie F; Keenan, Anne-Maree; Misajon, Roseanne; Conaghan, Philip G; Tennant, Alan

    2009-01-01

    Background To assess the internal construct validity of the Perceived Impact of Problem Profile (PIPP), a patient based outcome measure based on the International Classification of Functioning, Disability and Health (ICF), which assesses impact and distress, in an osteoarthritis (OA) cohort. Methods A questionnaire comprising the 23-item PIPP, which assesses five domains (mobility, participation, self care, psychological well being and relationships), the Western Ontario McMasters University Osteoarthritis Index (WOMAC), the General Well-Being Index (GWBI), and the Hospital Anxiety and Depression Scale (HADS) was posted to people with clinician diagnosed OA. Assessment of the internal construct validity of the PIPP was undertaken using Rasch analysis performed with RUMM2020 software and concurrent validity through comparator measures. Results Two hundred and fifty-nine participants with OA responded. Analysis of the five individual domains of the PIPP indicated that there was good fit to the Rasch model, with high person separation reliability. One item required removal from the Mobility subscale and the Participation subscale. There were strong correlations between the PIPP Mobility scores and the WOMAC disability and pain subscales (rho = .73 and rho = .68), and between the PIPP Psychological well-being and HADS Depression (rho = .71) and GWBI (rho = -.69). High inter-correlations between the impact and distress subscales for each domain (range rho = .85 to .96), suggested redundancy of the latter. Conclusion This study demonstrates that the PIPP has good psychometric properties in an OA population. The PIPP, using just the impact subscales, provides a brief, reliable and valid means of assessing the impact of OA from the individual's perspective and operationalizing the bio-psychosocial model by the application of a single multi-domain questionnaire. PMID:19400966

  19. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    PubMed Central

    Santos, Thiago R. T.; Oliveira, Bárbara A.; Ocarino, Juliana M.; Holt, Kenneth G.; Fonseca, Sérgio T.

    2015-01-01

    Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. PMID:26039034

  20. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-05-18

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  1. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed Central

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-01-01

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  2. The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis

    PubMed Central

    Hashemi, Masoud; Jalili, Parviz; Mennati, Shirin; Koosha, Alireza; Rohanifar, Ramin; Madadi, Firouz; Razavi, Seyed Sajad; Taheri, Farinaz

    2015-01-01

    Background: Knee osteoarthritis (KOA) is a common disabling disease. Limited studies have demonstrated that prolotherapy with dextrose or with prolozone can be helpful in the treatment of patients with KOA. Objectives: In the current study, we compared the results between these two treatment methods. Patients and Methods: In the current randomized clinical trial, 80 patients with mild to moderate KOA were randomly assigned equally into two groups (ozone group and dextrose group). In each group, injections were repeated three times with 10-day intervals. Before the treatment and 3 months after the injections, the pain intensity was measured by using a visual analogue scale and the Western Ontario and McMaster university arthritis index scores. Finally, the results were compared between the two groups. Results: In the two groups, the pain intensity and WOMAC scores significantly decreased and increased, respectively (P < 0.001). However, there was no significant difference between the two groups. Conclusions: Prolotherapy with dextrose and with prolozone result in the same pain relief or functional improvement in patients with mild to moderate KOA. PMID:26587401

  3. Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients

    PubMed Central

    Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew

    2015-01-01

    Objective To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Design Semistructured interviews exploring the experience of recovery from hip fracture at two time points—4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. Participants 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Setting Single major trauma centre in the West Midlands of the UK. Results Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Conclusions Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health

  4. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

    PubMed Central

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

    2016-01-01

    Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  5. Fracture of the femoral alignment stem of a hip resurfacing arthroplasty. A case report.

    PubMed

    Bhutta, Mohammed A; Shah, Vinod B

    2011-02-01

    Metal-on-metal hip resurfacing arthroplasty has become increasingly popular for the treatment of osteoarthritis in a younger patient population. While the initial complication of femoral neck fracture is being addressed, we describe a fracture of the femoral alignment stem in a component two years from the primary procedure. PMID:21473460

  6. Patient Participation and Physical Activity during Rehabilitation and Future Functional Outcomes in Patients following Hip Fracture

    PubMed Central

    Lenze, Eric J.; Munin, Michael C.; Harrison, Christopher C; Brach, Jennifer S

    2016-01-01

    Objective We examined the association between physical activity recorded by Actigraphy during therapy sessions (therapy) to therapist rated patient participation and self reported future functional outcomes. We hypothesized those participants who were more active during rehab would have higher participation scores and better functional outcomes following hip fracture compared to those who were less active. Design Longitudinal study with 3 and 6 month follow-up. Setting Participants were recruited from skilled nursing (SN) and inpatient rehabilitation (IR) facilities. Participants Participants included 18 community dwelling older adults admitted to SN or IR facilities after hip fracture. Participants were included if they were ≥ 60 years of age and ambulatory with or without assistance from a device or another person. Intervention Not Applicable Main Outcome Measure Physical activity was quantified during participants’ rehab using the Actigraph accelerometer worn consecutively over 5 days. The Pittsburgh Participation Rating Scale was used to quantify patient participation during their inpatient therapy sessions. Self reported functional outcomes were measured by the Hip Fracture Functional Recovery Scale (HFRS) at baseline, 3 and 6 months following fracture. Results Participants with higher Actigraphy counts during rehab were ranked by their therapists as having excellent participation compared to those who were less active. Participants who were more active reported better functional abilities at both 3 and 6 month time points and achieved 78% and 91% recovery of self reported pre-fracture function compared to those who were less active achieving 64% and 73% recovery. Conclusion Actigraphy provides an objective measure of physical activity exhibiting predictive validity for future functional outcomes and concurrent validity against patient participation in patients after hip fracture. PMID:19345777

  7. Physicians’ accuracy and interrator reliability for the diagnosis of unstable meniscal tears in patients having osteoarthritis of the knee

    PubMed Central

    Dervin, Geoffrey F.; Stiell, Ian G.; Wells, George A.; Rody, Kelly; Grabowski, Jenny

    2001-01-01

    Objective To determine clinicians’ accuracy and reliability for the clinical diagnosis of unstable meniscus tears in patients with symptomatic osteoarthritis of the knee. Design A prospective cohort study. Setting A single tertiary care centre. Patients One hundred and fifty-two patients with symptomatic osteoarthritis of the knee refractory to conservative medical treatment were selected for prospective evaluation of arthroscopic débridement. Intervention Arthroscopic débridement of the knee, including meniscal tear and chondral flap resection, without abrasion arthroplasty. Outcome measures A standardized assessment protocol was administered to each patient by 2 independent observers. Arthroscopic determination of unstable meniscal tears was recorded by 1 observer who reviewed a video recording and was blinded to preoperative data. Those variables that had the highest interobserver agreement and the strongest association with meniscal tear by univariate methods were entered into logistic regression to model the best prediction of resectable tears. Results There were 92 meniscal tears (77 medial, 15 lateral). Interobserver agreement between clinical fellows and treating surgeons was poor to fair (κ < 0.4) for all clinical variables except radiographic measures, which were good. Fellows and surgeons predicted unstable meniscal tear preoperatively with equivalent accuracy of 60%. Logistic regression modelling revealed that a history of swelling and a ballottable effusion were negative predictors. A positive McMurray test was the only positive predictor of unstable meniscal tear. “Mechanical” symptoms were not reliable predictors in this prospective study. The model was 69% accurate for all patients and 76% for those with advanced medial compartment osteoarthritis defined by a joint space height of 2 mm or less. Conclusions This study underscored the difficulty in using clinical variables to predict unstable medial meniscal tears in patients with pre

  8. Patients' and Practitioners' Views of Knee Osteoarthritis and Its Management: A Qualitative Interview Study

    PubMed Central

    Alami, Sophie; Boutron, Isabelle; Desjeux, Dominique; Hirschhorn, Monique; Meric, Gwendoline; Rannou, François; Poiraudeau, Serge

    2011-01-01

    Purpose To identify the views of patients and care providers regarding the management of knee osteoarthritis (OA) and to reveal potential obstacles to improving health care strategies. Methods We performed a qualitative study based on semi-structured interviews of a stratified sample of 81 patients (59 women) and 29 practitioners (8 women, 11 general practitioners [GPs], 6 rheumatologists, 4 orthopedic surgeons, and 8 [4 GPs] delivering alternative medicine). Results Two main domains of patient views were identified: one about the patient–physician relationship and the other about treatments. Patients feel that their complaints are not taken seriously. They also feel that practitioners act as technicians, paying more attention to the knee than to the individual, and they consider that not enough time is spent on information and counseling. They have negative perceptions of drugs and a feeling of medical uncertainty about OA, which leads to less compliance with treatment and a switch to alternative medicine. Patients believe that knee OA is an inevitable illness associated with age, that not much can be done to modify its evolution, that treatments are of little help, and that practitioners have not much to propose. They express unrealistic fears about the impact of knee OA on daily and social life. Practitioners' views differ from those of patients. Physicians emphasize the difficulty in elaborating treatment strategies and the need for a tool to help in treatment choice. Conclusions This qualitative study suggests several ways to improve the patient–practitioner relationship and the efficacy of treatment strategies, by increasing their acceptability and compliance. Providing adapted and formalized information to patients, adopting more global assessment and therapeutic approaches, and dealing more accurately with patients' paradoxal representation of drug therapy are main factors of improvement that should be addressed. PMID:21573185

  9. Tanezumab for Patients with Osteoarthritis of the Knee: A Meta-Analysis

    PubMed Central

    Yuan, Zhi-Fang; Chen, Ling-Xiao; Bi, Ming-Chao; Sun, Jing-Cheng; Feng, Shi-Qing

    2016-01-01

    Objective Tanezumab is a new therapeutic intervention for patients with osteoarthritis (OA) of the knee. We performed the present meta-analysis to appraise the efficacy and safety of tanezumab for patients with knee OA. Methods We systematically searched randomized controlled trials from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcomes were mean change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, the WOMAC physical function and patient's global assessment (PGA). Outcomes were reported as the standard mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI). We assessed the pooled data using a random-effects model. Results Of the identified studies, four were eligible and were included in this meta-analysis (N = 1839 participants). Compared with the placebo groups, tanezumab yielded a significant reduction in mean change in the WOMAC pain (SMD = 0.51, 95% CI 0.34 to 0.69, P<0.00001), the WOMAC physical function (SMD = 0.56, 95% CI 0.38 to 0.74, P<0.00001) and PGA (SMD = 0.34, 95% CI 0.22 to 0.47, P<0.00001). There was no significant difference in serious adverse events (RR = 1.06, 95% CI 0.59 to 1.92, P = 0.84) between the tanezumab and placebo groups. Tanezumab significantly increased discontinuations due to adverse events (RR = 2.89, 95% CI 1.59 to 5.26, P = 0.0005), abnormal peripheral sensations (RR = 3.14, 95% CI 2.12 to 4.66, P<0.00001), and peripheral neuropathy (RR = 6.05, 95% CI 2.32 to 15.81, P = 0.0002). Conclusion Tanezumab can alleviate pain and improve function for patients with OA of the knee. However, considering the limited number of studies, this conclusion should be interpreted cautiously and more clinical randomized controlled trials are needed to verify the efficacy and safety of tanezumab for OA of the knee. PMID:27294371

  10. Alumina-on-alumina total hip prostheses in patients 40 years of age or younger.

    PubMed

    Bizot, P; Banallec, L; Sedel, L; Nizard, R

    2000-10-01

    To avoid the consequences of polyethylene wear in a high-risk population, 128 alumina-on-alumina total hip arthroplasties have been done in 104 consecutive patients. The maximum age of patients was 40 years. The main preoperative diagnoses were osteonecrosis and sequellae of congenital hip dislocation (71% of the hips). The same titanium alloy cemented stem was implanted in all of the hips. Four types of alumina acetabular component fixations were used: a cemented plain alumina socket (41 hips), a screw-in ring with an alumina insert (22 hips), a press-fit plain alumina socket (32 hips), and a press-fit titanium metal back with an alumina insert (33 hips). Eight patients (11 hips) died during the followup period. Sixteen revisions have been documented, 12 for acetabular aseptic loosening, three for bipolar loosening (two of which were septic), and one for unexplained pain. Eighty-eight hips in 74 patients have been followed up radiologically for 2 to 22 years. Wear was unmeasurable. Four additional sockets showed definite migration. The respective survival rates after 7 years were 94.1% for the cemented cup, 88.8% for the screw-in ring, 95.1% for cementless press-fit plain alumina socket and 94.3% for the metal-back press-fit component. The 10-year survival rate was 90.4% for the cemented socket and 88.8% for the screw-in ring. The 15-year survival rate was 78.9% for the cemented socket. Grafting was the only prognostic factor, with a survival rate of 62.6% after 10 years for the hips with a bone graft and of 90.1% for hips without a graft. The alumina-on-alumina bearing surfaces seem to be a valuable alternative to the standard metal-on-polyethylene system for young patients. However, an improvement in socket fixation is required to lengthen the life span of the prosthesis to match the life expectancy of this demanding population. PMID:11039794

  11. Total Hip Arthroplasty Using the S-ROM-A Prosthesis for Anatomically Difficult Asian Patients

    PubMed Central

    Hozumi, Akira; Kobayashi, Kyousuke; Tsuru, Nobuhisa; Miyamoto, Chikara; Maeda, Jyunichiro; Chiba, Ko; Goto, Hisataka; Osaki, Makoto

    2015-01-01

    Background. The S-ROM-A prosthesis has been designed for the Asian proximal femur with a small deformed shape and narrow canal. In this study, the clinical and radiological results using the S-ROM-A prosthesis for Japanese patients with severe deformity due to dysplasia and excessive posterior pelvic tilt were examined. Methods. 94 hips were followed up for a mean of 55 months, with a mean age at surgery of 61 years. The primary diagnoses were 94 coxarthritis cases, including 51 dysplasia and 37 primary OA, 1 avascular necrosis, 2 traumatic arthritis, and 3 Perthes disease. Thirty-one hips had been treated with osteotomy of the hip joints. Preoperative intramedullary canal shapes were stovepipe in 23 hips, normal in 51 hips, and champagne-flute in 5 hips. The maximum pelvic inclination angle was 56°. Results. The mean JOA score improved from 46 points preoperatively to 80 points at final follow-up. On radiological evaluation of the fixation of the implants according to the Engh classification, 92 (97%) hips were classified as “bone ingrown fixation.” Conclusion. In primary THA, using the S-ROM-A prosthesis for Asian patients with proximal femoral deformity, even after osteotomy and with posterior pelvic tilt, provided good short- to midterm results. PMID:26582575

  12. Total hip arthroplasty in paralytic dislocation from poliomyelitis.

    PubMed

    Laguna, Rafael; Barrientos, Jesús

    2008-02-01

    This article presents a case of a patient with degenerative hip disease in paralytic dislocation by poliomyelitis. Poliomyelitis is an acute infection disease caused by a group of neurotrophic viruses, which has a special affinity by the anterior horns cells of the spinal cord and for certain motor nuclei of the brain stem. Paralysis is a flaccid type and characteristically paralysis is asymmetrical. It is said that the joints of the affected limb by poliomyelitis are protected from the development of osteoarthritis. Hip dislocation in poliomyelitis is an acquired deformity caused by flaccid paralysis and the resulting muscular imbalance. In young children, when the gluteus maximus and medius muscles are paralyzed and the hip flexors and adductors are of normal strength, eventual luxation of the hip is almost inevitable. Hip osteoarthritis in a limb with poliomyelitis is an unusual entity because these limbs do not support excessive loads. In patients who present with the residual effects of poliomyelitis including degenerative disease and hip dysplastic, surgery is one of the most difficult challenges faced by reconstructive surgeons. In such cases, surgeons should attempt to optimize the component position and choice, surgical approach, and soft tissue tensioning because stability of the prosthesis can be problematic. PMID:19292189

  13. The Cost-Effectiveness of Surgical Treatment of Medial Unicompartmental Knee Osteoarthritis in Younger Patients

    PubMed Central

    Konopka, Joseph F.; Gomoll, Andreas H.; Thornhill, Thomas S.; Katz, Jeffrey N.; Losina, Elena

    2015-01-01

    Background: Surgical options for the management of medial compartment osteoarthritis of the varus knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. We sought to determine the cost-effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty as alternatives to total knee arthroplasty for patients fifty to sixty years of age. Methods: We built a probabilistic state-transition computer model with health states defined by pain, postoperative complications, and subsequent surgical procedures. We estimated transition probabilities from published literature. Costs were determined from Medicare reimbursement schedules. Health outcomes were measured in quality-adjusted life-years (QALYs). We conducted analyses over patients’ lifetimes from the societal perspective, with health and cost outcomes discounted by 3% annually. We used probabilistic sensitivity analyses to account for uncertainty in data inputs. Results: The estimated discounted QALYs were 14.62, 14.63, and 14.64 for high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty, respectively. Discounted total direct medical costs were $20,436 for high tibial osteotomy, $24,637 for unicompartmental knee arthroplasty, and $24,761 for total knee arthroplasty (in 2012 U.S. dollars). The incremental cost-effectiveness ratio (ICER) was $231,900 per QALY for total knee arthroplasty and $420,100 per QALY for unicompartmental knee arthroplasty. Probabilistic sensitivity analyses showed that, at a willingness-to-pay (WTP) threshold of $50,000 per QALY, high tibial osteotomy was cost-effective 57% of the time; total knee arthroplasty, 24%; and unicompartmental knee arthroplasty, 19%. At a WTP threshold of $100,000 per QALY, high tibial osteotomy was cost-effective 43% of time; total knee arthroplasty, 31%; and unicompartmental knee arthroplasty, 26%. Conclusions: In fifty to sixty-year-old patients with medial unicompartmental knee

  14. Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

    PubMed Central

    2012-01-01

    Introduction Cupping is used in various traditional medicine forms to relieve pain in musculoskeletal diseases. The aim of this study was to investigate the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA). Methods In a two-group, randomized controlled exploratory pilot study patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity > 40 mm on a 100 mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4 weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0 mm = no pain to 100 mm = maximum intensity) and Quality of Life (SF-36) 4 and 12 weeks after randomization. Use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome. Results 21 patients were allocated to the cupping group (5 male; mean age 68 ± SD 7.2) and 19 to the control group (8 male; 69 ± 6.8). After 4 weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p = 0.001). After 12 weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p = 0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12 weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets

  15. [Side effects of COX-2 selective inhibitors. Critic related with its administration in patients with rheumatoid arthritis and osteoarthritis].

    PubMed

    Carrillo Gutiérrez, Ofmara Y; Pérez Sánchez, Adriana G; Medina Serriteño, Nicolás; Rodríguez Orozco, Alain R

    2007-01-01

    At the end of 2000 the new age of AINEs was introduced, specially the selective inhibitors of the COX-2, whose main function is to block the production of the prostaglandins and the acute tissue inflammation. These inhibitors have analgesic, antithermal and antiinflammatory effects similar to traditional AINEs; they are prescribed specifically to diminish pain and inflammation in patients with rheumatoid arthritis and osteoarthritis. After them introduction, it was reported that they can produce cardiovascular effects, mainly infarcts. This revision exposes the adverse effects that selective inhibitors of the COX-2 produce when elevated doses are administered, during prolonged time, in patients with rheumatoid arthritis and osteoarthritis; in addition, it comments present recommendations for them prescription. PMID:18297851

  16. Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index.

    PubMed

    Wu, Eddie S; Cherian, Jeffrey J; Jauregui, Julio J; Robinson, Kristin; Harwin, Steven F; Mont, Michael A

    2016-05-01

    Obese patients undergoing total hip arthroplasty have been shown to have less functional recovery. This study prospectively compared temporal trends in patient-reported outcomes and activity levels between patients with a body mass index (BMI) of less than 30, 30 to 35, and 35 to 40 kg/m(2) after total hip arthroplasty. Patients were evaluated via the Harris Hip Score, Lower Extremity Activity Scale, and Short Form-12 physical and mental components. The results suggest that patients with BMIs of 35 to 40 kg/m(2) might have poorer functional outcomes preoperatively, with function returning more slowly or poor function being sustained and their not reaching other cohorts' levels. Surgeons must counsel these patients regarding functional expectations and the potential for slower functional returns. [Orthopedics. 2016; 39(3):e572-e577.]. PMID:27064775

  17. Current indications for hip resurfacing arthroplasty in 2016.

    PubMed

    Sershon, Robert; Balkissoon, Rishi; Valle, Craig J Della

    2016-03-01

    Hip resurfacing arthroplasty (HRA) is an alternative to conventional, stemmed total hip arthroplasty (THA). The best reported results are young, active patients with good bone stock and a diagnosis of osteoarthritis. Since the 1990s, metal-on-metal (MoM) HRA has achieved excellent outcomes when used in the appropriate patient population. Concerns regarding the metal-on-metal bearing surface including adverse local tissue reaction (ALTR) to metal debris have recently lead to a decline in the use of this construct. The current paper aims to provide an updated review on HRA, including a critical review of the most recent literature on HRA. PMID:26830851

  18. Upregulation of fibroblast growth factor 1 in the synovial membranes of patients with late stage osteoarthritis.

    PubMed

    Li, R; Wang, B; He, C Q; Yang, Y Q; Guo, H; Chen, Y; Du, T H

    2015-01-01

    Osteoarthritis (OA) is a degenerative disease of the systemic joint that involves multiple cytokines and growth factors. Fibroblast growth factor 1 (FGF-1) is increased in patients with rheumatic arthritis. The aim of this study was to determine whether the expression and secretion of FGF-1 differed in synovial tissue from patients with late stage OA from that in normal tissues. We selected eight patients with late stage OA and eight healthy donors for this study. An enzyme-linked immunosorbent assay was used to determine the amount of FGF-1 in the synovial fluid and in the culture medium of synovial fibroblasts. Real time quantitative polymerase chain reaction (qPCR) analysis was performed to examine the expression levels of FGF-1 and FGF receptor 2 (FGFR2) in synovial and cartilage tissues. We detected FGF-1 in the synovial fluid from all eight donors, as well as in the culture medium of synovial fibroblasts. Synovial fluid from patients with OA and culture medium of OA synovial fibroblasts contained significantly more FGF-1 than those from controls. FGF-1 expression was also lower in the synovial membranes of normal donors than in those of OA patients. FGFR2 expression was also higher in OA cartilage than in normal cartilage. Overall, these results demonstrated that FGF-1 synthesis and secretion by synovial fibroblasts were significantly increased in OA. FGFR2 expression was also shown to be upregulated in patients with OA. These findings suggest that increased FGF-1 signaling correlates with an OA pathological condition. PMID:26400350

  19. Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.

    PubMed

    Daniels, Alan H; Daiello, Lori A; Lareau, Craig R; Robidoux, Kathryn A; Luo, Wylie; Ott, Brian; Hayda, Roman A; Born, Christopher T

    2014-07-01

    We conducted a prospective study to evaluate the prevalence of cognitive impairment (CI) in elderly inpatients awaiting surgery for hip fracture, and to compare CI and normal cognition (NC) patients with respect to preoperative pain, fear, and anxiety. The study included patients who were older than 65 years when admitted to a hospital after acute hip fracture. Preoperative assessment involved use of Confusion Assessment Method-Short Form, Montreal Cognitive Assessment (MoCA), visual analog scales for anxiety and fear, and Wong-Baker Faces Pain Scale. Patients with delirium were excluded from the study. Patients with CI and NC, as determined by MoCA score, were compared for each assessment. Of the 65 hip fracture patients enrolled, 62 had evaluable cognitive data. Of these 62 patients, 23 (37.1%) had NC (MoCA score, ≥ 23) and 39 (62.9%) had CI (MoCA score, < 23). Only 5 (7.7%) of the 65 patients had a documented diagnosis of CI or dementia at time of hospitalization. Mean preoperative pain scores were significantly (P < .001) higher for CI patients (5.3) than for NC patients (2.8). Our study results showed that many elderly hip fracture patients had unrecognized CI before surgery, and CI patients had significantly more pain than NC patients did. Appropriate identification of preoperative CI and treatment of pain are crucial in optimizing patient outcomes. PMID:25046191

  20. [Complications after hip osteotomy].

    PubMed

    Renner, L; Perka, C; Zahn, R

    2014-01-01

    Complex deformities of the acetabulum are one of the most common reasons for secondary pelvic osteoarthritis. One option of treatment is osteotomy of the acetabulum close to the joint. The correction of the spatially reduced roof of the femoral head resulting from pelvic dysplasia can minimize the risk of developing secondary osteoarthritis or reduce the progression of an already existing osteoarthritis. The Ganz periacetabular osteotomy (PAO) and Tönnis triple osteotomy procedures are the predominant methods used to correct hip dysplasia in adolescents. Both are complex procedures which bear specific risks and complications, thus requiring very experienced surgeons. PMID:24356819

  1. Development and validation of the French version of a tool assessing patient's expectations in lower limb osteoarthritis

    PubMed Central

    Neuprez, Audrey; Delcour, Jean-Pierre; Fatemi, Firouzeh; Gillet, Philippe; Mawet, Marie; François, Garance; Bruyère, Olivier; Crielaard, Jean-Michel; Gosset, Christiane; Reginster, Jean-Yves

    2014-01-01

    Objective The Hospital for Special Surgery (HSS) Hip Replacement Expectations Survey and Knee Replacement Expectations Survey are validated tools developed to measure patients' preoperative expectations for hip and knee arthroplasty. These instruments have possible uses in both daily practice and research. Our objective was to assess the test-retest reliability and the construct validity of the French version of the surveys. Methods Patients scheduled for total hip (n = 82) or knee replacement (n = 61) aged 38–90 years were included. All completed the HSS Hip or Knee Replacement Expectations Survey and the Expectation WOMAC to determine concurrent validity. The test-retest reliability was assessed using the intraclass coefficient correlation (ICC), the Bland and Altman Method and the coefficient of variation; the internal consistency was assessed by the Cronbach α coefficient. The construct validity was investigated using the Pearson correlation coefficient and floor and ceiling effects by percentage frequency of lowest or highest possible score achieved by respondents. Results 143 patients scheduled for hip or knee arthroplasty were included. The reliability was excellent between the test and the rested total score, with an ICC of 0.902 (0.853–0.936) and CV of 4.06% for the French Hip Replacement Expectations Survey and 0.865 (0.786–0.917) and CV of 7.7% for the French Knee Replacement Expectations Survey, without bias. The Cronbach α coefficient was 0.72 for hip Survey and 0.82 for knee Survey showing a good internal consistency. Pearson correlation coefficients of 0.45 and 0.48 between Expectations WOMAC and HSS, respectively for hip Survey and knee Survey, were observed but with systematic bias. The lowest possible score was not reported by any patient and only three patients (3.66%) scheduled for hip arthroplasty reported the highest possible score. Conclusions The French version of the HSS Hip or Knee Replacement Expectations Survey is a reliable

  2. False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis

    SciTech Connect

    Feldman, N.; Makler, P.T. Jr.; Alavi, A.

    1986-01-01

    A Tronzo hip prosthesis is designed to elicit an inflammatory reaction in order to promote prosthesis stability. A three-phased bone scan and Ga-67 imaging in conjunction with physical examination and laboratory findings failed to demonstrate evidence for osteomyelitis in a patient with a painful hip prosthesis, in whom images obtained with In-111-labeled leukocytes were positive. This observation demonstrated that the interpretation of the latter technique in demonstrating inflammation can cause a false impression of an infectious process.

  3. Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

    PubMed Central

    Ristic, Branko; Rancic, Nemanja; Bukumiric, Zoran; Zeljko, Stepanovic; Ignjatovic-Ristic, Dragana

    2016-01-01

    Abstract Background There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients. Methods The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study. Results Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease. Conclusion Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened. PMID:27284379

  4. EVALUATION OF HEPATIC FUNCTION AMONG PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING ENOXAPARIN

    PubMed Central

    Wink, Felipe Vitiello; Schwartsmann, Carlos Roberto

    2015-01-01

    Objective: To evaluate hepatic changes resulting from the use of enoxaparin for prophylaxis of deep vein thrombosis among patients undergoing total hip arthroplasty. Methods: Thirty-two patients underwent elective total hip arthroplasty, using enoxaparin, and were followed up for 65 days with serial hepatic enzyme assays. Results: Changes in laboratory parameters were found in up to 75% of the patients during the study, but the parameters normalized after suspension of the treatment. No clinical evidence of hepatic lesions was found. Conclusion: The hepatic enzyme levels increase in most patients using enoxaparin, but without clinical correlation, and the levels normalize after suspension of the treatment. PMID:27022533

  5. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients.

    PubMed

    Guo, Jiong Jiong; Wu, Kailun; Guan, Huaqing; Zhang, Lei; Ji, Cheng; Yang, Huilin; Tang, Tiansi

    2016-07-01

    Little is known about the mid-term results of nonsurgical treatment for shoulder osteoarthritis (OA), especially in a Chinese population. This study sought to determine the efficacy of nonsurgical management in older patients with shoulder OA. A total of 129 conservatively treated unilateral shoulder OA patients who were older than 65 years were evaluated prospectively at the initial office visit and then subsequently at 3, 6, 12, 18, 24, and 36 months later. During the 36-month follow-up period, all patients could receive conventional therapy, such as nonsteroidal anti-inflammatory medication, corticosteroid injection, sodium hyaluronate, and education, at the discretion of treating physicians. Some patients received physiotherapy, rehabilitation training, and a shoulder strap to improve the range of motion and muscular strength training from a physical therapist. Parameters measured included comparative effectiveness of each therapeutic method, visual analog scale (VAS), Simple Shoulder Test (SST), and Short Form (36) Health Survey (SF-36) scores. At 3-year follow-up, most patients had a significant increase from their pretreatment values in pain, self-assessed shoulder function, mental health, and 5 of 8 SF-36 domains. The study showed a decline in SST and VAS at 6 and 12 months after an initial ascent at 3 months, and then it was rescued and continued at 3-year follow-up. Combined therapy could improve symptoms significantly. This study suggests that a conservative approach may be more appropriate and can produce satisfactory mid-term outcomes in selected cases. The findings of this study suggest that conservative treatments should be extended for longer than 12 months before the decision regarding shoulder arthroplasty is made. [Orthopedics. 2016; 39(4):e634-e641.]. PMID:27286050

  6. Good outcome of total hip replacement in patients with cerebral palsy

    PubMed Central

    King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W

    2016-01-01

    Background and purpose — People with cerebral palsy (CP) often have painful deformed hips, but they are seldom treated with hip replacement as the surgery is considered to be high risk. However, few data are available on the outcome of hip replacement in these patients. Patients and methods — We linked Hospital Episode Statistics (HES) records to the National Joint Registry for England and Wales to identify 389 patients with CP who had undergone hip replacement. Their treatment and outcomes were compared with those of 425,813 patients who did not have CP. Kaplan-Meier estimates were calculated to describe implant survivorship and the curves were compared using log-rank tests, with further stratification for age and implant type. Reasons for revision were quantified as patient-time incidence rates (PTIRs). Nationally collected patient-reported outcomes (PROMS) before and 6 months after operation were compared if available. Cumulative mortality (Kaplan-Meier) was estimated at 90 days and at 1, 3, and 5 years. Results — The cumulative probability of revision at 5 years post-surgery was 6.4% (95% CI: 3.8–11) in the CP cohort as opposed to 2.9% (CI 2.9–3%) in the non-CP cohort (p < 0.001). Patient-reported outcomes showed that CP patients had worse pain and function preoperatively, but had equivalent postoperative improvement. The median improvement in Oxford hip score at 6 months was 23 (IQR: 14–28) in CP and it was 21 (14–28) in non-CP patients. 91% of CP patients reported good or excellent satisfaction with their outcome. The cumulative probability of mortality for CP up to 7 years was similar to that in the controls after stratification for age and sex. Interpretation — Hip replacement for cerebral palsy appears to be safe and effective, although implant revision rates are higher than those in patients without cerebral palsy. PMID:26863583

  7. [Dynamics of hip joint biomechanics in patients with coxarthrosis at the time of hippotherapy].

    PubMed

    Nareklishvili, T M

    2008-02-01

    The problems of degenerative-dystrophic abnormalities stimulate the development of new skills and methods of treatment and rehabilitation of the diseases. The goal of the study was to determine the efficacy of hippotherapy in patients with coxarthrosis, according to functional and biomechanical parameters. Hippotherapy involves the utilization of horseback riding to stimulate the patient's normal reactions and locomotion; to improve the balance and coordination of movement, normalize muscle tension, and eliminate pathological reflexes. The advantage of the hippotherapy is in the specific posture, which is adopted by hip joint at the time of riding and in movement, which is accomplished by rider, at different paces of the horse. 10 female patients from 14 to 32 years old with coxarthrosis were under the observation. The rehabilitation of the patients was carried out by means of hippotherapy, which consisted of three months riding three times a week. To evaluate the efficacy of treatment, a new method of biomechanical registration of hip joint movement during hippotherapy on pacing horse was developed. The dynamics of biomechanical curves before and after the treatment, as well as the clinical and functional parameters of the patients allowed the authors to conclude: hippotherapy improves a hip joint functional state in patients with coxarthrosis; improves the muscle-tendineous component of hip joint movement. Hippotherapy may be considered as the pathogenetic method of treatment of coxarthrosis. Drawing the biomechanical curve of hip joint movement at the time of riding is the objective method of studying its function. PMID:18401052

  8. Platelet-Rich Plasma Treatment in Symptomatic Patients With Knee Osteoarthritis

    PubMed Central

    Gobbi, Alberto; Karnatzikos, Georgios; Mahajan, Vivek; Malchira, Somanna

    2012-01-01

    Background: With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA). Purpose: To determine the effectiveness of intra-articular PRP injections in active patients with knee OA and to evaluate clinical outcomes in patients with and without previous surgical treatment for cartilage lesions. Study Design: Case series. Materials and Methods: Fifty patients with knee OA were followed for a minimum of 12 months. All were treated with 2 intra-articular injections of autologous PRP. Twenty-five patients had undergone a previous operative intervention for cartilage lesions, whereas 25 had not. Operated patients had undergone either cartilage shaving or microfracture. Multiple evaluative scores were collected at pretreatment and at 6 and 12 months posttreatment. The required sample of patients was determined beforehand by using statistical power analysis; International Knee Documentation Committee (subjective) score was defined as the primary parameter. A P value of less than 0.05 was considered statistically significant. General linear model–repeated measure test evaluated within-time improvement for each variable for all patients. Post hoc test with Bonferroni adjustment for multiple comparisons was performed to investigate the significance in improvement within time evaluations for each variable for the total sample. The differences in improvement between operated and nonoperated patients were also investigated, as were those between sexes. Results: All patients showed significant improvement in all scores at 6 and 12 months (P < 0.01) and returned to previous activities. No significant difference in improvement was found between the evaluated subgroups (P < 0.01). Conclusions: The PRP treatment showed positive effects in patients with knee OA. Operated and nonoperated patients showed significant improvement by means of diminishing

  9. Increased 1-year survival and discharge to independent living in overweight hip fracture patients.

    PubMed

    Flodin, Lena; Laurin, Agnes; Lökk, Johan; Cederholm, Tommy; Hedström, Margareta

    2016-04-01

    Background and purpose - Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively. Patients and methods - This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living. Results - Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26. Interpretation - In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture. PMID:26986549

  10. Increased 1-year survival and discharge to independent living in overweight hip fracture patients

    PubMed Central

    Flodin, Lena; Laurin, Agnes; Lökk, Johan; Cederholm, Tommy; Hedström, Margareta

    2016-01-01

    Background and purpose — Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively. Patients and methods — This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living. Results — Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22–26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2–5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4–5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22–26. Interpretation — In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture. PMID:26986549

  11. Severe Vitamin D Deficiency in Swiss Hip Fracture Patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Based on evidence for fall and fracture prevention, most clinical guidelines for the prevention of hip fractures recommend 800 IU vitamin D per day. This dose shifted 25(OH)D levels in previous studies to between 60-100 nmol/l. Aim: As a direct test of clinical guideline practice in Swi...

  12. Abnormal Subcortical Brain Morphology in Patients with Knee Osteoarthritis: A Cross-sectional Study

    PubMed Central

    Mao, Cui Ping; Bai, Zhi Lan; Zhang, Xiao Na; Zhang, Qiu Juan; Zhang, Lei

    2016-01-01

    Despite the involvement of subcortical brain structures in the pathogenesis of chronic pain and persistent pain as the defining symptom of knee osteoarthritis (KOA), little attention has been paid to the morphometric measurements of these subcortical nuclei in patients with KOA. The purpose of this study is to explore the potential morphological abnormalities of subcortical brain structures in patients with KOA as compared to the healthy control subjects by using high-resolution MRI. Structural MR data were acquired from 26 patients with KOA and 31 demographically similar healthy individuals. The MR data were analyzed by using FMRIB’s integrated registration and segmentation tool. Both volumetric analysis and surface-based shape analysis were performed to characterize the subcortical morphology. The normalized volumes of bilateral caudate nucleus were significantly smaller in the KOA group than in the control group (P = 0.004). There was also a trend toward smaller volume of the hippocampus in KOA as compared to the control group (P = 0.027). Detailed surface analyses further localized these differences with a greater involvement of the left hemisphere (P < 0.05, corrected) for the caudate nucleus. Hemispheric asymmetry (right larger than left) of the caudate nucleus was found in both KOA and control groups. Besides, no significant correlation was found between the structural data and pain intensities. Our results indicated that patients with KOA had statistically significant smaller normalized volumes of bilateral caudate nucleus and a trend toward smaller volume of the hippocampus as compared to the control subjects. Further investigations are necessary to characterize the role of caudate nucleus in the course of chronicity of pain associated with KOA. PMID:26834629

  13. Friction Coefficient and Superficial Zone Protein are Increased in Patients with Advanced Osteoarthritis

    PubMed Central

    Neu, C.P.; Reddi, A.H.; Komvopoulos, K.; Schmid, T.M.; Di Cesare, P.E.

    2010-01-01

    Objective To quantify the concentration of superficial zone protein (SZP) in articular cartilage and synovial fluid of patients with advanced osteoarthritis (OA), and to further correlate the SZP content with the friction coefficient, OA severity, and levels of inflammatory cytokines. Methods Samples of articular cartilage and synovial fluid were obtained from patients undergoing elective total knee replacement surgery. Additional normal samples were obtained from donated body program and tissue bank sources. Regional SZP expression in cartilage obtained from the femoral condyles was quantified by enzyme-linked immunosorbant assay and visualized by immunohistochemistry. Friction coefficient measurements were obtained from cartilage plugs slid in the boundary lubrication regime. OA severity was graded using histochemical analyses. The concentration of SZP and inflammatory cytokines in synovial fluid were determined by enzyme-linked immunosorbant assays. Results A pattern of SZP localization in knee cartilage was identified, with load-bearing regions exhibiting high SZP expression. SZP patterns correlated to friction coefficient and OA severity; however SZP expression was observed in all samples at the articular surface, regardless of OA severity. SZP expression and aspirate volume of synovial fluid were higher in OA patients compared to normal controls. Expressions of cytokines were elevated in the synovial fluid of some patients. Conclusion The results reveal a mechano-chemical coupling in which physical forces regulate OA severity and joint lubrication. The findings of this study also suggest that SZP may be ineffective in reducing joint friction in the boundary lubrication regime at an advanced OA stage where other mechanisms may dominate the observed tribological behavior. PMID:20499384

  14. Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study

    PubMed Central

    Bruyere, O; Richy, F; Reginster, J

    2005-01-01

    Objective: To assess the clinical relevance of mean and minimum femorotibial joint space narrowing (JSN) for predicting future osteoarthritis related surgery in patients with knee osteoarthritis. Methods: 126 subjects with primary knee osteoarthritis were followed prospectively for a mean eight years. Minimum and mean joint space width (JSW) were assessed from standard x rays at baseline and after a follow up of three years. The rate of knee osteoarthritis related surgery was recorded for the following five years. Results: After a mean follow up of eight years, 16 patients (12.7%) had received osteoarthritis related joint surgery. The areas under the curves (AUC) resulting from the receiver operating characteristic curve analyses for predicting osteoarthritis surgery were 0.73 (p = 0.006) for minimum JSN and 0.55 (p = 0.54) for mean JSN. The cut off for minimum JSN maximising sensitivity and specificity for predicting future surgery was a change of 0.7 mm or more in minimum joint space width over a period of three years. However, no meaningful differences were observed for cut off values between 0.5 and 0.8 mm The relative risk (adjusted for age, body mass index, baseline symptoms, and baseline JSW) of experiencing osteoarthritis related surgery during the eight year of follow up was 5.15 (95% confidence interval, 1.70 to 15.60) (p = 0.004) in patients with a minimum joint space narrowing of 0.7 mm or more during the first three years of the study. Conclusions: A cut off of 0.5 to 0.8 mm in minimum JSN, measured on standard x rays, reflects a clinically relevant progression in patients with knee osteoarthritis. PMID:15843444

  15. What happens to patients when they fracture their hip during a skilled nursing facility stay?

    PubMed Central

    Leland, Natalie E.; Gozalo, Pedro; Bynum, Julie; Mor, Vincent; Christian, Thomas J.; Teno, Joan M.

    2015-01-01

    Objectives To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home (NH) receiving skilled nursing facility (SNF) services. Design Observational study. Participants Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during a SNF stay. Measurements Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community < 30 days), successful community discharge (in the community ≥30 days), death, and institutionalization. Results Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to a SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained less than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care. Conclusion SNF care aims to maximize the short-stay patient’s independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient’s plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed healthcare decisions. PMID:25944177

  16. Anterior hip pain.

    PubMed

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity. PMID:10537384

  17. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

    PubMed Central

    Rosemann, Thomas; Wensing, Michel; Joest, Katharina; Backenstrass, Matthias; Mahler, Cornelia; Szecsenyi, Joachim

    2006-01-01

    Background Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. Methods We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. Results Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. Conclusion GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed. PMID:16749935

  18. Hip Fractures in a Geriatric Population - Rehabilitation Based on Patients Needs

    PubMed Central

    Radosavljevic, Natasa; Nikolic, Dejan; Lazovic, Milica; Jeremic, Aleksandar

    2014-01-01

    With an increased life expectancy in humans and thus an increase in the number of the elderly population, the frequency of hip fractures will rise as well. Aside from a higher incidence, hip fractures in a geriatric population is a significant problem due to the possible onset of severe and in some cases dramatic complications and consequences. The primary purpose of treatment and rehabilitation in the elderly after a hip fracture is to improve an individual’s quality of life. It is important to underline that principles and methods of functional restoration after hip fracture should consider careful planning of a rehabilitation program individually for every patient and its implementation with respect to decisions made by the rehabilitation team. PMID:24900940

  19. The relevance of gender in the care of hip fracture patients.

    PubMed

    Saletti-Cuesta, Lorena; Tutton, Liz; Wright, Julie

    2016-08-01

    As in many conditions, gender interplays with other social structures of inequality to impact upon women's and men's health and healthcare. This narrative review examines knowledge about sex, gender and hip fracture and suggests ways of highlighting the influence of gender in hip fracture healthcare. These will be considered in relation to two areas. Firstly the multifactorial dimension of hip fractures which identifies ethnicity, marital status, lifestyle, co-morbidities, environment in relation to falls and osteoporosis as important factors influencing the experience of hip fracture. Secondly the importance of acknowledging gender as a key element within research and management of care. Implications for practice are that we need a raised awareness of gender when we assess and care for patients, to ask critical questions about the gender bias in the evidence we use and reflect on how services and care practices may be biased towards gendered assumptions. PMID:27215748

  20. Frontal Lobe Function and Risk of Hip Fracture in Patient With Alzheimer Disease

    PubMed Central

    Roh, Hyun Woong; Hong, Chang Hyung; Lee, SooJin; Lee, Yunhwan; Lee, Kang Soo; Chang, Ki Jung; Oh, Byoung Hoon; Choi, Seong Hye; Kim, Seong Yoon; Back, Joung Hwan; Chung, Young Ki; Lim, Ki Young; Noh, Jai Sung; Son, Sang Joon

    2015-01-01

    Abstract To determine the association between frontal lobe function and risk of hip fracture in patients with Alzheimer disease (AD). Retrospective cohort study using multicenter hospital-based dementia registry and national health insurance claim data was done. Participants who had available data of neuropsychological test, national health insurance claim, and other covariates were included. A total of 1660 patients with AD were included based on Stroop Test results. A total of 1563 patients with AD were included based on the Controlled Oral Word Association Test (COWAT) results. Hip fracture was measured by validated identification criteria using national health insurance claim data. Frontal lobe function was measured by Stroop Test and COWAT at baseline. After adjusting for potential covariates, including cognitive function in other domains (language, verbal and nonverbal memory, and attention), the Cox proportional hazard regression analysis revealed that risk of a hip fracture was decreased with a hazard ratio (HR) of 0.98 per one point of increase in the Stroop Test (adjusted HR = 0.98, 95% confidence interval [CI]: 0.97–1.00) and 0.93 per one point increase in COWAT (adjusted HR = 0.93, 95% CI: 0.88–0.99). The risk of hip fracture in AD patients was associated with baseline frontal lobe function. The result of this research presents evidence of association between frontal lobe function and risk of hip fracture in patients with AD. PMID:26559259

  1. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial

    PubMed Central

    Van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; De Bandt, Jean Pascal; Twisk, Jos W. R.; Van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): −0.54; 95% CI: −1.08–−0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00–3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: −1.10; 95% CI: −2.33–0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality. PMID:26035756

  2. Validating Efficacy of Shea Nut Oil Extract in Knee Osteoarthritis Patients

    PubMed Central

    Lo, Sui-Foon; Wang, Yu-Chia; Chou, Tzu-Yi; Chang, Kang-Ming

    2013-01-01

    Objectives. To examine and investigate the efficacy of shea nut oil extract (SheaFlex75) in relation to knee osteoarthritis (OA). Methods. Thirty-three patients (age 63.6 ± 5.8 years) with knee OA were recruited. Real-time ultrasound imaging and surface electromyography were used to objectively assess the morphological changes and the activity of vastus medialis oblique (VMO) muscles during a 16-week intervention of SheaFlex75. The intraclass correlation coefficient (ICC) was calculated to examine the reliability of the interscans. A paired-sample t-test was used to compare the findings in different stages. The Spearman's rank correlation coefficient was used to examine the relationship between the relevant variables of OA and percentage of thickness change of VMO at different contraction levels. Results. The baseline findings showed strong correlation, suggesting that the reliability of interscans at pretest was high. The ability to contract the muscles of the knee to a 30% contraction level showed significant change between the baseline and after 16-week testing, both in terms of morphological changes and muscle activity. Pain scale reported a significant decrease at the 16th week. Conclusion. The results suggest that SheaFlex75 can relieve the symptoms of knee OA and can result in improvement of muscle control of the knee. PMID:24454485

  3. Overcoming barriers to osteoporosis care in vulnerable elderly patients with hip fractures.

    PubMed

    Switzer, Julie A; Jaglal, Susan; Bogoch, Earl R

    2009-07-01

    Indications for and benefits of providing osteoporosis (OP) care for hip fracture patients have become widely understood. The hip fracture patient is frequently over age 80 years, minimally ambulatory, has multiple medical comorbidities, and has cognitive impairment. Patient barriers to initiation of effective OP treatment include: age, dementia, medical comorbidities, polypharmacy, lack of adherence with treatment, alcohol abuse, postoperative delirium, language barriers, inadequate social support, and socioeconomic status. In a large teaching hospital, 244 patients presented with hip fracture over 2 years: 72% were female and 64% were over age 80. Forty percent had been diagnosed with dementia; another 29% had other severe medical comorbidities.Opportunities for OP diagnosis and treatment are numerous. In acute care hospitals, coordinator facilitated programs are effective for identification, education, assessment, referral, and treatment of underlying OP in fracture patients. System modifications may include an automated care path or automatic specialist referral for hip fracture patients. In the rehabilitation hospital, the patients are in a more stable condition, there is a focus on the recent fracture, and there are opportunities to initiate OP treatment and to promote adherence. In long-term care, dietary intake including calcium and vitamin D supplementation and persistence with pharmacotherapy can be monitored. Patient education and referral to the family physician for osteoporosis investigation and treatment have improved patient knowledge and diagnosis, but the reported impact on treatment has been limited.Effective OP care for the vulnerable hip fracture patient should be initiated early but may be complex and require coordination. In addition to calcium and vitamin D supplementation, most patients in this category have an indication for aminobisphosphonate therapy. Liaison between the orthopaedic team and the discharge destination caregivers, an

  4. An economic model of long-term use of celecoxib in patients with osteoarthritis

    PubMed Central

    Loyd, Michael; Rublee, Dale; Jacobs, Philip

    2007-01-01

    Background Previous evaluations of the cost-effectiveness of the cyclooxygenase-2 selective inhibitor celecoxib (Celebrex, Pfizer Inc, USA) have produced conflicting results. The recent controversy over the cardiovascular (CV) risks of rofecoxib and other coxibs has renewed interest in the economic profile of celecoxib, the only coxib now available in the United States. The objective of our study was to evaluate the long-term cost-effectiveness of celecoxib compared with nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) in a population of 60-year-old osteoarthritis (OA) patients with average risks of upper gastrointestinal (UGI) complications who require chronic daily NSAID therapy. Methods We used decision analysis based on data from the literature to evaluate cost-effectiveness from a modified societal perspective over patients' lifetimes, with outcomes expressed as incremental costs per quality-adjusted life-year (QALY) gained. Sensitivity tests were performed to evaluate the impacts of advancing age, CV thromboembolic event risk, different analytic horizons and alternate treatment strategies after UGI adverse events. Results Our main findings were: 1) the base model incremental cost-effectiveness ratio (ICER) for celecoxib versus nsNSAIDs was $31,097 per QALY; 2) the ICER per QALY was $19,309 for a model in which UGI ulcer and ulcer complication event risks increased with advancing age; 3) the ICER per QALY was $17,120 in sensitivity analyses combining serious CV thromboembolic event (myocardial infarction, stroke, CV death) risks with base model assumptions. Conclusion Our model suggests that chronic celecoxib is cost-effective versus nsNSAIDs in a population of 60-year-old OA patients with average risks of UGI events. PMID:17610716

  5. The effects of physical therapeutic agents on serum levels of stress hormones in patients with osteoarthritis

    PubMed Central

    Tönük, Şükrü Burak; Serin, Erdinc; Ayhan, Fikriye Figen; Yorgancioglu, Zeynep Rezan

    2016-01-01

    Abstract To investigate the effects of physical agents on the levels of stress hormones in patients with osteoarthritis (OA). Transcutaneous electrical nerve stimulation, hot packs, and therapeutic ultrasound were applied to the lumbar region and knees of patients with OA. Blood samples were taken for the measurement of the serum levels of glucose, insulin (INS), growth hormone (GH), prolactin (PRL), cortisol (COR), and plasma adrenocorticotropic hormone (ACTH) immediately before and after the 1st session, to investigate the acute effects of those physical agents on the endocrine system. The hormone levels were also measured every 5 sessions in a total of 10 sessions. The treatment response was also evaluated by using the visual analogue scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) throughout the therapy period. After the 1st session, there was a decrease in INS levels and a mild decrease in PRL levels (P = 0.001 and P < 0.05, respectively). Throughout the 10-session therapy period, the INS levels increased, whereas the ACTH and COR levels decreased (P < 0.05 for all). The VAS-spine, RMDQ, VAS-knee, and WOMAC scores decreased (P = 0.001 for VAS-spine and P < 0.001 for all others). A positive correlation was detected between the changes in serum COR and WOMAC-pain score (P < 0.05). Although the combination therapy caused changes in INS level accompanied with steady glucose levels, the application of physical agents did not adversely affect the hormone levels. The decrease in ACTH and COR levels may be attributed to the analgesic effect of agents and may be an indicator of patient comfort through a central action. PMID:27583888

  6. The effects of physical therapeutic agents on serum levels of stress hormones in patients with osteoarthritis.

    PubMed

    Tönük, Şükrü Burak; Serin, Erdinc; Ayhan, Fikriye Figen; Yorgancioglu, Zeynep Rezan

    2016-08-01

    To investigate the effects of physical agents on the levels of stress hormones in patients with osteoarthritis (OA).Transcutaneous electrical nerve stimulation, hot packs, and therapeutic ultrasound were applied to the lumbar region and knees of patients with OA. Blood samples were taken for the measurement of the serum levels of glucose, insulin (INS), growth hormone (GH), prolactin (PRL), cortisol (COR), and plasma adrenocorticotropic hormone (ACTH) immediately before and after the 1st session, to investigate the acute effects of those physical agents on the endocrine system. The hormone levels were also measured every 5 sessions in a total of 10 sessions. The treatment response was also evaluated by using the visual analogue scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) throughout the therapy period.After the 1st session, there was a decrease in INS levels and a mild decrease in PRL levels (P = 0.001 and P < 0.05, respectively). Throughout the 10-session therapy period, the INS levels increased, whereas the ACTH and COR levels decreased (P < 0.05 for all). The VAS-spine, RMDQ, VAS-knee, and WOMAC scores decreased (P = 0.001 for VAS-spine and P < 0.001 for all others). A positive correlation was detected between the changes in serum COR and WOMAC-pain score (P < 0.05).Although the combination therapy caused changes in INS level accompanied with steady glucose levels, the application of physical agents did not adversely affect the hormone levels. The decrease in ACTH and COR levels may be attributed to the analgesic effect of agents and may be an indicator of patient comfort through a central action. PMID:27583888

  7. Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture

    PubMed Central

    Nie, Hongling; Yang, Ya-Xiong; Wang, Yang; Liu, Yong; Zhao, Bin; Luan, Bo

    2015-01-01

    BACKGROUND: Effective analgesia is essential for the postoperative care of orthopedic patients. OBJECTIVES: To evaluate the efficacy of continuous fascia iliaca compartment block (FIB) as postoperative analgesia after hip fracture surgery, and to compare FIB with patient-controlled intravenous analgesia (PCIA) using fentanyl for 48 h postoperatively. METHODS: Patients with hip fractures who were scheduled for open reduction and internal fixation surgery using the antirotation proximal femoral nail technique were randomly assigned to the FIB or PCIA groups. Postoperative pain was assessed using a numeral rating scale at 2 h, 4 h, 6 h, 12 h, 24 h and 48 h after analgesia was started. Delirium, postoperative nausea and vomiting (PONV), and pruritus were also monitored. RESULTS: Patients in the FIB group reported less pain than those in the PCIA group (P=0.039, d=−0.3). The change in pain scores over time was similar between the two groups. There were six patients with PONV and five patients with pruritus in the PCIA group, while no PONV or pruritus was noticed in the FIB group (P=0.013). Ten (19.6%) patients in the FIB group and three (5.7%) patients in the PCIA group developed postoperative delirium (P=0.032, d=0.77). CONCLUSION: Continuous FIB is a safe and effective technique for postoperative analgesia after hip fracture surgery, making it an option for pain management in elderly patients with hip fractures. PMID:26125194

  8. Anatomy of the proximal femur at the time of total hip arthroplasty is a matter of morphotype and etiology but not gender.

    PubMed

    Ollivier, Matthieu; Parratte, Sebastien; Le Corroller, Thomas; Lecorroller, Thomas; Reggiori, Andrea; Champsaur, Pierre; Argenson, Jean-Noël

    2015-05-01

    This study aimed to determine (1) whether: gender, morphotype, or etiology are correlated with the shape of the proximal femur in patients with advanced hip osteoarthritis and (2) is there any clinical predictive factors of potential abnormal anatomy of the hip at the time of total hip arthroplasty (THA)? We reviewed 689 European hips of patients who underwent THA for primary osteoarthritis (OA) or avascular necrosis (AVN), between 2000 and 2005. The patients were stratified according to their (1) Morphotype, (2) Gender, and (3) Etiology for undergoing THA. Two independent observers measured the following four anatomical parameters on preoperative CT-scans: neck shaft angle (NSA) and femoral neck version, femoral offset and lower-limb torsion. Our results showed that both morphotype and etiology, but not gender or body mass index, were correlated with femoral anatomical parameters. Two types of patients were identified as "at risk" for abnormal hip anatomy: (1) AVN-Endomorphic patients (2) OA-Ectomorphic patients. Etiology of the advanced hip osteoarthritis and patients' morphotype may predict the proximal femur anatomy at the time of THA. PMID:25193326

  9. Obesity affects the chondrocyte responsiveness to leptin in patients with osteoarthritis

    PubMed Central

    2010-01-01

    Introduction Increasing evidence support the regulatory role of leptin in osteoarthritis (OA). As high circulating concentrations of leptin disrupt the physiological function of the adipokine in obese individuals, the current study has been undertaken to determine whether the elevated levels of leptin found in the joint from obese OA patients also induce changes in the chondrocyte response to leptin. Methods Chondrocytes isolated from OA patients with various body mass index (BMI) were treated with 20, 100 or 500 ng/ml of leptin. The expression of cartilage-specific components (aggrecan, type 2 collagen), as well as regulatory (IGF-1, TGFβ, MMP-13, TIMP 2) or inflammatory (COX-2, iNOS, IL-1) factors was investigated by real-time PCR to evaluate chondrocyte responsiveness to leptin. Furthermore, the effect of body mass index (BMI) on leptin signalling pathways was analyzed with an enzyme-linked immunosorbent assay for STATs activation. Results Leptin at 20 ng/ml was unable to modulate gene expression in chondrocytes, except for MMP-13 in obese OA patients. Higher leptin levels induced the expression of IGF-1, type 2 collagen, TIMP-2 and MMP-13. However, the activity of the adipokine was shown to be critically dependent on both the concentration and the BMI of the patients with a negative association between the activation of regulated genes and BMI for 100 ng/ml of adipokine, but a positive association between chondrocyte responsiveness and BMI for the highest leptin dose. In addition, the gene encoding MMP-13 was identified as a target of leptin for chondrocytes originated from obese patients while mRNA level of TIMP-2 was increased in leptin-treated chondrocytes collected from normal or overweight patients. The adipokine at 500 ng/ml triggered signal transduction through a STAT-dependent pathway while 100 ng/ml of leptin failed to activate STAT 3 but induced STAT 1α phosphorylation in chondrocytes obtained from obese patients. Conclusions The current study

  10. Investigation and macroscopic anatomical study of referred pain in patients with hip disease.

    PubMed

    Sakamoto, Junya; Morimoto, Yosuke; Ishii, Shun; Nakano, Jiro; Manabe, Yoshitaka; Okita, Minoru; Tsurumoto, Toshiyuki

    2014-02-01

    [Purpose] The aim of this study was to examine the incidence and patterns of referred pain in patients with hip disease, as well as the nerve distribution in the hip and knee joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint disease were included in the investigation. The incidence of regional pain and referred pain patterns were evaluated before and after arthroplasty. Two cadavers were macroscopically observed to verify the nerve innervation of the hip and knee joints. [Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6% (in motion) of the patients, which was comparable with the incidence of greater trochanter pain. In addition, the preoperative incidence rates of knee pain in resting and motion markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating to the ventral lower limb. An anteromedial innervation was determined in the cadavers by the articular branches of the obturator and femoral nerve, which supply small branches to the knee joints. [Conclusion] Our results suggest that the distribution of the incidence of pain among the patients with hip disease is diverse owing to the sensory distribution of the femoral and obturator nerves. PMID:24648632

  11. Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques

    PubMed Central

    Ruiz Santiago, Fernando; Santiago Chinchilla, Alicia; Ansari, Afshin; Guzmán Álvarez, Luis; Castellano García, Maria del Mar; Martínez Martínez, Alberto; Tercedor Sánchez, Juan

    2016-01-01

    Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both. PMID:26885391

  12. Venous thromboembolism knowledge among older post-hip fracture patients and their caregivers

    PubMed Central

    Lee, Jung-Ah; Donaldson, Jill; Drake, Diane; Johnson, Linda; van Servellen, Gwen; Reed, Preston L.; Mulnard, Ruth A.

    2014-01-01

    Patient education about venous thromboembolism (VTE) prevention is needed to prevent complications and costly re-hospitalization. Nurses are uniquely positioned to provide vital education as patients transition from the inpatient setting to after discharge. Still, little is known about patient knowledge deficits and those of their caregivers. The purpose of this study was to explore VTE prevention knowledge in a sample of older hip fracture patients and family caregivers. At the time of hospital discharge, surveys were completed by hip fracture surgery patients (≥65; n=30) and family caregivers (n=30). Participants reported needs for more prophylactic anticoagulation and side effects education. Mean education satisfaction was 3.49 out of 5 among patients and 3.83 among caregivers. Focused patient education regarding the wisdom of VTE prevention, potential risks involved, and patient and care giver roles in advocating for better prevention measures is needed for these patients at risk for hospital readmission secondary to VTE. PMID:25012989

  13. Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation.

    PubMed

    Guyen, Olivier; Pibarot, Vincent; Vaz, Gualter; Chevillotte, Christophe; Carret, Jean-Paul; Bejui-Hugues, Jacques

    2007-09-01

    We performed a retrospective study on 167 primary total hip arthroplasty (THA) procedures in 163 patients at high risk for instability to assess the reliability of unconstrained tripolar implants (press-fit outer metal shell articulating a bipolar polyethylene component) in preventing dislocations. Eighty-four percent of the patients had at least 2 risk factors for dislocation. The mean follow-up length was 40.2 months. No dislocation was observed. Harris hip scores improved significantly. Six hips were revised, and no aseptic loosening of the cup was observed. The tripolar implant was extremely successful in achieving stability. However, because of the current lack of data documenting polyethylene wear at additional bearing, the routine use of tripolar implants in primary THA is discouraged and should be considered at the present time only for selected patients at high risk for dislocation and with limited activities. PMID:17826276

  14. Osteoarthritis: From Palliation to Prevention

    PubMed Central

    Chu, Constance R.; Millis, Michael B.; Olson, Steven A.

    2014-01-01

    Osteoarthritis is a leading cause of disability. The traditional focus on late-stage osteoarthritis has not yielded effective disease-modifying treatments. Consequently, current clinical care focuses on palliation until joint replacement is indicated. A symposium format was used to examine emerging strategies that support the transformation of the clinical approach to osteoarthritis from palliation to prevention. Central to this discussion are concepts for diagnosis and treatment of pre-osteoarthritis, meaning joint conditions that increase the risk of accelerated development of osteoarthritis. The presentation of translational and clinical research on three common orthopaedic conditions—anterior cruciate ligament tear, intra-articular fracture, and hip dysplasia—were used to illustrate these ideas. New information regarding the use of novel quantitative magnetic resonance imaging (MRI) in the form of ultrashort echo time enhanced T2* (UTE-T2*) mapping to evaluate the potential for articular cartilage to heal subsurface damage in a mechanically sound environment was presented. These data indicate that improved diagnostics can both identify cartilage at risk and evaluate the effectiveness of early treatment strategies. With use of a new mouse model for intra-articular fracture, it was shown that inflammation correlated to fracture severity and that super-healer mice avoided early posttraumatic osteoarthritis in part through an enhanced ability to dampen inflammation. These findings suggest that there is a role for acute and sustained anti-inflammatory treatment in the prevention of osteoarthritis. For long-term treatment, contemporary gene-therapy approaches may offer an effective means for sustained intra-articular delivery of anti-inflammatory and other bioactive agents to restore joint homeostasis. To illustrate the potential of early treatment to prevent or delay the onset of disabling osteoarthritis, the positive clinical effects on articular cartilage and

  15. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    PubMed Central

    Chaudhary, Milind M; Chaudhary, Ishani M; Vikas, KN; KoKo, Aung; Zaw, Than; Siddhartha, A

    2015-01-01

    Background: Cam femoroacetabular impingement is caused by a misshapen femoral head with a reduced head neck offset, commonly in the anterolateral quadrant. Friction in flexion, adduction and internal rotation causes limitation of the hip movements and pain progressively leading to labral and chondral damage and osteoarthritis. Surgical hip dislocation described by Ganz permits full exposure of the hip without damaging its blood supply. An osteochondroplasty removes the bump at the femoral head neck junction to recreate the offset for impingement free movement. Materials and Methods: Sixteen patients underwent surgery with surgical hip dislocation for the treatment of cam femoroacetabular impingement by open osteochondroplasty over last 6 years. Eight patients suffered from sequelae of avascular necrosis (AVN). Three had a painful dysplastic hip. Two had sequelae of Perthes disease. Three had combined cam and pincer impingement caused by retroversion of acetabulum. All patients were operated by the trochanteric flip osteotomy with attachments of gluteus medius and vastus lateralis, dissection was between the piriformis and gluteus minimus preserving the external rotators. Z-shaped capsular incision and dislocation of the hip was done in external rotation. Three cases also had subtrochanteric osteotomy. Two cases of AVN also had an intraarticular femoral head reshaping osteotomy. Results: Goals of treatment were achieved in all patients. No AVN was detected after a 6 month followup. There were no trochanteric nonunions. Hip range of motion improved in all and Harris hip score improved significantly in 15 of 16 cases. Mean alpha angle reduced from 86.13° (range 66°–108°) to 46.35° (range 39°–58°). Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term. PMID

  16. Improvements in spinal alignment after high tibial osteotomy in patients with medial compartment knee osteoarthritis.

    PubMed

    Kim, Yoon Hyuk; Dorj, Ariunzaya; Han, Ahreum; Kim, Kyungsoo; Nha, Kyung Wook

    2016-07-01

    Since the correlation between spinal and lower extremity alignments is high, high tibial osteotomy (HTO) surgery may also affect spinal alignment, where the spinal alignment parameters are the most important parameters for the evaluation of spinal disorders. In this study, the effect of HTO surgery on spinal alignment during gait was investigated by comparing spinal alignment parameters between patients with knee osteoarthritis (OA) and healthy young controls. Eight patients (age, 55.0±5.1years; height, 160.3±7.0cm; weight, 71.3±14.1kg) with a medial compartment knee OA participated in the gait experiment two times approximately one week before and one year after HTO surgery and eight healthy young controls (age, 26.7±1.7years; height, 163.4±6.5cm; weight, 58.4±11.3kg) participated only once. Cervical curvature angle, thoracic curvature angle, lumbar curvature angle, coronal vertical axis, and coronal pelvic tilt in the coronal plane and cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, and sagittal pelvic tilt in the sagittal plane were estimated using motion analysis system with skin markers. All spinal alignment parameters after HTO surgery were significantly closer to those of healthy young subjects than those before HTO, especially in the coronal plane. These findings suggest that the HTO had a positive effect on spinal alignment, as well as lower extremity alignment, and moreover, reduced the abnormality that may result in spinal problems such as degeneration or pain. PMID:27236638

  17. Autonomy, Choice, Patient-Centered Care, and Hip Protectors: The Experience of Residents and Staff in Long-Term Care

    PubMed Central

    Sims-Gould, Joanie; McKay, Heather A.; Feldman, Fabio; Scott, Victoria; Robinovitch, Stephen N.

    2013-01-01

    The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus groups on fall prevention and hip protector use. A total of 11 focus groups were conducted. Using framework analysis results show that residents and staff shared concerns on aesthetic and comfort issues with hip protectors. Residents also generally felt they did not need, or want to use, hip protectors. However, they also had desire to be cooperative within the LTC environment. Staff underscored their role in advocating for hip protector use and their desire to protect residents from harm. Practice considerations for facilities wishing to promote hip protectors within a patient centered framework are highlighted. PMID:24652886

  18. The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.

    PubMed

    Madanat, Rami; Hussey, Daniel K; Donahue, Gabrielle S; Potter, Hollis G; Wallace, Robert; Bragdon, Charles R; Muratoglu, Orhun K; Malchau, Henrik

    2015-10-01

    The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty. PMID:26055146

  19. A pilot randomized, placebo-controlled clinical trial to investigate the efficacy and safety of an extract of Artemisia annua administered over 12 weeks, for managing pain, stiffness, and functional limitation associated with osteoarthritis of the hip and knee.

    PubMed

    Stebbings, Simon; Beattie, Elizabeth; McNamara, Debra; Hunt, Sheena

    2016-07-01

    The objective of this study was to investigate the safety and efficacy of a dietary supplement, Arthrem, containing an extract from the medicinal plant Artemisia annua, on pain, stiffness, and functional limitation in osteoarthritis (OA) of the hip or knee. Forty-two patients were randomized to one of three groups (n = 14 in each group): 150-mg Artemisia annua extract (ART) twice daily (BD) (ART low dose), 300-mg ART BD (ART high dose), or placebo BD administered over 12 weeks. Efficacy was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®) and visual analog scale (VAS) for pain. Participants treated with ART low dose demonstrated significant improvement in WOMAC total scores from baseline to 12 weeks (mean change, -12.2; standard deviation, [SD] 13.84; p = 0.0159); improvement was not shown in the placebo group (mean change, -7.8; SD, 19.80; p = 0.1029). Statistically significant reductions were seen from baseline in the ART low-dose group for individual WOMAC components stiffness and physical function. VAS pain scores were statistically significantly reduced from baseline to 12 weeks in the ART low-dose group (mean change, -21.4 mm; SD, 23.48 mm; p = 0.0082) but not the placebo group (mean change, -11.5 mm; SD, 28.97 mm, p = 0.1757). No statistically significant changes occurred from baseline in the placebo or ART high-dose groups for any parameter. ART low dose was well tolerated. ART has potential as an anti-inflammatory/analgesic in OA. Treatment with ART 150 mg BD is associated with clinically relevant reductions in pain over 12 weeks. Further studies are warranted. PMID:26631103

  20. Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol.

    PubMed

    Belcaro, G; Cesarone, M R; Errichi, S; Zulli, C; Errichi, B M; Vinciguerra, G; Ledda, A; Di Renzo, A; Stuard, S; Dugall, M; Pellegrini, L; Gizzi, G; Ippolito, E; Ricci, A; Cacchio, M; Cipollone, G; Ruffini, I; Fano, F; Hosoi, M; Rohdewald, P

    2008-01-01

    In a previous, double-blind, placebo-controlled study we evaluated the efficacy of a 3-month treatment with Pycnogenol for 156 patients with osteoarthritis of the knee. Pycnogenol significantly decreased joint pain and improved joint function as evaluated using the WOMAC score and walking performance of patients on a treadmill. In this study, we further investigated the anti-inflammatory and antioxidant activity of Pycnogenol in a subset of the osteoarthritis patients presenting with elevated C-reactive protein (CRP) and plasma-free radicals. Elevated CRP levels have been suggested to be associated with disease progression in osteoarthritis. In our study, 29 subjects of the Pycnogenol group and 26 patients in the placebo group showed CRP levels higher than 3 mg/l at baseline. Comparison of blood specimens drawn at baseline and after 3-month treatment showed that Pycnogenol significantly decreased plasma free radicals to 70.1% of baseline values. Plasma CRP levels decreased from baseline 3.9 mg/l to 1.1 mg/l in the Pycnogenol group whereas the control group had initial values of 3.9 mg/l which decreased to 3.6 mg/l. The CRP decrease in the Pycnogenol was statistical significant as compared to the control group (P < 0.05). Fibrinogen levels were found to be lowered to 62.8% of initial values (P < 0.05) in response to Pycnogenol. No significant changes for plasma free radicals, CRP and fibrinogen were found in the placebo-treated group. The decrease of systemic inflammatory markers suggests that Pycnogenol may exert anti-inflammatory activity in osteoarthritic joints and patients did not present with other ailments or infections. The nature of the anti-inflammatory effects of Pycnogenol with regard to CRP warrants further investigation. PMID:19017467

  1. Association of ABO blood group with fracture pattern and mortality in hip fracture patients

    PubMed Central

    Smith, RP; Khan, A; Aghedo, D; Venkatesan, M

    2014-01-01

    Introduction The mechanism of falling has been proposed as the exclusive explanation for hip fracture pattern. Evidence exists that other genetic factors also influence proximal femoral fracture configuration. The ABO blood group serotype has been associated with other pathologies but any role in hip fracture has yet to be definitively characterised. Methods Our National Hip Fracture Database was interrogated over a four-year period. All patients had their blood group retrieved, and this was compared with hip fracture pattern and mortality rates. Confounding factors were accounted for using logistic regression and the Cox proportional hazards model. Results A total of 2,987 consecutive patients presented to our institution. Those with blood group A were significantly more likely to sustain intracapsular fractures than ‘non-A’ individuals (p=0.009). The blood group distribution of patients with intracapsular fractures was identical to that of the national population of England. However, blood group A was less common in patients with intertrochanteric fractures than in the general population (p=0.0002). Even after correction for age and sex, blood group A was associated with a decrease in the odds of suffering an intertrochanteric fracture to 80% (p=0.002). Blood group A had inferior survivorship correcting for age, sex and hip fracture pattern (hazard ratio: 1.14, p=0.035). This may be due to associated increased prevalence of co-morbid disease in this cohort. Conclusions Blood group is an independent predictor of hip fracture pattern, with group A patients more likely to sustain an intracapsular fracture and non-A individuals more likely to sustain an intertrochanteric fracture. The determinants of fracture pattern are likely to be related to complex interactions at a molecular level based on genetic susceptibility. The mechanism of fall may not be the only aetiological determinant of proximal femoral fracture configuration. PMID:25198976

  2. Birmingham Hip Resurfacing--Patient reported outcomes pre and post 'Metal-on-Metal' media attention.

    PubMed

    Barke, Samuel; Malagelada, Francesc; Stafford, Giles; McMinn, Derek; Field, Richard

    2016-03-01

    We have investigated whether patient reported outcomes provided by patients with Birmingham Hip Resurfacing (BHR) changed after negative media coverage of metal-on-metal (MOM) hip replacement. We also investigated whether patients whose procedures were performed by a designer surgeon behaved differently to those performed elsewhere. 1178 consecutive BHR procedures performed between January 2002 and December 2006, by one of the designer surgeons in his private practice, were reviewed. We also reviewed 402 BHRs undertaken by two non-designer surgeons in both their NHS and private practice. 150 of the latter cohort were undertaken at an NHS hospital and 252 at an independent private hospital. All patients had annual Oxford Hip Scores (OHS) collected. We chose 2007 as pre-"media attention" and compared scores from this year against subsequent years. We found no clinically significant change in OHS between 2007 and subsequent years, at all centres. We conclude that negative media reporting does not appear to have had an impact on patients' perceived outcome after BHR. In consequence, patients who have undergone this type of hip resurfacing and show deterioration should be investigated. PMID:26984649

  3. Risk factors associated with outcomes of hip fracture surgery in elderly patients

    PubMed Central

    Kim, Byung Hoon; Yoo, Byunghoon; Lee, Woo Yong; Lim, Yunhee; Kim, Mun-Cheol; Yon, Jun Heum

    2015-01-01

    Background Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. Methods In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. Results The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P < 0.05). Postoperative cardiovascular complications were related to frequent intraoperative hypotension (P <0.05). Postoperative respiratory complications were related to age, preoperative renal failure, neurological comorbidities, and bedridden state (P < 0.05). ICU admission was associated with the time from injury to operation, preoperative neurological comorbidities and frequent intraoperative hypotension (P < 0.05). Conclusions Adequate treatment of respiratory comorbidities and prevention of cardiovascular complications might be the critical factors in reducing postoperative mortality in elderly patients undergoing hip fracture surgery. PMID:26634079

  4. [Dislocation of the hip in a patient with von Recklinghausen disease].

    PubMed

    Del Bosque-Herrero, A; Ezquerra-Herrando, L; Albareda-Albareda, J

    2014-01-01

    Neurofibromatosis type 1 (NF-1) is one of the most common autosomal dominant disorders affecting humans. Patients with NF-1 may present with characteristic orthopaedic manifestations such as scoliosis, congenital pseudoarthrosis and limb hyperttrophy. Dislocation of the hip associated with NF-1 is a rare occurrence. There is a relative paucity of reported cases of pathological hip dislocation in patients with NF-1, with 13 documented cases found in the published literature. Seven dislocations occurred following trivial trauma and 6 cases were deemed atraumatic. We report a case of hip dislocation in a 26 years old male with NF-1 and scoliosis, that was treated successfully by closed reduction and skin traction. PMID:24094733

  5. Self-efficacy in multimorbid elderly patients with osteoarthritis in primary care--influence on pain-related disability.

    PubMed

    Schulz, Sven; Brenk-Franz, Katja; Kratz, Anne; Petersen, Juliana J; Riedel-Heller, Steffi G; Schäfer, Ingmar; Weyerer, Siegfried; Wiese, Birgitt; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Scherer, Martin; van den Bussche, Hendrik; Gensichen, Jochen

    2015-10-01

    The impact of self-efficacy on pain-related disability in multimorbid elderly patients in primary care is not known. The aim of our study was to analyze the influence of self-efficacy on the relation between pain intensity and pain-related disability, controlled for age and disease count, in aged multimorbid primary care patients with osteoarthritis and chronic pain. Patients were recruited in the German MultiCare study (trial registration: ISRCTN89818205). Pain was assessed using the Graded Chronic Pain Scale, and self-efficacy using the General Self-Efficacy Scale. We employed SPSS for statistical analysis. One thousand eighteen primary care patients were included in the study. Correlation analyses showed significant correlations between pain intensity and pain-related disability (r = 0.591, p < 0.001), pain intensity and general self-efficacy (r = 0.078, p < 0.05), and between general self-efficacy and pain-related disability (r = 0.153, p < 0.001). Multiple mediator analysis gives indications that self-efficacy partially mediates the relation between pain intensity and pain-related disability. In our results, we found little evidence that self-efficacy partially mediates the relation between pain intensity and pain-related disability in aged multimorbid primary care patients with osteoarthritis and chronic pain. Further research is necessary to prove the effect. PMID:25190365

  6. The athlete's hip and groin.

    PubMed

    Tammareddi, Kumar; Morelli, Vincent; Reyes, Miguel

    2013-06-01

    Groin and hip injuries are seen in athletes who perform quick directional changes and cutting movements. Because forces generated through athletic performance are transferred through the hip, injuries to these areas may limit athletes with mild pain or lead to career-ending injuries. The anatomy of the hip and groin is complex and symptoms often overlap. This article discusses some athletic causes, but other medical conditions may be associated with hip and groin pain as well. Updates in evaluation and treatment are discussed for adductor strains, hip osteoarthritis, femoroacetabular impingement, sports hernia, osteitis pubis, and obturator nerve entrapment. PMID:23668647

  7. Altered Expression of Wnt Signaling Pathway Components in Osteogenesis of Mesenchymal Stem Cells in Osteoarthritis Patients

    PubMed Central

    Herranz, Eva; Rodríguez-Rodríguez, Luis; Mucientes, Arkaitz; Abásolo, Lydia; Marco, Fernando; Fernández-Gutiérrez, Benjamín; Lamas, José Ramón

    2015-01-01

    Introduction Osteoarthritis (OA) is characterized by altered homeostasis of joint cartilage and bone, whose functional properties rely on chondrocytes and osteoblasts, belonging to mesenchymal stem cells (MSCs). WNT signaling acts as a hub integrating and crosstalking with other signaling pathways leading to the regulation of MSC functions. The aim of this study was to evaluate the existence of a differential signaling between Healthy and OA-MSCs during osteogenesis. Methods MSCs of seven OA patients and six healthy controls were isolated, characterised and expanded. During in vitro osteogenesis, cells were recovered at days 1, 10 and 21. RNA and protein content was obtained. Expression of WNT pathway genes was evaluated using RT-qPCR. Functional studies were also performed to study the MSC osteogenic commitment and functional and post-traslational status of β-catenin and several receptor tyrosine kinases. Results Several genes were downregulated in OA-MSCs during osteogenesis in vitro. These included soluble Wnts, inhibitors, receptors, co-receptors, several kinases and transcription factors. Basal levels of β-catenin were higher in OA-MSCs, but calcium deposition and expression of osteogenic genes was similar between Healthy and OA-MSCs. Interestingly an increased phosphorylation of p44/42 MAPK (ERK1/2) signaling node was present in OA-MSCs. Conclusion Our results point to the existence in OA-MSCs of alterations in expression of Wnt pathway components during in vitro osteogenesis that are partially compensated by post-translational mechanisms modulating the function of other pathways. We also point the relevance of other signaling pathways in OA pathophysiology suggesting their role in the maintenance of joint homeostasis through modulation of MSC osteogenic potential. PMID:26352263

  8. Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system

    PubMed Central

    2012-01-01

    Background The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients) who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA) in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. Methods Mean follow up was 3.3 years (1.0 to 6.3) and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. Results There were 16 revisions and four patients reported a Harris Hip Score <70 points at their latest follow up. There were no pending revisions. Kaplan-Meier implant survival probability, with revision for any reason as endpoint, was 93.5% at six years follow-up (95%-CI: 88.8-95.3). There were no revisions for Adverse Reactions to Metal Debris (ARMD) and no indications of ARMD in symptomatic non-revised patients, although diagnostics were limited to ultrasound scans. Conclusions This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. Trial registration ClinicalTrials.gov Identifier: NCT00603395 PMID:23234268

  9. Molecular mechanisms of osteoporotic hip fractures in elderly women.

    PubMed

    Föger-Samwald, Ursula; Vekszler, György; Hörz-Schuch, Edith; Salem, Sylvia; Wipperich, Markus; Ritschl, Peter; Mousavi, Mehdi; Pietschmann, Peter

    2016-01-01

    A common manifestation of age-related bone loss and resultant osteoporosis are fractures of the hip. Age-related osteoporosis is thought to be determined by a number of intrinsic factors including genetics, hormonal changes, changes in levels of oxidative stress, or an inflammatory status associated with the aging process. The aim of this study was to investigate gene expression and bone architecture in bone samples derived from elderly osteoporotic women with hip fractures (OP) in comparison to bone samples from age matched women with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 10 women with low-trauma hip fractures (mean age 83±6) and consecutive surgical hip replacement. Ten bone samples from patients undergoing hip replacement due to osteoarthritis (mean age 80±5) served as controls. One half of each bone sample was subjected to gene expression analysis. The second half of each bone sample was analyzed by microcomputed tomography. From each half, samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. We could show a significantly decreased expression of the osteoblast related genes RUNX2, Osterix, Sclerostin, WNT10B, and Osteocalcin, a significantly increased ratio of RANKL to Osteoprotegerin, and a significantly increased expression of the enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase GPX3, and of the inflammatory cytokine IL6 in bone samples from hip fracture patients compared to controls. Major microstructural changes in OP bone were seen in the neck and were characterized by a significant decrease of bone volume, trabecular number, and connectivity density and a significant increase of trabecular separation. In conclusion, our data give evidence for a decreased expression of osteoblast related genes and increased expression of osteoclast related genes. Furthermore, increased expression of SOD2 and GPX3 suggest increased

  10. Incidence, Morbidity and Mortality in Patients Older than 50 Years with Second Hip Fracture in a Jeju Cohort Study

    PubMed Central

    Park, Yong-Geun; Jang, Sunmee

    2014-01-01

    Purpose Although the incidence of a second hip fracture is relatively well described, mortality and morbidity after a second hip fracture are seldom evaluated. The purpose of this study was to determine the incidence, morbidity, and mid-term mortality of a second hip fracture and evaluate the cause of death after a second hip fracture. Materials and Methods Information on patients older than 50 years, who sustained a subsequent hip fracture, were obtained from the records of eight Jeju Island hospitals between 2002 and 2011 to calculate the incidence, morbidity, and mortality of hip fractures in this age group. All patients were followed a minimum of 2 years. A systemic search for death certificates at the National Statistical Office was conducted for patients who were lost to follow-up. Results Of 2,055 hip fractures (419 men and 1,636 women), 98 were second hip fractures (13 men and 85 women) during the study period. The mean ages of the patients at the time of the first and second fractures were 78.8 and 80.8 years, respectively. The incidence of a subsequent hip fracture among the first hip fracture was 4.8%. Mean mortality rates at 6 months, 1 year, 2 years, and 5 years were 10.5%, 15.2%, 23.5%, and 42.0% respectively. Cumulative mortality after the second hip fracture at the 5 years follow-up was 41.8%. Conclusion Our results demonstrate that a secondary fracture prevention program is necessary to prevent second hip fractures in elderly patients.

  11. ANALYSIS ON QUALITY OF LIFE OF PATIENTS WITH OSTEOARTHROSIS UNDERGOING TOTAL HIP ARTHROPLASTY

    PubMed Central

    de Araújo Loures, Elmanq; Leite, Isabel Cristina Gonçalves

    2015-01-01

    Objective: The aim of the study was to evaluate the health-related quality of life among patients affected by hip osteoarthrosis who were treated by means of total hip arthroplasty. Methods: A cohort of 38 patients operated by a single surgeon in a regional referential teaching hospital during the year 2010 was prospectively studied and followed up for at least six months until they had achieved satisfactory rehabilitation. Each patient gave responses to the SF-36 form immediately before the operation and six months later and the Harris Hip Score was obtained at the same time. The pre and postoperative results were analyzed and compared with the literature. Results: The pre and postoperative SF-36 results were as follows: physical function: 13.4–53.7; role physical: 9.21–48.0; body pain: 23.1–62.6; general health: 54.2–71.3; vitality: 40.3–69.9; social function: 40.8–74.3; role emotional: 23.7–64.9; and mental health: 52.6–80.4. The Harris Hip Score went from 36.1 to 92.1, on average. All the results were statistically significant (p < 0.001). Conclusions: The combination of two scales was shown to be valuable in identifying bias and gave greater reliability for understanding the different variables. The study showed that there was a significant improvement in health-related quality of life among patients affected by osteoarthrosis of different etiologies who underwent total hip arthroplasty. Health-related quality of life evaluations cannot replace clinical evaluations provided by specific instruments and physicians’ experience but can add important data through giving value to patients’ sets of expectations regarding medical treatment. Moreover, such evaluations can be considered to be an efficient tool for analyzing the outcomes from total hip arthroplasty. PMID:27047858

  12. Alumina-alumina hip replacement in patients younger than 50 years old.

    PubMed

    Sedel, L; Nizard, R S; Kerboull, L; Witvoet, J

    1994-01-01

    From April 1977 to December 1990, 131 total hip arthroplasties were performed on 113 patients younger than 50 years of age (median, 41 years); 64 were men and 49 women. The majority were active people. Sixty-six hips had no previous operations, and 33 had at least one previous arthroplasty. The femoral component was a cemented collared titanium alloy stem, and alumina socket was cemented for 99 hips and press-fit for 32. The mean follow-up period was five years, with 32 hips followed for more than ten years. Revision arthroplasty was considered as a failure. Survivorship analysis depicted a 97.5% rate of survival at five years, an 89.4% rate at ten years, and an 86.2% at 11 years. Nine revisions were performed: one experienced a femoral head rupture after three years, one had bipolar loosening, one experienced femoral cystic formation, and six were revised for acetabular cup loosening, all from the cemented group. Two revisions occurred on the same patient. No stem revision was necessary before ten years. Only one of these revisions was required in patients aged 40 or younger (64 patients). Alumina-alumina friction is an extremely interesting phenomenon in young patients, and could be related to the low wear debris production. PMID:8118972

  13. A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis.

    PubMed

    Jones, Richard K; Nester, Christopher J; Richards, Jim D; Kim, Winston Y; Johnson, David S; Jari, Sanjiv; Laxton, Philip; Tyson, Sarah F

    2013-03-01

    Increases in the external knee adduction moment (EKAM) have been associated with increased mechanical load at the knee and progression of knee osteoarthritis. Valgus knee braces and lateral wedged insoles are common approaches to reducing this loading; however no study has directly compared the biomechanical and clinical effects of these two treatments in patients with medial tibiofemoral osteoarthritis. A cross-over randomised design was used where each intervention was worn by 28 patients for a two week period. Pre- and post-intervention gait kinematic/kinetic data and clinical outcomes were collected to evaluate the biomechanical and clinical effects on the knee joint. The valgus knee brace and the lateral wedged insole significantly increased walking speed, reduced the early stance EKAM by 7% and 12%, and the knee adduction angular impulse by 8.6 and 16.1% respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p=0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients. This is the first study to biomechanically compare these two treatments, and demonstrates that given the potential role of knee loading in osteoarthritis progression, that both treatments reduce this but lateral wedge insoles appear to have a greater effect. PMID:22920242

  14. Effects of PEMF on patients with osteoarthritis: Results of a prospective, placebo-controlled, double-blind study.

    PubMed

    Wuschech, Heinz; von Hehn, Ulrike; Mikus, Eberhard; Funk, Richard H

    2015-12-01

    This study aimed to evaluate effects of pulsed electromagnetic fields (PEMF) in a double blind study on patients with knee joint osteoarthritis. The MAGCELL ARTHRO electrode-less therapy delivered a sinusoidal magnetic field, varying in frequency between 4 and 12 Hz. In 1 cm tissue depth, magnetic flux density was 105 mT. A total of n = 57 patients were randomly assigned to the verum, PEMF or placebo group (placebo device). Their average age was 61.6 ± 12.0 years. According to American College of Rheumatology criteria the osteoarthritis level was 2.8 ± 0.8. Treatment was performed twice a day for 5 min over a period of 18 days. Treatment with the MAGCELL device versus control (sham exposed) showed a highly significant reduction in pain (P < 0.001), a significant reduction in stiffness (P = 0.032) and a significant reduction in disability in daily activities (P = 0.005) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales-with a good overall treatment tolerance. In the placebo group there was no evidence of a significant change between the initial and final examination in any of the three above-mentioned WOMAC scales. Results of this partly randomized placebo-controlled double-blind study show clinically at any rate, that use of PEMF lead to highly significant better results in the treatment group compared to the placebo group with regard to the total WOMAC global score and especially for visual analogue scale. Patient assessment of the "effectiveness" was rated in 29.5% as very good and good in 27.3% compared to 0.0% and 15.4% in controls. This therapy is thus a useful complementary treatment option with no side effects. PMID:26562074

  15. Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Despite an extensive literature on treatment interventions for patients with knee osteoarthritis, studies comparing the efficacy of different exercise interventions and living the life as usual on quality of life, cartilage quality and cost-effectiveness are lacking. The aim of the present study is to compare the efficacy of two different exercise programs compared to a control group in individuals with established radiographic and symptomatic knee osteoarthritis on self-reported knee-related quality of life, knee pain, physical function, and cartilage quality. Methods/Design A three-armed randomized controlled trial involving two exercise interventions and a control group of individuals doing as they usually do is described. The patients will have mild to moderate radiographic osteoarthritis according to the Kellgren and Lawrence classification (grade 2–3), and fulfill the American College of Rheumatology clinical criteria, be aged between 45 and 65 years, and have no other serious physical or mental illnesses. The patients will be randomly allocated to a strength exercise group; a cycling group, or a control group. The primary outcome is the Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale. Secondary outcomes include all five Knee Injury and Osteoarthritis Outcome Score subscales, morphological evaluation of cartilage including focal thickness, subchondral bone marrow edema, proteoglycan content and collagen degradation (measured using magnetic resonance imaging clinical sequences, T2 mapping and T1ρ), specific serum biomarkers, isokinetic muscle strength, maximal oxygen uptake, quality of life (EuroQol 5D), and self-efficacy (Arthritis Self-Efficacy Scale). A sample size calculation on the primary outcome showed that 207 individuals, 69 in each group, is needed to detect a clinically relevant difference of 10 points with 80% power and a significance level of 5%. Assessments will be conducted at baseline, 14

  16. Identification of rheumatoid arthritis and osteoarthritis patients by transcriptome-based rule set generation

    PubMed Central

    2014-01-01

    Introduction Discrimination of rheumatoid arthritis (RA) patients from patients with other inflammatory or degenerative joint diseases or healthy individuals purely on the basis of genes differentially expressed in high-throughput data has proven very difficult. Thus, the present study sought to achieve such discrimination by employing a novel unbiased approach using rule-based classifiers. Methods Three multi-center genome-wide transcriptomic data sets (Affymetrix HG-U133 A/B) from a total of 79 individuals, including 20 healthy controls (control group - CG), as well as 26 osteoarthritis (OA) and 33 RA patients, were used to infer rule-based classifiers to discriminate the disease groups. The rules were ranked with respect to Kiendl’s statistical relevance index, and the resulting rule set was optimized by pruning. The rule sets were inferred separately from data of one of three centers and applied to the two remaining centers for validation. All rules from the optimized rule sets of all centers were used to analyze their biological relevance applying the software Pathway Studio. Results The optimized rule sets for the three centers contained a total of 29, 20, and 8 rules (including 10, 8, and 4 rules for ‘RA’), respectively. The mean sensitivity for the prediction of RA based on six center-to-center tests was 96% (range 90% to 100%), that for OA 86% (range 40% to 100%). The mean specificity for RA prediction was 94% (range 80% to 100%), that for OA 96% (range 83.3% to 100%). The average overall accuracy of the three different rule-based classifiers was 91% (range 80% to 100%). Unbiased analyses by Pathway Studio of the gene sets obtained by discrimination of RA from OA and CG with rule-based classifiers resulted in the identification of the pathogenetically and/or therapeutically relevant interferon-gamma and GM-CSF pathways. Conclusion First-time application of rule-based classifiers for the discrimination of RA resulted in high performance, with means

  17. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA.

    PubMed

    Vasilakis, Ioannis; Solomou, Ekaterini; Vitsas, Vasilis; Fennema, Peter; Korovessis, Panagiotis; Siamblis, Dimitrios K

    2012-12-01

    The 2 main null hypotheses of this study were: (1) the 4-year surgical trauma-related degeneration within the hip abductor muscles after a minimally invasive approach to total hip arthroplasty would be similar to that following a conventional approach; and (2) no differences in perioperative blood loss or postoperative hip pain would be observed between the minimally invasive and conventional approaches.In 40 consecutive randomly selected adult patients with unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (Smith & Nephew Orthopaedics, Baar, Switzerland) was implanted by a single surgeon in 1 institution during the same period. Twenty patients underwent a minimally invasive approach (group A), and 20 patients underwent a conventional anterolateral approach (group B). Four years postoperatively, the operated and contralateral nonoperated hips of 37 available patients from both groups were examined with magnetic resonance imaging to show any changes in the gluteus medius and tensor fascia latae. Simultaneously, hip abductor power was measured bilaterally in both groups. Anthropometric data, blood loss, Short Form 36 self-assessment questionnaire, visual analog pain score, and walking distance were also analyzed.The reliability of magnetic resonance imaging and hip abductor power measurements was high. No difference was found in hip abductor power on the operated side between the 2 groups, whereas hip abductor power on the nonoperated side was significantly higher in both groups. This study revealed no mechanical and functional benefits in favor of patients undergoing minimally invasive vs conventional total hip arthroplasty. PMID:23218622

  18. Early knee osteoarthritis

    PubMed Central

    Favero, Marta; Ramonda, Roberta; Goldring, Mary B; Goldring, Steven R; Punzi, Leonardo

    2015-01-01

    Concepts regarding osteoarthritis, the most common joint disease, have dramatically changed in the past decade thanks to the development of new imaging techniques and the widespread use of arthroscopy that permits direct visualisation of intra-articular tissues and structure. MRI and ultrasound allow the early detection of pre-radiographic structural changes not only in the peri-articular bone but also in the cartilage, menisci, synovial membrane, ligaments and fat pad. The significance of MRI findings such as cartilage defects, bone marrow lesions, synovial inflammation/effusions and meniscal tears in patients without radiographic signs of osteoarthritis is not fully understood. Nevertheless, early joint tissue changes are associated with symptoms and, in some cases, with progression of disease. In this short review, we discuss the emerging concept of early osteoarthritis localised to the knee based on recently updated knowledge. We highlight the need for a new definition of early osteoarthritis that will permit the identification of patients at high risk of osteoarthritis progression and to initiate early treatment interventions. PMID:26557380

  19. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

    PubMed Central

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty. PMID:26673427

  20. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    PubMed

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families. PMID:26575502

  1. Can bundled payment improve quality and efficiency of care for patients with hip fractures?

    PubMed

    Antonova, Evgeniya; Boye, Mark E; Sen, Namrata; O'Sullivan, Amy K; Burge, Russel

    2015-01-01

    The current Medicare reimbursement for hip fractures lacks accountability and promotes cost cutting. A bundled payment system-analogous to the Medicare Acute Care Episodes Demonstration for Orthopedic and Cardiovascular Surgery-may help curtail costs, foster communication among health care providers, and improve their accountability for patient outcomes. In hip fracture care, bundled payment may spur development of multidisciplinary best practice guidelines, quality assessment, and reporting, and result in benchmarking and best practices sharing. However, its implementation may face challenges: the need for quality assessment criteria and risk adjustment methods and possible risks of pushing costs outside of Medicare boundaries. PMID:25299851

  2. Tranexamic acid in hip fracture patients: a protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients

    PubMed Central

    Gausden, Elizabeth Bishop; Garner, Matthew R; Warner, Stephen J; Levack, Ashley; Nellestein, Andrew M; Tedore, Tiffany; Flores, Eva; Lorich, Dean G

    2016-01-01

    Introduction There is a high incidence of blood transfusion following hip fractures in elderly patients. Tranexamic acid (TXA) has proven efficacy in decreasing blood loss in general trauma patients as well as patients undergoing elective orthopaedic surgery. A randomised controlled trial will measure the effect of TXA in a population of patients undergoing hip fracture surgery. Methods This is a double-blinded, randomised placebo-controlled trial. Patients admitted through the emergency room that are diagnosed with an intertrochanteric or femoral neck fracture will be eligible for enrolment and randomised to either treatment with 1 g of intravenous TXA or intravenous saline at the time of skin incision. Patients undergoing percutaneous intervention for non-displaced or minimally displaced femoral neck fractures will not be eligible for enrolment. Postoperative transfusion rates will be recorded and blood loss will be calculated from serial haematocrits. Ethics and dissemination This protocol was approved by the Institutional Review Board (IRB) and is registered with clinicaltrials.gov. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations. Trial registration number NCT01940536. PMID:27329438

  3. Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years.

    PubMed

    Travis, Elizabeth C; Tan, Ruth S; Funaki, Penisimani; McChesney, Steve J; Patel, Sandeep C; Brogan, Kit

    2015-02-01

    To date, there has been little research into the clinical outcomes of total hip arthroplasty (THA) for intracapsular neck of femur (NOF) fracture in the very elderly. 44 patients over 75years underwent THA for an intracapsular NOF fracture over a two year period. Oxford Hip Scores were obtained from 37 patients with a mean score of 39.7 (range 11-47). Katz Index Scores were collected from 36 patients with a mean pre-operative score of 5.9 and post operative score of 5.7. THA in this population gives patients the best opportunity to return to premorbid function. When complications occur there is a catastrophic effect on independence. Therefore it is important to select these patients' appropriately and to optimise their medical condition peri-operatively. PMID:25311164

  4. The rate of joint replacement in osteoarthritis depends on the patient’s socioeconomic status

    PubMed Central

    Wetterholm, Malin; Turkiewicz, Aleksandra; Stigmar, Kjerstin; Hubertsson, Jenny; Englund, Martin

    2016-01-01

    Background and purpose Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods This was a cohort study in Skåne, Sweden. We included all residents aged ≥ 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72–0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79–0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72–0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68–0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75–0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80–0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0–1.2). Interpretation There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups. PMID:26982799

  5. Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency

    PubMed Central

    Al-Hadithy, Nawfal; Furness, Nicholas; Patel, Ronak; Jonas, Sam; Jobbagy, Attila; Lowdon, Ian

    2015-01-01

    Background Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears. Methods 41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n = 21) and cuff-deficient shoulders (n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography. Results Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly. Conclusions CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation.

  6. Effect of Home Exercise Program Performance in Patients with Osteoarthritis of the Knee or the Spine on the Visual Analog Scale after Discharge from Physical Therapy

    ERIC Educational Resources Information Center

    Chen, Hamilton; Onishi, Kentaro

    2012-01-01

    The aim of our study was to assess the effect of the frequency of home exercise program (HEP) performance on pain [10-point visual analog scale (VAS)] in patients with osteoarthritis of the spine or knee after more than 6 months discharge from physical therapy (PT). We performed a retrospective chart review of 48 adult patients with a clinical…

  7. The Choice Between Total Hip Arthroplasty and Arthrodesis in Adolescent Patients: A Survey of Orthopedic Surgeons.

    PubMed

    Kelman, Mark G; Studdert, David M; Callaghan, John J; Farid, Monica S; Titan, Ashley L; Dietz, Frederick R

    2016-01-01

    For adolescent patients with end-stage hip disease, the choice between total hip arthroplasty (THA) and arthrodesis is complex; the clinical evidence is not definitive, and there are difficult trade-offs between clear short-term benefits from THA and uncertain long-term risks. We surveyed nearly 700 members of the Pediatric Orthopedic Society of North America and the American Association of Hip and Knee Surgeons. Respondents chose between a recommendation of THA or arthrodesis in four clinical vignettes. A clear majority of surgeons recommended THA in two of the vignettes, however opinion was somewhat divided in one vignette (overweight adolescent) and deeply divided in another (adolescent destined for manual labor job). Across all vignettes, recommendations varied systematically according to surgeons' age and their attitudes regarding tradeoffs between life stages. PMID:26298281

  8. What do we tell patients about elective total hip replacement in the UK? An analysis of patient literature

    PubMed Central

    2013-01-01

    Background Although hip information literature is given to people following total hip replacement (THR) almost routinely, little evaluation has been conducted on it to date. Our aim was therefore to analyse and evaluate the literature provided to patients by occupational therapists concerning elective hip surgery in the UK. Methods This was a pragmatic, descriptive analysis of information leaflets routinely given to patients undergoing primary total hip replacement (THR). The literature was collected as part of a national survey of occupational therapy practice. In the absence of a suitable evaluation tool, the patient leaflets were compared using a checklist devised by the researchers. The three areas of interest were: accessibility including presentation of information, breadth of information covered and specific activities of daily living described. Results 111 information leaflets and booklets were examined. These ranged from hospital publications which were professionally printed to those produced by individual departments. There was a variation in the readability of the leaflets ranging from 13% to 83%; the mean was 45% (SD 15). There was also variation in the content ranging from those covering surgery and possible complications, to those including diet and hip exercises. The most commonly covered activity of daily living was advice on sitting (99; 89%); the least commonly covered was work (26; 23%). Only 3 (2.7%) booklets had involved patients in their production and only 22 (20%) signposted obtaining information in another language or in Braille. Conclusions There was a range of literature in terms of presentation and content given to people who had a total hip replacement (THR). Although some booklets and leaflets scored highly, some did not meet basic standards such as providing contact details for help, using good quality diagrams, suggesting further reading or involving patients in their design. These results highlight important and fundamental

  9. The concentration of manganese, iron, and strontium in hip joint bone obtained from patients undergoing hip replacement surgery.

    PubMed

    Budis, Halina; Kalisinska, Elzbieta; Lanocha, Natalia; Kosik-Bogacka, Danuta; Sokolowski, Sebastian; Dobiecki, Konrad; Kolodziej, Lukasz; Bohatyrewicz, Andrzej

    2014-01-01

    The aim of this study was to determine the concentrations of manganese (Mn), iron (Fe) and strontium (Sr) in the cartilage with adjacent compact bone and spongy bone collected from patients after total hip replacement surgery. In addition, we examined relations between the concentrations of the metals in the bone and selected environmental factors. The concentration of Fe was the highest while Mn concentration was the lowest. The concentrations of Fe in the spongy bone in patients from larger cities were higher than in those living in smaller towns and villages. Significant correlations were found between Fe and Mn concentrations in the cartilage with adjacent compact bone and in the spongy bone, and between Mn and Sr in the spongy bone. In general, Mn, Fe and Sr concentrations in the bones of patients from NW Poland were lower than in other Polish regions and Europe, especially in industrialized countries. In conclusion, it seems that in addition to routine monitoring of the abiotic environment, it is essential to monitor concentrations of heavy metals having a long-term impact in humans. PMID:24074650

  10. Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty

    SciTech Connect

    Healy, W.L.; Lo, T.C.; Covall, D.J.; Pfeifer, B.A.; Wasilewski, S.A. )

    1990-12-01

    Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.

  11. The Prevention and Treatment of Delirium in Elderly Patients Following Hip Fracture Surgery.

    PubMed

    Martocchia, Antonio; Curto, Martina; Comite, Fabrizia; Scaccianoce, Sergio; Girardi, Paolo; Ferracuti, Stefano; Nicoletti, Ferdinando; Falaschi, Paolo

    2015-01-01

    Osteoporotic hip fracture needs a specific approach and treatment, since elderly patients are at high risk for adverse outcomes after surgery. In particular, delirium often occurs in the peri-operative period, and it is associated with death, hospital-acquired complications, persistent cognitive impairments, poor functional recovery after surgery and increased healthcare costs. The pre-operative assessment of the risk factors for delirium improves the preventive measures. The delirium diagnostic tools should be included in the standard of orthogeriatric cure for hip fracture. Given the increasing complexity of the clinical pictures, we present a review of the available treatment options for delirium in patients with hip fracture. The metabolic pre-operative disorders and the management of co-morbid diseases are specific targets of treatment in order to optimize the outcomes after surgery. In particular, elderly patients with Alzheimer's disease are highly vulnerable to hip fracture and delirium, and they are severely frail with reduced physiologic reserves. An integrated approach combining environmental and pharmacological strategies is useful in the delirium treatment, with a close collaboration between the orthopedic and geriatric team. PMID:25687439

  12. A Multi-centre Study to Assess the Long-term Performance of the Summit™ Hip in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-08-03

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  13. A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

    ClinicalTrials.gov

    2011-09-01

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

  14. Abnormal loading of the major joints in knee osteoarthritis and the response to knee replacement.

    PubMed

    Metcalfe, Andrew; Stewart, Caroline; Postans, Neil; Barlow, David; Dodds, Alexander; Holt, Cathy; Whatling, Gemma; Roberts, Andrew

    2013-01-01

    Knee osteoarthritis is common and patients frequently complain that they are 'overloading' the joints of the opposite leg when they walk. However, it is unknown whether moments or co-contractions are abnormal in the unaffected joints of patients with single joint knee osteoarthritis, or how they change following treatment of the affected knee. Twenty patients with single joint medial compartment knee osteoarthritis were compared to 20 asymptomatic control subjects. Gait analysis was performed for normal level gait and surface EMG recordings of the medial and lateral quadriceps and hamstrings were used to investigate co-contraction. Patients were followed up 12 months post-operatively and the analysis was repeated. Results are presented for the first 14 patients who have attended follow-up. Pre-operatively, adduction moment impulses were elevated at both knees and the contra-lateral hip compared to controls. Co-contraction of hamstrings and quadriceps was elevated bilaterally. Post-operatively, moment waveforms returned to near-normal levels at the affected knee and co-contraction fell in the majority of patients. However, abnormalities persisted in the contra-lateral limb with partial or no recovery of both moment waveforms and co-contraction in the majority. Patients with knee osteoarthritis do experience abnormal loads of their major weight bearing joints bilaterally, and abnormalities persist despite treatment of the affected limb. Further treatment may be required if we are to protect the other major joints following joint arthroplasty. PMID:22841587

  15. [Nonarthroplasty methods for developmental dysplasia of the hip with complete dislocation at the age of 8-25 patients].

    PubMed

    Zang, Jiancheng; Zhang, Hong

    2015-06-01

    It is a tough challenge treatment of complete dislocation from developmental dysplasia of the hip at the age of 8-25 patients. Although the procedure of total hip arthroplasty (THA) can improve joint function significantly, the failure rate still remains high. Hip arthrodesis remains a sensible and safe option. A stable and painless hip joint can be obtained without multiple operations. Ganz et al.had described a modified Colonna capsular arthroplasty and surgical hip dislocation with well joint functions, radiographic findings and the less complications of the femoral head osteonecrosis. There is a obvious advantage in postponing THA, and subsequent THA could be technically easier and safer in a dislocated hip. The procedure of pelvic support osteotomy, which is proposed by Ilizarov, combined two steps of femur osteotomy and femur lengthening, provides an effective treatment option for adolescent hip dysplasia or dislocation. By this procedure, the hip could be reserved, the limb length recovered and the gait improved significantly. Resection arthroplasty is a reliable method, by which 90% dysplasia patients received a painless joint and good functional outcomes. In view of certain drawbacks, it is used only as a salvage operation currently. This article reviews some alternative nonarthroplasty methods for developmental dysplasia of the hip with complete dislocation. Good clinical results can be obtained through strict indications and nice surgical skills. PMID:26359064

  16. Traditional Chinese medicine in patients with osteoarthritis of the knee.

    PubMed

    Hou, Pu-Wei; Fu, Pin-Kuei; Hsu, Hsin-Cheng; Hsieh, Ching-Liang

    2015-10-01

    To evaluate whether the use of traditional Chinese medicine (TCM; zhōng yī) influences symptoms or functional outcomes in patients with osteoarthritis (OA) of the knee ( xī guān jié yán). A systematic review of randomized control trials was conducted. Searches for studies in PubMed that were performed between 1965 and August 2013, and retrieved studies were subjected to reference screening. The types of studies included in our review were 1) placebo-based or comparative studies; 2) open label, single-blinded or double-blinded studies; 3) studies evaluating the efficacy of TCM for treating OA of the knee; and 4) studies evaluating only TCM or combination preparations. Trials were conducted with participants over 18 years of age with knee pain and at least three of the following characteristics: 1) an age greater than 50 years; 2) morning stiffness lasting for fewer than 30 min; 3) a crackling or grating sensation; 4) bony tenderness of the knee; 5) bony enlargement of the knee; or 6) no detectable warmth of the joint to the touch. Studies were rated for risk of bias and graded for quality. After screening, 104 studies that satisfied the eligibility requirements were identified, and only 18 randomized control trials were included in the quantitative and qualitative synthesis. Upon review, we found "moderate-quality" evidence of effects from acupuncture ( zhēn jiǔ) on pain, which was measured using a visual analogue scale, and physical function, which was measured using qigong ( qì gōng) with motion. "Low-quality" evidence was found regarding the effects of acupuncture on physical function, and no evidence was found regarding the effects of herbal medicine on pain or physical function. Herbal patches ( yào bù) appeared to affect pain and physical and function, but these effects were not found to be significant. The initial findings included in this review suggest that acupuncture is a promising intervention according to the primary outcome measure, pain

  17. Traditional Chinese medicine in patients with osteoarthritis of the knee

    PubMed Central

    Hou, Pu-Wei; Fu, Pin-Kuei; Hsu, Hsin-Cheng; Hsieh, Ching-Liang

    2015-01-01

    To evaluate whether the use of traditional Chinese medicine (TCM; 中醫 zhōng yī) influences symptoms or functional outcomes in patients with osteoarthritis (OA) of the knee (膝關節炎 xī guān jié yán). A systematic review of randomized control trials was conducted. Searches for studies in PubMed that were performed between 1965 and August 2013, and retrieved studies were subjected to reference screening. The types of studies included in our review were 1) placebo-based or comparative studies; 2) open label, single-blinded or double-blinded studies; 3) studies evaluating the efficacy of TCM for treating OA of the knee; and 4) studies evaluating only TCM or combination preparations. Trials were conducted with participants over 18 years of age with knee pain and at least three of the following characteristics: 1) an age greater than 50 years; 2) morning stiffness lasting for fewer than 30 min; 3) a crackling or grating sensation; 4) bony tenderness of the knee; 5) bony enlargement of the knee; or 6) no detectable warmth of the joint to the touch. Studies were rated for risk of bias and graded for quality. After screening, 104 studies that satisfied the eligibility requirements were identified, and only 18 randomized control trials were included in the quantitative and qualitative synthesis. Upon review, we found “moderate-quality” evidence of effects from acupuncture (針灸 zhēn jiǔ) on pain, which was measured using a visual analogue scale, and physical function, which was measured using qigong (氣功 qì gōng) with motion. “Low-quality” evidence was found regarding the effects of acupuncture on physical function, and no evidence was found regarding the effects of herbal medicine on pain or physical function. Herbal patches (藥布 yào bù) appeared to affect pain and physical and function, but these effects were not found to be significant. The initial findings included in this review suggest that acupuncture is a promising intervention

  18. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients.

    PubMed

    Belcaro, Gianni; Cesarone, Maria Rosaria; Dugall, Mark; Pellegrini, Luciano; Ledda, Andrea; Grossi, Maria Giovanna; Togni, Stefano; Appendino, Giovanni

    2010-12-01

    In a previous three-month study of Meriva, a proprietary curcumin-phosphatidylcholine phytosome complex, decreased joint pain and improvement in joint function were observed in 50 osteoarthritis (OA) patients. Since OA is a chronic condition requiring prolonged treatment, the long-term efficacy and safety of Meriva were investigated in a longer (eight months) study involving 100 OA patients. The clinical end points (Western Ontario and McMaster Universities [WOMAC] score, Karnofsky Performance Scale Index, and treadmill walking performance) were complemented by the evaluation of a series of inflammatory markers (interleukin [IL]-1beta, IL-6, soluble CD40 ligand [sCD40L], soluble vascular cell adhesion molecule (sVCAM)-1, and erythrocyte sedimentation rate [ESR]). This represents the most ambitious attempt, to date, to evaluate the clinical efficacy and safety of curcumin as an anti-inflammatory agent. Significant improvements of both the clinical and biochemical end points were observed for Meriva compared to the control group. This, coupled with an excellent tolerability, suggests that Meriva is worth considering for the long-term complementary management of osteoarthritis. PMID:21194249

  19. Effects of isometric exercise using biofeedback on maximum voluntary isometric contraction, pain, and muscle thickness in patients with knee osteoarthritis

    PubMed Central

    Choi, Yun Lak; Kim, Bo Kyung; Hwang, Yong Pil; Moon, Ok Kon; Choi, Wan Suk

    2015-01-01

    [Purpose] The purpose of our study was to investigate the effects of isometric exercises using electromyographic biofeedback (EMGBF) and ultrasound biofeedback (USBF) on maximum voluntary isometric contraction (MVIC), pain assessed by the Visual Analogue Scale (VAS), and vastus medialis oblique (VMO) thickness in patients with knee osteoarthritis (OA). [Subjects and Methods] Thirty females over 65 years of age who had been diagnosed with knee osteoarthritis were recruited and randomly assigned to three groups, each comprising of 10 subjects. The Subjects in the EMGBF training and USBF training groups were trained with the corresponding physical training exercise program targeting the vastus medialis oblique, whereas the subjects in the control group were treated with conventional physical therapies, such as a hot pack, ultrasound, and transcutaneous electrical nerve stimulation. Subjects in each group were trained or treated for 20 min, 3 times a week for 8 weeks. [Results] The MVIC in the EMGBF and USBF training groups was significantly increased compared with that in the control group, and the VAS score (for measurement of pain) in the EMGBF and USBF training groups was significantly decreased compared with that in the control group. Only the EMGBF training group showed a significantly increased VMO thickness compared with before training. [Conclusion] These results suggest that USBF training is similar to EMGBF training in terms of its effectiveness and is helpful for treating patients with knee OA. PMID:25642061

  20. Gait characterization for osteoarthritis patients using wearable gait sensors (H-Gait systems).

    PubMed

    Tadano, Shigeru; Takeda, Ryo; Sasaki, Keita; Fujisawa, Tadashi; Tohyama, Harukazu

    2016-03-21

    The objective of this work was to investigate the possibilities of using the wearable sensors-based H-Gait system in an actual clinical trial and proposes new gait parameters for characterizing OA gait. Seven H-Gait sensors, consisting of tri-axial inertial sensors, were attached to seven lower limb body segments (pelvis, both thighs, both shanks and both feet). The acceleration and angular velocity data measured were used to estimate three-dimensional kinematic parameters of patients during level walking. Three new parameters were proposed to assess the severity of OA based on the characteristics of these joint center trajectories in addition to conventional gait spatio-temporal parameters. The experiment was conducted on ten subjects with knee OA. The kinematic results obtained (hip, knee and ankle joint angles, joint trajectory in the horizontal and sagittal planes) were compared with those from a reference healthy (control) group. As a result, the angle between the right and left knee trajectories along with that of the ankle joint trajectories were almost twice as large (21.3° vs. 11.6° and 14.9° vs. 7.8°) compared to those of the healthy subjects. In conclusion, it was found that the ankle joints during stance abduct less to avoid adduction at the knee as the severity of OA increases and lead to more acute angles (less parallel) between the right and left knee/ankle joints in the horizontal plane. This method was capable to provide quantitative information about the gait of OA patients and has the advantage to allow for out-of-laboratory monitoring. PMID:26947036

  1. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    PubMed

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  2. "Early Trigger" Intravenous Vitamin K: Optimizing Target-Driven Care in Warfarinised Patients With Hip Fracture.

    PubMed

    Diament, Marina; MacLeod, Kirsty; O'Hare, Jonathan; Tate, Anne; Eardley, Will

    2015-12-01

    Best practice tariff (BPT) was introduced as a financial incentive model to improve compliance with evidence-based care, such as operation for hip fracture within 36 hours of admission. We previously evaluated the impact of warfarin on patients with hip fracture, revealing significant delay to operation and subsequent loss of revenue. As a result of this, an "early trigger" intravenous vitamin K (IVK) pathway was introduced and the service reaudited a year later. The first cycle was a retrospective audit of all cases with hip fracture against BPT standards over a 32-month period. Subsequent protocol change resulted in all warfarinised cases being given 2 mg IVK in the emergency department prior to blood testing. This protocol was reaudited against the same BPT standards 12 months later. An intention-to-treat approach was used, despite breaches of protocol and other reasons for patients not progressing to theater. The data were analyzed with parametric tools to establish true clinical and statistical impact of the introduction of the protocol. In the first cycle, 80 patients were admitted on warfarin with a mean time to theater of 53.71 hours. Of these patients, 79% breached BPT due to anticoagulation. Twelve months following protocol introduction, 42 patients had a mean time to theater of 37.61 hours. Of these patients, 34% breached BPT due to anticoagulation. These data are both clinically and statistically significant (P < .001). No adverse events occurred. We have shown for the first time that "early-trigger" IVK can reduce delay to theater and maximize tariff payments in warfarinised patients with hip fracture. This is in addition to other established benefits associated with early surgery such as decreasing risk of pressure lesions and pneumonia. It affords high-quality patient-centered care while ensuring trauma units achieve maximal financial reimbursement through pay for improved performance and supports a culture of change behavior. PMID:26623160

  3. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    PubMed

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P < .001), discharge disposition showed a 13% improvement (P = .17) and patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes. PMID:26547684

  4. Sexual Activity after Total Hip Replacement in Korean Patients: How They Do, What They Want, and How to Improve

    PubMed Central

    Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Koo, Kyung-Hoi

    2013-01-01

    Background Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Methods Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Results Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Conclusions Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial. PMID:24340146

  5. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up.

    PubMed

    Shapiro, Lauren M; Safran, Marc R; Maloney, William J; Goodman, Stuart B; Huddleston, James I; Bellino, Michael J; Scuderi, Gaetano J; Abrams, Geoffrey D

    2016-08-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin-aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson's correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy. PMID:27583163

  6. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up

    PubMed Central

    Shapiro, Lauren M.; Safran, Marc R.; Maloney, William J.; Goodman, Stuart B.; Huddleston, James I.; Bellino, Michael J.; Scuderi, Gaetano J.; Abrams, Geoffrey D.

    2016-01-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin–aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson’s correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy. PMID:27583163

  7. Effects of the cyclooxygenase inhibiting nitric oxide donator naproxcinod versus naproxen on systemic blood pressure in patients with osteoarthritis.

    PubMed

    White, William B; Schnitzer, Thomas J; Fleming, Rosanna; Duquesroix, Brigitte; Beekman, Maarten

    2009-09-15

    Traditional nonsteroidal anti-inflammatory drugs are associated with the destabilization of blood pressure (BP) control, particularly in hypertensive patients treated with blockers of the renin-angiotensin system. To assess the potential impact of nitric oxide donation, the effects of naproxcinod with naproxen and placebo on changes in BP were compared in a randomized clinical trial of 916 patients with osteoarthritis after 13 weeks of therapy. In addition, the effects of naproxcinod versus naproxen and placebo on systolic BP in patients with hypertension treated with renin-angiotensin system blockers were evaluated. Naproxcinod 750 mg twice daily reduced systolic BP compared to naproxen 500 mg twice daily (p <0.02). The 2 doses of naproxcinod showed reductions from baseline in diastolic BP relative to naproxen (p <0.04) and similar changes compared to placebo. In 207 patients with hypertension treated with renin-angiotensin-blocking agents alone or with diuretics, the difference in mean change from baseline in systolic BP between naproxen 500 mg and naproxcinod 750 mg was 6.5 mm Hg in favor of naproxcinod (p <0.02). The proportion of patients in the overall population with systolic BP increases > or =10 mm Hg was greater with naproxen 500 mg (22%) compared to naproxcinod 750 mg (14%, p = 0.04), naproxcinod 375 mg (14%, p = 0.055), and placebo (15.6%, p = 0.155). In conclusion, naproxcinod did not induce elevations of BP seen with naproxen, and it had similar effects on BP to that of placebo in patients with osteoarthritis. PMID:19733721

  8. Hip and buttock implants to enhance the feminine contour for patients with HIV.

    PubMed

    Benito-Ruiz, J; Fontdevila, J; Manzano, M; Serra-Renom, J M

    2006-01-01

    The antiretroviral therapy for patients with human immunodeficiency virus (HIV) causes lipodystrophy, or a change in the distribution of body. Treatment for the facial changes is well addressed and covered in the recent literature, but female patients also report changes in their buttocks and lower limbs. There is no treatment for the lower limb deformity, but plastic surgeons can do something for the buttock. The authors propose a classification for the deformities of these patients and a new solution to improve the contour of this area and to reduce the social impact of deformity on women with HIV. This consists of placing two silicone implants, in the buttock and on the hip, to give a rounder appearance. The authors think that hip implants may be indicated also for gender reassignment surgery and for women with masculine features. PMID:16402157

  9. Bias towards dementia: are hip fracture trials excluding too many patients? A systematic review.

    PubMed

    Hebert-Davies, Jonah; Laflamme, G-Yves; Rouleau, Dominique

    2012-12-01

    Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may impact outcomes. This was a two part study; the first analyzing databases of two ongoing large-scale multi-centred hip fracture trials and the second being a systematic review. The FAITH and HEALTH studies were analyzed for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years. In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of which were due to dementia or cognitive impairment. In the HEALTH study, 575 were excluded with dementia/cognitive impairment representing 207 patients (36%). Following the systematic review, 251 articles were identified 17 of which were retained. The overall prevalence of dementia was 27.9% (range 2-51%). Only two studies compared demented and non-demented groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia. PMID:22999009

  10. Association of home care needs and functional recovery among community-dwelling elderly hip fracture patients.

    PubMed

    Wu, Li-Chu; Chou, Ming-Yueh; Liang, Chih-Kuang; Lin, Yu-Te; Ku, Yan-Chiou; Wang, Ruey-Hsia

    2013-01-01

    The aim of this study was to assess the home care needs and task difficulty of community-dwelling aged hip fracture and the association of functional recovery with care received. A cohort of hip fracture patients admitted to orthopedic wards for surgery was collected from August 2009 to December 2010. Patients transferred to long-term care facilities after surgery were excluded. Functional status (feeding, clothing, grooming, bathing, getting in/out of bed, walking, toileting, standing up/sitting down, and walking up/down stairs) and task difficulty for caregivers were recorded at discharge, one week and one month after discharge. In total, 116 patients (mean age: 79.4 ± 8.5 years, 51.7% males) were enrolled. The mean age of primary caregivers was 53.4 ± 14.2 years, and most were daughters or sons (54.3%), spouses (34.5%) or foreign workers (11.0%). The most common care needs were wound care (95.7%), medical visits (94.8%), cleaning and maintaining living quarters (92.2%) and vigilance to ensure patient safety (92.2%). The care needs and task difficulty significantly correlated with physical function before, one week and one month after discharge (r=-0.530, p<0.001; r=-0.326, p=0.001; r=-0.432, p<0.001; r=-0.684, p<0.001; and r=-0.475, p<0.001, respectively). The complex and taxing home care needs of community-dwelling elderly hip fracture patients were significantly associated with functional recovery. Comprehensive geriatric assessment and related special medical services may greatly help caregivers and promote the practice of aging in place. Further study is needed to develop appropriate caregiver education to promote the functional recovery of elderly hip fracture patients at home. PMID:23746577

  11. Determinants of return to work 12 months after total hip and knee arthroplasty.

    PubMed

    Leichtenberg, C S; Tilbury, C; Kuijer, Ppfm; Verdegaal, Shm; Wolterbeek, R; Nelissen, Rghh; Frings-Dresen, Mhw; Vliet Vlieland, Tpm

    2016-07-01

    Introduction A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA. Methods We conducted a prospective, observational study of working patients aged <65 years undergoing THA or TKA for osteoarthritis. The primary outcome was full versus partial or no return to work 12 months postoperatively. Factors analysed included preoperative sociodemographic and work characteristics, alongside the Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Hip and Knee Scores. Results Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work. Conclusions In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately. PMID:27138849

  12. Effect of Ginger Supplementation on Proinflammatory Cytokines in Older Patients with Osteoarthritis: Outcomes of a Randomized Controlled Clinical Trial.

    PubMed

    Mozaffari-Khosravi, Hassan; Naderi, Zahra; Dehghan, Ali; Nadjarzadeh, Azadeh; Fallah Huseini, Hassan

    2016-01-01

    There is limited evidence that ginger powder consumption can relieve pain and inflammation due to specific anti-inflammatory phytochemical constitutents. This study investigates the effect of ginger supplementation on proinflammatory factors in participants (n = 120) of a randomized double-blind placebo-controlled 3-month clinical trial investigating knee osteoarthritis. Patients were randomly assigned to one of two groups: the ginger group (GG) or the placebo group (PG). Administered daily for 3 months, participants in the GG intervention received capsules containing 500 mg of ginger powder, while PG participants received capsules filled with 500 mg starch. Serum samples collected at baseline and 3 months were analyzed for serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). At baseline, proinflammatory cytokine concentrations did not differ by group. However, at 3 months, both cytokines decreased in the GG relative to the PG. The results of this study indicate that ginger supplementation may have a promising benefits for knee osteoarthritis and may, therefore, may warrant further study. PMID:27559855

  13. Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients.

    PubMed

    Dubljanin-Raspopović, Emilija; Markovic Denić, Ljiljana; Marinković, Jelena; Grajić, Mirko; Tomanovic Vujadinović, Sanja; Bumbaširević, Marko

    2012-01-01

    Hip fractures remain one of the most devastating injuries in the elderly. Early prediction of outcome following hip fracture potentially results in more efficient health care. The aims of this study were to explore predictors of ambulation status at hospital discharge in patients ≥65 years of age operated on for fracture of the hip, and to investigate the impact of ambulation status at hospital discharge on 1-year mortality after hip fracture. We studied 344 patients who underwent surgery for hip fracture during a 12 month period. Multivariate regression analysis was used to explore predictive factors for ambulatory status at discharge, and 1-year mortality adjusted on important baseline variables. Cumulative 1-year mortality was significantly lower for patients in the ambulatory group when compared to patients in the non-ambulatory group. Patients who were older, had severe cognitive impairment, lower functional level before injury, and in whom postoperative delirium and pressure ulcers occurred had a higher chance of not recovering their gait ability at hospital discharge, and being dead 1 year after hip fracture. Inability to walk at hospital discharge and presence of delirium are independent predictors of 1-year mortality. Every effort should be made to assure early mobilisation after hip fracture surgery, and prevention, prompt recognition and treatment of postoperative complications is important in order to facilitate better short-and long-term outcome. PMID:23233176

  14. Isolated patellofemoral osteoarthritis

    PubMed Central

    Poolman, Rudolf W; van Kampen, Albert

    2010-01-01

    Backgrou