The role of imaging in early hip OA.

PubMed

Siebelt, M; Agricola, R; Weinans, H; Kim, Y J

2014-10-01

Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Characterization of the cartilage DNA methylome in knee and hip osteoarthritis.

PubMed

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

2014-09-01

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. 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. 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. 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. © 2014 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

Prevalence of hip osteoarthritis in chiropractic practice in Denmark: a descriptive cross-sectional and prospective study.

PubMed

Poulsen, Erik; Christensen, Henrik W; Overgaard, Søren; Hartvigsen, Jan

2012-05-01

The purposes of this study were to measure the prevalence of clinical and radiographic hip osteoarthritis (OA) and first-time diagnosis of hip OA in consecutive patients presenting to chiropractic practices in Denmark and to report the components of the initial treatment rendered by the chiropractic practitioner. A total of 2000 patient records and 1000 radiographs were reviewed retrospectively in 20 chiropractic clinics throughout Denmark. Information obtained included patients' primary complaint, physical examination and radiographic findings of hip OA, and treatment. Subsequently, the 20 clinics participated in a prospective survey where they collected equivalent information over a 2-week period. Retrospective review of records revealed that 1.4% of patients in Danish chiropractic practice had signs of clinical hip OA. Of these, 59% demonstrated radiographic signs of hip OA. Prospective data collection revealed that 3.4% of new patients had signs of clinical hip OA. Fifty-four percent of these demonstrated radiographic signs of hip OA, and of these 70% were diagnosed as having OA of the hip for the first time. Initial treatment involved manual treatment and advice on over-the-counter pain medication and/or supplements. Of all 1000 retrospectively reviewed radiographs in patients 40 years or older, 19.2% demonstrated radiographic signs of hip OA. Osteoarthritis of the hip is diagnosed and managed in primary care chiropractic practice in Denmark; however, it is likely underdiagnosed. In those newly presenting to chiropractic practitioners, first-time diagnosis with clinical and radiographic signs of hip OA appears to be common. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

The incidence of primary hip osteoarthritis in active duty US military servicemembers.

PubMed

Scher, Danielle L; Belmont, Philip J; Mountcastle, Sally; Owens, Brett D

2009-04-15

Although multiple studies have reported the prevalence of primary hip osteoarthritis (OA), little has been reported on incidence rates of hip OA. We sought to determine the incidence rate and demographic risk factors of hip OA in an ethnically diverse and physically active population of US military servicemembers. A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for hip OA (715.95). Multivariate Poisson regression analysis was used to estimate the rate of hip OA per 100,000 person-years, controlling for sex, race, age, rank, and service. The overall unadjusted incidence rate of hip OA was 35 per 100,000 person-years. Women, compared with men, had a significantly increased adjusted incidence rate ratio for hip OA of 1.87 (95% confidence interval [95% CI] 1.73-2.01). The adjusted incidence rate ratio for black servicemembers when compared with white servicemembers was 1.32 (95% CI 1.23-1.41). The adjusted incidence rate ratio for the > or =40-year-old age group compared with the 20-year-old group was 22.21 (95% CI 17.54-28.14). With junior officers as the referent category, junior enlisted, senior enlisted, and senior officers rank groups had a significantly increased adjusted incidence rate ratio for hip OA. With the Air Force as the referent category, each service had a significantly increased adjusted incidence rate ratio for hip OA. Female sex; black race; age > or =40 years; junior enlisted, senior enlisted, and senior officer rank groups; and military service in the Navy, Army, or Marines were all risk factors for hip OA.

Relationship between synovial inflammatory cytokines and progression of osteoarthritis after hip arthroscopy: Experimental assessment.

PubMed

Fukushima, Kensuke; Inoue, Gen; Uchida, Kentaro; Fujimaki, Hisako; Miyagi, Masayuki; Nagura, Naoshige; Uchiyama, Katsufumi; Takahira, Naonobu; Takaso, Masashi

2018-01-01

Synovial membrane inflammation is the most commonly presenting finding during hip arthroscopy and may have a role in the pathomechanism of hip osteoarthritis (OA). The aim of this study was to determine the relationship between synovial cytokine levels and progression of OA after hip arthroscopy. We prospectively examined 20 patients (20 hips) who underwent arthroscopic hip surgery. For all patients, radiographs and severity of pain were evaluated preoperatively. During arthroscopy, we harvested a sample of the synovial membrane and determined the levels of six typical inflammatory cytokines with real-time polymerase chain reaction. We compared the levels of these cytokines in patients who showed OA progression and non-progression after hip arthroscopy. Although the average age of patients who showed OA progression postoperatively tended to be higher, there were no significant differences in characteristics involving clinical assessment between patients who showed OA progression and those who showed non-progression. Intraoperative tumour necrosis factor α (TNFα) expression was significantly higher in patients who showed OA progression postoperatively ( p = 0.042). Elevation of TNFα level might be a predictor of OA progression after hip arthroscopy.

Variations in Hip Shape Are Associated with Radiographic Knee Osteoarthritis: Cross-sectional and Longitudinal Analyses of the Johnston County Osteoarthritis Project.

PubMed

Nelson, Amanda E; Golightly, Yvonne M; Renner, Jordan B; Schwartz, Todd A; Liu, Felix; Lynch, John A; Gregory, Jenny S; Aspden, Richard M; Lane, Nancy E; Jordan, Joanne M

2016-02-01

Hip shape by statistical shape modeling (SSM) is associated with hip radiographic osteoarthritis (rOA). We examined associations between hip shape and knee rOA given the biomechanical interrelationships between these joints. Bilateral baseline hip shape assessments [for those with at least 1 hip with a Kellgren-Lawrence arthritis grading scale (KL) 0 or 1] from the Johnston County Osteoarthritis Project were available. Proximal femur shape was defined on baseline pelvis radiographs and evaluated by SSM, producing mean shape and continuous variables representing independent modes of variation (14 modes = 95% of shape variance). Outcomes included prevalent [baseline KL ≥ 2 or total knee replacement (TKR)], incident (baseline KL 0/1 with followup ≥ 2), and progressive knee rOA (KL increase of ≥ 1 or TKR). Limb-based logistic regression models for ipsilateral and contralateral comparisons were adjusted for age, sex, race, body mass index (BMI), and hip rOA, accounting for intraperson correlations. We evaluated 681 hips and 682 knees from 342 individuals (61% women, 83% white, mean age 62 yrs, BMI 29 kg/m(2)). Ninety-nine knees (15%) had prevalent rOA (4 knees with TKR). Lower modes 2 and 3 scores were associated with ipsilateral prevalent knee rOA, and only lower mode 3 scores were associated with contralateral prevalent knee rOA. No statistically significant associations were seen for incident or progressive knee rOA. Variations in hip shape were associated with prevalent, but not incident or progressive, knee rOA in this cohort, and may reflect biomechanical differences between limbs, genetic influences, or common factors related to both hip shape and knee rOA.

Femoral head-neck junction deformity is related to osteoarthritis of the hip.

PubMed

Barros, Hilton José Melo; Camanho, Gilberto Luis; Bernabé, Antônio Carlos; Rodrigues, Marcelo Bordalo; Leme, Luiz Eugênio Garcez

2010-07-01

Primary or idiopathic osteoarthritis (OA) of the hip has increasingly been attributed to the presence of presumably minor femoral or acetabular deformities that are not routinely identified. The alpha angle reflects one such deformity of the femoral neck and reflects a risk for femoroacetabular impingement, which in turn reportedly is associated with OA. If impingement is in fact associated with OA, then one might expect the mean alpha angle to be greater in patients with presumed idiopathic hip OA. We therefore compared the alpha angle among a group of elderly patients with idiopathic OA with that in a control group of elderly individuals without OA. We measured the alpha angles in 50 individuals (72 hips) with a mean age of 70 years (range, 60-84 years) with apparently idiopathic OA and compared their angles with those from a control group of 56 individuals without OA. The alpha angle was measured by means of radiographs of their hips using the Dunn view at 45 degrees flexion. The patients with OA had a greater percentage with abnormal alpha angles than did the normal subjects: 82% versus 30%, respectively. The mean alpha angle in the group with OA was larger than in the control subjects: 66.4 masculine (range, 28 degrees -108 degrees ) versus 48.1 masculine (range, 34 degrees -68 degrees ). Hips with presumably idiopathic OA had more abnormalities at the femoral head-neck junction than did the control hips without OA and may relate to the risk of OA developing. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Management of osteoarthritis in general practice in Australia.

PubMed

Brand, Caroline A; Harrison, Christopher; Tropea, Joanne; Hinman, Rana S; Britt, Helena; Bennell, Kim

2014-04-01

To describe management of osteoarthritis (OA) of the hip (OA-hip) and knee (OA-knee) by Australian general practitioners (GPs). We analyzed data from the Bettering the Evaluation and Care of Health program, from April 1, 2005 to March 31, 2010. Patient and GP characteristics and encounter management data were extracted. Data were classified by the International Classification of Primary Care, version 2, and summarized using descriptive statistics and 95% confidence intervals around point estimates. There were 489,900 GP encounters at which OA was managed (rate of 26.4 per 1,000 encounters). OA-hip was managed at a rate of 2.3 per 1,000 encounters (n = 1,106, 8.6% OA) and OA-knee at a rate of 6.2 per 1,000 (n = 3,058, 23.7% OA). The encounter management rate per 1,000 for OA-hip was higher among non-metropolitan dwellers (2.85 per 1,000 versus 1.97 per 1,000) and lower for non-English-speaking people (1.53 per 1,000 encounters versus 2.39 per 1,000). The rate for OA-knee was higher for non-English-speaking background (8.50 per 1,000 encounters versus 6.24 per 1,000) and lower among indigenous people (3.16 per 1,000 encounters versus 6.46 per 1,000). Referral to an orthopedic surgeon was the most frequently used nonpharmacologic management (OA-knee 17.4 per 100 contacts and OA-hip 17.7 per 100), followed by advice, education, and counselling. As first-line treatment, medication prescription rates (OA-knee 78.7 per 100 contacts and OA-hip 73.2 per 100) were substantially higher than rates of lifestyle management (OA-knee 20.7 per 100 contacts and OA-hip 14.8 per 100). OA-hip and OA-knee encounters and management differ. Nonpharmacologic treatments as first-line management were low compared with pharmacologic management rates, and surgical referral rates were high. However, lack of longitudinal data limits definitive assessment of appropriateness of care. Copyright © 2014 by the American College of Rheumatology.

Joint pain undergoes a transition in accordance with signal changes of bones detected by MRI in hip osteoarthritis.

PubMed

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

2013-01-01

In this study, we aimed to investigate whether joint pain is derived from cartilage or bone alterations. We reviewed 23 hip joints of 21 patients with primary hip osteoarthritis (OA), which were classified into Kellgren-Laurence (KL) grading I to IV. Plain radiographs and magnetic resonance imaging (MRI) were obtained from all of the 23 joints. Two of the 21 patients had bilateral hip OA. Pain was assessed based on the pain scale of Denis. A Welch t test was performed for age, height, weight, body mass index, bone mineral density, and a Mann-Whitney U test was performed for KL grading. Four of 8 hip joints with pain and OA showed broad signal changes detected by MRI. Fourteen hip joints without pain, but with OA did not show broad signal changes by MRI. Collectively, MRI analyses showed that broad signal changes in OA cases without joint pain or with a slight degree of joint pain were not observed, while broad signal changes were observed in OA cases with deteriorated joint pain. Our findings suggest that hip joint pain might be associated with bone signal alterations in the hips of OA patients.

Methodologies for semiquantitative evaluation of hip osteoarthritis by magnetic resonance imaging: approaches based on the whole organ and focused on active lesions.

PubMed

Jaremko, Jacob L; Lambert, Robert G W; Zubler, Veronika; Weber, Ulrich; Loeuille, Damien; Roemer, Frank W; Cibere, Jolanda; Pianta, Marcus; Gracey, David; Conaghan, Philip; Ostergaard, Mikkel; Maksymowych, Walter P

2014-02-01

As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability.

Outcomes and Factors Influencing Response to an Individualized Multidisciplinary Chronic Disease Management Program for Hip and Knee Osteoarthritis.

PubMed

Gwynne-Jones, David P; Gray, Andrew R; Hutton, Liam R; Stout, Kirsten M; Abbott, J Haxby

2018-04-16

The objective of the study was to investigate the effectiveness of, and factors associated with, response to a chronic disease management program for patients with hip and knee osteoarthritis (OA). Over a 2-year period (2012-2014), 218 patients (97 hip OA; 121 knee OA) were managed with an individualized program of interventions that could include education, physiotherapy, orthotics, occupational therapy, or dietitian referral. Changes in Oxford Hip Score or Oxford Knee Score and Short Form-12 (SF-12) Physical and Mental Component Summary Score (PCS, MCS) were analyzed by joint affected, both unadjusted, and gender and age adjusted. A further analysis also adjusted for body mass index. At mean 12-month follow-up, patients with knee OA had a statistically significant improvement in Oxford Knee Score and PCS, while patients with hip OA had a statistically significant deterioration in all 3 scores. There was evidence that these changes differed between joints for Oxford and PCS scores. Older age was associated with worse outcomes for Oxford scores. Higher body mass index was associated with worse outcomes for Oxford and PCS scores. Patients with hip OA (35%) were more likely to deteriorate to a clinically significant extent (5 points) for Oxford scores than those with knee OA. Gender was not associated with outcomes. Patients with hip OA (54%) were more likely than those with knee OA (24%) to have subsequently had surgery (P < .001). Patients with knee OA were more likely to improve with a chronic disease management plan than patients with hip OA and efforts should be directed to them. Copyright © 2018 Elsevier Inc. All rights reserved.

Weight-bearing asymmetries during Sit-To-Stand in patients with mild-to-moderate hip osteoarthritis.

PubMed

Eitzen, Ingrid; Fernandes, Linda; Nordsletten, Lars; Snyder-Mackler, Lynn; Risberg, May Arna

2014-02-01

The Sit-To-Stand (STS) transition is a mechanically demanding task that may pose particular challenges for individuals with lower limb osteoarthritis (OA). Biomechanical features of STS have been investigated in patients with OA, but not in patients with early stage hip OA. The purpose of this study was to explore inter-limb weight-bearing asymmetries (WBA) and selected kinematic and kinetic variables during STS in patients with mild-to-moderate hip OA compared with healthy controls. Twenty-one hip OA patients and 23 controls were included in the study. Sagittal and frontal plane kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. There were no distinctive biomechanical alterations in sagittal or frontal plane kinematics or kinetics, movement time, or time to reach peak ground reaction force (GRF) in hip OA patients compared with controls. However, the hip OA patients revealed a distinct pattern of WBA compared with the controls, in unloading their involved limb by 18.4% at peak GRF. These findings indicate that patients with early stage hip OA are not yet forced into a stereotypical movement strategy for STS; however, the observed pattern of WBA requires clinical attention. Copyright © 2013 Elsevier B.V. All rights reserved.

Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study.

PubMed

Ageberg, Eva; Nilsdotter, Anna; Kosek, Eva; Roos, Ewa M

2013-08-08

The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee. 87 patients (60-77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients' data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups. At baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27-47%, knee 14-52%, of reference scores, respectively) and had functional limitations (hip 72-85%, knee 42-85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9-29%, knee 7-20%) and physical function (hip 3-18%, knee 5-19%) (p < 0.005). Between 42% and 62% of hip OA patients, and 39% and 61% of knee OA patients, displayed a clinically meaningful improvement (≥15%) in HOOS/KOOS subscales by training. The improvement in HOOS/KOOS subscale ADL was greater for patients with knee OA than hip OA, while the improvement in subscale Sport/Rec was greater for patients with hip OA than knee OA. Both self-reported outcomes and physical function were clearly worse compared with the reference group. Neuromuscular training with an individualized approach and gradual progression showed promise for improving patient-reported outcomes and physical function even in older patients with severe primary OA of the hip or knee.

Increased expression of damage-associated molecular patterns (DAMPs) in osteoarthritis of human knee joint compared to hip joint.

PubMed

Rosenberg, John H; Rai, Vikrant; Dilisio, Matthew F; Sekundiak, Todd D; Agrawal, Devendra K

2017-12-01

Osteoarthritis (OA) is a degenerative disease characterized by the destruction of cartilage. The greatest risk factors for the development of OA include age and obesity. Recent studies suggest the role of inflammation in the pathogenesis of OA. The two most common locations for OA to occur are in the knee and hip joints. The knee joint experiences more mechanical stress, cartilage degeneration, and inflammation than the hip joint. This could contribute to the increased incidence of OA in the knee joint. Damage-associated molecular patterns (DAMPs), including high-mobility group box-1, receptor for advanced glycation end products, and alarmins (S100A8 and S100A9), are released in the joint in response to stress-mediated chondrocyte and cartilage damage. This facilitates increased cartilage degradation and inflammation in the joint. Studies have documented the role of DAMPs in the pathogenesis of OA; however, the comparison of DAMPs and its influence on OA has not been discussed. In this study, we compared the DAMPs between OA knee and hip joints and found a significant difference in the levels of DAMPs expressed in the knee joint compared to the hip joint. The increased levels of DAMPs suggest a difference in the underlying pathogenesis of OA in the knee and the hip and highlights DAMPs as potential therapeutic targets for OA in the future.

Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial

PubMed Central

Patil, Radhika; Karinkanta, Saija; Tokola, Kari; Kannus, Pekka

2017-01-01

Introduction. Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the older population. Although exercise is an effective treatment for knee OA, there is lack of evidence regarding hip OA. The aim of this trial was to test the safety and feasibility of a specifically designed exercise program in relieving hip pain and improving function in hip OA participants and to evaluate various methods to measure changes in their physical functioning. Materials and Methods. 13 women aged ≥ 65 years with hip OA were recruited in this 12-week pilot study. Results. Pain declined significantly over 30% from baseline, and joint function and health-related quality of life improved slightly. Objective assessment of physical functioning showed statistically significant improvement in the maximal isometric leg extensor strength by 20% and in the hip extension range of motion by 30%. Conclusions. The exercise program was found to be safe and feasible. The present evidence indicates that the exercise program is effective in the short term. However, adequate powered RCTs are needed to determine effects of long-term exercise therapy on pain and progression of hip OA. PMID:28116214

Cartilage collagen damage in hip osteoarthritis similar to that seen in knee osteoarthritis; a case-control study of relationship between collagen, glycosaminoglycan and cartilage swelling.

PubMed

Hosseininia, Shahrzad; Lindberg, Lisbeth R; Dahlberg, Leif E

2013-01-09

It remains to be shown whether OA shares molecular similarities between different joints in humans. This study provides evidence for similarities in cartilage molecular damage in osteoarthritic (OA) joints. Articular cartilage from osteoarthritic hip joints were analysed and compared to non-OA controls regarding collagen, glycosaminoglycan and water content. Femoral heads from 16 osteoarthritic (OA) and 20 reference patients were obtained from hip replacement surgery due to OA and femoral neck fracture, respectively. Cartilage histological changes were assessed by Mankin grading and denatured collagen type II immunostaining and cartilage was extracted by α-chymotrypsin. Hydroxyproline and Alcian blue binding assays were used to measure collagen and glycosaminoglycan (GAG) content, respectively. Mankin and immunohistology scores were significantly higher in hip OA samples than in reference samples. Cartilage water content was 6% higher in OA samples than in references. 2.5 times more collagen was extracted from OA than from reference samples. There was a positive association between water content and percentage of extractable collagen pool (ECP) in both groups. The amounts of collagen per wet and dry weights did not differ statistically between OA and reference cartilage. % Extractable collagen was not related to collagen per dry weight in either group. However when collagen was expressed by wet weight there was a negative correlation between % extractable and collagen in OA cartilage. The amount of GAG per wet weight was similar in both groups but the amount of GAG per dry weight was higher in OA samples compared to reference samples, which suggests a capacity for GAG biosynthesis in hip OA cartilage. Neither of the studied parameters was related to age in either group. Increased collagen extractability and water content in human hip cartilage is associated with OA pathology and can be observed at early stages of the degenerative hip OA process. Our results suggest a common degradative pathway of collagen in articular cartilage of different joints. Furthermore, the study suggests that biochemical changes precede more overt OA changes and that chondrocytes may have a capability to compensate molecular loss in the early phase of OA.

Occupational lifting is associated with hip osteoarthritis: a Japanese case-control study.

PubMed

Yoshimura, N; Sasaki, S; Iwasaki, K; Danjoh, S; Kinoshita, H; Yasuda, T; Tamaki, T; Hashimoto, T; Kellingray, S; Croft, P; Coggon, D; Cooper, C

2000-02-01

Hip osteoarthritis (OA) is a frequent cause of pain and disability in Western countries, but the disorder is less common in Japan. A case-control study in Britain found obesity, hip injury, and occupational lifting to be associated with hip OA among men and women. However, there are few epidemiological studies concerning factors associated with hip OA in Japan. We performed a comparable case-control study of the disorder in Japan, and contrasted the findings with those from Britain. The study was carried out in 2 health districts in Wakayama Prefecture, Japan. Cases were men and women aged > or = 45 years listed for total hip arthroplasty due to OA over one year, and who did not have an established cause of secondary OA (e.g., rheumatoid arthritis, ankylosing spondylitis). For each case, a control was selected randomly from the general population and was individually matched to the case for age, sex, and district of residence. Cases and controls were interviewed with a structured questionnaire about medical history, physical activity, socioeconomic factors, and occupation. Measurements were made of height and weight. One hundred fourteen cases (103 women, 11 men) were compared with 114 controls. We found no relationship between obesity and hip OA (OR = 1.0, 95% CI 0.5-1.9; highest vs lowest thirds of distribution of body mass index). There was, however, a statistically significant association between occupational lifting and hip OA, such that regular lifting of 25 kg in the individual's first job (OR = 3.6, 95% CI 1.3-9.7) or of 50 kg in their main job (OR = 4.0, 95% CI 1.1-14.2) was associated with increased risk of hip OA. These associations remained after adjustment for potential confounding variables. In contrast, those subjects who spent > 2 h each day sitting during their first job were significantly less likely to have the disorder (crude OR = 0.5, 95% CI 0.3-0.9). This association also remained statistically significant after adjustment for potential risk factors. Our findings support the hypothesis that occupational physical activity, particularly the lifting of very heavy loads in the workplace at regular intervals, predisposes to hip OA in both Britain and Japan. The lack of association between obesity or hand involvement and hip OA in Japan suggests that the contribution of constitutional and mechanical risk factors to this disorder might differ in different populations. However, attention to manual handling in the workplace would appear an important aspect of preventive strategies against hip OA in Western and Oriental populations.

A narrative overview of the current status of MRI of the hip and its relevance for osteoarthritis research - what we know, what has changed and where are we going?

PubMed

Crema, M D; Watts, G J; Guermazi, A; Kim, Y-J; Kijowski, R; Roemer, F W

2017-01-01

To review and discuss the role of magnetic resonance imaging (MRI) in the context of hip osteoarthritis (OA) research. The content of this narrative review, based on an extensive PubMed database research including English literature only, describes the advances in MRI of the hip joint and its potential usefulness in hip OA research, reviews the relevance of different MRI features in regard to symptomatic and structural progression in hip OA, and gives an outlook regarding future use of MRI in hip OA research endeavors. Recent technical advances have helped to overcome many of the past difficulties related to MRI assessment of hip OA. MRI-based morphologic scoring systems allow for detailed assessment of several hip joint tissues and, in combination with the recent advances in MRI, may increase reproducibility and sensitivity to change. Compositional MRI techniques may add to our understanding of disease onset and progression. Knowledge about imaging pitfalls and anatomical variants is crucial to avoid misinterpretation. In comparison to research on knee OA, the associations between MRI features and the incidence and progression of disease as well as with clinical symptoms have been little explored. Anatomic alterations of the hip joint as seen in femoro-acetabular impingement (FAI) seem to play a role in the onset and progression of structural damage. With the technical advances occurring in recent years, MRI may play a major role in investigating the natural history of hip OA and provide an improved method for assessment of the efficacy of new therapeutic approaches. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study.

PubMed

Hoglund, Lisa T; Pontiggia, Laura; Kelly, John D

2018-01-01

Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks ( P  < 0.05). Timed-Up-and-Go time score improved at 6 weeks ( P  = 0.005). Peak hip external rotator torque increased ( P  = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).

ARE UNILATERAL AND BILATERAL KNEE OSTEOARTHRITIS PATIENTS UNIQUE SUBSETS OF KNEE OSTEOARTHRITIS? A BIOMECHANICAL PERSPECTIVE

PubMed Central

Messier, Stephen P.; Beavers, Daniel P.; Herman, Cassandra; Hunter, David J.; DeVita, Paul

2016-01-01

Objective To compare the gait of adults with unilateral and bilateral symptomatic and radiographic knee osteoarthritis (OA) to determine whether these subgroups can be treated similarly in the clinic and when recruiting for randomized clinical trials, and to use these data to generate future hypotheses regarding gait in these subsets of knee OA patients. Methods Cross-sectional investigation of patients with unilateral and bilateral knee OA on gait mechanics using 136 older adults (age ≥ 55 yrs.; 27 kg.m−2 ≥ BMI ≤ 41 kg.m−2; 82% female) with radiographic knee OA. Comparisons were made between the most affected side of the bilateral group (Bi) and the affected side of the unilateral group (Uni), and between symmetry indices of each group. Results There were no significant differences in any temporal, kinematic, or kinetic measures between the Uni and Bi cohorts. Comparison of symmetry indices between groups also revealed no significant differences. Conclusion The similarity in lower extremity mechanics between unilateral and bilateral knee OA patients is sufficiently robust to consider both subsets as a single cohort. We hypothesize that biomechanical adaptations to knee OA are at least partially systemic in origin and not based solely on the physiological characteristics of an affected knee joint. PMID:26706699

Asymmetry of the leg alignment affects trunk bending in the coronal plane after unilateral total knee arthroplasty.

PubMed

Harato, Kengo; Yoshida, Hiroki; Otani, Toshiro

2013-08-01

Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76 years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending. Copyright © 2013 Elsevier Inc. All rights reserved.

Linkage analysis of candidate genes as susceptibility loci for osteoarthritis-suggestive linkage of COL9A1 to female hip osteoarthritis.

PubMed

Mustafa, Z; Chapman, K; Irven, C; Carr, A J; Clipsham, K; Chitnavis, J; Sinsheimer, J S; Bloomfield, V A; McCartney, M; Cox, O; Sykes, B; Loughlin, J

2000-03-01

To examine 11 candidate genes as susceptibility loci for osteoarthritis (OA). A total of 481 families have been ascertained in which at least two siblings have had joint replacement surgery of the hip, or knee, or hip and knee for idiopathic OA. Each candidate gene was targeted using one or more intragenic or closely linked microsatellite marker. The linkage data were analysed unstratified and following stratification by sex and by joint replaced (hip or knee). The analyses revealed suggestive linkage of the type IX collagen gene COL9A1 (6q12-q13) to a subset of 132 families that contained affected females who were concordant for hip OA (female-hip) with a P-value of 0.00053 and logarithm of the odds (LOD) score of 2.33 [corrected P-value of 0. 0016, corrected LOD score of 1.85]. COL9A1 may therefore be a susceptibility locus for female hip OA. In addition, there was weak evidence of linkage to HLA/COL11A2 (6p21.3) in female hip OA with a corrected P-value of 0.016.

Large-scale meta-analysis of interleukin-1 beta and interleukin-1 receptor antagonist polymorphisms on risk of radiographic hip and knee osteoarthritis and severity of knee osteoarthritis.

PubMed

Kerkhof, H J M; Doherty, M; Arden, N K; Abramson, S B; Attur, M; Bos, S D; Cooper, C; Dennison, E M; Doherty, S A; Evangelou, E; Hart, D J; Hofman, A; Javaid, K; Kerna, I; Kisand, K; Kloppenburg, M; Krasnokutsky, S; Maciewicz, R A; Meulenbelt, I; Muir, K R; Rivadeneira, F; Samuels, J; Sezgin, M; Slagboom, E; Smith, A J P; Spector, T D; Tamm, A; Tamm, A; Uitterlinden, A G; Wheeler, M; Zhai, G; Zhang, W; van Meurs, J B J; Valdes, A M

2011-03-01

To clarify the role of common genetic variation in the Interleukin-1β (IL1B) and Interleukin-1R antagonist (IL1RN) genes on risk of knee and hip osteoarthritis (OA) and severity of knee OA by means of large-scale meta-analyses. We searched PubMed for articles assessing the role of IL1B and IL1RN polymorphisms/haplotypes on the risk of hip and/or knee OA. Novel data were included from eight unpublished studies. Meta-analyses were performed using fixed- and random-effects models with a total of 3595 hip OA and 5013 knee OA cases, and 6559 and 9132 controls respectively. The role of ILRN haplotypes on radiographic severity of knee OA was tested in 1918 cases with Kellgren-Lawrence (K/L) 1 or 2 compared to 199 cases with K/L 3 or 4. The meta-analysis of six published studies retrieved from the literature search and eight unpublished studies showed no evidence of association between common genetic variation in the IL1B or IL1RN genes and risk of hip OA or knee OA (P>0.05 for rs16944, rs1143634, rs419598 and haplotype C-G-C (rs1143634, rs16944 and rs419598) previously implicated in risk of hip OA). The C-T-A haplotype formed by rs419598, rs315952 and rs9005, previously implicated in radiographic severity of knee OA, was associated with reduced severity of knee OA (odds ratio (OR)=0.71 95%CI 0.56-0.91; P=0.006, I(2)=74%), and achieved borderline statistical significance in a random-effects model (OR=0.61 95%CI 0.35-1.06 P=0.08). Common genetic variation in the Interleukin-1 region is not associated with prevalence of hip or knee OA but our data suggest that IL1RN might have a role in severity of knee OA. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Effects of weekly and fortnightly therapeutic exercise on physical function and health-related quality of life in individuals with hip osteoarthritis.

PubMed

Jigami, Hirofumi; Sato, Daisuke; Tsubaki, Atsuhiro; Tokunaga, Yuta; Ishikawa, Tomoji; Dohmae, Yoichiro; Iga, Toshiroh; Minato, Izumi; Yamamoto, Noriaki; Endo, Naoto

2012-11-01

Most previous studies on the effects of therapeutic exercise on osteoarthritis (OA) of the hip joint included participants with knee OA or postoperative participants. Moreover, although some systematic reviews recommend therapeutic exercise for hip OA, a consensus on the effective interventional frequency has not been reached. This study aimed to investigate the effects of therapeutic exercise performed at different frequencies on physical function and health-related quality of life in participants with hip OA. Individuals diagnosed with hip OA (36 women, age 42-79 years; 19 in 2009 and 17 in 2010) were recruited from the cooperating medical institutions. They were divided into two groups depending on the frequency of therapeutic exercise: fortnightly in 2009 (fortnightly group) and weekly in 2010 (weekly group). Participants in each group performed the same land-based and aquatic exercises on the same day for a total of ten sessions. Muscle strength of the lower extremity, "timed up and go" (TUG), time of one-leg standing with open eyes (TOLS), Harris Hip Score, and scores of the Medical Outcomes Survey Short Form-36 questionnaire, were measured before and after interventions. The fortnightly group had no significant changes in lower-extremity muscle strength following intervention, but the strength of all muscles in the weekly group improved significantly after intervention. Further, in both groups, TUG and TOLS of the worse side of the hip joint significantly improved after interventions. Weekly exercise improves muscle strength of the lower extremity and may therefore be an effective interventional technique for managing hip OA. In addition, in persons with hip OA, therapeutic exercise consisting of both land- and water-based exercises markedly improved physical function.

Unilateral Trans-cerebellomedullary Fissure Approach for Occipital Artery to Posterior Inferior Cerebellar Artery Bypass during Aneurysmal Surgery.

PubMed

Abe, Hiroshi; Miki, Koichi; Kobayashi, Hiromasa; Ogata, Toshiyasu; Iwaasa, Mitsutoshi; Matsushima, Toshio; Inoue, Tooru

2017-06-15

Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015. Among them, the unilateral trans-CMF approach was used for OA-PICA anastomosis in 13 patients. The surgical procedures performed on and the medical records of all the patients were retrospectively reviewed. The unilateral trans-CMF approach was performed for two reasons depending on the PICA location or situation: either because the caudal loop could not be used as a recipient artery because of arterial dissection (3 patients) or because the tonsillo-medullary segment that was located in the upper part of the CMF did not have a caudal loop that was large enough (10 patients). The trans-CMF approach provided a good operative field for the OA-PICA bypass and the anastomosis were successfully performed in all patients. When the recipient artery was located in the upper part of the CMF, the unilateral trans-cerebello-medullary fissure approach provided a sufficient operative field for OA-PICA anastomosis.

Unilateral Trans-cerebellomedullary Fissure Approach for Occipital Artery to Posterior Inferior Cerebellar Artery Bypass during Aneurysmal Surgery

PubMed Central

ABE, Hiroshi; MIKI, Koichi; KOBAYASHI, Hiromasa; OGATA, Toshiyasu; IWAASA, Mitsutoshi; MATSUSHIMA, Toshio; INOUE, Tooru

2017-01-01

Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015. Among them, the unilateral trans-CMF approach was used for OA-PICA anastomosis in 13 patients. The surgical procedures performed on and the medical records of all the patients were retrospectively reviewed. The unilateral trans-CMF approach was performed for two reasons depending on the PICA location or situation: either because the caudal loop could not be used as a recipient artery because of arterial dissection (3 patients) or because the tonsillo-medullary segment that was located in the upper part of the CMF did not have a caudal loop that was large enough (10 patients). The trans-CMF approach provided a good operative field for the OA-PICA bypass and the anastomosis were successfully performed in all patients. When the recipient artery was located in the upper part of the CMF, the unilateral trans-cerebello-medullary fissure approach provided a sufficient operative field for OA-PICA anastomosis. PMID:28484132

Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?

PubMed

Lefèvre-Colau, Marie-Martine; Nguyen, Christelle; Haddad, Rebecca; Delamarche, Paul; Paris, Guillaume; Palazzo, Clémence; Poiraudeau, Serge; Rannou, François; Roren, Alexandra

2016-06-01

In this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors' expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to sport. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: design of a randomised clinical trial.

PubMed

van Es, Pauline P; Luijsterburg, Pim A J; Dekker, Joost; Koopmanschap, Marc A; Bohnen, Arthur M; Verhaar, Jan A N; Koes, Bart W; Bierma-Zeinstra, Sita M A

2011-10-12

Osteoarthritis (OA) is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP) care, compared to GP care alone, for patients with hip OA. Patients aged ≥ 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally) 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS]), direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire). These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed. The results of this trial will provide insight into the cost-effectiveness of adding exercise therapy to GPs' care in the treatment of OA of the hip. This trial is registered in the Dutch trial registry http://www.trialregister.nl: trial number NTR1462.

Transculturalization and validation of a Spanish translation of the specific lower limb osteoarthritis and quality of life questionnaire AMICAL: Arthrose des Membres Inférieurs et Qualité de vie AMIQUAL.

PubMed

Espinosa-Cuervo, Gisela; Guillermin, Francis; Rat, Anne-Christine; Duarte-Salazar, Carolina; Alemán-Hernández, Sylvia-I; Vergara-Álvarez, Yuriria; Goycochea-Robles, María-Victoria

2014-01-01

Several generic questionnaires have been used to measure quality of life in patients with Osteoarthritis (OA) since few instruments have been developed specifically for OA and none was developed for Spanish speaking patients. The purpose of the study was to validate and adapt to Spanish the French questionnaire AMICAL to measure quality of life in patients with hip and knee OA. Transversal, analytical study. The validation process was performed in phases: translation from French to Spanish, translated version analysis by a multidisciplinary expert team, application of a pilot test to patients to evaluate grammatical and content equivalence, blind back translation, and analysis. The questionnaire was applied to hip and knee OA patients, together with the SF-36 questionnaire, as well as the WOMAC and the Lequesne indexes. The reproducibility was evaluated applying the questionnaire after 72hours. The clinimetric analysis was calculated with SPSS 16.0. One hundred patients with hip OA and 100 patients with knee OA, radiological stages ii-iii, were included to evaluate homogeneity. Sixty-five patients with hip OA and 65 patients with knee OA were included to evaluate consistency. The final sample included 100 hip and 100 patients knee OA patients to estimate homogeneities and 65 patients were evaluated to estimate consistency. Mean (SD) age of patients with hip and knee OA, was 56.34 ± 13 and 60.1 ± 9.2, respectively. Sixty seven percent and 79.8% were female, respectively. Cronbach' alpha for AMICAL was 0.946 and 0.999, for hip OA and knee OA, respectively; and test-retest reliability using the intraclass correlation coefficients was 0.979 and 0.998, respectively. There was also a significant correlation with all the instruments (P<.05), except with the Lequesne index (r-0.383). The Spanish version of AMICAL questionnaire keep the clinimetric properties, homogeneity, and consistency, and has a good correlation with other instruments. Consequently, it is reliable, self-applicable, and includes domains beyond the functional capacity that better evaluate the quality of life. Copyright © 2013 Elsevier España, S.L. All rights reserved.

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 research. PMID:26419679

Comparison of Blood Loss After Total Hip Arthroplasty Between Ankylosing Spondylitis and Osteoarthritis.

PubMed

Li, Jia; Zhao, Jinzhu; He, Chongru; Tong, Wenwen; Zou, Yuming; Xu, Weidong

2016-07-01

This study was conducted to compare the blood loss during primary total hip arthroplasty (THA) between ankylosing spondylitis (AS) and hip osteoarthritis (OA). We reviewed 120 THAs in 68 patients comprising 3 groups: AS with total bony ankylosis of the hips (ASB), AS with stiff hips (ASS), and OA. Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, surgical complications, hospitalization cost, and length of stay (LOS) were collected and analyzed among ASB, ASS, and OA groups. The patients of the ASB and ASS groups were much younger and thinner than those of the OA group. There were no significant differences in the preoperative values of activated partial thromboplastin time, prothrombin time, and international normalized ratio among the 3 groups (all P > .05). The intraoperative blood loss, volume of drainage, hidden blood loss, transfusion rate, transfusion reactions, and hospitalization cost in the ASB group were significantly higher than in the other 2 groups, although not significantly different between the ASS and OA groups (P > .05). Both AS and OA can cause hyperosteogeny to the hips, but ASB patients have more serious symptoms in their affected hips. This may cause more blood loss in THA surgery because of bone surface bleeding. The reason that ASB patients suffered more blood loss may be related to the high difficulty and long duration of the operation. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement: a population-based prospective cohort study

PubMed Central

2012-01-01

Background Studies on leisure time physical activity as risk factor or protective factor for knee or hip osteoarthritis (OA) show divergent results. Longitudinal prospective studies are needed to clarify the association of physical activity with future OA. The aim was to explore in a prospective population-based cohort study the influence of leisure time physical activity on severe knee or hip OA, defined as knee or hip replacement due to OA. Methods Leisure time physical activity was reported by 28320 participants (mean age 58 years (SD 7.6), 60% women) at baseline. An overall leisure time physical activity score, taking both duration and intensity of physical activities into account, was created. The most commonly reported activities were also used for analysis. The incidence of knee or hip replacement due to OA over 11 years was monitored by linkage with the Swedish hospital discharge register. Cox’s proportional hazards model (crude and adjusted for potential confounding factors) was used to assess the incidence of total joint replacement, or osteotomy (knee), in separate analyses of leisure time physical activity. Results There was no significant overall association between leisure time physical activity and risk for knee or hip replacement due to OA over the 11-year observation time. For women only, the adjusted RR (95% CI) for hip replacement was 0.66 (0.48, 0.89) (fourth vs. first quartile), indicating a lower risk of hip replacement in those with the highest compared with the lowest physical activity. The most commonly reported activities were walking, bicycling, using stairs, and gardening. Walking was associated with a lower risk of hip replacement (adjusted RR 0.76 (95% CI 0.61, 0.94), specifically for women (adjusted RR 0.75 (95% CI 0.57, 0.98)). Conclusions In this population-based study of middle-aged men and women, leisure time physical activity showed no consistent overall relationship with incidence of severe knee or hip OA, defined as joint replacement due to OA, over 11 years. For women, higher leisure time physical activity may have a protective role for the incidence of hip replacement. Walking may have a protective role for hip replacement, specifically for women. PMID:22595023

How Do Physical Therapists in the United Kingdom Manage Patients With Hip Osteoarthritis? Results of a Cross-Sectional Survey.

PubMed

Holden, Melanie A; Bennell, Kim L; Whittle, Rebecca; Chesterton, Linda; Foster, Nadine E; Halliday, Nicola A; Spiers, Libby N; Mason, Elizabeth M; Quicke, Jonathan G; Mallen, Christian D

2018-06-01

Hip osteoarthritis (OA) is common, painful, and disabling. Physical therapists have an important role in managing patients with hip OA; however, little is known about their current management approach and whether it aligns with clinical guideline recommendations. The objective of this study is to describe United Kingdom (UK) physical therapists' current management of patients with hip OA and to determine whether it aligns with clinical guidelines. The design is a cross-section questionnaire. A questionnaire was mailed to 3126 physical therapists in the UK that explored physical therapists' self-reported management of a patient with hip OA using a case vignette and clinical management questions. The response rate was 52.7% (n = 1646). In total, 1148 (69.7%) physical therapists had treated a patient with hip OA in the last 6 months and were included in the analyses. A treatment package was commonly provided incorporating advice, exercise (strength training 95.9%; general physical activity 85.4%), and other nonpharmacological modalities, predominantly manual therapy (69.6%), and gait retraining (66.4%). There were some differences in reported management between physical therapists based in the National Health Service (NHS) and non-NHS-based physical therapists, including fewer treatment sessions being provided by NHS-based therapists. Limitations include the potential for nonresponder bias and, in clinical practice, physical therapists may manage patients with hip OA differently. UK-based physical therapists commonly provide a package of care for patients with hip OA that is broadly in line with current clinical guidelines, including advice, exercise, and other nonpharmacological treatments. There were some differences in clinical practice between NHS and non-NHS-based physical therapists, but whether these differences impact on clinical outcomes remains unknown.

Cumulative hip contact stress predicts osteoarthritis in DDH.

PubMed

Mavcic, Blaz; Iglic, Ales; Kralj-Iglic, Veronika; Brand, Richard A; Vengust, Rok

2008-04-01

Hip stresses are generally believed to influence whether a hip develops osteoarthritis (OA); similarly, various osteotomies have been proposed to reduce contact stresses and the risk of OA. We asked whether elevated hip contact stress predicted osteoarthritis in initially asymptomatic human hips. We identified 58 nonoperatively treated nonsubluxated hips with developmental dysplasia (DDH) without symptoms at skeletal maturity; the control group included 48 adult hips without hip disease. The minimum followup was 20 years (mean, 29 years; range, 20-41 years). Peak contact stress was computed with the HIPSTRESS method using anteroposterior pelvic radiographs at skeletal maturity. The cumulative contact stress was determined by multiplying the peak contact stress by age at followup. We compared WOMAC scores and radiographic indices of OA. Dysplastic hips had higher mean peak contact and higher mean cumulative contact stress than normal hips. Mean WOMAC scores and percentage of asymptomatic hips in the study group (mean age 51 years) were similar to those in the control group (mean age 68 years). After adjusting for gender and age, the cumulative contact stress, Wiberg center-edge angle, body mass index, but not the peak contact stress, independently predicted the final WOMAC score in dysplastic hips but not in normal hips. Cumulative contact stress predicted early hip OA better than the Wiberg center-edge angle. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial.

PubMed

Poulsen, E; Hartvigsen, J; Christensen, H W; Roos, E M; Vach, W; Overgaard, S

2013-10-01

To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI). In a single-center university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip osteoarthritis (OA) from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for 1 year. Primary analysis included 111 patients (94%). In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% confidence interval (CI) 0.9-2.9) was achieved. Effect size (Cohen's d) for the PE + MT minus the MCI was 0.92 (95% CI 0.41-1.42). Number needed to treat for PE + MT was 3 (95% CI 2-7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 to 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained. For primary care patients with OA of the hip, a combined intervention of MT and PE was more effective than a MCI. PE alone was not superior to the MCI. clinicaltrials.govNCT01039337. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Inversion of the acetabular labrum triggers rapidly destructive osteoarthritis of the hip: representative case report and proposed etiology.

PubMed

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

2014-12-01

The pathophysiology of rapidly destructive osteoarthritis (OA) of the hip is unknown. This study documented cases of inversion of the acetabular labrum, which has clinicoradiologic features similar to those of initial-stage rapidly destructive hip OA. Our study was based on a prospective review of data for 9 patients with rapidly destructive hip OA. Intraoperative findings showed that the anterosuperior portion of the acetabular labrum had inverted into the articular space, along with many fragments of articular cartilage, in all patients. Subchondral insufficiency fractures of the femoral heads were seen just under the inverted labra in 8 of the 9 patients. Inversion of the acetabular labrum may be involved in rapid joint-space narrowing and subchondral insufficiency fracture in rapidly destructive hip OA. Copyright © 2014 Elsevier Inc. All rights reserved.

A sex-specific association between incident radiographic osteoarthritis of hip or knee and incident peripheral arterial calcifications: 8-year prospective data from Cohort Hip and Cohort Knee (CHECK).

PubMed

Gielis, W P; Welsing, P M J; van Spil, W E; Runhaar, J; Weinans, H; de Jong, P A

2017-11-01

There is sparse evidence for a relationship between cardiovascular disease (CVD) and osteoarthritis (OA). We investigated the association between incidence of arterial calcifications and incidence of radiographic knee and/or hip OA. We used baseline and 8-year follow-up data of Cohort Hip and Cohort Knee (CHECK). Knees and hips were either Kellgren-Lawrence (KL) grade 0 or 1 at baseline. Arterial calcifications were scored on hip and knee radiographs using a four-grade scale. Scores were summed for patient-level analyses. To investigate incidence, participants with arterial calcifications at baseline or missing follow-up were excluded. Incident OA was defined per joint as KL ≥ 2 or prosthesis at year eight. The association between incidenct of arterial calcifications and incident OA was studied using mixed-effects logistic regression. Of 763 participants included, 623 (82%) were women. Mean (sd) age was 56 (5.1) years, mean (sd) body mass index (BMI) 26.2 (4.1) kg/m 2 . Arterial calcifications developed in 174 participants (283 joints). OA developed in 456 participants (778 joints). Sex modified the association between arterial calcification and OA. In women, incident arterial calcification around a joint was positively associated with incident OA in that joint (adjusted OR 2.51 (95% CI 1.57-4.03)). In men, no association was observed on joint-level, but at patient-level the arterial calcification sum score was negatively associated with incident OA (adjusted OR per point increase 0.70 (95% CI 0.54-0.90)) indicating a systemic effect. We observed sex-dependent associations between incident arterial calcification and incident radiographic knee and/or hip OA, which differs between joint- and patient-level. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Comparison of EMG activity on abdominal muscles during plank exercise with unilateral and bilateral additional isometric hip adduction.

PubMed

Kim, Soo-Yong; Kang, Min-Hyeok; Kim, Eui-Ryong; Jung, In-Gui; Seo, Eun-Young; Oh, Jae-Seop

2016-10-01

The aim of this study was to investigate the effects of additional isometric hip adduction during the plank exercise on the abdominal muscles. Twenty healthy young men participated in this study. Surface electromyography (EMG) was used to monitor the activity of the bilateral rectus abdominis (RA), the internal oblique (IO), and the external oblique (EO) muscles. The participants performed three types of plank exercise; the standard plank exercise, the plank exercise with bilateral isometric hip adduction, and the plank exercise with unilateral isometric hip adduction. All abdominal muscle activity was significantly increased during the plank exercise combined with the bilateral and unilateral isometric hip adduction compared with the standard plank exercise (p<0.05). Bilateral IO, EO, and left RA muscle activity was significantly increased during the unilateral isometric hip adduction compared with the bilateral isometric hip adduction (p<0.05). These findings suggest that additional isometric hip adduction during the plank exercise could be a useful method to enhance abdominal muscle activity. In particular, the unilateral isometric hip adduction is a more beneficial exercise than the bilateral isometric hip adduction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study.

PubMed

Fearon, Angela; Neeman, Teresa; Smith, Paul; Scarvell, Jennie; Cook, Jill

2017-02-01

What are the functional differences between people with greater trochanteric pain syndrome (GT), hip osteoarthritis (OA) or an asymptomatic population as measured by walking, Time Up and Go, single leg standing and strength? Cross sectional study with blinded measurers. 38 participants with GT, 20 with end stage hip OA and 21 asymptomatic healthy control (AS) participants. All participants were women. Pain (numeric rating scale), Walking speed (m/s), cadence (steps/min) and step length (m) measured via the 10m walk test and the Timed Up and Go; balance via single leg stance (s) duration; and hip abduction, adduction, medial and lateral rotation strength, standardized to body mass (BM) via the body mass average index (BMavg), measured via a wall mounted dynamometer. The two symptomatic groups reported similar pain levels (p=0.226), more pain then the AS group (p<0.000). Compared to the AS participants, participants with GT or hip OA demonstrated lower walking speed (10mwt and TUG, p<0.001), lower cadence and shorter duration single leg stance on the affected leg (p<0.05). Participants with GT or hip OA also demonstrated bilaterally weaker hip abduction than the AS group (p≤0.005). Compared to AS and GT participants, participants with hip OA demonstrated adduction weakness on the affected side (p=0.008 and p=0.002 respectively). There is a significant level of dysfunction and impairments associated with GT and hip OA. As activity limitations do not appear to be differentiated by structural impairments, we suggest that pain, rather than the underlying pathology may be the driving impairment that leads to walking and single leg standing dysfunction. Copyright © 2016 Elsevier B.V. All rights reserved.

Early identification of radiographic osteoarthritis of the hip using an active shape model to quantify changes in bone morphometric features: can hip shape tell us anything about the progression of osteoarthritis?

PubMed

Gregory, Jennifer S; Waarsing, Jan H; Day, Judd; Pols, Huibert A; Reijman, Max; Weinans, Harrie; Aspden, Richard M

2007-11-01

Few methods exist to measure the progression of osteoarthritis (OA) or to identify people at high risk of developing OA. Striking radiographic changes include deformation of the femoral head and osteophyte growth, which are usually measured semiquantitatively following visual assessment. In this study, an active shape model (ASM) of the proximal femur was used to determine whether morphologic changes to the bone could be quantified and used as a marker of hip OA. One hundred ten subjects who had no signs of radiographic hip OA at baseline (Kellgren/Lawrence [K/L] scores 0-1) were selected from the Rotterdam Study cohort of subjects ages > or = 55 years. To measure the progression of OA, subjects were followed up with radiographic assessment after 6 years. At the 6-year followup, 55 subjects had established OA (K/L score 3), and in 12 of these OA subjects, the progression of the disease required a total hip replacement (THR). Age- and sex-matched control subjects had a K/L score of 0 at followup. Using the ASM, subjects were assessed for shape changes in the femoral head and neck before, during, and after the development of radiographic OA. Scores of shape variance, or mode scores, were assigned for 10 modes of variation in each subject, and differences in mode scores were determined. During followup, significant changes in shape of the proximal femur occurred within the OA group from baseline to followup (P < 0.0001 for mode 1 and P = 0.002 for mode 6) but not within the control group. At baseline (all subjects having K/L scores 0-1), there were significant differences in mode 6 between the OA group and the control group (P = 0.020), and in modes 3 and 6 between the OA subjects who underwent THR and the remaining OA subjects (P = 0.012 and P = 0.019, respectively). Compared with traditional scoring methods, the ASM can be used more precisely to quantify the deforming effect of OA on the proximal femur and to identify, at an earlier stage of disease, those subjects at highest risk of developing radiographic OA or needing a THR. The ASM may therefore be useful as an imaging biomarker in the assessment of patients with hip OA.

Validity and reliability of three definitions of hip osteoarthritis: cross sectional and longitudinal approach.

PubMed

Reijman, M; Hazes, J M W; Pols, H A P; Bernsen, R M D; Koes, B W; Bierma-Zeinstra, S M A

2004-11-01

To compare the reliability and validity in a large open population of three frequently used radiological definitions of hip osteoarthritis (OA): Kellgren and Lawrence grade, minimal joint space (MJS), and Croft grade; and to investigate whether the validity of the three definitions of hip OA is sex dependent. from the Rotterdam study (aged > or= 55 years, n = 3585) were evaluated. The inter-rater reliability was tested in a random set of 148 x rays. The validity was expressed as the ability to identify patients who show clinical symptoms of hip OA (construct validity) and as the ability to predict total hip replacement (THR) at follow up (predictive validity). Inter-rater reliability was similar for the Kellgren and Lawrence grade and MJS (kappa statistics 0.68 and 0.62, respectively) but lower for Croft's grade (kappa statistic, 0.51). The Kellgren and Lawrence grade and MJS showed the strongest associations with clinical symptoms of hip OA. Sex appeared to be an effect modifier for Kellgren and Lawrence and MJS definitions, women showing a stronger association between grading and symptoms than men. However, the sex dependency was attributed to differences in height between women and men. The Kellgren and Lawrence grade showed the highest predictive value for THR at follow up. Based on these findings, Kellgren and Lawrence still appears to be a useful OA definition for epidemiological studies focusing on the presence of hip OA.

Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index and a self-report format of the self-administered Lequesne-Algofunctional index in patients with knee and hip osteoarthritis.

PubMed

Stucki, G; Sangha, O; Stucki, S; Michel, B A; Tyndall, A; Dick, W; Theiler, R

1998-03-01

To compare the metric properties and validity of German versions of the WOMAC (Western Ontario and McMaster Universities) and a self-administered questionnaire-format of the Lequesne-Algofunctional-Index in patients with osteoarthritis (OA) of the lower extremities. Cross-sectional analysis of the instruments' internal consistency (Cronbach's coefficient alpha) and construct validity (correlation with radiological OA-severity and limitation in range-of-motion) in ambulatory patients and patients before hip arthroplasty. Test-retest reliability was assessed on a subsample after 10 days. Data from 51 patients out of 91 contacted could be analyzed. Twenty-nine patients had knee and 22 patients had hip OA. Both the WOMAC and Lequesne OA-indices and their scales or sections had a satisfactory test-retest reliability (Intraclass correlation coefficient 0.43-0.96). All scales of the WOMAC were internally consistent (Cronbach's coefficient alpha 0.81-0.96) and associated with radiological OA-severity and joint range of motion. However, only the function but not the symptom sections (Cronbach's coefficient alpha knee: 0.55; hip: 0.63) of the self-administered Lequesne OA index were internally consistent for both, patients with knee and hip OA. Also, the symptom components were not or only weakly associated with radiological OA-severity and joint range of motion. Although our results are based on a German version using a self-report format we may caution using the self-administered Lequesne OA index without prior testing of its metric properties and validity.

Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review.

PubMed

Nguyen, Christelle; Lefèvre-Colau, Marie-Martine; Poiraudeau, Serge; Rannou, François

2016-06-01

Rehabilitation is widely recommended in national and international guidelines for managing osteoarthritis (OA) in primary care settings. According to the 2014 OA Research Society International (OARSI) recommendations, rehabilitation is even considered the core treatment of OA and is recommended for all patients. Rehabilitation for OA widely includes land- and water-based exercise, strength training, weight management, self-management and education, biomechanical interventions, and physically active lifestyle. We performed a critical narrative review of the efficacy and safety of rehabilitation for managing OA and discuss evidence-based international recommendations. The process of article selection was unsystematic. Articles were selected based on authors' expertise, self-knowledge, and reflective practice. For the purpose of the review, we focused on land- and water-based exercise and strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere in this special issue. Exercise therapy is widely recommended for managing knee, hip and hand OA. However, the level of evidence varies according to OA location. Overall, consistent evidence suggests that exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore, because of the lack of specific studies, recommendations for hip and hand OA are mainly derived from studies of knee OA. In addition, no recommendations have been established regarding the exercise regimen. The efficacy and safety of exercise therapy and strength training need to be further evaluated in randomized controlled trials of patients with hip and hand OA. The optimal delivery of exercise programs also has to be more clearly defined. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Extended application of WISH type S-form hip brace for patients with bilateral painful hip osteoarthritis: report of two cases.

PubMed

Sato, Takahisa; Yamaji, Takehiko; Inose, Hideyuki; Sato, Ena; Yoshikawa, Ayako; Usuda, Shigeru; Watanabe, Hideomi

2009-06-01

Dynamic lateral instability of the femoral head develops in patients with osteoarthritis (OA) of the hip. Recently we have developed a hip brace, called the WISH-type hip brace, and showed successful response of the patients quantitatively. However, a negligible effect was observed in patients with bilateral involvement. Here, we extended the application of the WISH-type hip brace for two patients with bilateral OA joints. The resultant WISH-type hip brace with two S-form portions for bilateral thighs provided good recovery in hip function. Interestingly Timed Up & Go (TUG) test performed for one patient revealed a positive effect of the brace on the functional mobility. To the best of our knowledge, this is the first report elucidating the therapeutic effect of brace therapy with bilateral hip stabilization from hip functional and functional mobility points of view. Application of the present brace should be taken into account for patients with painful bilateral hip OA before easy application of invasive surgery such as total hip arthroplasty.

Structure and function of the abductors in patients with hip osteoarthritis: Systematic review and meta-analysis.

PubMed

Marshall, Amelia Rose; Noronha, Marcos de; Zacharias, Anita; Kapakoulakis, Theo; Green, Rodney

2016-04-27

Hip osteoarthritis (OA) is a major cause of morbidity. Rehabilitation for this population focuses on strengthening the hip muscles, particularly the abductors, however the deficit in function of these muscles is unclear. To review the evidence for the differences in structure and function of hip abductors (gluteus medius and minimus and tensor fascia lata) in hip OA. A systematic review was conducted using MEDLINE, AMED, CINAHL and SportDISCUS, from the earliest date to September 2013. Studies that compared hip OA patients with controls, or the unaffected contralateral hip were included. Studies needed to report data on an outcome related to gross gluteal muscle function. An initial yield of 141 studies was reduced to 22 after application of inclusion/exclusion criteria. Meta-analysis confirmed greater hip abductor strength in the control group (standardized mean difference = SMD -0.93, 95%CI -1.70 to -0.16) and the unaffected limb (SMD -0.26, 95%CI -0.48 to -0.04). Meta-analyses showed no differences in muscle size either between groups or limbs. Few electromyography studies have been reported and meta-analysis was not possible. Hip abductor strength is reduced in OA patients when compared to healthy controls and to the unaffected limb. Data on muscle size and activity is limited.

OA Go Away: Development and Preliminary Validation of a Self-Management Tool to Promote Adherence to Exercise and Physical Activity for People with Osteoarthritis of the Hip or Knee

PubMed Central

Toupin April, Karine; Backman, Catherine; Tugwell, Peter

2016-01-01

Purpose: To determine the face and content validity, construct validity, and test–retest reliability of the OA Go Away (OGA), a personalized self-management tool to promote adherence to exercise and physical activity for people with osteoarthritis (OA) of the hip or knee. Methods: The face and content validity of OGA version 1.0 were determined via interviews with 10 people with OA of the hip or knee and 10 clinicians. A revised OGA version 2.0 was then tested for construct validity and test–retest reliability with a new sample of 50 people with OA of the hip or knee by comparing key items in the OGA journal with validated outcome measures assessing similar health outcomes and comparing scores on key items of the journal 4–7 days apart. Face and content validity were then confirmed with a new sample of 5 people with OA of the hip or knee and 5 clinicians. Results: Eighteen of 30 items from the OGA version 1.0 and 41 of 43 items from the OGA version 2.0 journal, goals and action plan, and exercise log had adequate content validity. Construct validity and test–retest reliability were acceptable for the main items of the OGA version 2.0 journal. The OGA underwent modifications based on results and participant feedback. Conclusion: The OGA is a novel self-management intervention and assessment tool for people with OA of the hip or knee that shows adequate preliminary measurement properties. PMID:27909359

Unilateral vs bilateral hip bone mineral density measurement for the diagnosis of osteoporosis.

PubMed

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

2014-01-01

It has not been established whether unilateral or bilateral hip dual-energy X-ray absorptiometry (DXA) is preferable for the diagnosis of osteoporosis. We investigated the discordance in DXA measurements in bilateral hips to determine whether unilateral DXA is valid for osteoporosis diagnosis. The subjects were 2964 Japanese patients without a previous diagnosis of primary osteoporosis. We measured bilateral femoral bone mineral density (BMD) and calculated indices, related to the unilateral results, for predicting contralateral hip osteoporosis. A likelihood ratio (LR) of a negative test (LR [-]) of less than 0.2 was considered to exclude the diagnosis. In the normal spinal BMD group, the sensitivity of unilateral DXA for women was 27-73% and LR (-) was 0.28-0.73; the sensitivity for men was 0-50% and LR (-) was 0.51-1.00; the diagnosis of contralateral osteoporosis was not excluded. Sensitivity increased and LR (-) increased with worsening spinal BMD status; however, LR (-) did not meet the cutoff for exclusion. We could exclude unilateral hip osteoporosis, in women only, by performing contralateral femoral DXA; this necessitated lowering the T-score cutoff from -2.5 to -2.0. Unilateral femoral DXA is not useful for excluding the diagnosis of contralateral hip osteoporosis. Copyright © 2014 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials.

PubMed

Adatia, Aleem; Rainsford, K D; Kean, Walter F

2012-05-01

We review the pharmacological properties and clinical evidence pertaining to the efficacy of ibuprofen as a first-line treatment in hip and knee osteoarthritis (OA). In the context of our previous paper's exploration of the aetiology and pathogenesis of OA as a basis for pharmacotherapy, we discuss the pharmacokinetics (PK) and clinical pharmacodynamics (PD) of ibuprofen relevant to OA. Although widely used, the benefits and risks of ibuprofen, especially compared with other non-steroidal anti-inflammatory drugs (NSAIDs) and placebo, have only recently been evaluated in OA of the hip and knee in randomized-controlled clinical trials (RCT). The efficacy and occurrence of adverse reactions from ibuprofen was compared with placebo in a structural review of the literature and systematic review of RCTs in large-scale clinical trials. Ibuprofen has been found to result in approximately 50-60% improvement over placebo in WOMAC scores, including those reflecting inflammatory joint pain in knee and hip OA or other indices of pain, disability and impaired function. Mega-trials performed in comparison with the newer NSAIDs, the coxibs, have shown that ibuprofen has comparable therapeutic benefits and although serious gastrointestinal conditions are sometimes more frequent after short-term treatment, longer-term (several months) therapy in OA reduces the advantages of the coxibs over other NSAIDs including ibuprofen. Cardiovascular risk, though present with coxibs and some NSAIDs in OA, is lower or slightly so with ibuprofen compared with coxibs. Ibuprofen is effective and relatively safe (especially at low over-the-counter doses and in the short term) for mild-to-moderate OA of the knee and hip. The PK properties of ibuprofen in OA (short plasma t½) confer advantages of this drug for OA, while evidence for clinically relevant PD benefits in joints of patients with OA, though limited, is suggestive of local anti-inflammatory activity. © 2012 The Authors. JPP © 2012 Royal Pharmaceutical Society.

Muscle mass and composition of the hip, thigh and abdominal muscles in women with and without hip osteoarthritis.

PubMed

Fukumoto, Yoshihiro; Ikezoe, Tome; Tateuchi, Hiroshige; Tsukagoshi, Rui; Akiyama, Haruhiko; So, Kazutaka; Kuroda, Yutaka; Yoneyama, Tomohide; Ichihashi, Noriaki

2012-09-01

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA. Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis.

PubMed

Alentorn-Geli, Eduard; Samuelsson, Kristian; Musahl, Volker; Green, Cynthia L; Bhandari, Mohit; Karlsson, Jón

2017-06-01

Study Design Systematic review and meta-analysis. Background Running is a healthy and popular activity worldwide, but data regarding its association with osteoarthritis (OA) are conflicting. Objectives To evaluate the association of hip and knee OA with running and to explore the influence of running intensity on this association. Methods PubMed, Embase, and Cochrane Library databases were used to identify studies investigating the occurrence of OA of the hip and/or knee among runners. A meta-analysis of studies comparing this occurrence between runners and controls (sedentary, nonrunning individuals) was conducted. Runners were regarded as "competitive" if they were reported as professional/elite athletes or participated in international competitions. Recreational runners were individuals running in a nonprofessional (amateur) context. The prevalence rate and odds ratio (with 95% confidence interval [CI]) for OA between runners (at competitive and recreational levels) and controls were calculated. Subgroup analyses were conducted for OA location (hip or knee), sex, and years of exposure to running (less or more than 15 years). Results Twenty-five studies (n = 125810 individuals) were included and 17 (n = 114829 individuals) were meta-analyzed. The overall prevalence of hip and knee OA was 13.3% (95% CI: 11.6%, 15.2%) in competitive runners, 3.5% (95% CI: 3.4%, 3.6%) in recreational runners, and 10.2% (95% CI: 9.9%, 10.6%) in controls. The odds ratio for hip and/or knee OA in competitive runners was higher than that in recreational runners (1.34; 95% CI: 0.97, 1.86 and 0.86; 95% CI: 0.69, 1.07, respectively; controls as reference group; for difference, P<.001). Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with controls (OR = 0.6; 95% CI: 0.49, 0.73). Conclusion Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury. Level of Evidence Etiology/harm, level 2a. J Orthop Sports Phys Ther 2017;47(6):373-390. doi:10.2519/jospt.2017.7137.

Is coxa valga a predictor for the severity of knee osteoarthritis? A cross-sectional study.

PubMed

Coskun Benlidayi, Ilke; Guzel, Rengin; Basaran, Sibel; Aksungur, Erol H; Seydaoglu, Gulsah

2015-05-01

In the present study, we aimed to evaluate the affect of the variations in hip anatomy and pelvic geometry on the severity of knee OA. Idiopathic knee OA patients fulfilling the clinical criteria of American College of Rheumatology for OA were enrolled in the study. Several measurements regarding the hip and pelvis were performed on pelvic radiographs. Each knee was graded according to the Kellgren and Lawrence (KL) radiographic system (0-4) along with a categorization in accordance with the medial tibiofemoral joint space widths (JSW). The study group consisted of 111 subjects. The inner and outer pelvic diameters were getting wider as the JSW grade increased. Likewise, among the hip measurements, femoral head, neck and shaft diameters and hip axis lengths were linked with KL grade. There were significant differences in neck-shaft angle (NSA) between groups of JSW with a highest NSA in JSW grade 3. The optimal cut-off value for NSA in predicting the severity of knee OA was 134.4°. Furthermore, NSA beyond 134.4° was found to increase the risk of severe knee OA eightfold. Variations in pelvic geometry and hip anatomy are associated with the severity of knee OA. People with NSA of above 134.4° have eightfold increased risk of developing severe knee OA. Pelvic radiographies could be evaluated at younger ages-particularly in people with high genetic predispositions-to identify the individuals at high risk and in turn, to tailor the preventive measures to these subjects.

Lower Limb Osteoarthritis and the Risk of Falls in a Community-Based Longitudinal Study of Adults with and without Osteoarthritis

PubMed Central

Doré, Adam L.; Golightly, Yvonne M.; Mercer, Vicki S.; Shi, Xiaoyan A.; Renner, Jordan B.; Jordan, Joanne M.; Nelson, Amanda E.

2014-01-01

Objective Knee and hip osteoarthritis (OA) are known risk factors for falls, but whether they together additionally contribute to falls risk is unknown. This study utilizes a biracial cohort of men and women to examine the influence of lower limb OA burden on the risk for future falls. Methods A longitudinal analysis was performed using data from 2 time points of a large cohort. The outcome of interest was falls at follow up. Covariates included age, sex, race, body mass index, a history of prior falls, symptomatic OA of the hip and/or knee, a history of neurologic or pulmonary diseases, and current use of narcotic medications. Symptomatic OA was defined as patient reported symptoms and radiographic evidence of OA in the same joint. Logistic regression analyses were used to determine associations between covariates and falls at follow-up. Results The odds of falling increased with an increasing number of lower limb symptomatic OA joints: those with 1 joint had 53% higher odds, those with 2 joints had 74% higher odds, those with 3–4 OA joints had 85% higher odds. When controlling for covariates, patients who had symptomatic knee or hip OA had an increased likelihood of falling (aOR 1.39 95% CI [1.02, 1.88]; aOR 1.60 95% CI [1.14, 2.24], respectively). Conclusions This study reveals the risk for falls increases with additional symptomatic OA lower limb joints and confirms that symptomatic hip and knee OA are important risk factors for falls. PMID:25331686

Cartilage biomarkers in the osteoarthropathy of alkaptonuria reveal low turnover and accelerated ageing.

PubMed

Taylor, Adam M; Hsueh, Ming-Feng; Ranganath, Lakshminarayan R; Gallagher, James A; Dillon, Jane P; Huebner, Janet L; Catterall, Jon B; Kraus, Virginia B

2017-01-01

Alkaptonuria (AKU) is a rare autosomal recessive disease resulting from a single enzyme deficiency in tyrosine metabolism. As a result, homogentisic acid cannot be metabolized, causing systemic increases. Over time, homogentisic acid polymerizes and deposits in collagenous tissues, leading to ochronosis. Typically, this occurs in joint cartilages, leading to an early onset, rapidly progressing osteoarthropathy. The aim of this study was to examine tissue turnover in cartilage affected by ochronosis and its role in disease initiation and progression. With informed patient consent, hip and knee cartilages were obtained at surgery for arthropathy due to AKU (n = 6; 2 knees/4 hips) and OA (n = 12; 5 knees/7 hips); healthy non-arthritic (non-OA n = 6; 1 knee/5 hips) cartilages were obtained as waste from trauma surgery. We measured cartilage concentrations (normalized to dry weight) of racemized aspartate, GAG, COMP and deamidated COMP (D-COMP). Unpaired AKU, OA and non-OA samples were compared by non-parametric Mann-Whitney U test. Despite more extractable total protein being obtained from AKU cartilage than from OA or non-OA cartilage, there was significantly less extractable GAG, COMP and D-COMP in AKU samples compared with OA and non-OA comparators. Racemized Asx (aspartate and asparagine) was significantly enriched in AKU cartilage compared with in OA cartilage. These novel data represent the first examination of cartilage matrix components in a sample of patients with AKU, representing almost 10% of the known UK alkaptonuric population. Compared with OA and non-OA, AKU cartilage demonstrates a very low turnover state and has low levels of extractable matrix proteins. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cartilage biomarkers in the osteoarthropathy of alkaptonuria reveal low turnover and accelerated ageing

PubMed Central

Hsueh, Ming-Feng; Ranganath, Lakshminarayan R.; Gallagher, James A.; Dillon, Jane P.; Huebner, Janet L.; Catterall, Jon B.; Kraus, Virginia B.

2017-01-01

Objective. Alkaptonuria (AKU) is a rare autosomal recessive disease resulting from a single enzyme deficiency in tyrosine metabolism. As a result, homogentisic acid cannot be metabolized, causing systemic increases. Over time, homogentisic acid polymerizes and deposits in collagenous tissues, leading to ochronosis. Typically, this occurs in joint cartilages, leading to an early onset, rapidly progressing osteoarthropathy. The aim of this study was to examine tissue turnover in cartilage affected by ochronosis and its role in disease initiation and progression. Methods. With informed patient consent, hip and knee cartilages were obtained at surgery for arthropathy due to AKU (n = 6; 2 knees/4 hips) and OA (n = 12; 5 knees/7 hips); healthy non-arthritic (non-OA n = 6; 1 knee/5 hips) cartilages were obtained as waste from trauma surgery. We measured cartilage concentrations (normalized to dry weight) of racemized aspartate, GAG, COMP and deamidated COMP (D-COMP). Unpaired AKU, OA and non-OA samples were compared by non-parametric Mann–Whitney U test. Results. Despite more extractable total protein being obtained from AKU cartilage than from OA or non-OA cartilage, there was significantly less extractable GAG, COMP and D-COMP in AKU samples compared with OA and non-OA comparators. Racemized Asx (aspartate and asparagine) was significantly enriched in AKU cartilage compared with in OA cartilage. Conclusions. These novel data represent the first examination of cartilage matrix components in a sample of patients with AKU, representing almost 10% of the known UK alkaptonuric population. Compared with OA and non-OA, AKU cartilage demonstrates a very low turnover state and has low levels of extractable matrix proteins. PMID:28028161

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.

PubMed

Hochberg, Marc C; Altman, Roy D; April, Karine Toupin; Benkhalti, Maria; Guyatt, Gordon; McGowan, Jessie; Towheed, Tanveer; Welch, Vivian; Wells, George; Tugwell, Peter

2012-04-01

To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA. A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee. Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA. Copyright © 2012 by the American College of Rheumatology.

Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review.

PubMed

Richmond, Sarah A; Fukuchi, Reginaldo K; Ezzat, Allison; Schneider, Kathryn; Schneider, Geoff; Emery, Carolyn A

2013-08-01

Systematic review with meta-analysis. To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups. OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA. Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow-up, study population, OA definition, risk factors, and results (effect estimates reported or calculated where available). The quality of evidence was assessed based on a modified version of the Downs and Black checklist. Joint injury, obesity, and occupational activity were associated with an increased risk of OA of the knee and hip. Sport and physical activity produced inconsistent findings. Joint injury was identified as a significant risk factor for knee OA (combined odds ratio = 3.8; 95% confidence interval: 2.0, 7.2) and hip OA (combined odds ratio = 5.0; 95% confidence interval: 1.4, 18.2), as was previous meniscectomy with or without anterior cruciate ligament injury for knee OA (combined odds ratio = 7.4; 95% confidence interval: 4.0, 13.7). There is a paucity of research examining risk factors associated with ankle OA; this review identified only 2 studies with this outcome. Joint injury, obesity, and occupational activity are associated with an increased risk of knee and hip OA. Some findings remain inconclusive, including levels of physical activity and sport specificity in individuals who do not suffer an injury. Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior. There is a need in the literature for additional high-quality studies, such as prospective cohort studies, that minimize potential bias in examining the relationship between physical risk factors and OA. Prognosis, level 2a-.

Long Intergenic Noncoding RNAs Mediate the Human Chondrocyte Inflammatory Response and Are Differentially Expressed in Osteoarthritis Cartilage.

PubMed

Pearson, Mark J; Philp, Ashleigh M; Heward, James A; Roux, Benoit T; Walsh, David A; Davis, Edward T; Lindsay, Mark A; Jones, Simon W

2016-04-01

To identify long noncoding RNAs (lncRNAs), including long intergenic noncoding RNAs (lincRNAs), antisense RNAs, and pseudogenes, associated with the inflammatory response in human primary osteoarthritis (OA) chondrocytes and to explore their expression and function in OA. OA cartilage was obtained from patients with hip or knee OA following joint replacement surgery. Non-OA cartilage was obtained from postmortem donors and patients with fracture of the neck of the femur. Primary OA chondrocytes were isolated by collagenase digestion. LncRNA expression analysis was performed by RNA sequencing (RNAseq) and quantitative reverse transcriptase-polymerase chain reaction. Modulation of lncRNA chondrocyte expression was achieved using LNA longRNA GapmeRs (Exiqon). Cytokine production was measured with Luminex. RNAseq identified 983 lncRNAs in primary human hip OA chondrocytes, 183 of which had not previously been identified. Following interleukin-1β (IL-1β) stimulation, we identified 125 lincRNAs that were differentially expressed. The lincRNA p50-associated cyclooxygenase 2-extragenic RNA (PACER) and 2 novel chondrocyte inflammation-associated lincRNAs (CILinc01 and CILinc02) were differentially expressed in both knee and hip OA cartilage compared to non-OA cartilage. In primary OA chondrocytes, these lincRNAs were rapidly and transiently induced in response to multiple proinflammatory cytokines. Knockdown of CILinc01 and CILinc02 expression in human chondrocytes significantly enhanced the IL-1-stimulated secretion of proinflammatory cytokines. The inflammatory response in human OA chondrocytes is associated with widespread changes in the profile of lncRNAs, including PACER, CILinc01, and CILinc02. Differential expression of CILinc01 and CIinc02 in hip and knee OA cartilage, and their role in modulating cytokine production during the chondrocyte inflammatory response, suggest that they may play an important role in mediating inflammation-driven cartilage degeneration in OA. © 2016 The Authors. Arthritis & Rheumatology published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

How much arthritis is too much for hip arthroscopy: a systematic review.

PubMed

Domb, Benjamin G; Gui, Chengcheng; Lodhia, Parth

2015-03-01

The purpose of this study was to determine the extent of preoperative osteoarthritis (OA) that precludes benefit from hip arthroscopy by systematically reviewing the literature on hip arthroscopy in the setting of OA. We searched the Medline and PubMed databases using the following Medical Subject Heading terms: arthritis, osteoarthritis, chondral damage, chondral injury, chondral delamination, and hip arthroscopy. Two authors independently reviewed the literature and included articles if they were in the English language; commented on preoperative factors, parameters, physical examination, or diagnostic testing that may be evidence of cartilage damage and/or arthritis; contained outcome data on patients undergoing hip arthroscopy; and had a sample size of at least 10 patients with arthritic changes in the hip. We excluded review articles, technique articles, articles with overlapping patient populations, articles with hip arthroscopy used as an adjunct to an open procedure, articles with inflammatory and septic arthritis, and articles with a mean age younger than 18 years. Our search identified 518 articles, of which 15 met the inclusion and exclusion criteria. Two thousand fifty-one hips underwent arthroscopy at a mean patient age of 40.2 years. Of these, 1,195 hips had signs of OA. There were 345 conversions to total hip arthroplasty/surface replacement arthroplasty. Of these patients, 274 had OA. Eight patient-reported outcome instruments were used. Factors influencing outcomes were preoperative OA, age, chondral damage, femoroacetabular impingement, and duration of symptoms. Current evidence is insufficient to define a cutoff for how much arthritis is too much for hip arthroscopy. However, this analysis shows that patients with a Tönnis grade of 1 or greater or a joint space of 2 mm or less are less likely to benefit from hip arthroscopy and more likely to require conversion to total hip arthroplasty/surface replacement arthroplasty. Postoperative scores on patient-reported outcome instruments are lower in the arthritic population at follow-up compared with their nonarthritic counterparts. Level IV, systematic review of Level III and IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study

PubMed Central

Reyes, Carlen; Leyland, Kirsten M; Peat, George; Cooper, Cyrus; Arden, Nigel K

2016-01-01

Objective Previous cohorts have reported associations between overweight/obesity and knee and hand osteoarthritis (OA). However, no data on the effect of these on the OA burden are available. We aimed to analyse the effect of overweight and obesity on the incidence of routinely diagnosed knee, hip, and hand OA. Methods Design: population-based cohort Setting: primary care records from the SIDIAP database (>5.5 million subjects) covering >80% of the population of Catalonia, Spain. Participants: ≥40 years old with no OA on 01/01/2006 and with body mass index (BMI) data available. Follow-up: from 01/01/2006 to 12/31/2010, loss to follow-up, or death. Measures: BMI World Health Organization categories (exposure), and incident clinical diagnoses of knee, hip, or hand OA (ICD-10 codes). Results 1,764,061 subjects were observed for a median (inter-quartile range) of 4.45 (4.19 to 4.98) years. Incidence rates (per 1000 PY) of knee, hip and hand OA ranged from 3.7 (3.6 to 3.8), 1.7 (1.7 to 1.8) and 2.6 (2.5 to 2.7) amongst normal-weight, to 19.5 (19.1 to 19.9), 3.8 (3.7 to 4.0) and 4.0 (3.9 to 4.2) in the grade II obese respectively. Compared to normal-weight subjects, being overweight or obese increased the risk of OA at all three sites, especially at the knee: overweight and (grade I, II) obesity increased knee OA risk by a factor of 2, 3.1 and 4.7 fold respectively. Conclusions Both overweight and obesity increase the risk of hand, hip, and knee OA, especially for the latter, with a dose-response gradient with increasing BMI. PMID:27059260

Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS).

PubMed

Vignon, Eric; Valat, Jean-Pierre; Rossignol, Michel; Avouac, Bernard; Rozenberg, Sylvie; Thoumie, Philippe; Avouac, Jérôme; Nordin, Margareta; Hilliquin, Pascal

2006-07-01

The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).

Electromyographic analysis of gluteus maximus and hamstring activity during the supine resisted hip extension exercise versus supine unilateral bridge to neutral.

PubMed

Youdas, James W; Hartman, James P; Murphy, Brooke A; Rundle, Ashley M; Ugorowski, Jenna M; Hollman, John H

2017-02-01

Hip extension strengthening exercises which maximize gluteus maximus contributions and minimize hamstring influences may be beneficial for persons with hip pain. This study's aim was to compare muscle activation of the gluteus maximus and hamstrings from healthy subjects during a supine resisted hip extension exercise versus supine unilateral bridge to neutral. Surface electromyographic (EMG) signals were obtained from the right gluteus maximus and hamstrings in 13 healthy male and 13 healthy female subjects. Maximum voluntary isometric contractions (MVICs) were collected to normalize data and permit meaningful comparisons across muscles. Peak median activation of the gluteus maximus was 33.8% MVIC for the bridge and 34.7% MVIC for the hip extension exercise, whereas peak median recruitment for hamstrings was 28.4% MVIC for the bridge and 51% MVIC for the hip extension exercise. The gluteus maximus to hamstrings ratio was compared between the two exercises using the Wilcoxon signed-ranks test (α = 0.05). The ratio (p = 0.014) was greater in the supine unilateral bridge (median = 111.3%) than supine hip extension exercise (median = 59.2%), suggesting a reduction of hamstring recruitment in the unilateral bridge to neutral compared to the supine resisted hip extension exercise. The supine hip extension exercise demonstrated higher EMG activity of hamstrings in comparison with supine unilateral bridge and, therefore, may be less appropriate in subjects who need to increase gluteus maximus activation.

Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol.

PubMed

Abbott, J Haxby; Robertson, M Clare; McKenzie, Joanne E; Baxter, G David; Theis, Jean-Claude; Campbell, A John

2009-02-08

Non-pharmacological, non-surgical interventions are recommended as the first line of treatment for osteoarthritis (OA) of the hip and knee. There is evidence that exercise therapy is effective for reducing pain and improving function in patients with knee OA, some evidence that exercise therapy is effective for hip OA, and early indications that manual therapy may be efficacious for hip and knee OA. There is little evidence as to which approach is more effective, if benefits endure, or if providing these therapies is cost-effective for the management of this disorder. The MOA Trial (Management of OsteoArthritis) aims to test the effectiveness of two physiotherapy interventions for improving disability and pain in adults with hip or knee OA in New Zealand. Specifically, our primary objectives are to investigate whether:1. Exercise therapy versus no exercise therapy improves disability at 12 months;2. Manual physiotherapy versus no manual therapy improves disability at 12 months;3. Providing physiotherapy programmes in addition to usual care is more cost-effective than usual care alone in the management of osteoarthritis at 24 months. This is a 2 x 2 factorial randomised controlled trial. We plan to recruit 224 participants with hip or knee OA. Eligible participants will be randomly allocated to receive either: (a) a supervised multi-modal exercise therapy programme; (b) an individualised manual therapy programme; (c) both exercise therapy and manual therapy; or, (d) no trial physiotherapy. All participants will continue to receive usual medical care. The outcome assessors, orthopaedic surgeons, general medical practitioners, and statistician will be blind to group allocation until the statistical analysis is completed. The trial is funded by Health Research Council of New Zealand Project Grants (Project numbers 07/199, 07/200). The MOA Trial will be the first to investigate the effectiveness and cost-effectiveness of providing physiotherapy programmes of this kind, for the management of pain and disability in adults with hip or knee OA. Australian New Zealand Clinical Trials Registry ref: ACTRN12608000130369.

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. Copyright © 2016 Elsevier B.V. All rights reserved.

Radiographic Hip or Knee Osteoarthritis and the Ability to Drive.

PubMed

von Bernstorff, Maximilian; Feierabend, Martina; Jordan, Maurice; Glatzel, Christopher; Ipach, Ingmar; Hofmann, Ulf Krister

2017-01-01

The question of whether patients with musculoskeletal disorders are fit to drive is of paramount importance for them and frequently is directed to the treating orthopedic specialist. Although perioperative braking performance has been increasingly investigated in recent years, scientific data on braking safety in individuals with osteoarthritis (OA) are scarce. This study analyzed the braking performance of 158 patients with OA of the right or left knee or hip and compared the results with radiographic OA grading according to the Kellgren-Lawrence classification scale. Reaction time and foot transfer time (together called brake response time [BRT]) and brake force were measured in a real car cabin, and the values were compared with measurements obtained from young (n=34) and age-matched (n=36) control groups. Although the majority of BRTs in both control groups remained below 600 milliseconds, patients with both hip and knee OA, whether on the right or left side, had significantly worse values (P<.001) and frequently exceeded this limit. A stronger impact was observed on the right side and in knee OA, with the worst results found in patients with bilateral OA (median BRT for bilateral hip OA, 656 milliseconds [range, 468-1459 milliseconds]; median BRT for bilateral knee OA, 696 milliseconds [range, 527-772 milliseconds]), leading to an increased total stopping distance of up to 32 m at 100 km/h. No correlation of braking performance with radiographic OA manifestation was observed (Kendall tau for BRT: τ=0.007, P=.92; Kendall tau for brake force: τ=-0.014, P=.82), which makes radiographs an inadequate tool for medical driving recommendations. [Orthopedics. 2017; 40(1):e82-e89.]. Copyright 2016, SLACK Incorporated.

Manual therapy in osteoarthritis of the hip: outcome in subgroups of patients.

PubMed

Hoeksma, H L; Dekker, J; Ronday, H K; Breedveld, F C; Van den Ende, C H M

2005-04-01

To investigate whether manual therapy has particular benefit in subgroups of patients defined on the basis of hip function, range of joint motion, pain and radiological deterioration. The study was performed in the out-patient clinic of physical therapy of a large hospital. Data on 109 patients with OA of the hip (clinical ACR criteria) participating in a randomized clinical trial on the effects of manual therapy were used. The outcomes for hip function (Harris hip score), range of joint motion (ROM) and pain (VAS) were compared for specific subgroups. Subgroups were assigned by the median split method. The interaction effect between subgroup and treatment was tested using multiple regression analysis. No differences were observed in the effect of manual therapy in specific subgroups of patients defined on the basis of baseline levels of hip function, pain and ROM. On the basis of radiological grading of osteoarthritis (OA), we found that patients with severe radiological grading of OA had significantly worse outcome on ROM as a result of manual therapy than patients with mild or moderate radiological grading of OA. A significant interaction effect was found for only 1 out of 12 hypotheses investigated. Therefore, we conclude that there is no evidence for the particular benefit of manual therapy in subgroups of patients.

A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee.

PubMed

Kinds, M B; Welsing, P M J; Vignon, E P; Bijlsma, J W J; Viergever, M A; Marijnissen, A C A; Lafeber, F P J G

2011-07-01

There is ongoing debate on whether an association between radiographic and clinical osteoarthritis (OA) exists. We hypothesized that the inconsistency in the detection of an association might be caused by different definitions of OA, by different radiographic protocols, and by scoring methods for radiographic damage and symptoms. The goal of this study was to evaluate which methodological criteria are important to detect an association between radiographic and clinical OA of hip and knee. A literature search was performed with the keywords 'OA', 'hip', 'knee', 'radiographic', and 'clinical' and results were screened for relevant studies. Quality criteria for study characteristics and methodology were developed. Studies were classified according to these criteria and the presence of an association between radiographic and clinical OA was scored. The importance of methodological quality and patient characteristics on the presence of an association was evaluated. The literature search resulted in 39 studies describing an association between radiographic and clinical OA. The frequency of an association between radiographic and clinical OA outcome measures diminished when less quality criteria were fulfilled. Specifically the criterion for standardized outcome measures appeared important in the detection of an association. The association was not influenced by patient characteristics. Only four studies were identified that fulfilled all quality criteria and in these studies an association was found for the knee joint and an inconsistent association was found for the hip joint. Methodological quality criteria are of importance to reveal an association between radiographic and clinical OA. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Associations between weather conditions and clinical symptoms in patients with hip osteoarthritis: a 2-year cohort study.

PubMed

Dorleijn, Desirée M J; Luijsterburg, Pim A J; Burdorf, Alex; Rozendaal, Rianne M; Verhaar, Jan A N; Bos, Pieter K; Bierma-Zeinstra, Sita M A

2014-04-01

The goal of this study was to assess whether there is an association between ambient weather conditions and patients' clinical symptoms in patients with hip osteoarthritis (OA). The design was a cohort study with a 2-year follow-up and 3-monthly measurements and prospectively collected data on weather variables. The study population consisted of 222 primary care patients with hip OA. Weather variables included temperature, wind speed, total amount of sun hours, precipitation, barometric pressure, and relative humidity. The primary outcomes were severity of hip pain and hip disability as measured with the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) pain and function subscales. Associations between hip pain and hip disability and the weather variables were assessed using crude and multivariate adjusted linear mixed-model analysis for repeated measurements. On the day of questionnaire completion, mean relative humidity was associated with WOMAC pain (estimate 0.1; 95% confidence interval=0.0-0.2; P=.02). Relative humidity contributed < or = 1% to the explained within-patient variance and between-patient variance of the WOMAC pain score. Mean barometric pressure was associated with WOMAC function (estimate 0.1; 95% confidence interval=0.0-0.1; P=.02). Barometric pressure contributed < or = 1% to the explained within-patient variance and between-patient variance of the WOMAC function score. The other weather variables were not associated with the WOMAC pain or function score. Our results support the general opinion of OA patients that barometric pressure and relative humidity influence perceived OA symptoms. However, the contribution of these weather variables (< or = 1%) to the severity of OA symptoms is not considered to be clinically relevant. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Butler, W; Merrick, G; Kurko, B

Purpose: To quantify the effect of metal hip prosthesis on the ability to track and localize electromagnetic transponders. Methods: Three Calypso transponders were implanted into two prostate phantoms. The geometric center of the transponders were identified on computed tomography and set as the isocenter. With the phantom stationary on the treatment table and the tracking array 14-cm above the isocenter, data was acquired by the Calypso system at 10 Hz to establish the uncertainty in measurements. Transponder positional data was acquired with unilateral hip prostheses of different metallic compositions and then with bilateral hips placed at variable separation from themore » phantom. Results: Regardless of hip prosthesis composition, the average vector displacement in the presence of a unilateral prosthesis was < 0.5 mm. The greatest contribution to overall vector displacement occurred in the lateral dimension. With bilateral hip prosthesis, the average vector displacement was 0.3 mm. The displacement in the lateral dimension was markedly reduced compared with a unilateral hip, suggesting that there was a countervailing effect with bilateral hip prosthesis. The greatest average vector displacement was 0.6 mm and occurred when bilateral hip prostheses were placed within 4 cm of the detector array. Conclusion: Unilateral and bilateral hip prostheses did not have any meaningful effect on the ability to accurately track electromagnetic transponders implanted in a prostate phantom. At clinically realistic distances between the hip and detection array, the average tracking error is negligible.« less

Radiographic and clinical factors associated with one-leg standing and gait in patients with mild-to-moderate secondary hip osteoarthritis.

PubMed

Tateuchi, Hiroshige; Koyama, Yumiko; Akiyama, Haruhiko; Goto, Koji; So, Kazutaka; Kuroda, Yutaka; Ichihashi, Noriaki

2016-09-01

A decline in physical function associated with secondary hip osteoarthritis (OA) may be caused by both radiographic and clinical factors; however, the underlying mechanism remains unclear. The purpose of this study was to determine how joint degeneration, hip morphology, pain, hip range of motion (ROM), and hip muscle strength relate to one-leg standing (OLS) and gait in patients with mild-to-moderate secondary hip osteoarthritis. Fifty-five female patients (ages 22-65 years) with mild-to-moderate hip OA secondary to hip dysplasia were consecutively enrolled. Balance during OLS and three-dimensional hip angle changes while maintaining the OLS and at foot-off of the raised leg were measured. Gait speed and peak three-dimensional hip joint angles during gait were also measured. The associations between dependent variables (balance, gait speed, and hip kinematic changes) and independent variables (age, body mass index, pain, joint degeneration, hip morphologic abnormality, passive hip ROM, and hip muscle strength) were determined. While lower hip muscle strength was associated with hip kinematic changes such as flexion and internal rotation while maintaining OLS, decreased acetabular head index (AHI) and increased pain were associated with hip extension and abduction at foot-off in OLS. Decreased passive hip ROM was associated with decreased peak hip angles (extension, adduction, and external and internal rotation) during gait, although increased pain and decreased hip extension muscle strength were associated with slower gait speed. In this study of patients with secondary hip OA, AHI, pain, and hip impairments were associated with OLS and gait independently from age and radiographic degeneration. Copyright © 2016 Elsevier B.V. All rights reserved.

Interventions for Hip Pain in the Maturing Athlete

PubMed Central

Gomberawalla, M. Mustafa; Kelly, Bryan T.; Bedi, Asheesh

2014-01-01

Context: Femoroacetabular impingement (FAI) alters hip mechanics, results in hip pain, and may lead to secondary osteoarthritis (OA) in the maturing athlete. Hip impingement can be caused by osseous abnormalities in the proximal femur or acetabulum. These impingement lesions may cause altered loads within the hip joint, which result in repetitive collision damage or sheer forces to the chondral surfaces and acetabular labrum. These anatomic lesions and resultant abnormal mechanics may lead to early osteoarthritic changes. Evidence Acquisition: Relevant articles from the years 1995 to 2013 were identified using MEDLINE, EMBASE, and the bibliographies of reviewed publications. Level of Evidence: Level 4. Results: Improvements in hip arthroscopy have allowed FAI to be addressed utilizing the arthroscope. Adequately resecting the underlying osseous abnormalities is essential to improving hip symptomatology and preventing further chondral damage. Additionally, preserving the labrum by repairing the damaged tissue and restoring the suction seal may theoretically help normalize hip mechanics and prevent further arthritic changes. The outcomes of joint-preserving treatment options may be varied in the maturing athlete due to the degree of underlying OA. Irreversible damage to the hip joint may have already occurred in patients with moderate to advanced OA. In the presence of preexisting arthritis, these patients may only experience fair or even poor results after hip arthroscopy, with early conversion to hip replacement. For patients with advanced hip arthritis, total hip arthroplasty remains a treatment option to reliably improve symptoms with good to excellent outcomes and return to low-impact activities. Conclusion: Advances in the knowledge base and treatment techniques of intra-articular hip pain have allowed surgeons to address this complex clinical problem with promising outcomes. Traditionally, open surgical dislocations for hip preservation surgery have shown good long-term results. Improvements in hip arthroscopy have led to outcomes equivalent to open surgery while utilizing significantly less invasive techniques. However, outcomes may ultimately depend on the degree of underlying OA. When counseling the mature athlete with hip pain, an understanding of the underlying anatomy, degree of arthritis, and expectations will help guide the treating surgeon in offering appropriate treatment options. PMID:24427445

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.

PubMed

Bennell, Kim L; Egerton, Thorlene; Pua, Yong-Hao; Abbott, J Haxby; Sims, Kevin; Metcalf, Ben; McManus, Fiona; Wrigley, Tim V; Forbes, Andrew; Harris, Anthony; Buchbinder, Rachelle

2010-10-14

Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.

Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank.

PubMed

Runhaar, Jos; Rozendaal, Rianne M; van Middelkoop, Marienke; Bijlsma, Hans J W; Doherty, Michael; Dziedzic, Krysia S; Lohmander, L Stefan; McAlindon, Timothy; Zhang, Weiya; Bierma Zeinstra, Sita

2017-11-01

To evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) based on baseline pain severity, body mass index (BMI), sex, structural abnormalities and presence of inflammation using individual patient data. After a systematic search of the literature and clinical trial registries, all randomised controlled trials (RCTs) evaluating the effect of any oral glucosamine substance in patients with clinically or radiographically defined hip or knee OA were contacted. As a minimum, pain, age, sex and BMI at baseline and pain as an outcome measure needed to be assessed. Of 21 eligible studies, six (n=1663) shared their trial data with the OA Trial Bank. Five trials (all independent of industry, n=1625) compared glucosamine with placebo, representing 55% of the total number of participants in all published placebo-controlled RCTs. Glucosamine was no better than placebo for pain or function at short (3 months) and long-term (24 months) follow-up. Glucosamine was also no better than placebo among the predefined subgroups. Stratification for knee OA and type of glucosamine did not alter these results. Although proposed and debated for several years, open trial data are not widely made available for studies of glucosamine for OA, especially those sponsored by industry. Currently, there is no good evidence to support the use of glucosamine for hip or knee OA and an absence of evidence to support specific consideration of glucosamine for any clinically relevant OA subgroup according to baseline pain severity, BMI, sex, structural abnormalities or presence of inflammation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

PubMed

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

2015-06-01

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. 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. 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. 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. Copyright © 2015. Published by Elsevier Ltd.

An update on surgical approaches in hip arthoplasty: lateral versus posterior approach.

PubMed

Mukka, Sebastian S; Sayed-Noor, Arkan S

2014-10-02

In this update we searched the literature about the outcome of the lateral versus posterior approach in hip arthoplasty for osteoarthritis (OA) and femoral neck fracture (FNF) patients. The available evidence shows that the use of posterior approach in OA patients is associated with lower mortality and better functional outcome while the use of lateral approach in FNF patients gives lower dislocation rate. We recommend therefore the use of posterior approach in OA patients and lateral approach in FNF patients.

Relationship between selected measures of strength and hip and knee excursion during unilateral and bilateral landings in women.

PubMed

McCurdy, Kevin; Walker, John; Armstrong, Rusty; Langford, George

2014-09-01

The purpose of this study was to compare the relationship between several measures of single-joint, isometric, eccentric, and squat strength and unilateral and bilateral landing mechanics at the hip and knee in women. Twenty six healthy female subjects with previous athletic experience (height, 165.1 ± 7.01 cm; mass, 60.91 ± 7.14 kg; age, 20.9 ± 1.62 years) participated in this study. Hip and knee mechanics were measured using the MotionMonitor capture system (Innovative Sports Training, Inc.) with 3-dimensional electromagnetic sensors during bilateral (60 cm) and unilateral drop jumps (30 cm). On a separate day, isometric hip extension, external rotation, and abduction strength (lbs) were measured using a handheld dynamometer (Hoggan Health Industries, Inc.). Eccentric and isometric knee strength were measured on the Biodex IV Isokinetic Dynamometer (Biodex Medical Systems, Inc.). Free weight was used to measure the bilateral squat and a modified single-leg squat. The strongest correlations were found between squat strength and knee valgus (-0.77 ≤ r ≤ -0.83) and hip adduction (-0.5 ≤ r ≤ -0.65). After controlling for squat strength, hip external rotation strength and unilateral knee valgus (-0.41), hip abduction strength and bilateral knee valgus (-0.43), and knee flexion strength and bilateral hip adduction (-0.57) remained significant. Eccentric knee flexion strength and unilateral knee internal rotation was the only significant correlation for eccentric strength (-0.40). Squat strength seems to be the best predictor of knee valgus and was consistently related to hip adduction. Isometric and eccentric measures demonstrated few significant correlations with hip and knee excursion while demonstrating a low-to-moderate relationship. Hip and knee flexion and rotation do not seem to be related to strength. Squat strength should receive consideration during risk assessment for noncontact knee injury.

Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia?

PubMed

Brand, Caroline; Hunter, David; Hinman, Rana; March, Lyn; Osborne, Richard; Bennell, Kim

2011-05-01

There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well-described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

Prevalence of radiographic hip osteoarthritis is increased in high bone mass.

PubMed

Hardcastle, S A; Dieppe, P; Gregson, C L; Hunter, D; Thomas, G E R; Arden, N K; Spector, T D; Hart, D J; Laugharne, M J; Clague, G A; Edwards, M H; Dennison, E M; Cooper, C; Williams, M; Davey Smith, G; Tobias, J H

2014-08-01

Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of radiographic hip OA compared with controls. HBM cases came from the UK-based HBM study: HBM was defined by BMD Z-score. Unaffected relatives of index cases were recruited as family controls. Age-stratified random sampling was used to select further population controls from the Chingford and Hertfordshire cohort studies. Pelvic radiographs were pooled and assessed by a single observer blinded to case-control status. Analyses used logistic regression, adjusted for age, gender and body mass index (BMI). 530 HBM hips in 272 cases (mean age 62.9 years, 74% female) and 1702 control hips in 863 controls (mean age 64.8 years, 84% female) were analysed. The prevalence of radiographic OA, defined as Croft score ≥3, was higher in cases compared with controls (20.0% vs 13.6%), with adjusted odds ratio (OR) [95% CI] 1.52 [1.09, 2.11], P = 0.013. Osteophytes (OR 2.12 [1.61, 2.79], P < 0.001) and subchondral sclerosis (OR 2.78 [1.49, 5.18], P = 0.001) were more prevalent in cases. However, no difference in the prevalence of joint space narrowing (JSN) was seen (OR 0.97 [0.72, 1.33], P = 0.869). An increased prevalence of radiographic hip OA and osteophytosis was observed in HBM cases compared with controls, in keeping with a positive association between HBM and OA and suggesting that OA in HBM has a hypertrophic phenotype. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The role of obesity, biomechanical constitution of the pelvis and contact joint stress in progression of hip osteoarthritis.

PubMed

Recnik, G; Kralj-Iglic, V; Iglic, A; Antolic, V; Kramberger, S; Rigler, I; Pompe, B; Vengust, R

2009-07-01

The aim of our study was to explore whether earlier hip arthroplasty for idiopathic osteoarthritis (OA) might be explained by enlarged contact stress in the hip joint, and to what amount can that be attributed to obesity and biomechanical constitution of the pelvis. Fifty subjects were selected from a list of consecutive recipients of hip endoprosthesis due to idiopathic OA; standard pelvic radiographs made years prior to surgery were the main selection criteria. For 65 hips resultant hip force and peak contact hip stress normalized to the body weight (R/Wb and p(max)/Wb) were determined from the radiographs with the HIPSTRESS method. Body weight and body mass index (BMI) were obtained with an interview. Regression analysis was used to correlate parameters of obesity (body weight, BMI), biomechanical constitution of the pelvis (R/Wb, p(max)/Wb) and mechanical loading within the hip joint (R, p(max)) with age at hip arthroplasty. Younger age at hip arthroplasty was associated with higher body weight (P=0.009), higher peak contact hip stress normalized to the body weight - p(max)/Wb (P=0.019), higher resultant hip force -R (P=0.027) and larger peak contact hip stress - p(max) (P<0.001), but not with BMI (P=0.121) or R/Wb (P=0.614). Our results suggest that enlarged contact stress (p(max)) plays an important role in rapid progression of hip OA with both obesity (increased body weight) and unfavorable biomechanical constitution of the pelvis (greater p(max)/Wb) contributing.

Hip, Knee, and Ankle Osteoarthritis Negatively Affects Mechanical Energy Exchange.

PubMed

Queen, Robin M; Sparling, Tawnee L; Schmitt, Daniel

2016-09-01

Individuals with osteoarthritis (OA) of the lower limb find normal locomotion tiring compared with individuals without OA, possibly because OA of any lower limb joint changes limb mechanics and may disrupt transfer of potential and kinetic energy of the center of mass during walking, resulting in increased locomotor costs. Although recovery has been explored in asymptomatic individuals and in some patient populations, the effect of changes in these gait parameters on center of mass movements and mechanical work in patients with OA in specific joints has not been well examined. The results can be used to inform clinical interventions and rehabilitation that focus on improving energy recovery. We hypothesized that (1) individuals with end-stage lower extremity OA would exhibit a decrease in walking velocity compared with asymptomatic individuals and that the joint affected with OA would differntially influence walking velocity, (2) individuals with end-stage lower extremity OA would show decreased energy recovery compared with asymptomatic individuals and that individuals with end-stage hip and ankle OA would have greater reductions in recovery than would individuals with end-stage knee OA owing to restrictions in hip and ankle motion, and (3) that differences in the amplitude and congruity of the center of mass would explain the differences in energy recovery that are observed in each population. Ground reaction forces at a range of self-selected walking speeds were collected from individuals with end-stage radiographic hip OA (n = 27; 14 males, 13 females; average age, 55.6 years; range, 41-70 years), knee OA (n = 20; seven males, 13 females; average age, 61.7 years; range, 49-74 years), ankle OA (n = 30; 14 males, 16 females; average age, 57 years; range, 45-70 years), and asymptomatic individuals (n = 13; eight males, five females; average age, 49.8 years; range, 41-67 years). Participants were all patients with end-stage OA who were scheduled to have joint replacement surgery within 4 weeks of testing. All patients were identified by the orthopaedic surgeon as having end-stage radiographic disease and to be a candidate for joint replacement surgery. Patients were excluded if they had pain at any other lower extremity joint, previous joint replacement surgery, or needed to use an assistive device for ambulation. Patients were enrolled if they met the study inclusion criteria. Our study was comparative and cohorts could be compared with each other, however, the asymptomatic group served to verify our methods and provided a recovery standard with which we could compare our patients. Potential and kinetic energy relationships (% congruity) and energy exchange (% recovery) were calculated. Linear regressions were used to examine the effect of congruity and amplitude of energy fluctuations and walking velocity on % recovery. Analysis of covariance was used to compare energy recovery between groups. The results of this study support our hypothesis that individuals with OA walk at a slower velocity than asymptomatic individuals (1.4 ± 0.2 m/second, 1.2-1.5 m/second) and that the joint affected by OA also affects walking velocity (p < 0.0001). The cohort with ankle OA (0.9 ± 0.2 m/second, 0.77-0.94 m/second) walked at a slower speed relative to the cohort with hip OA (1.1 ± 0.2 m/second, 0.96-1.1 m/second; p = 0.002). However, when comparing the cohorts with ankle and knee OA (0.9 ± 0.2 m/second, 0.77-0.94 m/second) there was no difference in walking speed (p = 0.16) and the same was true when comparing the cohorts with knee and hip OA (p = 0.14). Differences in energy recovery existed when comparing the OA cohorts with the asymptomatic cohort and when examining differences between the OA cohorts. After adjusting for walking speeds these results showed that asymptomatic individuals (65% ± 3%, 63%-67%) had greater recovery than individuals with hip OA (54% ± 10%, 50%-58%; p = 0.014) and ankle OA (47% ± 13%, 40%-52%; p = 0.002) but were not different compared with individuals with knee OA (57% ± 10%, 53%-62%; p = 0.762). When speed was accounted for, 80% of the variation in recovery not attributable to speed was explained by congruity with only 10% being explained by amplitude. OA in the hip, knee, or ankle reduces effective exchange of potential and kinetic energy, potentially increasing the muscular work required to control movements of the center of mass. The fatigue and limited physical activity reported in patients with lower extremity OA could be associated with increased mechanical work of the center of mass. Focused gait retraining potentially could improve walking mechanics and decrease fatigue in these patients.

The Economic Impact of Acetabular Labral Tears: A Cost-effectiveness Analysis Comparing Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Patients Without Osteoarthritis.

PubMed

Lodhia, Parth; Gui, Chengcheng; Chandrasekaran, Sivashankar; Suarez-Ahedo, Carlos; Dirschl, Douglas R; Domb, Benjamin G

2016-07-01

Hip arthroscopic surgery has emerged as a successful procedure to manage acetabular labral tears and concurrent hip injuries, which if left untreated, may contribute to hip osteoarthritis (OA). Therefore, it is essential to analyze the economic impact of this treatment option. To investigate the cost-effectiveness of hip arthroscopic surgery versus structured rehabilitation alone for acetabular labral tears, to examine the effects of age on cost-effectiveness, and to estimate the rate of symptomatic OA and total hip arthroplasty (THA) in both treatment arms over a lifetime horizon. Economic and decision analysis; Level of evidence, 2. A cost-effectiveness analysis of hip arthroscopic surgery compared with structured rehabilitation for symptomatic labral tears was performed using a Markov decision model constructed over a lifetime horizon. It was assumed that patients did not have OA. Direct costs (in 2014 United States dollars), utilities of health states (in quality-adjusted life years [QALYs] gained), and probabilities of transitioning between health states were estimated from a comprehensive literature review. Costs were estimated using national averages of Medicare reimbursements, adjusted for all payers in the United States from a societal perspective. Utilities were estimated from the Harris Hip Score. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to determine the effect of uncertainty on the model outcomes. For a cohort representative of patients undergoing hip arthroscopic surgery at our facility, arthroscopic surgery was more costly (additional $2653) but generated more utility (additional 3.94 QALYs) compared with rehabilitation over a lifetime. The mean ICER was $754/QALY, well below the conventional willingness to pay of $50,000/QALY. Arthroscopic surgery was cost-effective for 94.5% of patients. Although arthroscopic surgery decreased in cost-effectiveness with increasing age, arthroscopic surgery remained more cost-effective than rehabilitation for patients in the second to seventh decades of life. The lifetime incidence of symptomatic hip OA was over twice as high for patients treated with rehabilitation compared with arthroscopic surgery. The preferred treatment was sensitive to the utility after successful hip arthroscopic surgery, although the utility at which arthroscopic surgery becomes less cost-effective than rehabilitation is far below our best estimate. For older patients, the lifetime cost of arthroscopic surgery was greater, while the lifetime utility of arthroscopic surgery was less, approaching that of the rehabilitation arm. Hip arthroscopic surgery is more cost-effective and results in a considerably lower incidence of symptomatic OA than structured rehabilitation alone in treating symptomatic labral tears of patients in the second to seventh decades of life without pre-existing OA. © 2016 The Author(s).

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

PubMed Central

2010-01-01

Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044 PMID:20946621

Serum transforming growth factor-beta 1 is not a robust biomarker of incident and progressive radiographic osteoarthritis at the hip and knee: The Johnston County Osteoarthritis Project

PubMed Central

Nelson, Amanda E.; Golightly, Yvonne M.; Kraus, Virginia B.; Stabler, Thomas; Renner, Jordan B.; Helmick, Charles G.; Jordan, Joanne M.

2010-01-01

Purpose: To test whether serum transforming growth factor-beta 1 (TGF-β1) predicts incident and progressive hip or knee radiographic OA (rOA). Methods: Serum TGF-β1 was measured for 330 participants aged 45 years and older in the Johnston County Osteoarthritis Project, with paired longitudinal films available for 618 hips and 658 knees. Incident and progressive rOA were defined using Kellgren-Lawrence (K-L) grade as well as osteophyte (OST) and joint space narrowing scores (JSN). Natural logarithm transformation was used to produce near-normal distributions for continuous TGF-β1 (lnTGF-β1). Separate multivariable Weibull regression models were used to provide hazard ratios (HR) for a 1-unit increase lnTGF-β1 with each rOA outcome, accounting for variable follow-up times and clustering by individual, adjusted for age, race, gender, and body mass index (BMI). Interaction terms were considered statistically significant at p <0.10. Results: The mean (±SD) age of the sample was 61.9 ± 9.7 years, the mean BMI was 30.3 ± 6.9 kg/m2, with 60.6% women and 42.4% AA. The mean (± SD) TGF-β1 was 17.8 ± 6.1 ng/ml; follow up time was 6.1 ± 1.3 years. There were no significant interac tions by race or gender. HRs showed no significant relationship between lnTGF-β1 and incident or progressive rOA, OST, or JSN, at the knee or the hip. Conclusions: Levels of TGF-β1 do not predict incident or progressive rOA, OST, or JSN at the hip or knee in this longitudinal, population-based study, making it unlikely that TGF-β1 will be a robust biomarker for rOA in future studies. PMID:20206313

New application of 18F-fluoride PET for the detection of bone remodeling in early-stage osteoarthritis of the hip.

PubMed

Kobayashi, Naomi; Inaba, Yutaka; Tateishi, Ukihide; Yukizawa, Yohei; Ike, Hiroyuki; Inoue, Tomio; Saito, Tomoyuki

2013-10-01

Recent studies have reported the acceleration of subchondral bone remodeling during the development of osteoarthritis (OA). However, it is not possible to evaluate such molecular abnormalities using conventional radiographic techniques. We have applied 18F-fluoride PET to the analysis of painful or dysplastic hips at various stages of OA and then compared this with radiographic findings and clinical findings. A consecutive series of 65 joints from 48 patients (average age, 40 years; range, 19-72 years) with a hip joint complaint or radiographic dysplastic hip were enrolled in this study. Twenty-five contralateral joints without any evidence of OA or clinical symptoms were assigned as a normal control group. Radiographic evaluations were performed on the basis of Kellgren and Lawrence grade and the minimum joint space. Clinical evaluations were performed using the grading scale for pain severity and the SUVmax was measured for each joint. The association between SUVmax and the radiographic or clinical findings was evaluated. 18F-fluoride PET shows a significantly higher uptake value for progressive-stage OA cases than for early-stage cases and also shows a significantly higher uptake value in cases with severe pain. Even in early-OA-stage patients who do not show joint space narrowing on a plain x-ray, cases with severe pain show a significantly higher uptake value. 18F-fluoride PET has great potential as an imaging method for diagnosing early-stage OA without any marked radiographic changes.

Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial.

PubMed

Hoeksma, Hugo L; Dekker, Joost; Ronday, H Karel; Heering, Annet; van der Lubbe, Nico; Vel, Cees; Breedveld, Ferdinand C; van den Ende, Cornelia H M

2004-10-15

To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip. A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life. Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks. The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.

Bone Parameters in Anorexia Nervosa and Athletic Amenorrhea: Comparison of Two Hypothalamic Amenorrhea States.

PubMed

Kandemir, Nurgun; Slattery, Meghan; Ackerman, Kathryn E; Tulsiani, Shreya; Bose, Amita; Singhal, Vibha; Baskaran, Charumathi; Ebrahimi, Seda; Goldstein, Mark; Eddy, Kamryn; Klibanski, Anne; Misra, Madhusmita

2018-04-05

We have reported low bone mineral density (BMD), impaired bone structure, and increased fracture risk in anorexia nervosa (AN) and normal-weight, oligo-amenorrheic athletes (OA). However, data directly comparing compartment-specific bone parameters in AN, OA and controls are lacking. 426 females 14-21.9 years old were included; 231 AN, 94 OA and 101 normal-weight eumenorrheic controls. Dual energy x-ray absorptiometry was used to assess areal BMD (aBMD) of the whole body less head (WBLH), spine, and hip. High resolution peripheral quantitative CT was used to assess volumetric BMD (vBMD), bone geometry and structure at the non-weight bearing distal radius and weight-bearing distal tibia. AN had lower WBLH and hip aBMD Z-scores than OA and controls (p<0.0001). AN and OA had lower spine aBMD Z-scores than controls (p<0.01). At the radius, total and cortical vBMD, percent cortical area and thickness were lower in AN and OA vs. controls (p≤0.04); trabecular vBMD was lower in AN than controls. At the tibia, AN had lower measures for most parameters vs. OA and controls (p<0.05); OA had lower cortical vBMD than controls (p=0.002). AN and OA had higher fracture rates vs. controls. Stress fracture prevalence was highest in OA (p<0.0001); non-stress fracture prevalence was highest in AN (p<0.05). AN is deleterious to bone at all sites and both bone compartments. A high stress fracture rate in OA, who have comparable WBLH and hip aBMD measures to controls, indicates that BMD in these women may need to be even higher to avoid fractures.

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

2016-07-25

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.

Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip

PubMed Central

Chandrasekaran, Sivashankar; Lodhia, Parth; Suarez-Ahedo, Carlos; Vemula, S. Pavan; Martin, Timothy J.; Domb, Benjamin G.

2016-01-01

The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA). These treatments play an important biological role in the non-operative management of these conditions. Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection—local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and FAI. Seventy-two full text articles were suitable for inclusion. There were 18 articles addressing the efficacy of diagnostic intra-articular hip injections. With respect to efficacy in OA there were 25 articles pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There were three articles addressing the efficacy of biologics in FAI. Diagnostic intra-articular hip injections are sensitive and specific for differentiating between intra-articular, extra-articular and spinal causes of hip symptoms. Ultrasound and fluoroscopy improves the precision of intra-articular positioning of diagnostic injections. Corticosteroids are more effective than HA and PRP in alleviating pain from hip OA. A higher dose of corticosteroids produces a longer benefit but volume of injection has no significant effect. Intra-articular corticosteroids do not increase infection rates of subsequent arthroplasty. There is currently limited evidence to warrant the routine use of therapeutic injections in the management of labral tears and FIA. PMID:27026814

PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee.

PubMed

Rillo, Oscar; Riera, Humberto; Acosta, Carlota; Liendo, Verónica; Bolaños, Joyce; Monterola, Ligia; Nieto, Edgar; Arape, Rodolfo; Franco, Luisa M; Vera, Mariflor; Papasidero, Silvia; Espinosa, Rolando; Esquivel, Jorge A; Souto, Renee; Rossi, Cesar; Molina, José F; Salas, José; Ballesteros, Francisco; Radrigan, Francisco; Guibert, Marlene; Reyes, Gil; Chico, Araceli; Camacho, Walter; Urioste, Lorena; Garcia, Abraham; Iraheta, Isa; Gutierrez, Carmen E; Aragón, Raúl; Duarte, Margarita; Gonzalez, Margarita; Castañeda, Oswaldo; Angulo, Juan; Coimbra, Ibsen; Munoz-Louis, Roberto; Saenz, Ricardo; Vallejo, Carlos; Briceño, Julio; Acuña, Ramón P; De León, Anibal; Reginato, Anthony M; Möller, Ingrid; Caballero, Carlo V; Quintero, Maritza

2016-10-01

The objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America. Recommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique. Both "strong" and "conditional" recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement. These recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.

Kinematic alterations of the lower limbs and pelvis during an ascending stairs task are associated with the degree of knee osteoarthritis severity.

PubMed

Gonçalves, Glaucia Helena; Selistre, Luiz Fernando Approbato; Petrella, Marina; Mattiello, Stela Márcia

2017-03-01

Individuals with knee osteoarthritis (OA) generally demonstrate great difficulty in ascending stairs. The strategies and compensations used by these individuals in stair activities have not been fully established. The purpose of this study was to investigate the joint kinematics of the pelvis, hip, knee and ankle throughout the gait cycle, in the sagittal and frontal planes, in individuals with mild and moderate knee OA, during an ascending stairs task. Thirty-one individuals with knee OA and 19 controls were subjected to clinical and radiographic analysis, divided into three groups: control, mild knee OA, and moderate knee OA. Participants answered a self-reported questionnaire, carried out performance-based tests, and their kinematic data were recorded during an ascending stairs task using an eight-camera Qualisys 3D-Motion analysis system. The individuals with moderate degrees of knee OA demonstrated kinematic alterations in the pelvis, hip, knee, and ankle in the sagittal plane. The individuals with mild degrees of knee OA demonstrated kinematic alterations of the hip in the frontal plane, and kinematic alterations of the ankle in the sagittal plane. The ascending stairs task allowed verification of meaningful information regarding gait strategies used by individuals with mild and moderate knee OA. The strategies of these two groups of individuals are different for this task, although more pronounced in individuals with moderate knee OA. The findings should be taken into account in the development of rehabilitation programs. Copyright © 2017 Elsevier B.V. All rights reserved.

Individual patient data meta-analysis of trials investigating the effectiveness of intra-articular glucocorticoid injections in patients with knee or hip osteoarthritis: an OA Trial Bank protocol for a systematic review

PubMed Central

2013-01-01

Background Based on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. A meta-analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA in specific subgroups of patients with severe pain and (mild) inflammatory signs, over both short-term and long-term follow-up, using IPD from existing studies; to reach consensus on the rules for cooperation in a consortium; and to develop and explore the methodological issues of meta-analysis with individual OA patient data. Methods/Design For the current IPD analysis we will collect and synthesize IPD from randomized trials studying the effect of intra-articular glucocorticoid injections in patients with hip or knee OA. Subgroup analyses will be performed for the primary outcome of pain at both short-term and long-term follow-up, in the subgroups of patients with and without severe pain and with and without inflammatory signs. Discussion This study protocol includes the first study of the OA Trial Bank, an international collaboration that initiates meta-analyses on predefined subgroups of OA patients from existing literature. This approach ensures a widely supported initiative and is therefore likely to be successful in data collection of existing trials. The collaboration developed (that is, the OA Trial Bank) may also lead to future IPD analyses on subgroups of patients with several intervention strategies applied in OA patients. PMID:23830482

Individual patient data meta-analysis of trials investigating the effectiveness of intra-articular glucocorticoid injections in patients with knee or hip osteoarthritis: an OA Trial Bank protocol for a systematic review.

PubMed

van Middelkoop, Marienke; Dziedzic, Krysia S; Doherty, Michael; Zhang, Weiya; Bijlsma, Johannes W; McAlindon, Timothy E; Lohmander, Stefan L; Bierma-Zeinstra, Sita M A

2013-07-05

Based on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. A meta-analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA in specific subgroups of patients with severe pain and (mild) inflammatory signs, over both short-term and long-term follow-up, using IPD from existing studies; to reach consensus on the rules for cooperation in a consortium; and to develop and explore the methodological issues of meta-analysis with individual OA patient data. For the current IPD analysis we will collect and synthesize IPD from randomized trials studying the effect of intra-articular glucocorticoid injections in patients with hip or knee OA. Subgroup analyses will be performed for the primary outcome of pain at both short-term and long-term follow-up, in the subgroups of patients with and without severe pain and with and without inflammatory signs. This study protocol includes the first study of the OA Trial Bank, an international collaboration that initiates meta-analyses on predefined subgroups of OA patients from existing literature. This approach ensures a widely supported initiative and is therefore likely to be successful in data collection of existing trials. The collaboration developed (that is, the OA Trial Bank) may also lead to future IPD analyses on subgroups of patients with several intervention strategies applied in OA patients.

Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections

PubMed Central

Pasquale, Margaret K.; Louder, Anthony M.; Cheung, Raymond Y.; Reiners, Andrew T.; Mardekian, Jack; Sanchez, Robert J.; Goli, Veerainder

2015-01-01

Background Given the dramatic increase in total knee and hip replacement procedures among the US population aged 45 years and older, there is a need to compare the downstream healthcare utilization and costs between patients who undergo joint replacement and those who receive intraarticular injections as a low-cost alternative. Objective To compare changes in osteoarthritis (OA)-related healthcare utilization and costs for Medicare members with OA who underwent knee or hip replacement versus those receiving steroid or viscosupplementation injections. Methods Medicare members aged ≥45 years diagnosed with OA were identified for this retrospective longitudinal study. Data were compared for patients who underwent primary knee or hip replacement surgery between July 1, 2007, and June 30, 2012, and those receiving injection of pain-relief medication during the same period. The date of joint replacement surgery was considered the index date. For the comparison cohort, the index date was 180 days postinjection of the first intraarticular injection. Medical and pharmacy claims were examined longitudinally in 90-day increments, from 180 days preindex until 360 days postindex. Difference-in-difference analyses were conducted to compare the change in OA-related healthcare costs, postindex versus preindex, between the study cohorts. Time-to-event analyses were used to measure rates of readmissions and venous thromboembolism (VTE). Results The mean age was 70.7 years for patients with knee replacement, 71.7 years for those with hip replacement, and 71.1 years for those receiving pain-relief injection (P <.0001). The RxRisk-V comorbidity index scores were 4.7, 4.4, and 4.8, respectively (P <.0001). Difference-in-difference analyses indicated that decreases in OA-related costs were greater for the joint replacement cohorts (coefficient for knee replacement*time: −0.603; hip replacement*time: −0.438; P <.001 for both) than for the comparison cohort. The VTE rates were 5.6% (knee) and 5.1% (hip) postsurgery versus 1.4% (knee) and 1.3% (hip) presurgery. Conclusion The overall difference-in-difference results showed a greater decrease in healthcare utilization and costs for the members with joint replacement than for those receiving injection. PMID:26557232

The effect of disease site (knee, hip, hand, foot, lower back or neck) on employment reduction due to osteoarthritis.

PubMed

Sayre, Eric C; Li, Linda C; Kopec, Jacek A; Esdaile, John M; Bar, Sherry; Cibere, Jolanda

2010-05-03

Osteoarthritis (OA) has a significant impact on individuals' ability to work. Our goal was to investigate the effects of the site of OA (knee, hip, hand, foot, lower back or neck) on employment reduction due to OA (EROA). This study involved a random sample of 6,000 patients with OA selected from the Medical Service Plan database in British Columbia, Canada. A total of 5,491 were alive and had valid addresses, and of these, 2,259 responded (response rate = 41%), from which 2,134 provided usable data. Eligible participants were 19 or older with physician diagnosed OA based on administrative data between 1992 and 2006. Data of 688 residents were used (mean age 62.1 years (27 to 86); 60% women). EROA had three levels: no reduction; reduced hours; and total cessation due to OA. The (log) odds of EROA was regressed on OA sites, adjusting for age, sex, education and comorbidity. Odds ratios (ORs) represented the effect predicting total cessation and reduced hours/total cessation. The strongest effect was found in lower back OA, with OR = 2.08 (95% CI: 1.47, 2.94), followed by neck (OR = 1.59; 95% CI: 1.11, 2.27) and knee (OR = 1.43; 95% CI: 1.02, 2.01). We found an interaction between sex and foot OA (men: OR = 1.94; 95% CI: 1.05, 3.59; women: OR = 0.89; 95% CI = 0.57, 1.39). No significant effect was found for hip OA (OR = 1.33) or hand OA (OR = 1.11). Limitations of this study included a modest response rate, the lack of an OA negative group, the use of administrative databases to identify eligible participants, and the use of patient self-reported data. After adjusting for socio-demographic variables, comorbidity, and other OA disease sites, we find that OA of the lower back, neck and knee are significant predictors for EROA. Foot OA is only significantly associated with EROA in males. For multi-site combinations, ORs are multiplicative. These findings may be used to guide resource allocation for future development/improvement of vocational rehabilitation programs for site-specific OA.

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.

THE CLINICAL, FUNCTIONAL AND BIOMECHANICAL PRESENTATION OF PATIENTS WITH SYMPTOMATIC HIP ABDUCTOR TENDON TEARS.

PubMed

Ebert, Jay R; Retheesh, Theertha; Mutreja, Rinky; Janes, Gregory C

2016-10-01

Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome (GTPS), though limited information exists on the disability associated with this condition and specific presentation of these patients. To describe the clinical, functional and biomechanical presentation of patients with symptomatic HAT tears. Secondary purposes were to investigate the association between these clinical and functional measures, and to compare the pain and disability reported by HAT tear patients to those with end-stage hip osteoarthritis (OA). Prospective case series. One hundred forty-nine consecutive patients with symptomatic HAT tears were evaluated using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, an additional series of 10 questions more pertinent to those with lateral hip pain, active hip range of motion (ROM), maximal isometric hip abduction strength, six-minute walk capacity and 30-second single limb stance (SLS) test. The presence of a Trendelenburg sign and pelvis-on-femur (POF) angle were determined via 2D video analysis. An age matched comparative sample of patients with end-stage hip OA was recruited for comparison of all patient-reported outcome scores. Independent t-tests investigated group and limb differences, while analysis of variance evaluated pain changes during the functional tests. Pearson's correlation coefficients investigated the correlation between clinical measures in the HAT tear group. No differences existed in patient demographics and patient-reported outcome scores between HAT tear and hip OA cohorts, apart from significantly worse SF-12 mental subscale scores (p = 0.032) in the HAT tear group. Patients with HAT tears demonstrated significantly lower (p < 0.05) hip abduction strength and active ROM in all planes of motion on their affected limb. Pain significantly increased throughout the 30-second SLS test for the HAT tear group, with 57% of HAT tear patients demonstrating a positive Trendelenburg sign. POF angle during the test was not significantly associated with pain. Patients with symptomatic HAT tears demonstrate poor function, and report pain and disability similar to or worse than those with end-stage hip OA. This information better defines and differentiates the presentation of these patients. Level 3 case-controlled study, with matched comparison.

Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype.

PubMed

Hogervorst, Tom; Eilander, Wouter; Fikkers, Joost T; Meulenbelt, Ingrid

2012-12-01

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not. We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with hip ontogenesis. We performed a systematic literature review of mechanical and genetic factors of hip ontogeny. We focused on three fields that in recent years have advanced our knowledge of adult hip morphology: imaging, evolution, and genetics. WHERE ARE WE NOW?: Mechanical factors can be understood in view of human evolutionary peculiarities and may summate to load histories conducive to DHD. Genetic factors most likely act through multiple genes, each with modest effect sizes. Single genes that explain a DHD are therefore unlikely to be found. Apparently, the interplay between genes and load history not only determines hip morphotype, but also joint cartilage robustness ("cartilotype") and resistance to symptomatic OA. WHERE DO WE NEED TO GO?: We need therapies that can improve both morphotype and cartilotype. HOW DO WE GET THERE?: Better phenotyping, improving classification systems of hip morphology, and comparative population studies can be done with existing methods. Quantifying load histories likely requires new tools, but proof of principle of modifying morphotype in treatment of DDH and of cartilotype with exercise is available.

Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index.

PubMed

Klässbo, Maria; Larsson, Eva; Mannevik, Eva

2003-01-01

To further develop the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC LK 3.0) for people with hip disability with or without hip osteoarthritis (OA), 52 subjects (median age 64 yrs, 35 women) answered a version of the Index with additional dimensions, twice, with a one-week interval. Reproducibility, percentage of zero scores (best possible scores), mean score of symptoms, and importance, were analyzed. This resulted in the Hip disability and osteoarthritis outcome score (HOOS LK 1.1), a 39-item questionnaire with five separate sub-scales. There were higher median scores (more symptoms) for three of HOOS sub-scales Pain, Activity limitations--sport and recreation, and Hip-related Quality of life compared to those in the WOMAC, improving the ability to assess change in patients over time. The HOOS appears to be an evaluative instrument for assessing important self-rated hip problems for people with hip disability with/without hip OA, but additional studies are needed.

Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis.

PubMed

French, Helen P; Smart, Keith M; Doyle, Frank

2017-08-01

Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain. Accurate identification of any neuropathic pain in hip or knee OA is important for appropriate management, but neuropathic pain prevalence is unknown. We aimed to obtain an overall prevalence estimate by systematically reviewing and meta-analysing the prevalence of neuropathic pain in people with hip or knee OA. Observational studies which measured neuropathic pain in people aged 18 years and older with hip or knee OA were considered for inclusion. Electronic databases were searched up to February 2016. Two reviewers independently identified eligible studies and assessed methodological quality. Prevalence estimates and 95% confidence intervals were calculated using random effects meta-analytic techniques. Nine studies met the inclusion criteria. Study samples were from general population, hospital and community settings and all used self-report questionnaires to determine neuropathic pain. The overall prevalence estimate was 23% (95% CI: 10-39%), with considerable heterogeneity (I 2 = 97.9%, p < 0.001). This estimate was largely unchanged with subgroup analyses based on index joint, questionnaire type, setting and consideration of other potential causes of neuropathic pain. However, the estimate for two studies that excluded other potential causes of neuropathic pain was substantially higher (32%, 95% CI: 29-35%). Neuropathic pain prevalence in people with knee or hip OA is considerable at 23%, and may be higher after other potential causes of neuropathic pain are excluded. Concerns regarding the validity of neuropathic pain questionnaires, selection bias, methodological quality and study heterogeneity suggest caution with interpretation of these findings. Prevalence studies using standardised criteria for neuropathic pain are required. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors Contributing to Pelvis Instability in Female Adolescent Athletes During Unilateral Repeated Partial Squat Activity

PubMed Central

Scarborough, Donna Moxley; Linderman, Shannon; Berkson, Eric M.; Oh, Luke S.

2017-01-01

Objectives: Unilateral partial squat tasks are often used to assess athletes’ lower extremity (LE) neuromuscular control. Single squat biomechanics such as lateral drop of the non-stance limb’s pelvis have been linked to knee injury risk. Yet, there are limited studies on the factors contributing to pelvic instability during the unilateral partial squat such as anatomical alignment of the knee and hip strength. The purpose of this study was 1) to assess the influence of leg dominance on pelvic drop among female athletes during the repeated unilateral partial squat activity and 2) to investigate the contributions that lower limb kinematics and hip strength have on pelvis drop. Methods: 42 female athletes (27= softball pitchers, 15=gymnasts, avg age=16.48 ± 2.54 years) underwent lower limb assessment. The quadriceps angle (Q angle) and the average of 3 trials for hip abduction and extension strength (handheld dynamometer measurements) were used for analyses. 3D biomechanical analysis of the repeated unilateral partial squat activity followed using a 20 motion capture camera system which created a 15 segment model of each subject. The subject stood on one leg at the lateral edge of a 17.78 cm box with hands placed on the hips and squatted so that the free hanging contralateral limb came as close to the ground without contact for 5 continuous repetitions. One trial for each limb was performed. Peak pelvic drop and ankle, knee and hip angles and torques (normalized by weight) at this time point were calculated using Visual 3D (C-Motion) biomechanical software. Paired T-test, Spearman correlations and multiple regression model statistical analyses were performed. Results: Peak pelvic drop during the unilateral partial squat did not differ significantly on the basis of limb dominance (p=0.831, Dom: -3.40 ± 5.10° , ND: -3.46 ± 4.44°). Peak pelvic drop displayed a Spearman correlation with the functional measure of hip abduction/adduction (ABD/ADD) angle (rs= 0.627, p< 0.001) (Figure 1). No association was noted between peak pelvic drop and anatomical measures of Q angle or isometric hip extension strength. A multiple regression was performed to predict pelvis drop angle from the following 6 variables: isometric hip ABD strength, hip ABD/ADD angle, hip internal/external rotation angle, ankle supination/pronation (S/P) angle, height and weight. These variables statistically predicted pelvis drop, F(6,73) = 17.848, p < .0005, R2 = 0.595. The strongest combined predictor variables for pelvic drop in the female athletes were hip abduction/ adduction angle and strength followed by subject’s weight and ankle S/P angle (Table 1). Conclusion: Peak pelvic drop during the repeated unilateral partial squat activity did not correlate significantly with Q angle and hip extension strength. Instead, peak pelvic drop appears more related to a combination of biomechanical limb positioning, hip ABD strength and subject demographics. The regression model run on the repeated unilateral partial squat demonstrates predictive power of this dynamic assessment tool based on kinematic measures across multiple joints. Results could guide clinician screening for excessive pelvic drop in female athletes and based on the predictive model make recommendations for corrective conditioning to help prevent knee injury and guide return to sport following LE surgery. Table 1: Multivariate linear regression model for pelvic drop, Isometric hip strength and lower extremity kinematics during repeated partial squat activity among female athletes. Variable P Isometric hip abduction strength 0.034* Hip Abduction/Adduction Angle <0.001* Hip Internal/External Rotation Angle 0.936 Ankle Internal/External Rotation Angle 0.072 Height 0.398 Weight 0.011* * Level of significance established at p<0.05

Analyzing Movements Development and Evaluation of the Body Awareness Scale Movement Quality (BAS MQ).

PubMed

Sundén, A; Ekdahl, C; Horstman, V; Gyllensten, A L

2016-06-01

Limitations in everyday movements, physical activities are/or pain are the main reasons for seeking help from a physiotherapist. The purpose of this study was to investigate the psychometric properties of the Body Awareness Scale Movement Quality (BAS MQ) focusing on factor structure, validity and reliability and to explore whether BAS MQ could discriminate between healthy individuals and patients. BAS MQ assesses both limitations and resources concerning functional ability and quality of movements. The total sample in the study (n = 172) consisted of individuals with hip osteoarthritis (OA) (n = 132), individuals with psychiatric disorders (n = 33) and healthy individuals (n = 7). A factor analysis of the BAS MQ was performed for the total group. Inter-rater reliability was tested in a group of individuals with hip OA (n = 24). Concurrent validity was tested in a group of individuals with hip OA (n = 89). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the 6-Minute Walk Test (6MWT) and the Hip Osteoarthritis Outcome Score (HOOS) were chosen in the validation process. The factor analysis revealed three factors that together explained 60.8% of the total variance of BAS MQ. The inter-rater reliability was considered good or very good with a kappa value of 0.61. Significant correlations between BAS MQ and SF-36, HOOS and 6MWT in the subjects with hip OA confirmed the validity. The BAS MQ was able to discriminate between healthy individuals and individuals with physical and psychiatric limitations. Results of the study revealed that BAS MQ has a satisfactory factor structure. The inter-rater reliability and validity were acceptable in a group of individuals with hip OA. BAS MQ could be a useful assessment tool for physiotherapists when evaluating the quality of everyday movements in different patient groups. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

Development of the "Treatment beliefs in knee and hip OsteoArthritis (TOA)" questionnaire.

PubMed

Selten, Ellen M H; Vriezekolk, Johanna E; Schers, Henk J; Nijhof, Marc W; van der Laan, Willemijn H; van der Meulen-Dilling, Roelien G; Geenen, Rinie; van den Ende, Cornelia H M

2017-09-19

Use of conservative treatment modalities in osteoarthritis (OA) is suboptimal, which appears to be partly due to patients' beliefs about treatments. The aim of this study was to develop a research instrument assessing patients' beliefs about various treatment modalities of hip and knee OA: the 'Treatment beliefs in OA (TOA) questionnaire'. The item pool that was retrieved from interviews with patients and healthcare providers comprised beliefs regarding five treatment modalities: physical activity, pain medication, physiotherapy, injections and arthroplasty. After an extensive selection procedure, a draft questionnaire with 200 items was constructed. Descriptive analyses and exploratory factor analyses with oblique rotation were conducted for each treatment modality separately to decide upon the final questionnaire. Internal consistency and test-retest reliability were determined. The final questionnaire comprised 60 items. It was completed by 351 patients with knee or hip OA. Each of the five treatment modalities yielded a two factor solution with 37% to 51% explained variance and high face validity. Factor I included 'positive treatment beliefs' and factor II 'negative treatment beliefs'. Internal consistency (Cronbach α's from 0.72 to 0.87) and test-retest reliability (i.e. intraclass correlation coefficient from 0.66-0.88; standard error of measurement from 0.06-0.11) were satisfactory to good. The TOA questionnaire is the first questionnaire assessing positive and negative treatment beliefs regarding five treatment modalities for knee and hip OA. The instrument will help to understand whether and to what extent treatment beliefs influence treatment choices.

Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA.

PubMed

Miki, Hidenobu; Sugano, Nobuhiko; Hagio, Keisuke; Nishii, Takashi; Kawakami, Hideo; Kakimoto, Akihiro; Nakamura, Nobuo; Yoshikawa, Hideki

2004-04-01

In 17 patients with unilateral hip disease who underwent total hip arthroplasty (THA), the gait was analyzed preoperatively and 1, 3, 6, and 12 months after unilateral THA using a Vicon system to assess the recovery of walking speed and symmetrical movement of the hip, knee, ankle, and pelvis. The walking speed of these patients reached that of normal Japanese persons by 12 months after surgery. Walking speed was correlated with the range of hip motion on the operated side at 1 month postoperatively, and was correlated with the hip joint extension moment of force on both sides from 3 to 6 months after surgery. Before THA, asymmetry was observed in the range of the hip motion, maximum hip flexion, maximum hip extension, maximum knee flexion, as well as in pelvic obliquity, pelvic tilt, and pelvic rotation. There were no differences of the stride length or step length between both sides throughout the observation period. The preoperative range of hip flexion on the operated side during a gait cycle (21.3+/-7.9 degrees ) was significantly smaller than on the non-operated side (46.7+/-7.1 degrees ), and the difference between sides was still significant at 12 months after surgery (35.1+/-6.2 degrees on the operated side and 43.6+/-5.7 degrees on the non-operated side). The majority (74%) of the difference in hip motion range during this period was due to the difference in maximum extension of the hip. The increase in the range of pelvic tilt and the range of motion of the opposite hip showed an inverse correlation with the range of motion of the operated hip, suggesting a compensatory preoperative role. However, this correlation became insignificant after 6 months postoperatively. Asymmetry of the range of hip motion persisted at 12 months after THA in patients with unilateral coxoarthropathy during free level walking, while the operation normalized the spatial asymmetry of other joints and the walking speed prior to the recovery of hip motion.

A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis

PubMed Central

Golightly, Yvonne M.; Allen, Kelli D.; Caine, Dennis J.

2014-01-01

Exercise is recommended as a first-line conservative intervention approach for osteoarthritis (OA). A wide range of exercise programs are available, and scientific evidence is necessary for advising patients with OA on the optimal treatment strategy. The purpose of this review is to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild to moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, gender and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial. PMID:23306415

Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial.

PubMed

Beselga, Carlos; Neto, Francisco; Alburquerque-Sendín, Francisco; Hall, Toby; Oliveira-Campelo, Natália

2016-04-01

Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA). To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA. Randomized controlled trial with immediate follow-up. Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. pain recorded by numerical rating scale (NRS). hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention. For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable. Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial.

PubMed

Kloek, Corelien J J; Bossen, Daniël; Spreeuwenberg, Peter M; Dekker, Joost; de Bakker, Dinny H; Veenhof, Cindy

2018-05-17

Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. The design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial. The setting included 143 primary care physical therapist practices. The participants were 208 people with hip/knee OA and were 40 to 80 years of age. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee osteoarthritis. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. The e-Exercise group (N = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (N = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. The response rate at 12 months was 65%. The blended intervention e-Exercise was not more effective than usual physical therapy in people with hip/knee osteoarthritis.

Association Between Overweight and Obesity and Risk of Clinically Diagnosed Knee, Hip, and Hand Osteoarthritis: A Population-Based Cohort Study.

PubMed

Reyes, Carlen; Leyland, Kirsten M; Peat, George; Cooper, Cyrus; Arden, Nigel K; Prieto-Alhambra, Daniel

2016-08-01

Studies of previous cohorts have demonstrated an association between a status of overweight/obesity and the presence of knee and hand osteoarthritis (OA). However, no data on the effect of these factors on the OA burden are available. The aim of the present study was to analyze the effect of being overweight or obese on the incidence of routinely diagnosed knee, hip, and hand OA. The study was conducted in a population-based cohort using primary care records from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària database (>5.5 million subjects, covering >80% of the population of Catalonia, Spain). Participants were subjects ages ≥40 years who were without a diagnosis of OA on January 1, 2006 and had available body mass index (BMI) data. All subjects were followed up from January 1, 2006 to December 31, 2010 or to the time of loss to follow-up or death. Measures included the World Health Organization categories of BMI (exposure), and incident clinical diagnoses of knee, hip, or hand OA according to International Classification of Diseases, Tenth Revision codes. In total, 1,764,061 subjects were observed for a median follow-up period of 4.45 years (interquartile range 4.19-4.98 years). Incidence rates (per 1,000 person-years at risk) of knee, hip, and hand OA were 3.7 (99% confidence interval [99% CI] 3.6-3.8), 1.7 (99% CI 1.7-1.8), and 2.6 (99% CI 2.5-2.7), respectively, among subjects in the normal weight category, and 19.5 (99% CI 19.1-19.9), 3.8 (99% CI 3.7-4.0), and 4.0 (99% CI 3.9-4.2), respectively, in those with a classification of grade II obesity. Compared to subjects with normal weight, being overweight or obese increased the risk of OA at all 3 joint sites, especially at the knee. A status of overweight, grade I obesity, and grade II obesity increased the risk of knee OA by a factor of 2-fold, 3.1-fold, and 4.7-fold, respectively. Being overweight or obese increases the risk of hand, hip, and knee OA, with the greatest risk in the knee, and this occurs on a dose-response gradient of increasing BMI. © 2016, American College of Rheumatology.

The effect of unilateral osteoarthritis of the hip on postural balance disorders.

PubMed

Truszczyńska, Aleksandra; Trzaskoma, Zbigniew; Białecki, Jerzy; Drzał-Grabiec, Justyna; Dadura, Emilia; Rąpała, Kazimierz; Tarnowski, Adam

2016-11-10

Postural stability is of great importance because imbalances and muscle weakness are significant risk factors for falls experienced by the elderly. Hip arthrosis, which causes pain and gait disorders that affect balance control, is common in the ageing population. The aim of this study was to assess postural stability in patients with unilateral hip arthrosis before total hip arthroplasty. The study population consisted of 52 patients with hip arthrosis (study group) and 47 subjects with no history of clinical symptoms of hip pain. The groups did not differ statistically in terms of age and BMI. Static balance was assessed by conducting a quantitative analysis of balance reaction parameters in a quiet standing position with the eyes open and closed. Analysis of the collected data revealed numerous statistically significant differences between patients with unilateral hip arthrosis before total hip arthoplasty and the asymptomatic group for parameters tested with eyes closed (p<0.05). We observed higher values of total length of centre of pressure (COP), sway path (SP), length of COP path in the medial-lateral plane (SPML), maximal amplitude between the 2 most distant points in the medial-lateral plane (MaxML), mean COP velocity (MV), and mean COP velocity in medial-lateral (MVML) in the study group.

Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial.

PubMed

Murphy, Nicholas J; Eyles, Jillian; Bennell, Kim L; Bohensky, Megan; Burns, Alexander; Callaghan, Fraser M; Dickenson, Edward; Fary, Camdon; Grieve, Stuart M; Griffin, Damian R; Hall, Michelle; Hobson, Rachel; Kim, Young Jo; Linklater, James M; Lloyd, David G; Molnar, Robert; O'Connell, Rachel L; O'Donnell, John; O'Sullivan, Michael; Randhawa, Sunny; Reichenbach, Stephan; Saxby, David J; Singh, Parminder; Spiers, Libby; Tran, Phong; Wrigley, Tim V; Hunter, David J

2017-09-26

Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these approaches. In particular, it is unknown whether these management approaches modify the future risk of developing hip OA. The primary objective of this randomised controlled trial is to determine if participants with FAI who undergo hip arthroscopy have greater improvements in hip cartilage health, as demonstrated by changes in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to those who undergo physiotherapy-led non-surgical management. This is a pragmatic, multi-centre, two-arm superiority randomised controlled trial comparing hip arthroscopy to physiotherapy-led management for FAI. A total of 140 participants with FAI will be recruited from the clinics of participating orthopaedic surgeons, and randomly allocated to receive either surgery or physiotherapy-led non-surgical care. The surgical intervention involves arthroscopic FAI surgery from one of eight orthopaedic surgeons specialising in this field, located in three different Australian cities. The physiotherapy-led non-surgical management is an individualised physiotherapy program, named Personalised Hip Therapy (PHT), developed by a panel to represent the best non-operative care for FAI. It entails at least six individual physiotherapy sessions over 12 weeks, and up to ten sessions over six months, provided by experienced musculoskeletal physiotherapists trained to deliver the PHT program. The primary outcome measure is the change in dGEMRIC score of a ROI containing both acetabular and femoral head cartilages at the chondrolabral transitional zone of the mid-sagittal plane between baseline and 12 months. Secondary outcomes include patient-reported outcomes and several structural and biomechanical measures relevant to the pathogenesis of FAI and development of hip OA. Interventions will be compared by intention-to-treat analysis. The findings will help determine whether hip arthroscopy or an individualised physiotherapy program is superior for the management of FAI, including for the prevention of hip OA. Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . Trial registered 2/11/2015 (retrospectively registered).

Failure of serum transforming growth factor-beta (TGF-β1) as a biomarker of radiographic osteoarthritis at the knee and hip: A cross-sectional analysis in the Johnston County Osteoarthritis Project

PubMed Central

Nelson, Amanda E.; Fang, Fang; Shi, Xiaoyan Amy; Kraus, Virginia B.; Stabler, Thomas; Renner, Jordan B.; Schwartz, Todd A.; Helmick, Charles G.; Jordan, Joanne M.

2009-01-01

PURPOSE To assess associations between serum TGF-β1 and radiographic knee and hip osteoarthritis (rOA) in African American (AA) and White men and women. METHODS Baseline data from 330 participants in the Johnston County Osteoarthritis Project were used in the analysis. Radiographs were scored with the Kellgren-Lawrence scale and rOA defined as grade ≥ 2. Individual radiographic features (IRFs) were rated 0–3. TGF-β1 was measured using a sandwich ELISA. General linear models were used to estimate associations between lnTGF-β1 and rOA presence, laterality or severity, and IRF presence and severity, adjusting for age, gender, race, and body mass index. Interactions by race and gender were considered significant at p < 0.1. RESULTS Mean lnTGF-β1 levels were higher among AAs compared to Whites, and among women compared to men (p<0.009). Mean lnTGF-β1 levels were higher in those with knee OST, but this association was not significant after adjustment. There were no other significant differences in mean lnTGF-β1 levels by presence, laterality, or severity of knee or hip rOA or IRFs. No race or gender interactions were identified, although a borderline significant association between lnTGF-β1 and knee OST was seen among AAs (p < 0.06). CONCLUSIONS Although serum TGF-β1 varied by race and gender and several rOA variables, there were no independent significant associations with presence, laterality, or severity of knee or hip rOA by K-L grade or IRFs, suggesting that serum TGF-β1 is unlikely to be useful as a stand-alone biomarker in OA studies. A possible association between TGF-β1 and OST in AAs cannot be excluded. PMID:19091605

Associations of the interleukin-1 gene locus polymorphisms with risk to hip and knee osteoarthritis: gender and subpopulation differences.

PubMed

Kaarvatn, M H; Jotanovic, Z; Mihelic, R; Etokebe, G E; Mulac-Jericevic, B; Tijanic, T; Balen, S; Sestan, B; Dembic, Z

2013-02-01

Genetic predisposition to the complex hereditary disease like osteoarthritis (OA) of the large joints (hip and knee) includes the interleukin-1 gene (IL-1) cluster on chromosome 2. Using a case-control study with 500 OA patients (240 knee and 260 hip OA patients, all with joint replacement), we analysed frequencies of IL-1 gene cluster polymorphisms in Croatian Caucasian population. The control samples came from 531 healthy individuals including blood donors. We genotyped two single nucleotide polymorphisms in the IL-1 gene locus at IL-1A (-889, C>T, rs1800587) and IL-1B (+3594, C>T, rs1143634) and compared their frequencies between patients and controls. We predicted haplotypes by combining current data with our previous results on gene polymorphisms (IL-1B, rs16944 and the IL-1 receptor antagonist gene [IL-1RN] variable number tandem repeat [VNTR]) for the same population. Haplotype analyses revealed gender disparities and showed that women carriers of the 1-2-1-1 haplotype [IL-1A(rs1800587) - IL-1B(rs1143634) - IL-1B(rs16944) - IL-1RN(VNTR)] had sixfold lower risk to develop knee OA. However, carriers of the 1-1-1-2 haplotype of both sexes had over twofold higher predisposition to hip OA. Our results differ from some earlier studies in Caucasian subpopulations, which may be due to the fact that this is the first study to separate genders in assessing the IL-1-locus genetic risk of OA. The results suggest that inflammatory mediators like IL-1 might be implicated in the pathogenesis of primary OA in large joints and that as yet unidentified gender-specific factors exist in a Croatian Caucasian population. © 2012 The Authors. Scandinavian Journal of Immunology © 2012 Blackwell Publishing Ltd.

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

The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review.

PubMed

Pereira, D; Peleteiro, B; Araújo, J; Branco, J; Santos, R A; Ramos, E

2011-11-01

To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified. Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition. Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Impact of socioeconomic factors on informed decision making and treatment choice in patients with hip and knee OA.

PubMed

Youm, Jiwon; Chan, Vanessa; Belkora, Jeffrey; Bozic, Kevin J

2015-02-01

It is unclear how socioeconomic (SES) status influences the effectiveness of shared decision making (SDM) tools. The purpose of this study was to assess the impact of SES on the utility of SDM tools among patients with hip and knee osteoarthritis (OA). We performed a secondary analysis of data from a randomized controlled trial of 123 patients with hip or knee OA. Higher education and higher income were independently associated with higher knowledge survey scores. Patients with private insurance were 2.7 times more likely than patients with Medicare to arrive at a decision after the initial office visit. Higher education was associated with lower odds of choosing surgery, even after adjusting for knowledge. Patient knowledge of their medical condition and treatment options varies with SES. Copyright © 2014 Elsevier Inc. All rights reserved.

Further evidence of the developmental origins of osteoarthritis: results from the Hertfordshire Cohort Study.

PubMed

Clynes, M A; Parsons, C; Edwards, M H; Jameson, K A; Harvey, N C; Sayer, A Aihie; Cooper, C; Dennison, E M

2014-12-01

Investigators have suggested a link between birth weight and both hand and lumbar spine osteoarthritis (OA). In this study, we sought to extend these observations by investigating relationships between growth in early life, and clinical and radiological diagnoses of OA at the hand, knee and hip, among participants from the Hertfordshire Cohort Study. Data were available for 222 men and 222 women. Clinical OA was defined based on American College of Rheumatology criteria. Radiographs were taken of the knees and hips, and graded for the presence of osteophytes and overall Kellgren and Lawrence (KL) score. Lower weight at year one was associated with higher rates of clinical hand OA (OR 1.396, 95% CI 1.05, 1.85, P=0.021). Individuals with lower birth weights were more likely to have hip osteophytes (OR 1.512, 95% CI 1.14, 2.00, P=0.004) and this remained robust after adjustment for confounders. Furthermore, a low weight at one year was also associated with a higher osteophyte number in the lateral compartment of the knee, after adjustment for confounders (OR 1.388, 95% CI 1.01, 1.91, P=0.043). We have found further evidence of a relationship between early life factors and adult OA. These findings accord with previous studies.

Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

PubMed

Farrokhi, Shawn; Voycheck, Carrie A; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

2016-01-01

The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.

PubMed

Barr, Andrew J; Campbell, T Mark; Hopkinson, Devan; Kingsbury, Sarah R; Bowes, Mike A; Conaghan, Philip G

2015-08-25

Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA. A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring. In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively. Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target. PROSPERO registration number: CRD 42013005009.

Resource utilization and costs before and after total joint arthroplasty.

PubMed

Bozic, Kevin J; Stacey, Brett; Berger, Ariel; Sadosky, Alesia; Oster, Gerry

2012-03-23

The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.). Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test. 14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553. Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.

THE CLINICAL, FUNCTIONAL AND BIOMECHANICAL PRESENTATION OF PATIENTS WITH SYMPTOMATIC HIP ABDUCTOR TENDON TEARS

PubMed Central

Retheesh, Theertha; Mutreja, Rinky; Janes, Gregory C.

2016-01-01

Background Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome (GTPS), though limited information exists on the disability associated with this condition and specific presentation of these patients. Purpose To describe the clinical, functional and biomechanical presentation of patients with symptomatic HAT tears. Secondary purposes were to investigate the association between these clinical and functional measures, and to compare the pain and disability reported by HAT tear patients to those with end-stage hip osteoarthritis (OA). Study Design Prospective case series. Methods One hundred forty-nine consecutive patients with symptomatic HAT tears were evaluated using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, an additional series of 10 questions more pertinent to those with lateral hip pain, active hip range of motion (ROM), maximal isometric hip abduction strength, six-minute walk capacity and 30-second single limb stance (SLS) test. The presence of a Trendelenburg sign and pelvis-on-femur (POF) angle were determined via 2D video analysis. An age matched comparative sample of patients with end-stage hip OA was recruited for comparison of all patient-reported outcome scores. Independent t-tests investigated group and limb differences, while analysis of variance evaluated pain changes during the functional tests. Pearson's correlation coefficients investigated the correlation between clinical measures in the HAT tear group. Results No differences existed in patient demographics and patient-reported outcome scores between HAT tear and hip OA cohorts, apart from significantly worse SF-12 mental subscale scores (p = 0.032) in the HAT tear group. Patients with HAT tears demonstrated significantly lower (p < 0.05) hip abduction strength and active ROM in all planes of motion on their affected limb. Pain significantly increased throughout the 30-second SLS test for the HAT tear group, with 57% of HAT tear patients demonstrating a positive Trendelenburg sign. POF angle during the test was not significantly associated with pain. Conclusion Patients with symptomatic HAT tears demonstrate poor function, and report pain and disability similar to or worse than those with end-stage hip OA. This information better defines and differentiates the presentation of these patients. Level of Evidence Level 3 case-controlled study, with matched comparison PMID:27757285

Power of a Labrador Retriever-Greyhound pedigree for linkage analysis of hip dysplasia and osteoarthritis.

PubMed

Todhunter, Rory J; Casella, George; Bliss, Stuart P; Lust, George; Williams, Alma Jo; Hamilton, Samuel; Dykes, Nathan L; Yeager, Amy E; Gilbert, Robert O; Burton-Wurster, Nancy I; Mellersh, Cathryn C; Acland, Gregory M

2003-04-01

To estimate the number of dogs required to find linkage to heritable traits of hip dysplasia in dogs from an experimental pedigree. 147 Labrador Retrievers, Greyhounds, and their crossbreed offspring. Labrador Retrievers with hip dysplasia were crossed with unaffected Greyhounds. Age at detection of femoral capital ossification, distraction index (DI), hip joint dorsolateral subluxation (DLS) score, and hip joint osteoarthritis (OA) were recorded. Power to find linkage of a single marker to a quantitative trait locus (QTL) controlling 100% of the variation in a dysplastic trait in the backcross dogs was determined. For the DI at the observed effect size, recombination fraction of 0.05, and heterozygosity of 0.75, 35 dogs in the backcross of the F1 to the Greyhound generation would yield linkage at a power of 0.8. For the DLS score, 35 dogs in the backcross to the Labrador Retriever generation would be required for linkage at the same power. For OSS, 45 dogs in the backcross to the founding Labrador Retrievers would yield linkage at the same power. Fewer dogs were projected to be necessary to find linkage to hip OA. Testing for linkage to the DLS at 4 loci simultaneously, each controlling 25% of the phenotypic variation, yielded an overall power of 0.7 CONCLUSIONS AND CLINICAL SIGNIFICANCE: Based on this conservative single-marker estimate, this pedigree has the requisite power to find microsatellites linked to susceptibility loci for hip dysplasia and hip OA by breeding a reasonable number of backcross dogs.

Predictors of short-term outcome to exercise and manual therapy for people with hip osteoarthritis.

PubMed

French, Helen P; Galvin, Rose; Cusack, Tara; McCarthy, Geraldine M

2014-01-01

Physical therapy for hip osteoarthritis (OA) has shown short-term effects but limited long-term benefit. There has been limited research, with inconsistent results, in identifying prognostic factors associated with a positive response to physical therapy. The purpose of this study was to identify potential predictors of response to physical therapy (exercise therapy [ET] with or without adjunctive manual therapy [MT]) for hip OA based on baseline patient-specific and clinical characteristics. A prognostic study was conducted. Secondary analysis of data from a multicenter randomized controlled trial (RCT) (N=131) that evaluated the effectiveness of ET and ET+MT for hip OA was undertaken. Treatment response was defined using OMERACT/OARSI responder criteria. Ten baseline measures were used as predictor variables. Regression analyses were undertaken to identify predictors of outcome. Discriminative ability (sensitivity, specificity, and likelihood ratios) of significant variables was calculated. The RCT results showed no significant difference in most outcomes between ET and ET+MT at 9 and 18 weeks posttreatment. Forty-six patients were classified as responders at 9 weeks, and 36 patients were classified as responders at 18 weeks. Four baseline variables were predictive of a positive outcome at 9 weeks: male sex, pain with activity (<6/10), Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale score (<34/68), and psychological health (Hospital Anxiety and Depression Scale score <9/42). No predictor variables were identified at the 18-week follow-up. Prognostic accuracy was fair for all 4 variables (sensitivity=0.5-0.58, specificity=0.57-0.72, likelihood ratios=1.25-1.77), indicating fair discriminative ability at predicting treatment response. The short-term follow-up limits the interpretation of results, and the low number of identified responders may have resulted in possible overfitting of the predictor model. The authors were unable to identify baseline variables in patients with hip OA that indicate those most likely to respond to treatment due to low discriminative ability. Further validation studies are needed to definitively define the best predictors of response to physical therapy in people with hip OA.

Different methods of treatment related to the bilateral occurrence of Perthes' disease.

PubMed

Futami, T; Suzuki, S

1997-11-01

We treated 98 consecutive patients with Perthes' disease by a unilateral brace in external rotation, flexion and abduction and a further consecutive 110 by a bilateral cast with the hips in internal rotation and abduction. During treatment in the unilateral brace, six (6.1%) hips on the opposite side developed evidence of Perthes' disease and one developed this after the brace had been removed. In children managed in bilateral casts, no contralateral Perthes' disease was seen. Adequate containment of the femoral head may prevent subsequent changes in the opposite hip.

Computerized Posturographic Measurement in Elderly Women with Unilateral Knee Osteoarthritis

PubMed Central

Lim, Kil-Byung

2012-01-01

Objective To identify the subtle change of postural control in elderly patients with unilateral knee osteoarthritis (OA) with computerized dynamic posturography. Method Twenty-two healthy women and twenty-six women with unilateral knee OA, aged 60 and over, were enrolled. The computerized posturographic measures included a weight bearing pattern during squatting and sit-to-stand, sway velocity of center of gravity (COG) during one leg standing, on-axis velocity and directional control of COG during rhythmic weight shift, rising index during sit-to-stand, end sway during tandem walk, and movement time during step up/over. Results It was shown that patients bore significantly less weight on the affected side during the 30° and 60° squat and sit-to-stand. Sway velocity of COG during one leg standing was greater whereas the on-axis velocity and directional control during the front/back rhythmic weight shift were significantly lower in the patient group. The rising index during sit-to-stand was significantly lower and movement time during step up/over with the affected side was significantly longer in patients. Conclusion This study demonstrated in detail a decline of postural balance by utilizing computerized posturography in elderly women with unilateral knee OA. They had less weight-bearing, more sway, and less ability of intentional postural control on the affected side. PMID:23185725

Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis--treatment effects of neuromuscular exercise and total joint replacement.

PubMed

Kosek, E; Roos, E M; Ageberg, E; Nilsdotter, A

2013-09-01

To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters. The dataset consisted of knee (n = 66) and hip (n = 47) OA patients assigned for total joint replacement at Lund University Hospital undergoing pre-operative neuromuscular exercise and 43 matched controls. Sensitivity to pressure pain was assessed by pressure algometry at 10 sites. Subjects were then instructed to perform a standardized static knee extension. Pressure pain thresholds (PPTs) were assessed at the contracting quadriceps muscle (Q) and at the resting deltoid muscle (D) before and during contraction. The relative increase in PPTs during contraction was taken as a measure of localized (Q) or generalized (D) EIA. Patients were assessed at baseline, following on average 12 weeks of neuromuscular exercise and 3 months following surgery. We found a normal function of EIA in OA patients at baseline. Previous studies have reported beneficial effects of physical exercise on pain modulation in healthy subjects. However, no treatment effects on EIA were seen in OA patients despite the increase in muscle strength following neuromuscular exercise and reduced pain following surgery. Compared to controls, OA patients had increased pain sensitivity and no beneficial effects on pain sensitivity were seen following treatment. To our knowledge, this is the first study of EIA in OA patients. Despite increased pain sensitivity, OA patients had a normal function of EIA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip: a randomized controlled trial.

PubMed

Brantingham, James W; Parkin-Smith, Gregory; Cassa, Tammy Kay; Globe, Gary A; Globe, Denise; Pollard, Henry; deLuca, Katie; Jensen, Muffit; Mayer, Stephan; Korporaal, Charmaine

2012-02-01

To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). Parallel-group randomized trial with 3-month follow-up. Two chiropractic outpatient teaching clinics. Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Association between serum levels of the proinflammatory protein S100A8/A9 and clinical and structural characteristics of patients with established knee, hip, and hand osteoarthritis.

PubMed

Mahler, E A M; Zweers, M C; van Lent, P L; Blom, A B; van den Hoogen, F H; van den Berg, W B; Roth, J; Vogl, T; Bijlsma, J W J; van den Ende, C H M; den Broeder, A A

2015-01-01

To explore the association between S100A8/A9 serum levels with clinical and structural characteristics of patients with established knee, hip, or hand osteoarthritis (OA). A cross-sectional exploratory study was conducted with 162 OA patients. Measures for pain, stiffness, and function included the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire or the Australian Canadian Osteoarthritis Hand (AUSCAN) Index and for structural abnormalities, osteophytes and joint space narrowing grades. The association between S100A8/A9 and clinical or structural characteristics was analysed using linear regression or logistic regression where appropriate. The mean age of the OA patients was 56 years, 71% were female, and 61% had a Kellgren and Lawrence (K&L) score ≥ 2. The serum S100A8/A9 level did not differ between knee, hip, and hand OA patients and no association was found between serum S100A8/A9 and clinical characteristics. The serum S100A8/A9 level was negatively associated with the sum score of osteophytes after adjusting for sex and body mass index (BMI) [adjusted β -0.015, 95% confidence interval (CI) -0.030 to 0.001, p = 0.062] and positively associated with erythrocyte sedimentation rate (ESR) > 12 mm/h (adjusted OR 1.002, 95% CI 1.000-1.004 p = 0.049) for each increase in S100A8/A9 of 1 ng/mL. For hand OA patients, a negative association of S100A8/A9 with sum score of joint space narrowing was found (adjusted β -0.007, 95% CI -0.016 to 0.001, p = 0.099). The results from this cross-sectional exploratory study do not support an important role for serum S100A8/A9 levels as a biomarker for clinical and structural characteristics in established knee, hip, and hand OA patients. The inverse association with structural abnormalities and the positive association with ESR may reflect inflammatory synovial processes in patients with OA before structural abnormalities occur.

Hip Strength Testing of Soccer Players With Long-Standing Hip and Groin Pain: What are the Clinical Implications of Pain During Testing?

PubMed

Rafn, Bolette S; Tang, Lars; Nielsen, Martin P; Branci, Sonia; Hölmich, Per; Thorborg, Kristian

2016-05-01

To investigate whether self-reported pain during hip strength testing correlates to a large degree with hip muscle strength in soccer players with long-standing unilateral hip and groin pain. Cross-sectional study. Clinical assessments at Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Denmark. Twenty-four male soccer players with unilateral long-standing hip and groin pain. The soccer players performed 5 reliable hip muscle strength tests (isometric hip flexion, adduction, abduction, isometric hip flexion-modified Thomas test, and eccentric hip adduction). Muscle strength was measured with a hand-held dynamometer, and the players rated the pain during testing on a numerical rating scale (0-10). In 4 tests (isometric hip adduction, abduction, flexion, and eccentric adduction), no significant correlations were found between pain during testing and hip muscle strength (Spearman rho = -0.28 to 0.06, P = 0.09-0.39). Isometric hip flexion (modified Thomas test position) showed a moderate negative correlation between pain and hip muscle strength (Spearman rho = -0.44, P = 0.016). Self-reported pain during testing does not seem to correlate with the majority of hip muscle strength tests used in soccer players with long-standing hip and groin pain.

Reliability Exercise for the Polymyalgia Rheumatica Classification Criteria Study: The Oranjewoud Ultrasound Substudy

PubMed Central

Scheel, Alexander K.; Matteson, Eric L.; Dasgupta, Bhaskar; Bruyn, George A. W.; Ohrndorf, Sarah; Werner, Carola; Schmidt, Wolfgang A.

2009-01-01

Objective. A study supported by the EULAR and the ACR being conducted to establish classification criteria for polymyalgia rheumatica (PMR) will include ultrasound examination of the shoulders and hips. Ultrasound (US) depicts glenohumeral joint effusion, biceps tenosynovitis, subdeltoid bursitis, hip joint synovitis, and trochanteric bursitis in PMR. These findings may aid in distinguishing PMR from other diseases. The purpose of this study was to assess standards and US interreader agreement of participants in the PMR classification criteria study. Methods. Sixteen physicians in four groups examined shoulders and hips of 4 patients and 4 healthy adults with ultrasound. Overall agreement and interobserver agreement were calculated. Results. The overall agreement (OA) between groups was 87%. The OA for healthy shoulders was 88.8%, for healthy hips 100%, for shoulders with pathology 85.2%, and 74.3% for hips with pathology, respectively. Conclusion. There was a high degree of agreement found for the examination of healthy shoulders and pathologic hips. Agreement was moderate for pathologic shoulders and perfect for healthy hips. US of shoulder and hips performed by different examiners is a reliable and feasible tool for assessment of PMR related disease pathology and can be incorporated into a classification criteria study. PMID:20130800

Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study.

PubMed

Selten, Ellen M H; Geenen, Rinie; van der Laan, Willemijn H; van der Meulen-Dilling, Roelien G; Schers, Henk J; Nijhof, Marc W; van den Ende, Cornelia H M; Vriezekolk, Johanna E

2017-02-01

To improve patients' use of conservative treatment options of hip and knee OA, in-depth understanding of reasons underlying patients' treatment choices is required. The current study adopted a concept mapping method to thematically structure and prioritize reasons for treatment choice in knee and hip OA from a patients' perspective. Multiple reasons for treatment choices were previously identified using in-depth interviews. In consensus meetings, experts derived 51 representative reasons from the interviews. Thirty-six patients individually sorted the 51 reasons in two card-sorting tasks: one based on content similarity, and one based on importance of reasons. The individual sortings of the first card-sorting task provided input for a hierarchical cluster analysis (squared Euclidian distances, Ward's method). The importance of the reasons and clusters were examined using descriptive statistics. The hierarchical structure of reasons for treatment choices showed a core distinction between two categories of clusters: barriers [subdivided into context (e.g. the healthcare system) and disadvantages] and outcome (subdivided into treatment and personal life). At the lowest level, 15 clusters were identified of which the clusters Physical functioning, Risks and Prosthesis were considered most important when making a treatment decision for hip or knee OA. Patients' treatment choices in knee and hip OA are guided by contextual barriers, disadvantages of the treatment, outcomes of the treatment and consequences for personal life. The structured overview of reasons can be used to support shared decision-making. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA).

PubMed

Castell, Maria Victoria; van der Pas, Suzan; Otero, Angel; Siviero, Paola; Dennison, Elaine; Denkinger, Michael; Pedersen, Nancy; Sanchez-Martinez, Mercedes; Queipo, Rocio; van Schoor, Natasja; Zambon, Sabina; Edwards, Mark; Peter, Richard; Schaap, Laura; Deeg, Dorly

2015-11-17

Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project. Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates. The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints. Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management.

Walking efficiency before and after total hip replacement.

PubMed

Brown, M; Hislop, H J; Waters, R L; Porell, D

1980-10-01

The energy cost of walking and gait characteristics of patients with hip disease were studied to determine changes in walking efficiency following total hip replacement. Twenty-nine patients, 24 with unilateral hip disease and 5 with bilateral hip disease, were tested preoperatively and at various times postoperatively. Oxygen uptake was measured by a modified Douglas bag procedure. The temporal and distance characteristics of gait were measured with contact closing heel switches. Results showed postoperative increases in velocity, cadence, and stride length in patients with unilateral disease and with bilateral disease with bilateral replacement. After surgery, energy cost tended toward more normal levels, but the subjects were not within normal limits for oxygen uptake per minute, oxygen uptake per distance walked, or percent of predicted maximum aerobic capacity. Comparison of energy expenditure data with temporal and distance factors of gait indicated that all subjects became more physiologically efficient after hip replacement.

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

The association of proximal femoral shape and incident radiographic hip OA in elderly women.

PubMed

Lynch, J A; Parimi, N; Chaganti, R K; Nevitt, M C; Lane, N E

2009-10-01

Variations in femoral head shape are reported to predict incident hip osteoarthritis (OA). This study evaluated if proximal femur shape at baseline was a risk factor for incident radiographic hip OA (RHOA) after 8.3 years of follow-up in a cohort of elderly Caucasian women. Supine pelvic radiographs were obtained as part of the Study of Osteoporotic Fractures (SOF) at baseline and Visit 5 (8.3 years later), and were scored for RHOA. A nested case-control study was performed: hips were eligible for inclusion if they had no prevalent RHOA in either hip at baseline. Cases of incident RHOA were defined as no RHOA at baseline and RHOA in their right hip present at Visit 5 [or right total hip replacement (THR) for OA between baseline for follow-up] and a random selection of one half of all incident RHOA cases plus right THR cases (n=102) were chosen. A random selection (n=249) of control subjects who had no RHOA in their right hip at both baseline and follow-up visit were included for comparison. The shape of the right proximal femur was outlined on a digitized baseline radiograph and a statistical image analysis technique, Active Shape Modeling (ASM), was used to generate 10 unique and independent "modes" or variations in shape, which explained 95% of the variance in the shape of the proximal femurs studied. Any hip shape was therefore described as the average shape plus a linear combination of these 10 independent modes of variation. The values for each of these 10 modes for each hip analyzed were entered into a logistic regression model as independent predictors of incident RHOA adjusting for covariates. The incident RHOA cases were slightly taller, heavier and had higher total hip bone mineral density (BMD) than control subjects (P<0.05), but were otherwise similar demographically. Results of ASM showed that Modes 1, 2 and 3 together explained 81% of the variance in proximal femur shape among all subjects analyzed. Modes 3, 5, 9 which accounted for 8.9%, 3.3% and 0.8% of the variance respectively, were significant predictors of incident RHOA with adjusted odds-ratios ranging from 1.61 to 1.99 (P<0.001) for every 1 standard deviation (SD) increase in the mode score. These results suggest that variations in the relative sizes of the femoral head and neck at baseline are modest determinants of incident RHOA in elderly Caucasian women.

Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and McMaster Universities Osteoarthritis Index.

PubMed

Escobar, A; Quintana, J M; Bilbao, A; Azkárate, J; Güenaga, J I

2002-11-01

The aim of this study was to validate a translated version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire in Spanish patients with hip or knee osteoarthritis (OA). The WOMAC questionnaire and the SF-36 were administered to a sample of 269 patients on the waiting list for hip or knee replacement. We studied the convergent validity and the item-scale correlation using Pearson's correlation coefficient and Spearman's pi. For the reliability study we used another sample of 58 patients who received the WOMAC twice within 15 days. The Pearson's, Spearman's pi, and intraclass correlation coefficients were calculated. Internal consistency was measured by Cronbach's alpha. The responsiveness study was carried out by resending the two questionnaires to all patients 6 months after surgical intervention; responsiveness was measured by means of the paired t-test, the effect size I and the standardised response mean. The Pearson's coefficients for the convergent validity ranged from -0.52 to -0.63. The coefficients obtained for the item-scale correlation of the pain area were 0.74 or higher, 0.91 or higher for stiffness, and 0.61 or higher for function. When measuring the test-retest reliability, the coefficients ranged from 0.66 to 0.81. Internal consistency yielded a Cronbach's alpha ranging from 0.81 to 0.93. The responsiveness showed an effect size I ranging from 1.5 to 2.2 in patients who underwent hip replacement; for those who underwent knee replacement the range was 1 to 1.8. The standardised response mean ranged from 1.3 to 1.9 for patients with hip OA; those with knee OA ranged from 0.8 to 1.5. The Spanish version of WOMAC is a valid, reliable and responsive instrument in patients with hip or knee OA.

Compliance With the AAOS Guidelines for Treatment of Osteoarthritis of the Knee: A Survey of the American Association of Hip and Knee Surgeons.

PubMed

Carlson, Victor Rex; Ong, Alvin Chua; Orozco, Fabio Ramiro; Hernandez, Victor Hugo; Lutz, Rex William; Post, Zachary Douglas

2018-02-01

The American Academy of Orthopaedic Surgeons (AAOS) published a series of evidence-based guidelines for treatment of knee osteoarthritis (OA). We studied compliance with these guidelines among orthopaedic surgeons. We sent a survey to members of the American Association of Hip and Knee Surgeons. It included five clinical vignettes based on the Kellgren-Lawrence radiographic system for classification of knee OA. Respondents selected treatment currently supported or not supported by the AAOS guidelines. Of 345 responses, the frequency of use of recommended interventions was 80%, 82%, 21%, 50%, and 98% for OA at stages 0 through 4, respectively. For stage 2 and stage 3 OA, intra-articular hyaluronic acid was the most commonly selected intervention not recommended by the AAOS. Apparently, AAOS guidelines on the treatment of OA have not reached the orthopaedic community, resulting in lack of treatment consensus and continued use of modalities with no proven patient benefits. Management of moderate to severe knee OA does not align with AAOS guidelines. We encourage researchers to conduct clinical trials to identify the role of intra-articular corticosteroids in treating this condition.

Bilateral femoral neck stress fractures in military recruits with unilateral hip pain.

PubMed

Moo, Ing How; Lee, Y H D; Lim, K K; Mehta, K V

2016-10-01

Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Clinical Tests of Standing Balance in the Knee Osteoarthritis Population: Systematic Review and Meta-analysis

PubMed Central

Hatfield, Gillian L.; Morrison, Adam; Wenman, Matthew; Hammond, Connor A.

2016-01-01

Background People with knee osteoarthritis (OA) have a high prevalence of falls. Poor standing balance is one risk factor, but the extent of standing balance deficits in people with knee OA is unknown. Purpose The primary purpose of this study was to summarize available data on standing balance in people with knee OA compared with people without knee OA. A secondary purpose was to establish the extent of balance impairment across disease severity. Data Sources A literature search of the MEDLINE, EMBASE, CINAHL, and Web of Science databases through November 19, 2014, was conducted. Study Selection Studies on individuals with knee OA containing clinical, quantifiable measures of standing balance were included. Methodological quality was assessed by 2 reviewers using a 16-item quality index developed for nonrandomized studies. Studies scoring >50% on the index were included. Data Extraction Participant characteristics (age, sex, body mass index, OA severity, compartment involvement, unilateral versus bilateral disease) and balance outcomes were extracted by 2 reviewers. Standardized mean differences were pooled using a random-effects model. Data Synthesis The search yielded 2,716 articles; 8 met selection and quality assessment criteria. The median score on the quality index was 13/17. People with knee OA consistently performed worse than healthy controls on the Step Test, Single-Leg Stance Test, Functional Reach Test, Tandem Stance Test, and Community Balance and Mobility Scale. The pooled standardized mean difference was −1.64 (95% confidence interval=−2.58, −0.69). No differences were observed between varying degrees of malalignment, or between unilateral versus bilateral disease. Limitations No studies compared between-knee OA severities. Thus, expected changes in balance as the disease progresses remain unknown. Conclusions Few studies compared people with knee OA and healthy controls, but those that did showed that people with knee OA performed significantly worse. More research is needed to understand the extent of balance impairments in people with knee OA using easy-to-administer, clinically available tests. PMID:26183586

Individual MRI and radiographic features of knee OA in subjects with unilateral knee pain: Health ABC study

PubMed Central

Javaid, MK; Kiran, A; Guermazi, A; Kwoh, K; Zaim, S; Carbone, L; Harris, T.; McCulloch, C.E.; Arden, NK; Lane, NE; Felson, D; Nevitt, M

2012-01-01

Strong associations between radiographic features of knee OA and pain have been demonstrated in persons with unilateral knee symptoms. Our objectives were to compare radiographic with MRI features of knee OA and assess the discrimination between painful and non-painful knees in persons with unilateral symptoms. 283 individuals with unilateral knee pain aged 71 to 80 years from Health ABC, a study of weight-related diseases and mobility, had bilateral knee radiographs, read for KL grade and individual radiographic features, and 1.5T MRIs, read using WORMS. The association of structural features with pain was assessed using a within-person case/control design and conditional logistic regression. Receiver operator characteristics (ROC) were then used to test the discriminatory performance of structural features. In conditional logistic analyses, knee pain was significantly associated with both radiographic (any JSN grade >=1: OR 3.20 (1.79 – 5.71) and MRI (any cartilage defect:>=2: OR 3.67 (1.49 – 9.04)) features. However, most subjects had MR detected osteophytes, cartilage and bone marrow lesions in both knees and no individual structural feature discriminated well between painful and non-painful knees using ROC. The best performing MRI feature (synovitis/effusion) was not significantly more informative than KL grade >=2 (p=0.42). In persons with unilateral knee pain, MR and radiographic features were associated with knee pain confirming an important role in the etiology of pain. However, no single MRI or radiographic finding performed well in discriminating painful from non-painful knees. Further work is needed to examine how structural and non-structural factors influence knee pain. PMID:22736267

Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial.

PubMed

Gremeaux, Vincent; Renault, Julien; Pardon, Laurent; Deley, Gaelle; Lepers, Romuald; Casillas, Jean-Marie

2008-12-01

To assess the effects of low-frequency electric muscle stimulation associated with usual physiotherapy on functional outcome after total hip arthroplasty (THA) for hip osteoarthritis (OA) in elderly subjects. Randomized controlled trial; pre- and posttreatment measurements. Hospital rehabilitation department. Subjects (N=29) referred to the rehabilitation department after THA for hip OA. The intervention group (n=16; 78+/-8 y) received simultaneous low-frequency electric muscle stimulation of bilateral quadriceps and calf muscles (highest tolerated intensity, 1h session, 5 d/wk, for 5 weeks) associated with conventional physical therapy including resistance training. The control group (n=13; 76+/-10 y) received conventional physical therapy alone (25 sessions). Maximal isometric strength of knee extensors, FIM instrument, before and after; a six-minute walk test and a 200 m fast walk test, after; length of stay (LOS). Low-frequency electric muscle stimulation was well tolerated. It resulted in a greater improvement in strength of knee extensors on the operated side (77% vs 23%; P<.01), leading to a better balance of muscle strength between the operated and nonoperated limb. The low-frequency electric muscle stimulation group also showed a greater improvement in FIM scores, though improvements in the walk tests were similar for the 2 groups, as was LOS. Low-frequency electric muscle stimulation is a safe, well-tolerated therapy after THA for hip OA. It improves knee extensor strength, which is one of the factors leading to greater functional independence after THA.

Association of slower walking speed with incident knee osteoarthritis-related outcomes.

PubMed

Purser, Jama L; Golightly, Yvonne M; Feng, Qiushi; Helmick, Charles G; Renner, Jordan B; Jordan, Joanne M

2012-07-01

To determine whether slower walking speed was associated with an increased risk of incident hip and knee osteoarthritis (OA)-related outcomes. After providing informed consent, community-dwelling participants in the Johnston County Osteoarthritis Project completed 2 home-based interviews and an additional clinic visit for radiographic and physical evaluation. One thousand eight hundred fifty-eight noninstitutionalized residents ages ≥ 45 years living for at least 1 year in 1 of 6 townships in Johnston County, North Carolina, completed the study's questionnaires and clinical examinations at baseline and at followup testing. Walking time was assessed using a manual stopwatch in 2 trials over an 8-foot distance, and walking speed was calculated as the average of both trials. For the hip and knee, we examined 3 outcomes per joint site: radiographic OA (weight-bearing anteroposterior knee radiographs, supine anteroposterior pelvic radiographs of the hip), chronic joint symptoms, and symptomatic OA. Covariates included age, sex, race, education, marital status, body mass index, number of self-reported chronic conditions diagnosed by a health care provider, number of prescriptions, depressive symptoms, self-rated health, number of lower body functional limitations, smoking, and physical activity. Faster walking speed was consistently associated with a lower incidence of radiographic (adjusted odds ratio [OR] 0.88, 95% confidence interval [95% CI] 0.79-0.97) and symptomatic knee OA (adjusted OR 0.84, 95% CI 0.75-0.95); slower walking speed was associated with a greater incidence of these outcomes across a broad range of different clinical and radiographic OA outcomes. Slower walking speed may be a marker for incident knee OA, but other studies must confirm this finding. Copyright © 2012 by the American College of Rheumatology.

PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

PubMed Central

Laver, Lior; Marom, Niv; Dnyanesh, Lad; Mei-Dan, Omer; Espregueira-Mendes, João; Gobbi, Alberto

2016-01-01

Objective: To explore the utilization of platelet-rich plasma (PRP) for degenerative cartilage processes and evaluate whether there is sufficient evidence to better define its potential effects. Design: Systematic literature reviews were conducted in PubMed/MEDLINE and Cochrane electronic databases till May 2015, using the keywords “platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP AND cartilage OR chondrocyte OR chondrogenesis OR osteoarthritis (OA) OR arthritis.” Results: The final result yielded 29 articles. Twenty-six studies examined PRP administration for knee OA and 3 involved PRP administration for hip OA. The results included 9 prospective randomized controlled trials (RCTs) (8 knee and 1 hip), 4 prospective comparative studies, 14 case series, and 2 retrospective comparative studies. Hyaluronic acid (HA) was used as a control in 11 studies (7 RCTs, 2 prospective comparative studies, and 2 retrospective cohort). Overall, all RCTs reported on improved symptoms compared to baseline scores. Only 2 RCTs—one for knee and one for hip—did not report significant superiority of PRP compared to the control group (HA). Nine out of 11 HA controlled studies showed significant better results in the PRP groups. A trend toward better results for PRP injections in patients with early knee OA and young age was observed; however, lack of uniformity was evident in terms of indications, inclusion criteria, and pathology definitions in the different studies. Conclusion: Current clinical evidence supports the benefit in PRP treatment for knee and hip OA, proven to temporarily relieve pain and improve function of the involved joint with superior results compared with several alternative treatments. Further research to establish the optimal preparation protocol and characteristics of PRP injections for OA is needed. PMID:28317389

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol.

PubMed

Holden, Melanie A; Burke, Danielle L; Runhaar, Jos; van Der Windt, Danielle; Riley, Richard D; Dziedzic, Krysia; Legha, Amardeep; Evans, Amy L; Abbott, J Haxby; Baker, Kristin; Brown, Jenny; Bennell, Kim L; Bossen, Daniël; Brosseau, Lucie; Chaipinyo, Kanda; Christensen, Robin; Cochrane, Tom; de Rooij, Mariette; Doherty, Michael; French, Helen P; Hickson, Sheila; Hinman, Rana S; Hopman-Rock, Marijke; Hurley, Michael V; Ingram, Carol; Knoop, Jesper; Krauss, Inga; McCarthy, Chris; Messier, Stephen P; Patrick, Donald L; Sahin, Nilay; Talbot, Laura A; Taylor, Robert; Teirlinck, Carolien H; van Middelkoop, Marienke; Walker, Christine; Foster, Nadine E

2017-12-22

Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. CRD42017054049. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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 Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. Discussion Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. Trial registration NCT01130740 (VA); NCT 01435109 (NIH) PMID:22530979

Patients With Chondrolabral Pathology Have Bilateral Functional Impairments 12 to 24 Months After Unilateral Hip Arthroscopy: A Cross-sectional Study.

PubMed

Kemp, Joanne L; Risberg, May Arna; Schache, Anthony G; Makdissi, Michael; Pritchard, Michael G; Crossley, Kay M

2016-11-01

Study Design Cross-sectional study. Background Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. Objectives To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. Methods Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. Results Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R 2 range, 0.197-0.407; P<.001). Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. Conclusion Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls. Level of Evidence Therapy/symptom prevalence, level 3b. J Orthop Sports Phys Ther 2016;46(11):947-956. doi:10.2519/jospt.2016.6577.

SMAD3 Is Upregulated in Human Osteoarthritic Cartilage Independent of the Promoter DNA Methylation.

PubMed

Aref-Eshghi, Erfan; Liu, Ming; Razavi-Lopez, Seyd Babak; Hirasawa, Kensuke; Harper, Patricia E; Martin, Glynn; Furey, Andrew; Green, Roger; Sun, Guang; Rahman, Proton; Zhai, Guangju

2016-02-01

To compare SMAD3 gene expression between human osteoarthritic and healthy cartilage and to examine whether expression is regulated by the promoter DNA methylation of the gene. Human cartilage samples were collected from patients undergoing total hip/knee joint replacement surgery due to primary osteoarthritis (OA), and from patients with hip fractures as controls. DNA/RNA was extracted from the cartilage tissues. Real-time quantitative PCR was performed to measure gene expression, and Sequenom EpiTyper was used to assay DNA methylation. Mann-Whitney test was used to compare the methylation and expression levels between OA cases and controls. Spearman rank correlation coefficient was calculated to examine the association between the methylation and gene expression. A total of 58 patients with OA (36 women, 22 men; mean age 64 ± 9 yrs) and 55 controls (43 women, 12 men; mean age 79 ± 10 yrs) were studied. SMAD3 expression was on average 83% higher in OA cartilage than in controls (p = 0.0005). No difference was observed for DNA methylation levels in the SMAD3 promoter region between OA cases and controls. No correlation was found between SMAD3 expression and promoter DNA methylation. Our study demonstrates that SMAD3 is significantly overexpressed in OA. This overexpression cannot be explained by DNA methylation in the promoter region. The results suggest that the transforming growth factor-β/SMAD3 pathway may be overactivated in OA cartilage and has potential in developing targeted therapies for OA.

Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.

PubMed

Barten, Di-Janne J A; Swinkels, Llse C S; Dorsman, Sara A; Dekker, Joost; Veenhof, Cindy; de Bakker, Dinny H

2015-06-27

A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy. Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy. Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients. In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.

Gender differences exist in the hip joint moments of healthy older walkers.

PubMed

Boyer, Katherine A; Beaupre, Gary S; Andriacchi, Thomas P

2008-12-05

Gender differences in the incidence of symptomatic hip osteoarthritis (OA), changes in hip cartilage volume and hip joint space and rates hip arthroplasty of older people are reported in the literature. As the rate of progression of OA is in part mechanically modulated it is possible that this gender bias may be related to inherent differences (if they exist) in walking mechanics between older males and females. The purpose of this study was to examine potential mechanisms for gender differences in hip joint mechanics during walking by testing the hypotheses that females would exhibit higher hip flexion, adduction and internal rotation moments but not significantly greater normalized ground reaction forces (GRFs). Forty-two healthy subjects (21 male, 21 female), ages 50-79yr were recruited for gait analysis. In support of the hypotheses, greater external hip adduction and internal rotation along with hip extension moments were found for females compared to males after normalizing for body size for all self-selected walking speeds. Differences in walking style (kinematics) were the main determinants in the joint kinetic differences as no differences in the normalized GRFs were found. As external joint moments are surrogate measures of the joint contact forces, the results of this study suggest the hip joint stress for the female population is higher compared to male population. This is in favor of a hypothesis that the increased joint contact stress in a female population could contribute to a greater joint degeneration at the hip in females as compared with males.

Knee Joint Contact Mechanics during Downhill Gait and its Relationship with Varus/Valgus Motion and Muscle Strength in Patients with Knee Osteoarthritis

PubMed Central

Farrokhi, Shawn; Voycheck, Carrie A.; Gustafson, Jonathan A.; Fitzgerald, G. Kelley; Tashman, Scott

2015-01-01

Objective The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Methods Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Group differences in contact mechanics and frontal-plane motion excursions were compared using analysis of covariance with adjustments for body mass index. Differences in strength were compared using independent sample t-tests. Additionally, linear associations between contact mechanics with frontal-plane knee motion and muscle strength were evaluated using Pearson's correlation coefficients. Results Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p<0.02) and greater heel-strike joint contact point velocities (p<0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p=0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p<0.01) and greater quadriceps and hip abductor muscle weakness (p=0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p<0.04) but not with quadriceps or hip abductor strength. Conclusion Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength. PMID:27030846

Bone Morphogenetic Proteins and myostatin pathways: key mediator of human sarcopenia.

PubMed

Scimeca, Manuel; Piccirilli, Eleonora; Mastrangeli, Francesca; Rao, Cecilia; Feola, Maurizio; Orlandi, Augusto; Gasbarra, Elena; Bonanno, Elena; Tarantino, Umberto

2017-02-15

Sarcopenia, osteoporosis and osteoarthritis are the most frequent musculoskeletal disorders affecting older people. The main aim of this study was to test the hypothesis that the balance between BMPs and myostatin pathways regulates the age-related muscle degeneration in OP and OA patients. To this end, we investigated the relationship among the expression of BMP-2/4-7, myostatin and phosphorylated Smads1-5-8 and the muscle quality, evaluated in term of fibers atrophy and satellite cells activity. In this retrospective study, we collected 123 biopsies of vastus lateralis: 48 biopsies from patients who underwent hip arthroplasty for subcapital fractures of the femur (OP), 55 biopsies from patients who underwent hip arthroplasty for osteoarthritis (OA) and 20 biopsies from patients who underwent hip arthroplasty for high-energy hip fractures (CTRL). Muscle biopsies were fixed in 4% paraformaldehyde and paraffin embedded. Serial sections were used for morphometrical and immunohistochemical analysis (BMP/2/4-7, myostatin, Smads1-5-8, Pax7 and myogenin). In addition, 1 mm 3 of muscle tissue of each patient was embedded in epon for ultrastructural study. Morphometric data indicated an increase of the number of atrophic fibers in OP patients compare to OA. In line with these data, we found an high regenerative potential in muscle tissues of OA patients due to the significant amount of both Pax7 and myogenin positive satellite cells detected in OA group. In addition, our data showed the decrease of BMP2/4 and -7 expression in OP patients compared to both OA group and CTRL. Conversely, OP patients were characterized by high levels of myostatin expression. A different expression profile was also found for phosphorylated Smad1-5-8 between OP and OA patients. In particular, OP patients showed a low number of positive phosphorylated Smad1-5-8 nuclei. The identification of molecular pathways involved in the pathogenesis of sarcopenia open new prospective for the development of drugs able to prevent/treat the muscle impairment that occur in elderly. Results here reported, highlighting the role of BMPs and myostatin pathways in physio-pathogenesis of human sarcopenia, allow us to propose human recombinant BMP-2/7 and anti-myostatin antibodies as a possible therapeutic option for the sarcopenia.

Factors associated with physical activity in Australians with hip or knee osteoarthritis.

PubMed

Heesch, Kristiann Corbusier; Ng, Norman; Brown, Wendy

2011-03-01

Physical activity (PA) is recommended for managing osteoarthritis (OA). However, few people with OA are physically active. Understanding the factors associated with PA is necessary to increase PA in this population. This cross-sectional study examined factors associated with leisure-time PA, stretching exercises, and strengthening exercises in people with OA. For a mail survey, 485 individuals, aged 68.0 years (SD = 10.6) with hip or knee OA, were asked about factors that may influence PA participation, including use ofnon-PAOA management strategies and both psychological and physical health-related factors. Associations between factors and each PA outcome were examined in multivariable logistic regression models. Non-PA management strategies were the main factors associated with the outcomes. Information/education courses, heat/cold treatments, and paracetamol were associated with stretching and strengthening exercises (P < .05). Hydrotherapy and magnet therapy were associated with leisure-time PA; using orthotics and massage therapy, with stretching exercises; and occupational therapy, with strengthening exercises (P < .05). Few psychological or health-related factors were associated with the outcomes. Some management strategies may make it easier for people with OA to be physically active, and could be promoted to encourage PA. Providers of strategies are potential avenues for recruiting people with OA into PA programs.

High-Riding Congenital Hip Dislocation: THA With Unilateral vs Bilateral Transverse Femoral Shortening Osteotomy.

PubMed

Can, Ata; Sarikaya, Ilker A; Yontar, Necip S; Erdogan, Ayse O; Gorgun, Baris; Erdogan, Fahri

2018-05-01

We argue that 1-stage bilaterally total hip arthroplasty (THA) could be acceptable in bilateral coxarthrosis because of high-riding developmental dysplasia of the hip (DDH). Sixty-nine cases (51 patients) of high-riding DDH in patients who underwent THA from 2010 to 2013 were reviewed. Patients were divided into 2 groups: unilateral (group 1) and 1-stage bilateral surgery (group 2). The clinical measurements were the visual analog scale and Harris Hip Score. The average follow-up was 37.3 months for group 1 and 38.8 months for group 2. The hospital stay time was 5.2 days in group 1 and 6.2 days in group 2 (P = .334). The mean Harris Hip Score and visual analog scale score were improved significantly after surgery for both groups, and there was no statistically significant difference (P = .988). There was no difference between groups 1 and 2 in terms of complications (P = .137). Our data confirm that 1-stage bilateral transverse osteotomy with THA is an effective method as unilateral and it does not increase the length of patients' hospital stays and features a low risk of postoperative complications in the treatment of patients with high-riding DDH. Copyright © 2017 Elsevier Inc. All rights reserved.

Bone accrual in oligo-amenorrheic athletes, eumenorrheic athletes and non-athletes.

PubMed

Singhal, Vibha; Reyes, Karen Campoverde; Pfister, Brooke; Ackerman, Kathryn; Slattery, Meghan; Cooper, Katherine; Toth, Alexander; Gupta, Nupur; Goldstein, Mark; Eddy, Kamryn; Misra, Madhusmita

2018-05-11

Mechanical loading improves bone mineral density (BMD) and strength while decreasing fracture risk. Cross-sectional studies show that exercise advantage is lost in oligo-amenorrheic athletes (OA). Longitudinal studies examining the opposing effects of exercise and hypogonadism on bone are lacking in adolescents/young adults. Evaluate differences in bone accrual over 12 months in OA, eumenorrheic athletes (EA) and non-athletes (NA). We hypothesized that bone accrual would be lower in OA than EA and NA, with differences most pronounced at non-weight bearing trabecular sites. 27 OA, 29 EA, and 22 NA, 14-25 years old, completed 12-months of the prospective study. Athletes were weight-bearing endurance athletes. Subjects were assessed for areal BMD and bone mineral content (BMC) using DXA at the femoral neck, total hip, lumbar spine and whole body (WB). Failure load (a strength estimate) at the distal radius and tibia was assessed using microfinite element analysis of data obtained via high resolution peripheral quantitative computed tomography (HRpQCT). The primary analysis was a comparison of changes in areal BMD, BMC, and failure load across groups over 12-months at the respective sites. Groups did not differ for baseline age, height or BMI. Percent body fat was lower in both OA and EA compared to NA. OA attained menarche later than EA and NA. Over the follow-up period, OA gained 1.9 ± 2.7 kg of weight compared to 0.5 ± 2.4 kg and 0.8 ± 2.3 kg in EA and NA respectively (p = 0.09); 39% of OA resumed menses. Changes in BMD, BMD Z-scores, and tibial failure load over 12-months did not differ among groups. At follow up, EA had higher femoral neck, hip and WB BMD Z-scores than NA, and higher hip BMD Z-scores than OA (p < 0.05) after adjusting for covariates. At follow-up, radial failure load was lower in OA vs. NA, and tibial failure load lower in OA and NA vs. EA (p ≤ 0.04 for all). Change in weight and fat mass were associated with changes in BMD measures at multiple sites. Despite weight gain and menses recovery in many OA during follow-up, residual deficits persist without catch-up raising concerns for suboptimal peak bone mass acquisition. Copyright © 2017. Published by Elsevier Inc.

Gait symmetry and hip strength in women with developmental dysplasia following hip arthroplasty compared to healthy subjects: A cross-sectional study.

PubMed

Leijendekkers, Ruud A; Marra, Marco A; Kolk, Sjoerd; van Bon, Geert; Schreurs, B Wim; Weerdesteyn, Vivian; Verdonschot, Nico

2018-01-01

Untreated unilateral developmental dysplasia of the hip (DDH) results in asymmetry of gait and hip strength and may lead to early osteoarthritis, which is commonly treated with a total hip arthroplasty (THA). There is limited knowledge about the obtained symmetry of gait and hip strength after the THA. The objectives of this cross-sectional study were to: a) identify asymmetries between the operated and non-operated side in kinematics, kinetics and hip strength, b) analyze if increased walking speed changed the level of asymmetry in patients c) compare these results with those of healthy subjects. Women (18-70 year) with unilateral DDH who had undergone unilateral THA were eligible for inclusion. Vicon gait analysis system was used to collect frontal and sagittal plane kinematic and kinetic parameters of the hip joint, pelvis and trunk during walking at comfortable walking speed and increased walking speed. Furthermore, hip abductor and extensor muscle strength was measured. Six patients and eight healthy subjects were included. In the patients, modest asymmetries in lower limb kinematics and kinetics were present during gait, but trunk lateral flexion asymmetry was evident. Patients' trunk lateral flexion also differed compared to healthy subjects. Walking speed did not significantly influence the level of asymmetry. The hip abduction strength asymmetry of 23% was not statistically significant, but the muscle strength of both sides were significantly weaker than those of healthy subjects. In patients with a DDH treated with an IBG THA modest asymmetries in gait kinematics and kinetics were present, with the exception of a substantial asymmetry of the trunk lateral flexion. Increased walking speed did not result in increased asymmetries in gait kinematics and kinetics. Hip muscle strength was symmetrical in patients, but significantly weaker than in healthy subjects. Trunk kinematics should be included as an outcome measure to assess the biomechanical benefits of the THA surgery after DDH.

Hemodynamic stability ensured by a low dose, low volume, unilateral hypobaric spinal block: modification of a technique.

PubMed

Elzinga, L; Marcus, M; Peek, D; Borg, P; Jansen, J; Koster, J; Enk, D

2009-01-01

We report the case of an 89-year-old female with a history of arterial hypertension, intermittent rapid atrial fibrillation and severe aortic valve stenosis, suffering from femoral neck fracture. Hyperbaric unilateral spinal anesthesia is a known technique to obtain stable hemodynamics combined with the possibility of continuous neurologic evaluation and preservation of cognitive functions. Because a hyperbaric unilateral technique can be very painful in case of traumatic hip fracture, a low dose, low volume, unilateral hypobaric spinal block may be an adequate alternative. In the present case report, a unilateral hypobaric spinal anesthesia was performed using 5 mg of bupivacaine in a 1.5 mL volume and a slow and steady, "air-buffered", directed injection technique, to allow an urgent hip arthroplasty. During surgery the patient was kept in the lateral recumbent position. Hemodynamics remained stable throughout the entire procedure without any need for vasoconstrictors. The impact of aortic valve stenosis combined with atrial fibrillation on anesthetic management and our considerations to opt for a unilateral hypobaric spinal anesthesia are discussed.

Using multidimensional topological data analysis to identify traits of hip osteoarthritis.

PubMed

Rossi-deVries, Jasmine; Pedoia, Valentina; Samaan, Michael A; Ferguson, Adam R; Souza, Richard B; Majumdar, Sharmila

2018-05-07

Osteoarthritis (OA) is a multifaceted disease with many variables affecting diagnosis and progression. Topological data analysis (TDA) is a state-of-the-art big data analytics tool that can combine all variables into multidimensional space. TDA is used to simultaneously analyze imaging and gait analysis techniques. To identify biochemical and biomechanical biomarkers able to classify different disease progression phenotypes in subjects with and without radiographic signs of hip OA. Longitudinal study for comparison of progressive and nonprogressive subjects. In all, 102 subjects with and without radiographic signs of hip osteoarthritis. 3T, SPGR 3D MAPSS T 1ρ /T 2 , intermediate-weighted fat-suppressed fast spin-echo (FSE). Multidimensional data analysis including cartilage composition, bone shape, Kellgren-Lawrence (KL) classification of osteoarthritis, scoring hip osteoarthritis with MRI (SHOMRI), hip disability and osteoarthritis outcome score (HOOS). Analysis done using TDA, Kolmogorov-Smirnov (KS) testing, and Benjamini-Hochberg to rank P-value results to correct for multiple comparisons. Subjects in the later stages of the disease had an increased SHOMRI score (P < 0.0001), increased KL (P = 0.0012), and older age (P < 0.0001). Subjects in the healthier group showed intact cartilage and less pain. Subjects found between these two groups had a range of symptoms. Analysis of this subgroup identified knee biomechanics (P < 0.0001) as an initial marker of the disease that is noticeable before the morphological progression and degeneration. Further analysis of an OA subgroup with femoroacetabular impingement (FAI) showed anterior labral tears to be the most significant marker (P = 0.0017) between those FAI subjects with and without OA symptoms. The data-driven analysis obtained with TDA proposes new phenotypes of these subjects that partially overlap with the radiographic-based classical disease status classification and also shows the potential for further examination of an early onset biomechanical intervention. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

Viscoelastic modeling and quantitative experimental characterization of normal and osteoarthritic human articular cartilage using indentation.

PubMed

Richard, F; Villars, M; Thibaud, S

2013-08-01

The viscoelastic behavior of articular cartilage changes with progression of osteoarthritis. The objective of this study is to quantify this progression and to propose a viscoelastic model of articular cartilage taking into account the degree of osteoarthritis that which be easily used in predictive numerical simulations of the hip joint behavior. To quantify the effects of osteoarthritis (OA) on the viscoelastic behavior of human articular cartilage, samples were obtained from the hip arthroplasty due to femoral neck fracture (normal cartilage) or advanced coxarthrosis (OA cartilage). Experimental data were obtained from instrumented indentation tests on unfrozen femoral cartilage collected and studied in the day following the prosthetic hip surgery pose. By using an inverse method coupled with a numerical modeling (FEM) of all experimental data of the indentation tests, the viscoelastic properties of the two states were quantified. Mean values of viscoelastic parameters were significantly lower for OA cartilage than normal (instantaneous and relaxed tension moduli, viscosity coefficient). Based on the results and in the thermodynamic framework, a constitutive viscoelastic model taking into account the degree of osteoarthritis as an internal variable of damage is proposed. The isotropic phenomenological viscoelastic model including degradation provides an accurate prediction of the mechanical response of the normal human cartilage and OA cartilage with advanced coxarthrosis but should be further validated for intermediate degrees of osteoarthritis. Copyright © 2013 Elsevier Ltd. All rights reserved.

Intractable bone marrow edema syndrome of the hip.

PubMed

Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji

2015-04-01

There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches. Copyright 2015, SLACK Incorporated.

Ipsilateral hip abductor weakness after inversion ankle sprain.

PubMed

Friel, Karen; McLean, Nancy; Myers, Christine; Caceres, Maria

2006-01-01

Hip stability and strength are important for proper gait mechanics and foot position during heel strike. To determine the relationships between hip muscle strength and chronic ankle sprains and hip muscle strength and ankle range of motion. Ex post facto design with the uninvolved limb serving as the control. Laboratory. A total of 23 subjects with unilateral chronic ankle sprain were recruited. Subjects had at least 2 ipsilateral ankle sprains and were bearing full weight, with the most recent injury occurring at least 3 months earlier. They were not undergoing formal or informal rehabilitation at the time of the study. We obtained goniometric measurements for all planes of motion at the ankle. Handheld dynamometry was used to assess the strength of the hip abductor and hip extensor muscles in both limbs. Hip abductor muscle strength and plantar flexion were significantly less on the involved side than the uninvolved side (P < .001 in each case). Strength of the involved hip abductor and hip extensor muscles was significantly correlated (r = 0.539, P < .01). No significant difference was noted in hip extensor muscle strength between sides (P = .19). Our subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar-flexion range of motion on the involved sides. Clinicians should consider exercises to increase hip abduction strength when developing rehabilitation programs for patients with ankle sprains.

Immediate efficacy of neuromuscular exercise in patients with severe osteoarthritis of the hip or knee: a secondary analysis from a randomized controlled trial.

PubMed

Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders; Christensen, Robin; Roos, Ewa M

2014-07-01

Knowledge about the effects of exercise in severe and endstage osteoarthritis (OA) is limited. The aim was to evaluate the efficacy of a neuromuscular exercise program in patients with clinically severe hip or knee OA. This was a randomized controlled assessor-blinded trial. Patients received an educational package (care-as-usual) only, or care-as-usual plus an 8-week neuromuscular exercise intervention (NEMEX-TJR). NEMEX-TJR was supervised by a physiotherapist, twice weekly for 1 h. The primary outcome was Activities of Daily Living (ADL) subscale from the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The secondary outcomes were the HOOS/KOOS subscales Pain, Symptoms, Sport and Recreation, and Joint-related Quality of Life. Exploratory outcomes were functional performance measures and lower limb muscle power. Included were 165 patients, 56% female, average age 67 years (SD ± 8), and a body mass index of 30 (SD ± 5), who were scheduled for primary hip or knee replacement. The postintervention difference between mean changes in ADL was 7.2 points (95% CI 3.5 to 10.9, p = 0.0002) in favor of NEMEX-TJR compared with control. Second, there were statistically significant differences between groups in favor of NEMEX-TJR on all self-reported outcomes and most functional performance tests (walk, chair stands, and 1-leg knee bends). Stratified analyses according to joint revealed moderate effect size for ADL for hip patients (0.63, 95% CI 0.26 to 1.00). Corresponding effect size for knee patients was small (0.23 95% CI -0.14 to 0.60). Feasibility of neuromuscular exercise was confirmed in patients about to have total joint replacement. Self-reported activities of daily living and objective performance were improved and pain reduced immediately following 8 weeks of neuromuscular exercise. While the effects were moderate in hip OA, they were only small in knee OA. ClinicalTrials.gov Identifier: NCT01003756.

Impact of clinical osteoarthritis of the hip, knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis.

PubMed

van Schoor, N M; Zambon, S; Castell, M V; Cooper, C; Denkinger, M; Dennison, E M; Edwards, M H; Herbolsheimer, F; Maggi, S; Sánchez-Martinez, M; Pedersen, N L; Peter, R; Schaap, L A; Rijnhart, J J M; van der Pas, S; Deeg, D J H

2016-06-01

Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH. Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index. The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function. Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.

High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial.

PubMed

Calatayud, Joaquin; Casaña, Jose; Ezzatvar, Yasmin; Jakobsen, Markus D; Sundstrup, Emil; Andersen, Lars L

2017-09-01

The benefits of preoperative training programmes compared with alternative treatment are unclear. The purpose of this study was to evaluate the effectiveness of a high-intensity preoperative resistance training programme in patients waiting for total knee arthroplasty (TKA). Forty-four subjects (7 men, 37 women) scheduled for unilateral TKA for osteoarthritis (OA) during 2014 participated in this randomized controlled trial. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), a 10-cm visual analogue scale (VAS), isometric knee flexion, isometric knee extension, isometric hip abduction, active knee range of motion and functional tasks (Timed Up and Go test and Stair ascent-descent test) were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3) and finally 3 months after TKA (T4). The intervention group completed an 8-week training programme 3 days per week prior to surgery. Isometric knee flexion, isometric hip abduction, VAS, WOMAC, ROM extension and flexion and all the functional assessments were greater for the intervention group at T2, T3 and T4, whereas isometric knee extension was greater for this group at T2 and T4 compared with control. The present study supports the use of preoperative training in end-stage OA patients to improve early postoperative outcomes. High-intensity strength training during the preoperative period reduces pain and improves lower limb muscle strength, ROM and functional task performance before surgery, resulting in a reduced length of stay at the hospital and a faster physical and functional recovery after TKA. The present training programme can be used by specialists to speed up recovery after TKA. I.

Predicting OA progression to total hip replacement: can we do better than risk factors alone using active shape modelling as an imaging biomarker?

PubMed

Barr, Rebecca J; Gregory, Jennifer S; Reid, David M; Aspden, Richard M; Yoshida, Kanako; Hosie, Gillian; Silman, Alan J; Alesci, Salvatore; Macfarlane, Gary J

2012-03-01

Previously, active shape modelling (ASM) of the proximal femur was shown to identify those individuals at highest risk of developing radiographic OA. Here we determine whether ASM predicts the need for total hip replacement (THR) independent of Kellgren-Lawrence grade (KLG) and other known risk factors. A retrospective cohort study of 141 subjects consulting primary care with new hip pain was conducted. Pelvic radiographs taken on recruitment were assessed for KLG, centre-edge angle, acetabular depth and femoral head migration. Clinical factors (duration of pain, use of a stick and physical function) were collected by self-completed questionnaires. ASM differences between shape mode scores at baseline for individuals who underwent THR during the 5-year follow-up (n = 27) and those whose OA did not progress radiographically (n = 75) were compared. A 1 s.d. reduction in baseline ASM mode 2 score was associated with an 81% reduction in odds of THR (OR = 0.19, 95% CI 0.52, 0.70) after adjustment for KLG, radiographic and clinical factors. A similar reduction in odds of THR was associated with a 1 s.d. reduction in mode 3 (OR = 0.45, 95% CI 0.28, 0.71) and a 1 s.d. increase in mode 4 score (OR = 2.8, 95% CI 1.7, 4.7), although these associations were no longer significant after adjustment for KLG and clinical factors. ASM of the hip joint is a reliable early biomarker of radiographic OA severity, which can improve the ability to identify patients at higher risk of rapid progression and poor outcome even when KLG and clinical risk factors are taken into account.

Does unilateral hip flexion increase the spinal anaesthetic level during combined spinal–epidural technique?

PubMed Central

Mohta, Medha; Agarwal, Deepti; Sethi, AK

2011-01-01

Needle-through-needle combined spinal–epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique. PMID:21808396

Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy?

PubMed

Niklasch, M; Döderlein, L; Klotz, M C; Braatz, F; Wolf, S I; Dreher, T

2015-02-01

Internal rotation gait is common among children with bilateral cerebral palsy. However, despite bilaterally increased femoral anteversion asymmetric internal rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly performed bilaterally. Variable functional outcomes are reported especially in cases with mild internal hip rotation during gait and abnormal preoperative pelvic rotation. A major question is if a unilateral treatment of the more involved side in asymmetric cases leads to a comparable or even superior outcome. One hundred and nine children with spastic bilateral CP treated with FDO with pre- and 1-year postoperative 3D gait analysis were retrospectively collected. The asymmetry was calculated from the preoperative difference between both limbs in hip rotation obtained by 3D gait analysis. Twenty-eight children with asymmetry larger than 20° were selected and classified into two groups, according to whether they obtained a unilateral or bilateral FDO. Preoperative clinical examination and pre- and postoperative hip and pelvic rotation in gait analysis on the more and the less involved side did not differ significantly between both groups. Interestingly, in both groups, hip rotation did not change significantly in less-involved limbs, although intraoperative derotation averaged 25°. After unilateral FDO a significant change in pelvic rotation resulted, whereas this was not found after bilateral FDO. The results of this study suggest that unilateral FDO in children with asymmetric internal rotation gait leads to a comparable functional outcome compared to bilateral treatment. Furthermore, it was shown for the first time that considering the asymmetry has a positive effect on pelvic rotation. Copyright © 2015 Elsevier B.V. All rights reserved.

Effects of fucoidan from Fucus vesiculosus in reducing symptoms of osteoarthritis: a randomized placebo-controlled trial

PubMed Central

Myers, Stephen P; Mulder, Ann M; Baker, Don G; Robinson, Shelley R; Rolfe, Margaret I; Brooks, Lyndon; Fitton, J Helen

2016-01-01

Purpose Preliminary investigation of a fucoidan with demonstrated reduction in the symptoms of osteoarthritis (OA) of the hip and knee. Patients and methods A double-blind randomized controlled trial was carried out to determine the safety and efficacy of a 300 mg dose of a Fucus vesiculosus extract (85% fucoidan) over a 12-week period in a population (n=122) with mild-to-moderate OA of the hip and knee as measured by the validated instrument “Comprehensive Osteoarthritis Test.” Safety was measured by assessing cholesterol, liver function, renal function, and hematopoietic function, and closely monitoring adverse events. Result Ninety-six participants completed the study. The reduction in symptoms of OA was not significantly different from the placebo response. There were no changes in the blood measurements that were of any clinical significance during the course of the study. Conclusion The F. vesiculosus fucoidan extract was safe and well tolerated. At a dose of 300 mg, the extract showed no difference in reduction of OA symptoms from the placebo. PMID:27307702

Low-level laser therapy of myofascial pain syndromes of patients with osteoarthritis of knee and hip joints

NASA Astrophysics Data System (ADS)

Gasparyan, Levon V.

2001-04-01

The purpose of the given research is the comparison of efficiency of conventional treatment of myofascial pain syndromes of patients with osteoarthritis (OA) of hip and knee joints and therapy with additional application of low level laser therapy (LLLT) under dynamic control of clinical picture, rheovasographic, electromyographic examinations, and parameters of peroxide lipid oxidation. The investigation was made on 143 patients with OA of hip and knee joints. Patients were randomized in 2 groups: basic group included 91 patients, receiving conventional therapy with a course of LLLT, control group included 52 patients, receiving conventional treatment only. Transcutaneous ((lambda) equals 890 nm, output peak power 5 W, frequency 80 - 3000 Hz) and intravenous ((lambda) equals 633 nm, output 2 mW in the vein) laser irradiation were used for LLLT. Studied showed, that clinical efficiency of LLLT in the complex with conventional treatment of myofascial pain syndromes at the patients with OA is connected with attenuation of pain syndrome, normalization of parameters of myofascial syndrome, normalization of the vascular tension and parameters of rheographic curves, as well as with activation of antioxidant protection system.

Spatial memory deficit and neurodegeneration induced by the direct injection of okadaic acid into the hippocampus in rats.

PubMed

He, J; Yamada, K; Zou, L B; Nabeshima, T

2001-01-01

We investigated the effects of okadaic acid (OA), a specific inhibitor of protein phosphatases 1 and 2A, on spatial memory and neuronal survival in rats. Rats were initially trained on a spatial memory task in an eight arm radial maze. Spatial reference and working memory was impaired 1 day after the unilateral microinjection of OA into the dorsal hippocampus. The impairment was transient, and had disappeared by the following day. In contrast, neurodegeneration induced by OA was persistent and extended to the contralateral side 13 days after the injection. These results suggest that OA causes spatial memory impairment and neurodegeneration when injected directly into the hippocampus. Our findings also indicate dissociation between memory impairment and neurodegeneration induced by OA.

Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

PubMed

Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

2010-02-01

: A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

Restriction of spontaneous and prednisolone-induced leptin production to dedifferentiated state in human hip OA chondrocytes: role of Smad1 and β-catenin activation.

PubMed

Charlier, E; Malaise, O; Zeddou, M; Neuville, S; Cobraiville, G; Deroyer, C; Sanchez, C; Gillet, P; Kurth, W; de Seny, D; Relic, B; Malaise, M G

2016-02-01

The aetiology of OA is not fully understood although several adipokines such as leptin are known mediators of disease progression. Since leptin levels were increased in synovial fluid compared to serum in OA patients, it was suggested that joint cells themselves could produce leptin. However, exact mechanisms underlying leptin production by chondrocytes are poorly understood. Nevertheless, prednisolone, although displaying powerful anti-inflammatory properties has been recently reported to be potent stimulator of leptin and its receptor in OA synovial fibroblasts. Therefore, we investigated, in vitro, spontaneous and prednisolone-induced leptin production in OA chondrocytes, focusing on transforming growth factor-β (TGFβ) and Wnt/β-catenin pathways. We used an in vitro dedifferentiation model, comparing human freshly isolated hip OA chondrocytes cultivated in monolayer during 1 day (type II, COL2A1 +; type X, COL10A1 + and type I collagen, COL1A1 -) or 14 days (COL2A1 -; COL10A1 - and COL1A1+). Leptin expression was not detected in day1 OA chondrocytes whereas day14 OA chondrocytes produced leptin, significantly increased with prednisolone. Activin receptor-like kinase 1 (ALK1)/ALK5 ratio was shifted during dedifferentiation, from high ALK5 and phospho (p)-Smad2 expression at day1 to high ALK1, endoglin and p-Smad1/5 expression at day14. Moreover, inactive glycogen synthase kinase 3 (GSK3) and active β-catenin were only found in dedifferentiated OA chondrocytes. Smad1 and β-catenin but not endoglin stable lentiviral silencing led to a significant decrease in leptin production by dedifferentiated OA chondrocytes. Only dedifferentiated OA chondrocytes produced leptin. Prednisolone markedly enhanced leptin production, which involved Smad1 and β-catenin activation. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Efficacy and safety of intravenous tanezumab for the symptomatic treatment of osteoarthritis: 2 randomized controlled trials versus naproxen.

PubMed

Ekman, Evan F; Gimbel, Joseph S; Bello, Alfonso E; Smith, Michael D; Keller, David S; Annis, Karen M; Brown, Mark T; West, Christine R; Verburg, Kenneth M

2014-11-01

Two studies evaluated efficacy and safety of tanezumab versus naproxen for treatment of knee or hip osteoarthritis (OA). Randomized controlled studies [NCT00830063 (Study 1015, n=828) and NCT00863304 (Study 1018, n=840)] of subjects with hip or knee OA compared intravenous tanezumab (5 mg or 10 mg) to placebo and naproxen (500 mg twice daily). Coprimary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function (0-10 numerical rating scale), and patient's global assessment of OA at Week 16. In both studies, tanezumab reduced pain versus placebo [least squares mean differences, 95% CI, tanezumab 5 mg: -1.21 (-1.72, -0.70); -1.13 (-1.65, -0.62); tanezumab 10 mg: -0.91 (-1.42, -0.40); -0.80 (-1.32, -0.29)], and improved function and global scores. Tanezumab 5 mg produced greater pain reduction [-0.76 (-1.28, -0.25); -0.69 (-1.21, -0.17)], and favorable functional and global outcomes versus naproxen. Pain reductions with tanezumab 10 mg versus naproxen did not reach significance, unlike functional (both studies) and global (1 study) outcomes; thus, tanezumab 10 mg was not superior to naproxen, and predefined statistical testing procedures were not met, allowing for conclusion of superiority of tanezumab 5 mg over naproxen despite replicated favorable coprimary outcomes. Tanezumab was associated with greater incidence of peripheral sensory adverse events (paresthesia, hyperesthesia, hypoesthesia, burning sensation), pain in extremity, peripheral edema, and arthralgia. Overall frequency and discontinuations as a result of adverse events were similar to placebo and naproxen. Tanezumab provides efficacious treatment of knee or hip OA and may have therapeutic utility in patients with OA who experience inadequate analgesia with nonsteroidal antiinflammatory drugs.

Migratory Bone Marrow Edema Syndrome of the Hips: A Case Report

PubMed Central

Santoso, A; Ingale, PS; Park, KS

2017-01-01

Migratory bone marrow edema syndrome (BMES) of the hip is a rare entity. We report the case of a 41-year old male with migratory BMES of the hip with eight months interval period between onset of the pain and consultation. This patient was successfully treated non-surgically. It is important to always inform the patient with unilateral BMES of the hip regarding the possibility of future involvement of the contralateral hip. PMID:29326770

Ipsilateral Hip Abductor Weakness After Inversion Ankle Sprain

PubMed Central

Friel, Karen; McLean, Nancy; Myers, Christine; Caceres, Maria

2006-01-01

Context: Hip stability and strength are important for proper gait mechanics and foot position during heel strike. Objective: To determine the relationships between hip muscle strength and chronic ankle sprains and hip muscle strength and ankle range of motion. Design: Ex post facto design with the uninvolved limb serving as the control. Setting: Laboratory. Patients or Other Participants: A total of 23 subjects with unilateral chronic ankle sprain were recruited. Subjects had at least 2 ipsilateral ankle sprains and were bearing full weight, with the most recent injury occurring at least 3 months earlier. They were not undergoing formal or informal rehabilitation at the time of the study. Main Outcome Measure(s): We obtained goniometric measurements for all planes of motion at the ankle. Handheld dynamometry was used to assess the strength of the hip abductor and hip extensor muscles in both limbs. Results: Hip abductor muscle strength and plantar flexion were significantly less on the involved side than the uninvolved side (P < .001 in each case). Strength of the involved hip abductor and hip extensor muscles was significantly correlated (r = 0.539, P < .01). No significant difference was noted in hip extensor muscle strength between sides (P = .19). Conclusions: Our subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar-flexion range of motion on the involved sides. Clinicians should consider exercises to increase hip abduction strength when developing rehabilitation programs for patients with ankle sprains. PMID:16619098

Osteoarthritis year in review: rehabilitation and outcomes.

PubMed

Davis, A M

2012-03-01

This review highlights seminal publications of rehabilitation interventions and outcomes in osteoarthritis (OA) of the hip or knee. Medline, CINAHL, and Embase databases from September 2010 through August 2011 were searched using the key words 'osteoarthritis', rehabilitation, physical therapy, exercise, and outcome(s), limited to human and English. Rehabilitation intervention studies were included if they were randomized trials (RCT), systematic reviews or meta-analyses. Studies of surgical interventions were excluded unless they included evaluation of a rehabilitation intervention. Outcome studies were included if they contributed methodologically to advancing outcome measurement. Reviews of measurement properties of outcomes were excluded. Eight publications were selected and reviewed that relate to interventions evaluating manual therapy in hip or knee OA, tele-rehabilitation and performance and participation measures as outcomes. One systematic review of hip and knee OA, one meta-analysis of knee OA provide limited support for the benefit of manual therapy with exercise for improving pain and function to a lesser extent in the short-term (3 months). Study quality overall was low. One high quality RCT in knee replacement of usual outpatient physiotherapy vs internet-based tele-rehabilitation based on a non-inferiority analysis demonstrated comparable outcomes on Western Ontario McMaster Universities' Osteoarthritis questionnaire (WOMAC) pain and function and performance measures. Three studies demonstrated that observed performance measures such as timed walk tests and stair-climbing and timed-up-and-go measure concepts differ from self-report of difficulty with physical function. Additionally, two studies showed differential times of recovery following total knee replacement (TKR). Two studies evaluated participation. One demonstrated the conceptual distinction of activity limitations and participation and a second re-analyzed trial data from knee OA studies. In one study, there were larger effects in combined activity/participation than for activity alone for arthroscopic lavage compared to intraarticular steroid and, in a second study, the effect was larger for activity with an advanced pharmacy intervention whereas the physiotherapy intervention demonstrated a larger effect for activity/participation. Interventions of manual therapy for hip and knee OA provided limited evidence of effectiveness. These studies are of limited quality due to lack of blinding and disclosure of co-intervention. Tele-rehabilitation may be a viable option to improve access to rehabilitation post joint replacement for those in rural and remote areas. Data continue to support the need to include performance measures as well as patient-reported outcomes in evaluating outcomes in OA. Additionally, measures of participation should be considered as core outcomes. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Effect of analgesic therapy on clinical outcome measures in a randomized controlled trial using client-owned dogs with hip osteoarthritis.

PubMed

Malek, Sarah; Sample, Susannah J; Schwartz, Zeev; Nemke, Brett; Jacobson, Peer B; Cozzi, Elizabeth M; Schaefer, Susan L; Bleedorn, Jason A; Holzman, Gerianne; Muir, Peter

2012-10-04

Pain and impaired mobility because of osteoarthritis (OA) is common in dogs and humans. Efficacy studies of analgesic drug treatment of dogs with naturally occurring OA may be challenging, as a caregiver placebo effect is typically evident. However, little is known about effect sizes of common outcome-measures in canine clinical trials evaluating treatment of OA pain. Forty-nine client-owned dogs with hip OA were enrolled in a randomized, double-blinded placebo-controlled prospective trial. After a 1 week baseline period, dogs were randomly assigned to a treatment (ABT-116 - transient receptor potential vanilloid 1 (TRPV1) antagonist, Carprofen - non-steroidal anti-inflammatory drug (NSAID), Tramadol - synthetic opiate, or Placebo) for 2 weeks. Outcome-measures included physical examination parameters, owner questionnaire, activity monitoring, gait analysis, and use of rescue medication. Acute hyperthermia developed after ABT-116 treatment (P < 0.001). Treatment with carprofen (P ≤ 0.01) and tramadol (P ≤ 0.001) led to improved mobility assessed by owner questionnaire. Nighttime activity was increased after ABT-116 treatment (P = 0.01). Kinetic gait analysis did not reveal significant treatment effects. Use of rescue treatment decreased with treatment in the ABT-116 and Carprofen groups (P < 0.001). Questionnaire score and activity count at the end of treatment were correlated with age, clinical severity at trial entry, and outcome measure baseline status (SR ≥ ±0.40, P ≤ 0.005). Placebo treatment effects were evident with all variables studied. Treatment of hip OA in client-owned dogs is associated with a placebo effect for all variables that are commonly used for efficacy studies of analgesic drugs. This likely reflects caregiver bias or the phenomenon of regression to the mean. In the present study, outcome measures with significant effects also varied between groups, highlighting the value of using multiple outcome measures, as well as an a priori analysis of effect size associated with each measure. Effect size data from the present study could be used to inform design of future trials studying analgesic treatment of canine OA. Our results suggest that analgesic treatment with ABT-116 is not as effective as carprofen or tramadol for treatment of hip arthritis pain in client-owned dogs.

Effect of analgesic therapy on clinical outcome measures in a randomized controlled trial using client-owned dogs with hip osteoarthritis

PubMed Central

2012-01-01

Background Pain and impaired mobility because of osteoarthritis (OA) is common in dogs and humans. Efficacy studies of analgesic drug treatment of dogs with naturally occurring OA may be challenging, as a caregiver placebo effect is typically evident. However, little is known about effect sizes of common outcome-measures in canine clinical trials evaluating treatment of OA pain. Forty-nine client-owned dogs with hip OA were enrolled in a randomized, double-blinded placebo-controlled prospective trial. After a 1 week baseline period, dogs were randomly assigned to a treatment (ABT-116 – transient receptor potential vanilloid 1 (TRPV1) antagonist, Carprofen – non-steroidal anti-inflammatory drug (NSAID), Tramadol - synthetic opiate, or Placebo) for 2 weeks. Outcome-measures included physical examination parameters, owner questionnaire, activity monitoring, gait analysis, and use of rescue medication. Results Acute hyperthermia developed after ABT-116 treatment (P < 0.001). Treatment with carprofen (P ≤ 0.01) and tramadol (P ≤ 0.001) led to improved mobility assessed by owner questionnaire. Nighttime activity was increased after ABT-116 treatment (P = 0.01). Kinetic gait analysis did not reveal significant treatment effects. Use of rescue treatment decreased with treatment in the ABT-116 and Carprofen groups (P < 0.001). Questionnaire score and activity count at the end of treatment were correlated with age, clinical severity at trial entry, and outcome measure baseline status (SR ≥ ±0.40, P ≤ 0.005). Placebo treatment effects were evident with all variables studied. Conclusion Treatment of hip OA in client-owned dogs is associated with a placebo effect for all variables that are commonly used for efficacy studies of analgesic drugs. This likely reflects caregiver bias or the phenomenon of regression to the mean. In the present study, outcome measures with significant effects also varied between groups, highlighting the value of using multiple outcome measures, as well as an a priori analysis of effect size associated with each measure. Effect size data from the present study could be used to inform design of future trials studying analgesic treatment of canine OA. Our results suggest that analgesic treatment with ABT-116 is not as effective as carprofen or tramadol for treatment of hip arthritis pain in client-owned dogs. PMID:23035739

Cross-cultural adaptation and validation of the Turkish version of Oxford hip score.

PubMed

Tuğay, Baki Umut; Tuğay, Nazan; Güney, Hande; Hazar, Zeynep; Yüksel, İnci; Atilla, Bülent

2015-06-01

The purpose of this study was to translate the Oxford hip score (OHS) into Turkish and to evaluate the psychometric properties by testing the internal consistency, reproducibility, construct validity, and responsiveness in patients with hip osteoarthritis (OA). Oxford hip score was translated and culturally adapted according to the guidelines in the literature. Seventy patients (mean age 61.45 ± 9.29 years) with hip osteoarthritis participated in the study. Patients completed the Turkish Oxford hip score (OHS-TR), the Short-Form 36 (SF-36), and Western Ontario and McMaster Universities Index (WOMAC). Internal consistency was tested using Cronbach's α coefficient. Patients completed OHS-TR questionnaire twice in 7 days for determining the reproducibility. Correlation between the total results of both tests was determined by the Pearson correlation coefficient and intraclass correlation coefficient (ICC). Validity was assessed by calculating the Pearson correlation coefficient between the OHS-TR and WOMAC and SF-36 scores. Floor and ceiling effects were analyzed. The internal consistency was high (Cronbach's α 0.93). The construct validity showed a significant correlation between the OHS-TR and WOMAC and related SF-36 domains (p < 0.001). The ICC's ranged between 0.80 and 0.99. There was no floor or ceiling effect in total OHS-TR score. The OHS-TR questionnaire is valid, reliable, and responsive for the Turkish-speaking patients with hip OA.

Reference genes for normalization of gene expression studies in human osteoarthritic articular cartilage.

PubMed

Pombo-Suarez, Manuel; Calaza, Manuel; Gomez-Reino, Juan J; Gonzalez, Antonio

2008-01-29

Assessment of gene expression is an important component of osteoarthritis (OA) research, greatly improved by the development of quantitative real-time PCR (qPCR). This technique requires normalization for precise results, yet no suitable reference genes have been identified in human articular cartilage. We have examined ten well-known reference genes to determine the most adequate for this application. Analyses of expression stability in cartilage from 10 patients with hip OA, 8 patients with knee OA and 10 controls without OA were done with classical statistical tests and the software programs geNorm and NormFinder. Results from the three methods of analysis were broadly concordant. Some of the commonly used reference genes, GAPDH, ACTB and 18S RNA, performed poorly in our analysis. In contrast, the rarely used TBP, RPL13A and B2M genes were the best. It was necessary to use together several of these three genes to obtain the best results. The specific combination depended, to some extent, on the type of samples being compared. Our results provide a satisfactory set of previously unused reference genes for qPCR in hip and knee OA This confirms the need to evaluate the suitability of reference genes in every tissue and experimental situation before starting the quantitative assessment of gene expression by qPCR.

Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively.

PubMed

Tomaru, Yohei; Yoshioka, Tomokazu; Sugaya, Hisashi; Aoto, Katsuya; Wada, Hiroshi; Akaogi, Hiroshi; Yamazaki, Masashi; Mishima, Hajime

2017-07-06

We had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH. In total, 222 patients (341 hips) with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH (238 hips), and 38 further patients had unilateral asymptomatic ONFH (38 hips). In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% (31/38). Therefore, the present study included 31 patients (19 males and 12 females), with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association (JOA) classification. Secondary collapse of the femoral head was observed in 6/10 hips and 5/10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients (3/31 hips), at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH. Early diagnosis of ONFH (i.e., before femoral head collapse) and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH.

Femoral head shape differences during development may identify hips at risk of degeneration.

PubMed

Vanden Berg-Foels, Wendy S; Schwager, Steven J; Todhunter, Rory J; Reeves, Anthony P

2011-12-01

Developmental dysplasia of the hip (DDH) is a common cause of elevated contact stress and early onset osteoarthritis (OA). We hypothesized that adaptation to focal loading during postnatal development would result in signature changes to the shape of the femoral head secondary center of ossification (SCO). SCO shape was evaluated in a canine model of DDH at ages 14 and 32 weeks. The evolving 3D morphology of the SCO was captured using serial quantitative computed tomography. A discrete medial representation shape model was fit to each SCO and served as the basis for quantitative thickness and bending measurements. Shape measurements were tested for associations with hip subluxation and degeneration. At 32 weeks, the SCO was thinner (flatter) in the perifoveal region, the site of focal loading; a greater bend to the SCO was present lateral to the site of thinning; SCO thinning and bending were associated with less femoral head coverage and with a higher probability of degeneration. Shape changes were not detected at 14 weeks. Measurement and visualization of SCO shape changes due to altered loading may provide a basis for identifying hips at risk of early onset OA and a tool for surgical planning of hip restructuring.

The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult

PubMed Central

Li, Ya-Min; Li, Jue-Hong; Li, Bin; Wang, Jia-Xing; Chen, Yun-Su

2016-01-01

Objectives To investigate whether adult patients with unilateral developmental dysplasia of the hip (UDDH) have pelvic asymmetry and what correlation existing between them. Methods A total of 100 adult patients with UDDH were enrolled in the retrospective observational study in Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China, between January 2012 and February 2014. The anteroposterior pelvic radiographs were reviewed and the pelvic heights and ischium heights were measured and compared between the affected and non-affected sides to find out the relationship between the pelvic morphology and hip dysplasia. Results The pelvic heights demonstrated significant differences between the non-affected side and the affected side in patients with Crowe type II-IV UDDH (p<0.05), but not in patients with Crowe type I UDDH (p=0.09). There were significant differences in the bilateral ischium heights in patients with Crowe type III and IV UDDH (p<0.05), but not in patients with Crowe type I and II UDDH (p=0.78, p=0.055). In addition, the degree of hip dysplasia was positively associated with the degrees of asymmetry of pelvis (r=0.78, p<0.001) and ischium (r=0.72, p<0.001) in UDDH patients. Conclusion The pelvic asymmetry exists in adult patients with UDDH. In addition, the degree of asymmetry has correlation with the degree of hip dysplasia. We recommend that it should be taken more cautions to use teardrops and ischial tuberosity as anatomy landmarks to balance leg-length discrepancy for unilateral DDH patients in preoperative planning and total hip arthroplasty. PMID:27874150

The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis.

PubMed

Arnold, Cathy M; Faulkner, Robert A

2010-07-01

To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis (OA). Seventy-nine adults, 65 years of age or older with hip OA and at least 1 fall risk factor, were randomly assigned to 1 of 3 groups: aquatics and education (AE; aquatic exercise twice a wk with once-a-wk group education), aquatics only (A; 2 wk aquatic exercise) and control (C; usual activity). Balance, falls efficacy, dual-task function, functional performance (chair stands), and walking performance were measured pre- and postintervention or control period. There was a significant improvement in fall risk factors (full-factorial MANCOVA, baseline values as covariates; p = .038); AE improved in falls efficacy compared with C and in functional performance compared with A and C. The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis.

Differences in Osteoarthritis Self-Management Support Intervention Outcomes According to Race and Health Literacy

ERIC Educational Resources Information Center

Sperber, Nina R.; Bosworth, Hayden B.; Coffman, Cynthia J.; Lindquist, Jennifer H.; Oddone, Eugene Z.; Weinberger, Morris; Allen, Kelli D.

2013-01-01

We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain…

Biomechanical balance response during induced falls under dual task conditions in people with knee osteoarthritis.

PubMed

Levinger, Pazit; Nagano, Hanatsu; Downie, Calum; Hayes, Alan; Sanders, Kerrie M; Cicuttini, Flavia; Begg, Rezaul

2016-07-01

People with knee osteoarthritis (OA) are at twice the risk of falling compared to older people without knee OA, however the mechanism for this is poorly understood. This study investigated the biomechanical response of the trunk and lower limb joints during a forward induced fall under different task conditions in people with and without knee OA. Twenty-four participants with OA (68.6±6.2 years) and 15 asymptomatic controls (72.4±4.8 years) participated in the study. Forward fall was induced by releasing participants from a static forward leaning position. Participants were required to recover balance during three conditions: normal, physical (obstacle clearance) and cognitive dual tasks (counting backwards). Spatiotemporal parameters, lower limb joint kinematics and kinetics of the recovery limb were compared between the two groups and across the three task conditions. The OA group demonstrated slower spatio-temporal characteristics and reduced hip and knee flexion angles, joint moments/powers and reduced muscle negative work at the knee and ankle (p<0.05). Cognitive dual task resulted in reduced centre of mass velocity and step length (p=0.03) compared to the physical dual task condition. Reduced knee (p=0.02) and hip joint powers (p=0.03) were demonstrated in the OA group in the physical task condition. When simulating a forward fall, participants with OA demonstrated difficulty in absorbing the impact and slowing down the forward momentum of the body during a recovery step. Moreover, poor dynamic postural control was demonstrated as task complexity increased. Copyright © 2016 Elsevier B.V. All rights reserved.

Swing limb mechanics and minimum toe clearance in people with knee osteoarthritis.

PubMed

Levinger, Pazit; Lai, Daniel T H; Menz, Hylton B; Morrow, Adam D; Feller, Julian A; Bartlett, John R; Bergman, Neil R; Begg, Rezaul

2012-02-01

Knee osteoarthritis (OA) has been shown to be a risk factor for falls. Reductions in foot clearance during the swing phase of walking can cause a trip and potentially lead to a fall. This study examined the swing phase mechanics of people with and without knee OA during walking. Minimum toe clearance (MTC) height, joint angles at the time of MTC and the influence of the angular changes of the hip, knee and ankle of the swing leg on foot clearance using sensitivity analysis were investigated in 50 knee OA participants and 28 age-matched asymptomatic controls. Although both groups had a similar MTC height (controls: 12.8±6.7 mm, knee OA: 13.4±7.0 mm), the knee OA group used a different strategy to achieve the same foot clearance, as evidenced by greater knee flexion (52.5±5.3° vs 49.4±4.8°, p=0.007), greater hip abduction (-3.6±3.3° vs -1.8±3.3°, p=0.03) and less ankle adduction (2.8±1.9° vs 4.2±2.1°, p=0.01). MTC height was comparable between the groups, however a different swing phase mechanism was used by the knee OA. Although adequate MTC is an important component of safe locomotion, it does not appear to be impaired in people with knee OA. Other factors, such as inadequate responses to postural perturbation, may be responsible for falls in this group. Copyright © 2011 Elsevier B.V. All rights reserved.

Advanced hip osteoarthritis: magnetic resonance imaging aspects and histopathology correlations.

PubMed

Leydet-Quilici, H; Le Corroller, T; Bouvier, C; Giorgi, R; Argenson, J-N; Champsaur, P; Pham, T; de Paula, A Maues; Lafforgue, P

2010-11-01

To correlate magnetic resonance imaging (MRI) aspects of the femoral head with histological findings in advanced hip osteoarthritis (OA), with special emphasis on bone marrow edema (BME). MRI was performed in patients with advanced hip OA scheduled for hip arthroplasty. Coronal T1-, fat-suppressed T2-, T1 with gadolinium intravenous injection sequences were obtained on a 1.5 T MR-scanner within 1 month before surgery. Coronal MR images corresponding to the ligamentum teres plane were analyzed by two independent readers blinded to histological data. Normal bone marrow, subchondral cyst, subchondral fracture, edema-like, necrosis-like, and necrosis MR patterns were reported on a synthesis scheme. After surgery, the femoral heads specimens were cut through the ligamentum teres plane and histologically analyzed for correlations. Twenty-three femoral heads were analyzed (female 56.5%, mean age 64.5 years). Edema-like MR pattern was correlated with histological (H) edema (Kappa (K): 0.77). Necrosis-like MR pattern was correlated with H fibrosis (K: 0.49) and with H necrosis (K: 0.24). Cyst MR pattern was correlated with H bone cysts (K: 0.58). Necrosis MR pattern corresponded to a mixture of histological lesions. Sensitivity and specificity of MRI varied from 26% to 80% and from 86% to 95% respectively. In advanced hip OA, the so-called "BME" MR lesion corresponds to a combination of edema, fibrosis, and necrosis at histopathology. When the classical "BME" is more specifically separated into edema-like and necrosis-like MR patterns, MR Imaging and histological findings show substantial agreement, with edema-like MR pattern mainly corresponding to histological edema. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Does clinical presentation predict response to a nonsurgical chronic disease management program for endstage hip and knee osteoarthritis?

PubMed

Eyles, Jillian P; Lucas, Barbara R; Patterson, Jillian A; Williams, Matthew J; Weeks, Kate; Fransen, Marlene; Hunter, David J

2014-11-01

To identify baseline characteristics of participants who will respond favorably following 6 months of participation in a chronic disease management program for hip and knee osteoarthritis (OA). This prospective cohort study assessed 559 participants at baseline and following 6 months of participation in the Osteoarthritis Chronic Care Program. Response was defined as the minimal clinically important difference of an 18% and 9-point absolute improvement in the Western Ontario and McMaster Universities Arthritis Index global score. Multivariate logistic regression modeling was used to identify predictors of response. Complete data were available for 308 participants. Those who withdrew within the study period were imputed as nonresponders. Three variables were independently associated with response: signal joint (knee vs hip), sex, and high level of comorbidity. Index joint and sex were significant in the multivariate model, but the model was not a sensitive predictor of response. Strong predictors of response to a chronic disease management program for hip and knee OA were not identified. The significant predictors that were found should be considered in future studies.

Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres

PubMed Central

Dieppe, Paul; Judge, Andrew; Williams, Susan; Ikwueke, Ifeoma; Guenther, Klaus-Peter; Floeren, Markus; Huber, Joerg; Ingvarsson, Thorvaldur; Learmonth, Ian; Lohmander, L Stefan; Nilsdotter, Anna; Puhl, Wofhart; Rowley, David; Thieler, Robert; Dreinhoefer, Karsten

2009-01-01

Background Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation. Methods A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC – Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out. Results Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common. Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores. Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment. Conclusion 1. Clinical disease severity varies widely at the time of THR for OA. 2. In advanced hip OA clinical severity shows no correlation with radiographic severity. 3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR. PMID:19208230

Muscle contributions to knee extension in the early stance phase in patients with knee osteoarthritis.

PubMed

Ogaya, Shinya; Kubota, Ryo; Chujo, Yuta; Hirooka, Eiko; Kwang-Ho, Kim; Hase, Kimitaka

2017-10-01

The aim of this study was to analyze individual muscle contributions to knee angular acceleration using a musculoskeletal simulation analysis and evaluate knee extension mechanics in the early stance phase in patients with knee osteoarthritis (OA). The subjects comprised 15 patients with medial knee OA and 14 healthy elderly individuals. All participants underwent gait performance test using 8 infrared cameras and two force plates to measure the kinetic and kinematic data. The simulation was driven by 92 Hill-type muscle-tendon units of the lower extremities and a trunk with 23° of freedom. We analyzed each muscle contribution to knee angular acceleration in the 5%-15% and 15%-25% periods of the stance phase (% SP) using an induced acceleration analysis. We compared accelerations by individual muscles between the two groups using an analysis of covariance for controlling gait speed. Patients with knee OA had a significantly lesser knee extension acceleration by the vasti muscles and higher knee acceleration by hip adductors than those in controls in 5-15% SP. In addition, knee OA resulted in significantly lesser knee extension acceleration by the vasti muscles in 15-25% SP. These results indicate that patients with knee OA have decreased dependency on the vasti muscles to control knee movements during early stance phase. Hip adductor muscles, which mainly control mediolateral motion, partly compensate for the weak knee extension by the vasti muscles in patients with knee OA. Copyright © 2017 Elsevier B.V. All rights reserved.

Widespread epigenomic, transcriptomic and proteomic differences between hip osteophytic and articular chondrocytes in osteoarthritis.

PubMed

Steinberg, Julia; Brooks, Roger A; Southam, Lorraine; Bhatnagar, Sahir; Roumeliotis, Theodoros I; Hatzikotoulas, Konstantinos; Zengini, Eleni; Wilkinson, J Mark; Choudhary, Jyoti S; McCaskie, Andrew W; Zeggini, Eleftheria

2018-05-08

To identify molecular differences between chondrocytes from osteophytic and articular cartilage tissue from OA patients. We investigated genes and pathways by combining genome-wide DNA methylation, RNA sequencing and quantitative proteomics in isolated primary chondrocytes from the cartilaginous layer of osteophytes and matched areas of low- and high-grade articular cartilage across nine patients with OA undergoing hip replacement surgery. Chondrocytes from osteophytic cartilage showed widespread differences to low-grade articular cartilage chondrocytes. These differences were similar to, but more pronounced than, differences between chondrocytes from osteophytic and high-grade articular cartilage, and more pronounced than differences between high- and low-grade articular cartilage. We identified 56 genes with significant differences between osteophytic chondrocytes and low-grade articular cartilage chondrocytes on all three omics levels. Several of these genes have known roles in OA, including ALDH1A2 and cartilage oligomeric matrix protein, which have functional genetic variants associated with OA from genome-wide association studies. An integrative gene ontology enrichment analysis showed that differences between osteophytic and low-grade articular cartilage chondrocytes are associated with extracellular matrix organization, skeletal system development, platelet aggregation and regulation of ERK1 and ERK2 cascade. We present a first comprehensive view of the molecular landscape of chondrocytes from osteophytic cartilage as compared with articular cartilage chondrocytes from the same joints in OA. We found robust changes at genes relevant to chondrocyte function, providing insight into biological processes involved in osteophyte development and thus OA progression.

Osteoarthritis year in review 2015: rehabilitation and outcomes.

PubMed

Bennell, K L; Hall, M; Hinman, R S

2016-01-01

The purpose of this narrative review was to highlight recent research in the rehabilitation of people with osteoarthritis (OA) by summarizing findings from selected key systematic reviews and randomized controlled trials (RCTs). A systematic search was conducted using the PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane databases from April 1st 2014 to March 31st 2015. A selection of these is discussed based on study quality, relevance, contribution to new knowledge or controversial findings. Methodological quality of RCTs was assessed using guidelines from PEDro. From 274 articles, 74 were deemed to meet the eligibility criteria including 24 systematic reviews and 50 studies reporting on findings from RCTs. Overall the methodological quality of the RCTs was moderate. The studies were grouped into several themes covering; evidence of rehabilitation outcomes in less studied joints including the hand and hip; new insights into exercise in knee OA; effects of biomechanical treatments on symptoms and structure in knee OA; and effects of acupuncture. Exercise was the most common treatment evaluated. Although little evidence supported benefit of exercise for hand OA, exercise has positive effects for hip and knee OA symptoms and these benefits may depend upon patient phenotypes. The first evidence that a brace can influence knee joint structure emerged. The latest evidence suggests that acupuncture has, at best, small treatment effects on knee OA pain of unlikely clinical relevance. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Malalignment and subchondral bone turnover in contralateral knees of overweight/obese women with unilateral osteoarthritis: implications for bilateral disease.

PubMed

Mazzuca, Steven A; Brandt, Kenneth D; Lane, Kathleen A; Chakr, Rafael

2011-11-01

To explore whether the risk of incident tibiofemoral (TF) osteoarthritis (OA) in the radiographically normal contralateral knee of overweight/obese women with unilateral knee OA is mediated by malalignment and/or preceded by increased turnover of subchondral bone. We used data of post hoc analyses from a randomized controlled trial. Cross-sectional analyses evaluated the baseline association between frontal plane alignment and bone turnover in the medial TF compartment in 78 radiographically normal contralateral knees. Longitudinal analyses ascertained whether incident radiographic OA (TF osteophyte formation within 30 months) was associated with malalignment and/or increased bone turnover at baseline. Alignment subcategories (varus/neutral/valgus) were based on the anatomic axis angle. (99m)Tc-methylene diphosphonate uptake in a late-phase bone scan was quantified in regions of interest in the medial tibia (MT) and medial femur (MF) and adjusted for uptake in a reference segment of the ipsilateral tibial shaft (TS). MF and MT uptake in varus contralateral knees was 50-55% greater than in the TS. Adjusted MT uptake in varus contralateral knees was significantly greater than that in neutral and valgus contralateral knees (mean 1.55 versus 1.38 and 1.43, respectively; P < 0.05). Among 69 contralateral knees followed longitudinally, 22 (32%) developed TF OA. Varus angulation was associated with a marginally significant increase in the odds of incident OA (adjusted odds ratio 3.98, P = 0.067). While the small sample size limited our ability to detect statistically significant risk factors, these data suggest that the risk of developing bilateral TF OA in overweight/obese women may be mediated by varus malalignment. Copyright © 2011 by the American College of Rheumatology.

Finite element analysis of mechanical behavior of human dysplastic hip joints: a systematic review.

PubMed

Vafaeian, B; Zonoobi, D; Mabee, M; Hareendranathan, A R; El-Rich, M; Adeeb, S; Jaremko, J L

2017-04-01

Developmental dysplasia of the hip (DDH) is a common condition predisposing to osteoarthritis (OA). Especially since DDH is best identified and treated in infancy before bones ossify, there is surprisingly a near-complete absence of literature examining mechanical behavior of infant dysplastic hips. We sought to identify current practice in finite element modeling (FEM) of DDH, to inform future modeling of infant dysplastic hips. We performed multi-database systematic review using PRISMA criteria. Abstracts (n = 126) fulfilling inclusion criteria were screened for methodological quality, and results were analyzed and summarized for eligible articles (n = 12). The majority of the studies modeled human adult dysplastic hips. Two studies focused on etiology of DDH through simulating mechanobiological growth of prenatal hips; we found no FEM-based studies in infants or children. Finite element models used either patient-specific geometry or idealized average geometry. Diversities in choice of material properties, boundary conditions, and loading scenarios were found in the finite-element models. FEM of adult dysplastic hips demonstrated generally smaller cartilage contact area in dysplastic hips than in normal joints. Contact pressure (CP) may be higher or lower in dysplastic hips depending on joint geometry and mechanical contribution of labrum (Lb). FEM of mechanobiological growth of prenatal hip joints revealed evidence for effects of the joint mechanical environment on formation of coxa valga, asymmetrically shallow acetabulum and malformed femoral head associated with DDH. Future modeling informed by the results of this review may yield valuable insights into optimal treatment of DDH, and into how and why OA develops early in DDH. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Thorax, pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis

PubMed Central

Molina-Rueda, Francisco; Alguacil-Diego, Isabel M.; Cuesta-Gómez, Alicia; Iglesias-Giménez, Javier; Martín-Vivaldi, Andrés; Miangolarra-Page, Juan C.

2014-01-01

Background: Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability. Objectives: The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA). Method: The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane. Results: The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01). Conclusions: The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking. PMID:25003278

End-stage coxarthrosis and gonarthrosis. Aetiology, clinical patterns and radiological features of idiopathic osteoarthritis.

PubMed

Chitnavis, J; Sinsheimer, J S; Suchard, M A; Clipsham, K; Carr, A J

2000-06-01

To determine and compare the aetiological background, clinical patterns and radiological features of idiopathic osteoarthritis (OA) of the hip and the knee warranting arthroplasty. A total of 402 Caucasians consecutively undergoing total hip replacement (THR) or total knee replacement (TKR) for idiopathic OA at a major centre was surveyed. Previous joint injury was more common in the TKR group (P < 0.0001). However, both groups manifested a mixed occupational background, body mass indices similar to the general population and a predominance of females (F:M = 1.3-1.4:1). The TKR group had a significantly younger age of symptom onset (56 yr) than the THR group (61 yr) but both groups had a tendency to bilateral arthroplasty (33%), nodal involvement (54-59%), a significant excess of right-sided replacements (1.8:1, THR; 2.2:1, TKR) and similar levels of pre-operative pain and disability. Up to 40% of hips manifested acetabular dysplasia and 10% possible previous slipped upper femoral epiphyses. Eighty-five per cent with end-stage coxarthrosis or gonarthrosis had an identical pattern of radiographic disease contralaterally. Our data suggest the importance of a constitutional tendency to idiopathic, end-stage OA, a disorder traditionally associated with environmental factors leading to 'wear and tear'.

Risk Factors for Falls in Older Adults with Lower Extremity Arthritis: A Conceptual Framework of Current Knowledge and Future Directions

PubMed Central

Gyurcsik, Nancy C.

2012-01-01

ABSTRACT Purpose: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. Method: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. Results: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. Conclusion: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning. PMID:23729967

Gender comparisons between unilateral and bilateral landings.

PubMed

Weinhandl, Joshua T; Joshi, Mukta; O'Connor, Kristian M

2010-11-01

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as "stiff" landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

Worse health-related quality of life and hip function in female patients with elevated chromium levels

PubMed Central

Hussey, Daniel K; Madanat, Rami; Donahue, Gabrielle S; Rolfson, Ola; Muratoglu, Orhun K; Malchau, Henrik

2016-01-01

Background and purpose Blood metal ion levels can be an indicator for detecting implant failure in metal-on-metal (MoM) hip arthroplasties. Little is known about the effect of bilateral MoM implants on metal ion levels and patient-reported outcomes. We compared unilateral patients and bilateral patients with either an ASR hip resurfacing (HR) or an ASR XL total hip replacement (THR) and investigated whether cobalt or chromium was associated with a broad spectrum of patient outcomes. Patients and methods From a registry of 1,328 patients enrolled in a multicenter prospective follow-up of the ASR Hip System, which was recalled in 2010, we analyzed data from 659 patients (311 HR, 348 THR) who met our inclusion criteria. Cobalt and chromium blood metal ion levels were measured and a 21-item patient-reported outcome measures (PROMs) questionnaire was used mean 6 years after index surgery. Results Using a minimal threshold of ≥7 ppb, elevated chromium ion levels were found to be associated with worse health-related quality of life (HRQoL) (p < 0.05) and hip function (p < 0.05) in women. These associations were not observed in men. Patients with a unilateral ASR HR had lower levels of cobalt ions than bilateral ASR HR patients (p < 0.001) but similar levels of chromium ions (p = 0.09). Unilateral ASR XL THR patients had lower chromium and cobalt ion levels (p < 0.005) than bilateral ASR XL THR patients. Interpretation Chromium ion levels of ≥7 ppb were associated with reduced functional outcomes in female MoM patients. PMID:27459602

The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult.

PubMed

Li, Ya-Min; Li, Jue-Hong; Li, Bin; Wang, Jia-Xing; Chen, Yun-Su

2016-12-01

To investigate whether adult patients with unilateral developmental dysplasia of the hip (UDDH) have pelvic asymmetry and what correlation existing between them. Methods: A total of 100 adult patients with UDDH were enrolled in the retrospective observational study in Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China, between January 2012 and February 2014. The anteroposterior pelvic radiographs were reviewed and the pelvic heights and ischium heights were measured and compared between the affected and non-affected sides to find out the relationship between the pelvic morphology and hip dysplasia. Results: The pelvic heights demonstrated significant differences between the non-affected side and the affected side in patients with Crowe type II-IV UDDH (p less than 0.05), but not in patients with Crowe type I UDDH (p=0.09). There were significant differences in the bilateral ischium heights in patients with Crowe type III and IV UDDH (p less than 0.05), but not in patients with Crowe type I and II UDDH (p=0.78, p=0.055). In addition, the degree of hip dysplasia was positively associated with the degrees of asymmetry of pelvis (r=0.78, p less than 0.001) and ischium (r=0.72, p less than 0.001) in UDDH patients. Conclusion: The pelvic asymmetry exists in adult patients with UDDH. In addition, the degree of asymmetry has correlation with the degree of hip dysplasia. We recommend that it should be taken more cautions to use teardrops and ischial tuberosity as anatomy landmarks to balance leg-length discrepancy for unilateral DDH patients in preoperative planning and total hip arthroplasty.

MRI and the distribution of bone marrow fat in hip osteoarthritis.

PubMed

Gregory, Jennifer S; Barr, Rebecca J; Varela, Victor; Ahearn, Trevor S; Gardiner, Jennifer Lee; Gilbert, Fiona J; Redpath, Thomas W; Hutchison, James D; Aspden, Richard M

2017-01-01

To characterize the distribution of bone marrow fat in hip osteoarthritis (OA) using magnetic resonance imaging (MRI) and to assess its use as a potential biomarker. In all, 67 subjects (39 female, 28 male) with either total hip replacement (THA) or different severities of radiographic OA, assessed by Kellgren-Lawrence grading (KLG), underwent 3T MRI of the pelvis using the IDEAL sequence to separate fat and water signals. Six regions of interest (ROIs) were identified within the proximal femur. Within each ROI the fractional-fat distribution, represented by pixel intensities, was described by its mean, standard deviation, skewness, kurtosis, and entropy. Hips were graded: 12 as severe symptomatic (THA), 33 had KLG0 or 1, 9 were KLG2, 11 with KLG3, and 2 with KLG4 were analyzed together. The fractional-fat content in the whole proximal femur did not vary with severity in males (mean (SD) 91.2 (6.0)%) but reduced with severity in females from 89.1 (6.7)% (KLG0,1), 91.5 (2.9)% (KLG2), 85.8 (16.7)% (KLG3,4) to 77.5 (11.9)% (THA) (analysis of variance [ANOVA] P = 0.029). These differences were most pronounced in the femoral head, where mean values fell with OA severity in both sexes from 97.9% (2.5%) (KLG0,1) to 73.0% (25.9%) (THA, P < 0.001) with the largest difference at the final stage. The standard deviation and the entropy of the distribution both increased (P < 0.001). Descriptors of the fractional fat distribution varied little with the severity of OA until the most severe stage, when changes appeared mainly in the femoral head, and have, therefore, limited value as biomarkers. 2 J. Magn. Reson. Imaging 2017;45:42-50. © 2016 International Society for Magnetic Resonance in Medicine.

Systems for implementing best practice for a chronic disease: management of osteoarthritis of the hip and knee.

PubMed

Brand, C; Cox, S

2006-03-01

Effective implementation of evidence-based care has been associated with better health outcomes; however, evidence-based clinical practice guidelines have been used with varying success. This study aimed to develop integrative tools to support implementation of best practice recommendations for nonsurgical management of osteoarthritis (OA) of the hip and knee and to identify barriers to effective implementation. Published, peer reviewed clinical practice guidelines were updated and translated into an OA care pathway. Key decision nodes in the pathway were identified by a Multidisciplinary Working Group. Qualitative research methods were used to inform pathway development and to identify barriers and enablers for pathway implementation. Qualitative components included purposively selected stakeholder focus groups, key informant interviews and patient process mapping of 10 patient journeys in different settings over a 3-month period. All interviews, facilitated by a trained project officer, were semistructured, recorded, then thematically analysed and summarized. An OA care pathway, clinician and patient toolkits were developed that met the needs of multidisciplinary end-users. Several system- and setting-specific barriers to pathway implementation were identified. Opportunities to improve patient access, interprofessional communication, patient information and education and continuity of care processes were identified. Integrative tools for implementation of best evidence care for patients with OA of the hip and knee were tailored to end-user needs and preferences. Multiple barriers exist that potentially limit effective implementation of best evidence. Comprehensive assessment of barriers and enablers to effective guideline or pathway implementation is recommended before implementation and evaluation.

Patient-reported outcomes to initiate a provider-patient dialog for the management of hip and knee osteoarthritis.

PubMed

Golightly, Yvonne M; Allen, Kelli D; Nyrop, Kirsten A; Nelson, Amanda E; Callahan, Leigh F; Jordan, Joanne M

2015-10-01

Although many treatment guidelines exist for hip and knee osteoarthritis (OA), uptake in clinical practice is typically low. Valid patient-reported outcome measures (PROs) that can be easily used in the clinic could aid implementation and evaluation of treatment recommendations, and the tracking of symptoms and function over time. This project responded to a 2012 Call to Action of the Chronic Osteoarthritis Management Initiative of the United States Bone and Joint Initiative; we aimed to develop a tiered list of recommended PROs that could be feasibly applied in common clinical settings, across four domains of pain, function, fatigue, and sleep. PROs were identified through a focused literature review. Clinicians and researchers with OA expertise evaluated each measure' feasibility for use in routine clinical practice, followed by meaningfulness in assessing OA outcomes. Eligible PROs were categorized by domain and ranked into Tiers One (very brief measures for initial use in clinical settings), Two (brief measures with more in-depth assessment), and Three (most detailed assessment). Total PROs identified were 172 for pain, 160 for function, 55 for fatigue, and 60 for sleep. Of these, 9 pain, 7 function, 7 fatigue, and 8 sleep PROs were ranked into one of three tiers. This three-tiered list of recommended PROs provides a basis for tools to systematically track outcomes, facilitate provider-patient dialog, and guide treatment for hip or knee OA. Research is needed to test the utility and feasibility of systematic implementation of these measures in primary care and specialty clinical settings. Copyright © 2015 Elsevier Inc. All rights reserved.

Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial.

PubMed

French, Helen P; Cusack, Tara; Brennan, Aisling; Caffrey, Aoife; Conroy, Ronán; Cuddy, Vanessa; FitzGerald, Oliver M; Fitzpatrick, Martina; Gilsenan, Clare; Kane, David; O'Connell, Paul G; White, Breon; McCarthy, Geraldine M

2013-02-01

To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention. Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up. Four academic teaching hospitals in Dublin, Ireland. Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43). Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction. There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group. Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study.

PubMed

Maheu, Emmanuel; Cadet, Christian; Marty, Marc; Moyse, Dominique; Kerloch, Isabelle; Coste, Philippe; Dougados, Maxime; Mazières, Bernard; Spector, Tim D; Halhol, Hafid; Grouin, Jean-Marie; Lequesne, Michel

2014-02-01

To assess the ability of avocado-soybean unsaponifiable-Expanscience (ASU-E) to slow radiographic progression in symptomatic hip osteoarthritis (OA). Prospective, randomised, double blind, parallel group, placebo controlled 3 year trial. Patients with symptomatic (painful ≥1 year, Lequesne Index between 3 and 10) hip OA (American College of Rheumatology criteria) and a minimum joint space width (JSW) of the target hip between 1 and 4 mm on a pelvic radiograph were randomly assigned to 300 mg/day ASU-E or placebo. Standing pelvis, target hip anteroposterior (AP) and oblique views were taken annually. The primary outcome was JSW change at year 3, measured at the narrowest point on pelvic or target hip AP view (manual measure using a 0.1 mm graduated magnifying glass). The full analysis dataset (FAS) included all patients having at least two successive radiographs. An analysis of covariance Mixed Model for Repeated Measurements with Missing at Random (for missing data) was performed to compare adjusted 3 year JSW changes (primary outcome) and the percentages of 'progressors' (JSW loss≥0.5 mm) between groups. 399 patients were randomised (345 kept in the FAS), aged 62 (35-84) years, 54% women, mean body mass index 27 (SD 4) kg/m(2), mean symptom duration 4 (SD 5) years, 0-100 normalised Lequesne Index 30 (SD 9) and global pain visual analogue scale 37 (SD 23) mm. Mean baseline JSW was 2.8 (0.9) mm. There was no significant difference on mean JSW loss (-0.638 mm vs -0.672 mm, p=0.72, in the ASU-E and placebo groups, respectively) but there were 20% less progressors in the ASU-E than in the placebo group (40% vs 50%, respectively, p=0.040). No difference was observed on clinical outcomes. Safety was excellent. 3 year treatment with ASU-E reduces the percentage of JSW progressors, indicating a potential structure modifying effect in hip OA to be confirmed, and the clinical relevance requires further assessment.

National trends and in hospital outcomes for total hip arthroplasty in avascular necrosis in the United States.

PubMed

Mayers, William; Schwartz, Brian; Schwartz, Aaron; Moretti, Vincent; Goldstein, Wayne; Shah, Ritesh

2016-09-01

While a majority of total hip arthroplasty (THA) is performed for osteoarthritis (OA), a significant portion is performed in the setting of avascular necrosis (AVN). The purpose of this study is to evaluate recent trends, patient demographics, and in hospital outcomes for primary THA in the setting of AVN in the United States. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals after a primary THA for the years 2001-2010. Patients were then separated into two groups by ICD-9 diagnosis codes for OA and AVN. The rates of THA for AVN (r = 0.65) and THA for OA (r = 0.82) both demonstrated a positive correlation with time. The mean patient age of the AVN group was significantly lower (56.9 vs 65.9 years, p < 0.01). Men accounted for 51.9 % of the AVN group and 43.0 % of the OA group (p < 0.01). The AVN group had a significantly higher percentage of African Americans (11.2 % vs 5.4 %, p < 0.01) when compared to the OA group. The AVN group had a higher rate of myocardial infarction (0.3 % vs 0.07 %, p = 0.0163) and a higher average number of medical co-morbidities (5.16 vs 4.77, p < 0.01). Patients undergoing THA for AVN were more likely to be younger, male, African American, have more medical co-morbidities, and more likely to have a myocardial infarction than those with OA. While the number of primary THAs performed for AVN in the United States has increased over the past ten years, the rate of primary THA for OA increased at a much more rapid rate.

Dietary garlic and hip osteoarthritis: evidence of a protective effect and putative mechanism of action

PubMed Central

2010-01-01

Background Patterns of food intake and prevalent osteoarthritis of the hand, hip, and knee were studied using the twin design to limit the effect of confounding factors. Compounds found in associated food groups were further studied in vitro. Methods Cross-sectional study conducted in a large population-based volunteer cohort of twins. Food intake was evaluated using the Food Frequency Questionnaire; OA was determined using plain radiographs. Analyses were adjusted for age, BMI and physical activity. Subsequent in vitro studies examined the effects of allium-derived compounds on the expression of matrix-degrading proteases in SW1353 chondrosarcoma cells. Results Data were available, depending on phenotype, for 654-1082 of 1086 female twins (median age 58.9 years; range 46-77). Trends in dietary analysis revealed a specific pattern of dietary intake, that high in fruit and vegetables, showed an inverse association with hip OA (p = 0.022). Consumption of 'non-citrus fruit' (p = 0.015) and 'alliums' (p = 0.029) had the strongest protective effect. Alliums contain diallyl disulphide which was shown to abrogate cytokine-induced matrix metalloproteinase expression. Conclusions Studies of diet are notorious for their confounding by lifestyle effects. While taking account of BMI, the data show an independent effect of a diet high in fruit and vegetables, suggesting it to be protective against radiographic hip OA. Furthermore, diallyl disulphide, a compound found in garlic and other alliums, represses the expression of matrix-degrading proteases in chondrocyte-like cells, providing a potential mechanism of action. PMID:21143861

Barriers and facilitators to physical activity in people with hip or knee osteoarthritis: protocol for a systematic review of qualitative evidence

PubMed Central

Kanavaki, Archontissa M; Rushton, Alison; Klocke, Rainer; Abhishek, Abhishek; Duda, Joan L

2016-01-01

Introduction This protocol aims to describe the objective and methods to be followed in a systematic review of qualitative studies on barriers and facilitators to physical activity (PA) in people with hip or knee osteoarthritis (OA). Methods and analysis MEDLINE, EMBASE, PhychINFO, Web of Science, CINAHL, SPORTDiscus, Scopus and grey literature sources will be electronically searched. Hand search of qualitative research-centred journals, reference screening of relevant reviews and inquiries to researchers active in the field will complement the search. Studies will be selected if they apply qualitative or mixed-methods designs to directly explore factors that correspond to engagement in PA/exercise or, the perceptions regarding PA/exercise in people with hip or knee OA. The Critical Appraisal Skills Programme Qualitative Checklist and the evaluative criteria of credibility, transferability, dependability and confirmability will be applied for the study appraisal. 2 independent reviewers will perform the search, study selection and study appraisal. Thematic synthesis will be used for synthesising the findings of the primary studies and the process and product of the synthesis will be checked by a second researcher. ConQual approach will be used for assessing the confidence in the qualitative findings. Ethics and dissemination This systematic review will inform our understanding of the PA determinants and how to optimise behaviour change in people living with hip or knee OA. The review findings will be reported in a peer-reviewed journal and presented at national or international conferences. The study raises no ethical issues. Trial registration number CRD42016030024. PMID:27810971

Imaging of non-osteochondral tissues in osteoarthritis.

PubMed

Guermazi, A; Roemer, F W; Crema, M D; Englund, M; Hayashi, D

2014-10-01

The aim of this review is to describe imaging techniques for evaluation of non-osteochondral structures such as the synovium, menisci in the knee, labrum in the hip, ligaments and muscles and to review the literature from recent clinical and epidemiological studies of OA. This is a non-systematic narrative review of published literature on imaging of non-osteochondral tissues in OA. PubMed and MEDLINE search for articles published up to 2014, using the keywords osteoarthritis, synovitis, meniscus, labrum, ligaments, plica, muscles, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), scintigraphy, and positron emission tomography (PET). Published literature showed imaging of non-osteochondral tissues in OA relies primarily on MRI and ultrasound. The use of semiquantitative and quantitative imaging biomarkers of non-osteochondral tissues in clinical and epidemiological OA studies is reported. We highlight studies that have compared both imaging methodologies directly, and those that have established a relationship between imaging biomarkers and clinical outcomes. We provide recommendations as to which imaging protocols should be used to assess disease-specific changes regarding synovium, meniscus in the knee, labrum in the hip, and ligaments, and highlight potential pitfalls in their usage. MRI and ultrasound are currently the most useful imaging modalities for evaluation of non-osteochondral tissues in OA. MRI evaluation of any tissue needs to be performed using appropriate MR pulse sequences. Ultrasound may be particularly useful for evaluation of small joints of the hand. Nuclear medicine and CT play a limited role in imaging of non-osteochondral tissues in OA. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Notification: EPA Enforcement of Superfund Orders and Agreements

EPA Pesticide Factsheets

Project #OA&E-FY18-0215, May 10, 2018. The OIG plans to begin preliminary research on the EPA's enforcement of Superfund Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Response Settlements and Unilateral Response Orders.

Prevalence of radiological findings related to femoroacetabular impingement in professional baseball players in Japan.

PubMed

Fukushima, Kensuke; Takahira, Naonobu; Imai, Sousuke; Yamazaki, Tetsuya; Kenmoku, Tomonori; Uchiyama, Katsufumi; Takaso, Masashi

2016-11-01

Femoroacetabular impingement (FAI) is a known patho-mechanism that causes hip pain and osteoarthritis (OA) and is considered uncommon in Japan, while secondary OA due to hip dysplasia is considered common. However, no studies have specifically targeted athletes in Japan and/or Asia. This study aimed to determine FAI prevalence using radiological findings among baseball players playing on a professional, Japanese team. We retrospectively assessed 63 plain anteroposterior (AP) hip radiographs (126 hips from 47 [74.6%] Asian players and 16 [25.3%] non-Asian players) obtained for medical evaluations. Radiographs were used to measure lateral center-edge (LCE) angle; acetabular roof obliquity (ARO); and the presence of crossover sign (COS), posterior wall sign (PWS), coxa profunda, pistol grip deformity, herniation pits, and labral ossification. Further, the prevalence of radiographic indicators related to FAI was compared between Asian and non-Asian players. In the 126 hips examined, 10 hips (7.94%) were classified as having hip dysplasia (LCE angles < 20°). Of the remaining 116 hips, eight (6.9%) had LCE angles > 40°, and 24 hips (20.7%) had AROs of <0°, indicating acetabular over-coverage. In Asian players, COS was identified in 47 hips (54.0%), positive PWS in 38 hips (43.7%), positive coxa profunda in 8 hips (9.2%), and pistol grip deformity in 37 hips (42.5%). Further, herniation pits and positive labral ossification were identified in 25 (28.7%) and 11 (12.6%) hips, respectively. A comparative review of COS prevalence (Asians vs. non-Asians) revealed that COS was significantly higher in Asian players. No differences were observed in the mean LCE angle, mean ARO, or other radiographic indicators. Radiological indicators related to FAI were identified in 76.6% (72/94 hips) of the Asian professional baseball players; this prevalence was considerably higher than that reported for general Asian populations. We consider that elite Asian athletes may frequently show morphological deformities related to FAI. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Retinal Nerve Fiber Layer and Peripapillary Choroidal Thicknesses in Non-Glaucomatous Unilateral Optic Atrophy Compared with Unilateral Advanced Pseudoexfoliative Glaucoma.

PubMed

Kucukevcilioglu, Murat; Ayyildiz, Onder; Aykas, Seckin; Gokce, Gokcen; Koylu, Mehmet Talay; Ozgonul, Cem; Ozge, Gokhan; Mumcuoglu, Tarkan; Yumusak, Erhan

2017-02-01

To investigate retinal nerve fiber layer thickness (RNFL-T) and peripapillary choroidal thickness (PC-T) in non-glaucomatous optic atrophy (OA) patients in comparison with unaffected and control eyes, furthermore, to compare thickness profiles with unilateral pseudoexfoliative advanced glaucoma. Thirty-three eyes with OA (Group A), 33 unaffected fellow eyes (Group B), 25 right eyes of 25 control subjects (Group C), and 15 eyes with advanced glaucoma (Group D) were enrolled. RNFL-T was measured in six regions by spectral-domain optical coherence tomography. Enhanced depth imaging optical coherence tomography was obtained to evaluate PC-T in corresponding regions. RNFL-T was significantly lower in Group A than in Groups B and C globally and at all peripapillary regions (all p < 0.001). P-CT in Group A was significantly lower globally (p = 0.03) and in three regions (temporal, p = 0.001; temporal-superior, p = 0.01; and nasal-inferior, p = 0.037) versus Group C. However, it was significantly thinner than in Group B in all regions (temporal, p = 0.02; temporal-superior, p = 0.013; nasal-superior, p = 0.044; nasal, p = 0.02; nasal-inferior, p < 0.001; and temporal-inferior, p < 0.001) and globally (p < 0.001). In Group A RNFL-T (thicker superiorly and inferiorly; thinner temporally and nasally) and PC-T (superior > temporal > nasal > inferior) profiles were almost identical to that in unaffected fellow eyes and control eyes. However, Group D showed different patterns with less regional differences in RNFL-T, and the greatest value of PC-T in nasal quadrant. Besides retinal nerve fiber layer thinning, non-glaucomatous OA is associated with choroidal thinning. The RNFL-T and PC-T profiles in advanced glaucoma eyes differed from the common patterns seen among OA eyes, unaffected fellow eyes, and control eyes.

Higher BMC and areal BMD in children and grandchildren of individuals with hip or knee replacement.

PubMed

Specker, Bonny L; Wey, Howard E; Binkley, Teresa L; Beare, Tianna M; Smith, Eric P; Rauch, Frank

2010-04-01

The relationship between aBMD and osteoarthritis (OA) remains unclear. We compared aBMD, BMC and bone size among children and grandchildren of Hutterites with hip or knee replacement (n=23 each) to children and grandchildren of age- and sex-matched controls (178 children and 267 grandchildren). There were no differences in anthropometric measures or activity levels between case and control probands, but femoral neck (FN) and spine (LS) aBMD and Z-scores were greater in cases than controls (0.89 vs. 0.80 g/cm2; 1.15 vs. 1.03 g/cm2; 1.5 vs. 0.8; 2.4 vs. 1.2: all p<0.05). Hip, FN and LS aBMD (1.05 vs. 0.97, 0.92 vs. 0.84, 1.15 vs. 1.03 g/cm2), BMC (34.1 vs. 32.0, 4.58 vs. 4.27, 69.5 vs. 62.4 g) and Z-scores (1.0 vs. 0.4; 0.9 vs. 0.2; 1.3 vs. 0.2) were greater in daughters of cases than controls (hip BMC p=0.06, others p<0.05); there were no differences between sons. Grandchildren (aged 8-39 years) were categorized as growing (premenarcheal or male<14 years) or not growing (> or =2 years post-menarcheal or males> or =18 years): 33 were not classified. Post-menarcheal, but not premenarcheal, granddaughters of cases had greater hip, FN and LS aBMD Z-scores (0.7 vs. -0.1; 0.6 vs. -0.1; 0.8 vs. -0.3); greater hip and spine aBMD (1.03 vs. 0.95, 1.10 vs. 0.98 g/cm2); greater femoral neck and spine BMC (4.77 vs. 4.21, 66.7 vs. 55.4 g); and greater spine bone area (60.7 vs. 56.6 cm2) compared to granddaughters of controls (all, p<0.05), which remained significant when height, weight, and age were included as covariates. Growing grandsons of cases were taller and heavier than control grandsons, and a greater hip aBMD among grandsons of cases (0.88 vs. 0.76 g/cm2) was the only bone difference that remained significant after taking into account body size differences. Grandsons who were not growing had greater spine bone area (1.19 vs. 1.08 cm2) if their grandparent had OA compared to grandsons whose grandparents did not have OA. We speculate that there is a genetic basis for OA that leads to early differences in growth patterns among boys and greater peak bone mass and aBMD among girls. Copyright 2010 Elsevier Inc. All rights reserved.

Osteoarthritis 2012 year in review: rehabilitation and outcomes.

PubMed

Roos, E M; Juhl, C B

2012-12-01

Recent scientific advances in the treatment of hip and knee osteoarthritis (OA) relating to education, exercise, weight control and passive non-pharmacological and non-surgical treatments such as manual therapy, orthoses/orthotics and other aids are described. A systematic literature search was performed in Medline from July 2011 to 10 April 2012 using the terms 'osteoarthritis, knee', 'osteoarthritis, hip' rehabilitation, physical therapy, exercise therapy and preoperative intervention; both as text words and as MeSH terms where possible. Trials evaluating rehabilitation interventions were included if they were randomized controlled trials (RCTs) or systematic reviews. Outcome papers were identified by combining the initial search with the terms 'outcome', 'measure*', 'valid*', 'reliabil*' or 'responsiveness'. Outcome studies were included if they contributed methodologically to advancing outcome measurement. The literature search identified 550 potentially relevant papers. Seventeen RCTs on rehabilitation were selected and the results from these were supported by six systematic reviews. Sixteen outcomes papers were considered relevant, but did not add significantly to current knowledge about outcome measures in OA and so, were not included. The current research focus on non-pharmacological and non-surgical treatments for hip and/or knee OA, when combined in systematic reviews, is improving the available evidence to identify best practice treatment. Education, exercise and weight loss are effective in the long term and supported as cost-effective first-line treatments. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem.

PubMed

Brodén, Cyrus; Mukka, Sebastian; Muren, Olle; Eisler, Thomas; Boden, Henrik; Stark, André; Sköldenberg, Olof

2015-04-01

Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5). We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group.

High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem

PubMed Central

Brodén, Cyrus; Mukka, Sebastian; Muren, Olle; Eisler, Thomas; Boden, Henrik; Stark, André; Sköldenberg, Olof

2015-01-01

Background and purpose Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). Patients and methods In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52–102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1–7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. Results 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2–79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3–12). Patients > 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1–4.5). Interpretation We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group. PMID:25280133

Cross-sectional association between muscle strength and self-reported physical function in 195 hip osteoarthritis patients.

PubMed

Hall, Michelle; Wrigley, Tim V; Kasza, Jessica; Dobson, Fiona; Pua, Yong Hao; Metcalf, Ben R; Bennell, Kim L

2017-02-01

This study aimed to evaluate associations between strength of selected hip and knee muscles and self-reported physical function, and their clinical relevance, in men and women with hip osteoarthritis (OA). Cross-sectional data from 195 participants with symptomatic hip OA were used. Peak isometric torque of hip extensors, flexors, and abductors, and knee extensors were measured, along with physical function using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Separate linear regressions in men and women were used to determine the association between strength and physical function accounting for age, pain, and radiographic disease severity. Subsequently, magnitudes of strength associated with estimates of minimal clinically important improvement (MCII) in physical function were estimated according to severity of difficulty with physical function. For men, greater strength of the hip extensors, hip flexors and knee extensors were each associated with better physical function. For women, greater muscle strength of all tested muscles were each associated with better physical function. For men and women, increases in muscle strength between 17-32%, 133-223%, and 151-284% may be associated with estimates of MCII in physical function for those with mild, moderate, and severe physical dysfunction, respectively. Greater isometric strength of specific hip and thigh muscle groups may be associated with better self-reported physical function in men and women. In people with mild physical dysfunction, an estimate of MCII in physical function may be associated with attainable increases in strength. However, in patients with more severe dysfunction, greater and perhaps unattainable strength increases may be associated with an estimate of MCII in physical function. Longitudinal studies are required to validate these observations. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg

PubMed Central

Kahloul, Mohamed; Nakhli, Mohamed Said; Chouchene, Amine; Chebbi, Nidhal; Mhamdi, Salah; Naija, Walid

2017-01-01

Introduction Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. Methods In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients’ socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Results Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. Conclusion The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability. PMID:29515726

Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg.

PubMed

Kahloul, Mohamed; Nakhli, Mohamed Said; Chouchene, Amine; Chebbi, Nidhal; Mhamdi, Salah; Naija, Walid

2017-01-01

Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients' socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis.

PubMed

Fitzgerald, G K; Hinman, R S; Zeni, J; Risberg, M A; Snyder-Mackler, L; Bennell, K L

2015-05-01

A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties.

PubMed

Peter, W F; van der Wees, P J; Hendriks, E J M; de Bie, R A; Verhoef, J; de Jong, Z; van Bodegom-Vos, L; Hilberdink, W K H A; Vliet Vlieland, T P M

2013-12-01

The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups. Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89. The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined. Copyright © 2012 John Wiley & Sons, Ltd.

Patient education and basic body awareness therapy in hip osteoarthritis - a qualitative study of patients' movement learning experiences.

PubMed

Olsen, Aarid Liland; Strand, Liv Inger; Skjaerven, Liv Helvik; Sundal, Mary-Anne; Magnussen, Liv Heide

2017-08-01

Osteoarthritis (OA) is associated with pain, dysfunction and reduced quality of life. Patient education (PE) followed by 12 weekly sessions of Basic Body Awareness Therapy (BBAT) was offered to patients with hip OA, aiming to strengthen their ability to move and act functionally in daily life. To explore how patients described their experiences and outcome from participating in PE and BBAT. Individual, semi-structured interviews with five patients, aged 52-78 years, were performed after PE and BBAT at four and ten months. Interview data were analyzed by systematic text condensation. Three main themes emerged. "Becoming motivated and involved" reflected experiences of encouragement and support from information given and communication with group members. In "Movement awareness learning" patients described becoming aware of and improving functional movement, alleviating symptoms and increasing daily functioning. "Movement and disease in a long-term perspective" reflected patientś experience of increased self-awareness and taking better care of themselves at 10 months after baseline. Practicing basic movement principles, they felt empowered to handle daily life challenges in more functional and energy-economical ways. PE followed by BBAT in groups may be beneficial to patients with hip OA, and provide lasting benefits regarding daily life function. Implications for Rehabilitation Insight into disease process and relationship to functional movement gained through patient education may empower patients with hip osteoarthritis in management of daily life Movement awareness and exploration of movement quality using principles from Basic Body Awareness Therapy was found to support patients in finding resources for functional movement, implemented in daily actions Movement strategies characterized by adjustment rather than force was experienced by the patients to support their general functioning, despite of prevailing hip pain Implementing group therapeutic factors (Yalom) in physiotherapy was found to strengthen patients' motivation and belief in functional improvement.

The Frank Stinchfield Award : Total Hip Arthroplasty for Femoral Neck Fracture Is Not a Typical DRG 470: A Propensity-matched Cohort Study.

PubMed

Schairer, William W; Lane, Joseph M; Halsey, David A; Iorio, Richard; Padgett, Douglas E; McLawhorn, Alexander S

2017-02-01

Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA. (1) What are the differences in in-hospital and 30-day postoperative clinical outcomes for THA performed for femoral neck fracture versus OA? (2) Is a patient's fracture status, that is whether or not a patient has a femoral neck fracture, associated with differences in in-hospital and 30-day postoperative clinical outcomes after THA? The National Surgical Quality Improvement Program (NSQIP) database, which contains outcomes for surgical patients up to 30 days after discharge, was used to identify patients undergoing THA for OA and femoral neck fracture. OA and fracture cohorts were matched one-to-one using propensity scores based on age, gender, American Society of Anesthesiologists grade, and medical comorbidities. Propensity scores represented the conditional probabilities for each patient having a femoral neck fracture based on their individual characteristics, excluding their actual fracture status. Outcomes of interest included operative time, length of stay (LOS), complications, transfusion, discharge destination, and readmission. There were 42,692 patients identified (41,739 OA; 953 femoral neck fractures) with 953 patients in each group for the matched analysis. For patients with fracture, operative times were slightly longer (98 versus 92 minutes, p = 0.015), they experienced longer LOS (6 versus 4 days, p < 0.001), and the overall frequency of complications was greater compared with patients with OA (16% versus 6%, p < 0.001). Although the frequency of preoperative transfusions was higher in the fracture group (2.0% versus 0.2%, p = 0.002), the frequency of postoperative transfusion was not different between groups (27% versus 24%, p = 0.157). Having a femoral neck fracture versus OA was strongly associated with any postoperative complication (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.1-3.8]; p < 0.001), unplanned readmission (OR, 1.8; 95% CI, 1.0-3.2; p = 0.049), and discharge to an inpatient facility (OR, 1.7; 95% CI, 1.4-2.0; p < 0.001). Compared with THA for OA, THA for femoral neck fracture is associated with greater rates of complications, longer LOS, more likely discharge to continued inpatient care, and higher rates of unplanned readmission. This implies higher resource utilization for patients with a fracture. These differences exist despite matching of other preoperative risk factors. As healthcare reimbursement moves toward bundled payment models, it would seem important to differentiate patients and procedures based on the resource utilization they represent to healthcare systems. These results show different expected resource utilization in these two fundamentally different groups of patients undergoing hip arthroplasty, suggesting a need to modify healthcare policy to maintain access to THA for all patients. Level III, therapeutic study.

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…

[Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index].

PubMed

Stucki, G; Meier, D; Stucki, S; Michel, B A; Tyndall, A G; Dick, W; Theiler, R

1996-01-01

The WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index is a tested questionnaire to assess symptoms and physical functional disability. We adapted the WOMAC for the German language and tested its metric properties, test-retest reliability and validity in 51 patients with knee and hip OA. All WOMAC scales (pain, stiffness, function) were internally consistent with Cronbach's coefficient alpha ranging from 0.80 to 0.96. Test-retest reliability was satisfactory with intraclass correlation coefficients ranging from 0.55 to 0.74. All scales and the global index calculated as the mean of scale scores had a bimodal distribution and a slight ceiling effect. As hypothesized the WOMAC scales were associated with radiological OA-severity and limitations of range-of-motion. Patients with more severe symptoms and functional disability perceived more limitations in their roles at home and at work. The presented German version of the WOMAC is a reliable and valid instrument for the assessment of symptoms and physical functional disability in patients with knee and hip OA.

Treatment outcomes of a Numeric Rating Scale (NRS)-guided pharmacological pain management strategy in symptomatic knee and hip osteoarthritis in daily clinical practice.

PubMed

Snijders, Gijs F; van den Ende, Cornelia H M; van den Bemt, Bart J F; van Riel, Piet L C M; van den Hoogen, Frank H J; den Broeder, Alfons A

2012-01-01

To describe the results of a Numeric Rating Scale (NRS)-guided pharmacological pain management strategy in symptomatic knee and hip osteoarthritis (OA) in daily clinical practice. In this observational cohort study, standardised conservative treatment was offered to patients with symptomatic knee and/or hip OA referred to secondary care. Pain management was guided by a NRS for pain, aiming for NRS ≤4. The first step in pharmacological treatment was paracetamol (acetaminophen) in case of no recent use in adequate dose. In case of treatment failure, patients switched to a non-steroidal anti-inflammatory drug (NSAID) and eventually to a second NSAID, each after a 4-week trial period. Predictors for response to treatment were identified. Moreover, reasons for protocol violations were collected. Three-hundred and forty-seven patients were included. The proportion of patients that reached a response after paracetamol, first and second NSAID was 25% (59/234), 16% (31/190) and 11% (10/87), respectively. Non-adherence to protocol occurred in 46% of cases when switch of analgesic was advised, mainly due to unwillingness of patients to change the analgesic. Identified predictors for response to analgesics included higher age, lower patient global assessment, less stiffness and more radiographic severity. Adequate use of paracetamol and switching to a NSAID after failing paracetamol resulted in moderate treatment response percentages, whereas the result of a second NSAID was disappointing in patients with advanced knee and hip OA. Predictors for response included patient and disease related factors. A substantial part of patients with NRS >4 were unwilling to change their analgesics.

Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review.

PubMed

Dobson, F; Hinman, R S; Hall, M; Terwee, C B; Roos, E M; Bennell, K L

2012-12-01

To systematically review the measurement properties of performance-based measures to assess physical function in people with hip and/or knee osteoarthritis (OA). Electronic searches were performed in MEDLINE, CINAHL, Embase, and PsycINFO up to the end of June 2012. Two reviewers independently rated measurement properties using the consensus-based standards for the selection of health status measurement instrument (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings. Twenty-four out of 1792 publications were eligible for inclusion. Twenty-one performance-based measures were evaluated including 15 single-activity measures and six multi-activity measures. Measurement properties evaluated included internal consistency (three measures), reliability (16 measures), measurement error (14 measures), validity (nine measures), responsiveness (12 measures) and interpretability (three measures). A positive rating was given to only 16% of possible measurement ratings. Evidence for the majority of measurement properties of tests reported in the review has yet to be determined. On balance of the limited evidence, the 40 m self-paced test was the best rated walk test, the 30 s-chair stand test and timed up and go test were the best rated sit to stand tests, and the Stratford battery, Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures. Further good quality research investigating measurement properties of performance measures, including responsiveness and interpretability in people with hip and/or knee OA, is needed. Consensus on which combination of measures will best assess physical function in people with hip/and or knee OA is urgently required. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Barriers and facilitators to physical activity in people with hip or knee osteoarthritis: protocol for a systematic review of qualitative evidence.

PubMed

Kanavaki, Archontissa M; Rushton, Alison; Klocke, Rainer; Abhishek, Abhishek; Duda, Joan L

2016-11-03

This protocol aims to describe the objective and methods to be followed in a systematic review of qualitative studies on barriers and facilitators to physical activity (PA) in people with hip or knee osteoarthritis (OA). MEDLINE, EMBASE, PhychINFO, Web of Science, CINAHL, SPORTDiscus, Scopus and grey literature sources will be electronically searched. Hand search of qualitative research-centred journals, reference screening of relevant reviews and inquiries to researchers active in the field will complement the search. Studies will be selected if they apply qualitative or mixed-methods designs to directly explore factors that correspond to engagement in PA/exercise or, the perceptions regarding PA/exercise in people with hip or knee OA. The Critical Appraisal Skills Programme Qualitative Checklist and the evaluative criteria of credibility, transferability, dependability and confirmability will be applied for the study appraisal. 2 independent reviewers will perform the search, study selection and study appraisal. Thematic synthesis will be used for synthesising the findings of the primary studies and the process and product of the synthesis will be checked by a second researcher. ConQual approach will be used for assessing the confidence in the qualitative findings. This systematic review will inform our understanding of the PA determinants and how to optimise behaviour change in people living with hip or knee OA. The review findings will be reported in a peer-reviewed journal and presented at national or international conferences. The study raises no ethical issues. CRD42016030024. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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.

Descriptive Epidemiology of Patients Undergoing Total Hip Arthroplasty in Korea with Focus on Incidence of Femoroacetabular Impingement: Single Center Study.

PubMed

Lee, Woo Yong; Hwang, Deuk Soo; Noh, Chang Kyun

2017-04-01

We analyzed the causes leading to total hip arthroplasty (THA), aimed to clarify the incidence of femoroacetabular impingement (FAI) among the causes, and compared the incidence in Korea with those in other countries. From January 2000 to December 2014, 1,206 hips of 818 patients who underwent primary THA at our institute were reviewed retrospectively in terms of radiographs and electronic charts. The radiographs and radiographic parameters were reviewed and measured by 2 of the authors, who are orthopedic surgeons. Patients were categorized in terms of the causes leading to THA as primary osteoarthritis (OA), rheumatoid arthritis (RA), posttraumatic arthritis, post infectious arthritis, avascular necrosis (AVN) of the femoral head, fracture of the femoral head or neck, ankylosing spondylitis (AS), developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), FAI, and others. There were 32 patients (3.91%) in the primary OA group, 41 (5.01%) in the RA group, 84 (10.27%) in the posttraumatic arthritis group, 39 (4.77%) in the post infectious arthritis group, 365 (44.62%) in the AVN group, 39 (4.77%) in the fracture group, 21 (2.57%) in the AS group, 52 (6.36%) in the DDH group, 71 (8.68%) in the LCPD group, 52 (6.36%) in the FAI group, and 22 (2.69%) in the 'other' group. The causes leading to THA in Korea differ from those in Western countries. FAI could be causes of severe secondary OA that requires THA in Korea, therefore symptomatic FAI should not be neglected. © 2017 The Korean Academy of Medical Sciences.

[Post-anesthetic autologous blood donation used in knee and hip arthroplasty].

PubMed

Wei, Wei; Kou, Bolong; Ju, Rongseng

2006-06-01

To explore the clinical application of the postanesthetic autologous donation and the postoperative transfusion during the knee and hip replacement surgeries. Thirty-three patients (17 males, 16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected. Of the 33 patients, 27 only received autologous transfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the post-anesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200-1 150 ml), haemoglobin (Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5%-31.5%). Hb and Hct were lower after operation than before operation (P < 0.01). Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing the knee or hip replacement so as to reduce complications of the allogeneic blood transfusion.

Preferences for Disease-Related Education and Support Among Younger People With Hip or Knee Osteoarthritis.

PubMed

Ackerman, Ilana N; Bucknill, Andrew; Page, Richard S; Broughton, Nigel S; Roberts, Carol; Cavka, Bernarda; Schoch, Peter; Brand, Caroline A

2017-04-01

To explore the usefulness and accessibility of different delivery modes of disease-related education and support, as perceived by younger people with osteoarthritis (OA). People ages 20-55 years with hip or knee OA were recruited from 3 major Australian public hospitals and the community (n = 147). Data were collected on use of disease-related education and support services, as well as perceived usefulness and accessibility of delivery modes including group-based programs, online resources, telephone helplines, mailed information, social media, and mobile applications (rated on visual analog scales from 1-10; higher scores indicate greater usefulness or accessibility). Very few participants had used social media (5%), group self-management programs (3%), or telephone helplines (2%) to obtain OA information. Mailed information packs and online education programs were considered the most useful (median usefulness scores 8.0 and 7.0, respectively) and accessible methods (median accessibility scores 10.0 and 9.0, respectively) for providing OA education and support. Social media was perceived as least useful (median usefulness score 2.0) and least accessible; 45% of participants considered it "not at all useful," while 35% reported it would be "very difficult" to access OA education and support by this means. Less educational attainment was associated with greater perceived difficulty in accessing online/electronic delivery modes, while people in paid work perceived easier access. These data highlight the value of mailed information and online education to younger people with OA and can be used to develop targeted resources for individuals of working age. Social media was not a highly valued source of disease-related education and support. © 2016, American College of Rheumatology.

The Association between Osteoarthritis and Occupational Clusters in the Korean Population: A Nationwide Study.

PubMed

Seok, Hongdeok; Choi, Sung Jae; Yoon, Jin-Ha; Song, Gwan Gyu; Won, Jong-Uk; Kim, Jae-Hoon; Roh, Jaehoon; Jung, Jae Hyun

2017-01-01

Osteoarthritis (OA) is a considerable health problem worldwide. It is known to be associated with certain occupational risk factors. We examined the prevalence rate of OA by occupational cluster. Data were collected from the Korea National Health and Nutrition Examination Surveys (2010-2013). The total number of unweighted sample size was 9,905 participants: 4,460 men and 5,445 women, and OA prevalence was 5.3% and 18.4% respectively. OA patients were defined as participants with knee/hip joint pain and radiographic change of knee/hip joint. Occupational type was classified as either white, pink, blue, or green collar based on the occupational characteristics following physical demand: white for manager and professionals; pink for clerks and service/sales workers; blue for craft/trade workers, machine operators and assemblers, and elementary manual workers; and green for agricultural/fishery workers. We calculated the odds ratios (ORs) and 95% confidence intervals (95% CI) for the odds of a participant's having OA according to the occupational cluster, with gender stratification. The multiple logistic regression model showed that, compared to the white collar group, the ORs of the pink, blue, and green collar workers were 1.23 (95% CI 0.64-2.36), 1.85 (95% CI 1.18-2.88), and 2.91 (95% CI 1.86-4.54), respectively, in males, and 2.53 (95% CI 1.71-3.73), 2.86 (95% CI 1.94-4.21), and 3.90 (95% CI 2.60-5.83), respectively in females. The prevalence rate of OA was associated with the occupational cluster, in order from highest to lowest: green, blue, pink, and white collar.

Quantifying metal artefact reduction using virtual monochromatic dual-layer detector spectral CT imaging in unilateral and bilateral total hip prostheses.

PubMed

Wellenberg, R H H; Boomsma, M F; van Osch, J A C; Vlassenbroek, A; Milles, J; Edens, M A; Streekstra, G J; Slump, C H; Maas, M

2017-03-01

To quantify the impact of prosthesis material and design on the reduction of metal artefacts in total hip arthroplasties using virtual monochromatic dual-layer detector Spectral CT imaging. The water-filled total hip arthroplasty phantom was scanned on a novel 128-slice Philips IQon dual-layer detector Spectral CT scanner at 120-kVp and 140-kVp at a standard computed tomography dose index of 20.0mGy. Several unilateral and bilateral hip prostheses consisting of different metal alloys were inserted and combined which were surrounded by 18 hydroxyapatite calcium carbonate pellets representing bone. Images were reconstructed with iterative reconstruction and analysed at monochromatic energies ranging from 40 to 200keV. CT numbers in Hounsfield Units (HU), noise measured as the standard deviation in HU, signal-to-noise-ratios (SNRs) and contrast-to-noise-ratios (CNRs) were analysed within fixed regions-of-interests placed in and around the pellets. In 70 and 74keV virtual monochromatic images the CT numbers of the pellets were similar to 120-kVp and 140-kVp polychromatic results, therefore serving as reference. A separation into three categories of metal artefacts was made (no, mild/moderate and severe) where pellets were categorized based on HU deviations. At high keV values overall image contrast was reduced. For mild/moderate artefacts, the highest average CNRs were attained with virtual monochromatic 130keV images, acquired at 140-kVp. Severe metal artefacts were not reduced. In 130keV images, only mild/moderate metal artefacts were significantly reduced compared to 70 and 74keV images. Deviations in CT numbers, noise, SNRs and CNRs due to metal artefacts were decreased with respectively 64%, 57%, 62% and 63% (p<0.001) compared to unaffected pellets. Optimal keVs, based on CNRs, for different unilateral and bilateral metal hip prostheses consisting of different metal alloys varied from 74 to 150keV. The Titanium alloy resulted in less severe artefacts and were reduced more effectively compared to the Cobalt alloy. Virtual monochromatic dual-layer Spectral CT imaging results in a significant reduction of streak artefacts produced by beam-hardening in mild and moderate artefacts by improving CT number accuracy, SNRs and CNRs, while decreasing noise values in a total hip arthroplasty phantom. An optimal monochromatic energy of 130keV was found ranging from 74keV to 150keV for different unilateral and bilateral hip prostheses consisting of different metal alloys. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Gap Junctions in the Ventral Hippocampal-Medial Prefrontal Pathway Are Involved in Anxiety Regulation

PubMed Central

Schoenfeld, Timothy J.; Kloth, Alexander D.; Hsueh, Brian; Runkle, Matthew B.; Kane, Gary A.; Wang, Samuel S.-H.

2014-01-01

Anxiety disorders are highly prevalent but little is known about their underlying mechanisms. Gap junctions exist in brain regions important for anxiety regulation, such as the ventral hippocampus (vHIP) and mPFC, but their functions in these areas have not been investigated. Using pharmacological blockade of neuronal gap junctions combined with electrophysiological recordings, we found that gap junctions play a role in theta rhythm in the vHIP and mPFC of adult mice. Bilateral infusion of neuronal gap junction blockers into the vHIP decreased anxiety-like behavior on the elevated plus maze and open field. Similar anxiolytic effects were observed with unilateral infusion of these drugs into the vHIP combined with contralateral infusion into the mPFC. No change in anxious behavior was observed with gap junction blockade in the unilateral vHIP alone or in the bilateral dorsal HIP. Since physical exercise is known to reduce anxiety, we examined the effects of long-term running on the expression of the neuronal gap junction protein connexin-36 among inhibitory interneurons and found a reduction in the vHIP. Despite this change, we observed no alteration in theta frequency or power in long-term runners. Collectively, these findings suggest that neuronal gap junctions in the vHIP–mPFC pathway are important for theta rhythm and anxiety regulation under sedentary conditions but that additional mechanisms are likely involved in running-induced reduction in anxiety. PMID:25411496

Effects of calcaneal eversion on three-dimensional kinematics of the hip, pelvis and thorax in unilateral weight bearing.

PubMed

Tateuchi, Hiroshige; Wada, Osamu; Ichihashi, Noriaki

2011-06-01

Understanding the kinematic chain from foot to thorax will provide a better basis for assessment of malalignment of the body. The purpose of this study was to investigate the effects of induced calcaneal eversion on the kinematics of the hip, pelvis and thorax in three dimensions under unilateral weight-bearing. Twenty-eight healthy males were requested to stand on one leg under three conditions: normal (standing directly on the floor), and on wedges producing 5° and 10° calcaneal eversion. Recorded kinematic parameters included the angles of the hip joint, pelvis, and thorax in three dimensions. Eversion induced by wedges produced significant increases in hip flexion, hip medial rotation, pelvic anterior tilt, and thoracic lateral tilt and axial rotation to the standing side. In the frontal plane, pelvic lateral tilt to the standing side was decreased in 5° eversion condition compared with normal condition; conversely, it was increased in 10° eversion condition compared with 5° eversion condition. Arch height was negatively correlated with change in thoracic axial rotation to standing side from the normal to 10° eversion (r=-.528, p<.01). We concluded that induced calcaneal eversion affects the three-dimensional kinematics of the thorax through the hip joint and the pelvis. Copyright © 2011 Elsevier B.V. All rights reserved.

Evaluation of local bone turnover in painful hip by 18F-fluoride positron emission tomography.

PubMed

Kobayashi, Naomi; Inaba, Yutaka; Tezuka, Taro; Ike, Hiroyuki; Kubota, So; Kawamura, Masaki; Saito, Tomoyuki

2016-04-01

The diagnosis of painful hip without remarkable radiographic findings is still challenging. In recent years, femoroacetabular impingement (FAI) has been recognized as an important cause of painful hip. The hypothesis of this study was that local bone turnover may be accelerated in painful hip, especially in FAI lesions. To test this, patients with unilateral symptomatic hip underwent F-fluoride PET, which directly correlates with osteoblast activity and therefore bone turnover. In total, 27 patients with unilateral symptomatic painful hip were enrolled. The diagnosis included 15 cam-type FAI cases, six labral tear cases, and six early-stage osteoarthritis cases. The region of interest for cam and pincer lesions was identified and the maximum standardized uptake value (SUVmax) in these regions and the contralateral asymptomatic regions were measured by F-fluoride PET. The SUVmax ratio was defined as symptomatic side SUVmax/asymptomatic side SUVmax. The α angle and center-edge angle were measured by plain radiograph. The SUVmax of both cam and pincer lesions were significantly higher than the SUVmax of the contralateral regions (P<0.0001). The cam SUVmax ratio correlated positively with the α angle (r=0.5, P=0.007). Patients with an α angle of more than or equal to 60° had a significantly higher cam SUVmax ratio than the less than 60° group (P=0.017). This study showed the accelerated local bone turnover in painful hip, partly in FAI cases. Accelerated bone turnover may play a significant role in FAI pathophysiology; therefore, its recognition by imaging modality may contribute toward a more sensitive diagnosis in painful hip.

Effect of experimentally reduced distal sensation on postural response to hip abductor/ankle evertor muscle vibration.

PubMed

Glasser, S; Collings, R; Paton, J; Marsden, J

2015-07-01

This study assessed whether postural responses induced by vibratory perturbations of the hip abductors and ankle evertors, were modified when distal tactile sensation was experimentally reduced through cooling. Sixteen healthy subjects were investigated pre and post cooling. Subjects stood with their eyes closed with a stance width of 4 cm. A 2s vibratory stimulus was applied to the left or right hip abductor or ankle evertor muscle. The order of the site and side of the stimulation was randomised. The postural response to hip abductor and ankle evertor vibration was recorded using 3D motion analysis (Codamotion, Leicestershire). Medio-lateral centre of pressure motion was simultaneously recorded during quiet standing via a force plate (Kistler, UK). Pre-cooling people responded to unilateral ankle vibration with an ipsilateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. People responded to unilateral hip vibration with a contralateral translation and tilt of the pelvis, and an ipsilateral tilt of the trunk. Following an experimental reduction in distal tactile sensation there was a significant reduction in the amplitude of pelvic tilt in response to ankle vibration (F(6.2)=P<0.05) and a significant increase in amplitude of pelvic tilt in response to hip vibration (F(5.2)=P<0.05). This suggests that the sensitivity to artificial stimulation of hip proprioception increases with distal cooling, possibly indicating a change in the gain/weighting placed upon sensory information from the hips. Copyright © 2015 Elsevier B.V. All rights reserved.

Genetic epidemiology of hip and knee osteoarthritis.

PubMed

Valdes, Ana M; Spector, Tim D

2011-01-01

Osteoarthritis (OA) is the most common cause of arthritis and represents an enormous healthcare burden in industrialized societies. Current therapeutic approaches for OA are limited and are insufficient to prevent the initiation and progression of the disease. Genetic studies of patients with OA can help to unravel the molecular mechanisms responsible for specific disease manifestations, including joint damage, nociception and chronic pain. Indeed, these studies have identified molecules, such as growth/differentiation factor 5, involved in signaling cascades that are important for the pathology of joint components. Genome-wide association studies have uncovered a likely role in OA for the genes encoding structural extracellular matrix components (such as DVWA) and molecules involved in prostaglandin metabolism (such as DQB1 and BTNL2). A ∼300 kilobase region in chromosome 7q22 is also associated with OA susceptibility. Finally, the identification of individuals at a high risk of OA and of total joint arthroplasty failure might be facilitated by the use of combinations of genetic markers, allowing for the application of preventive and disease-management strategies.

Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology.

PubMed

Taljanovic, Mihra S; Graham, Anna R; Benjamin, James B; Gmitro, Arthur F; Krupinski, Elizabeth A; Schwartz, Stephanie A; Hunter, Tim B; Resnick, Donald L

2008-05-01

To correlate the amount of bone marrow edema (BME) calculated by magnetic resonance imaging(MRI) with clinical findings, histopathology, and radiographic findings, in patients with advanced hip osteoarthritis(OA). The study was approved by The Institutional Human Subject Protection Committee. Coronal MRI of hips was acquired in 19 patients who underwent hip replacement. A spin echo (SE) sequence with four echoes and separate fast spin echo (FSE) proton density (PD)-weighted SE sequences of fat (F) and water (W) were acquired with water and fat suppression, respectively. T2 and water:fat ratio calculations were made for the outlined regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and histopathologic findings. Analyses of variance were done on the MRI data for W/(W + F) and for T2 values (total and focal values) for the symptomatic and contralateral hips. The values were significantly higher in the study group. Statistically significant correlations were found between pain and total W/(W + F), pain and focal T2 values, and the number of microfractures and calculated BME for the focal W/(W + F) in the proximal femora. Statistically significant correlations were found between the radiographic findings and MRI values for total W/(W + F), focal W/(W + F) and focal T2 and among the radiographic findings, pain, and hip movement. On histopathology, only a small amount of BME was seen in eight proximal femora. The amount of BME in the OA hip, as measured by MRI, correlates with the severity of pain, radiographic findings, and number of microfractures.

Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers.

PubMed

Duthon, Victoria B; Charbonnier, Caecilia; Kolo, Frank C; Magnenat-Thalmann, Nadia; Becker, Christophe D; Bouvet, Cindy; Coppens, Elia; Hoffmeyer, Pierre; Menetrey, Jacques

2013-03-01

To understand why professional female ballet dancers often complain of inguinal pain and experience early hip osteoarthritis (OA). Goals were to examine clinical and advanced imaging findings in the hips of dancers compared with those in a matched cohort of nondancers and to assess the femoral head translation in the forward split position using magnetic resonance imaging (MRI). Twenty professional female ballet dancers and 14 active healthy female individuals matched for age (control group) completed a questionnaire on hip pain and underwent hip examination with impingement tests and measurement of passive hip range of motion (ROM). All had a pelvic 1.5 T MRI in the back-lying position to assess femoroacetabular morphologic features and lesions. For the dancers, additional MR images were acquired in the split position to evaluate femoroacetabular congruency. Twelve of 20 dancers complained of groin pain only while dancing; controls were asymptomatic. Dancers' passive hip ROM was normal. No differences in α neck angle, acetabular depth, acetabular version, and femoral neck anteversion were found between dancers and controls. MRI of dancers while performing splits showed a mean femoral head subluxation of 2.05 mm. MRI of dancers' hips showed labral tears, cartilage thinning, and herniation pits, located in superior and posterosuperior positions. Lesions were the same for symptomatic and asymptomatic dancers. Controls had proportionally the same number of labral lesions but in an anterosuperior position. They also had 2 to 3 times fewer cartilage lesions and pits than did dancers. The results of our study are consistent with our hypothesis that repetitive extreme movements can cause femoral head subluxations and femoroacetabular abutments in female ballet dancers with normal hip morphologic features, which could result in early OA. Pathologic changes seen on MRI were symptomatic in less than two thirds of the dancers. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Adverse Outcomes in Infantile Bilateral Developmental Dysplasia of the Hip.

PubMed

Morbi, Abigail H M; Carsi, Belen; Gorianinov, Vitalli; Clarke, Nicholas M P

2015-01-01

It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilateral cases. A retrospective review of 36 patients (72 hips) with >4 years of follow-up. Patient population included surgically treated DDH including late presentations and failures of conservative treatment. The dislocated hips underwent either simultaneous closed or 1 open and 1 closed, or sequential open reduction. AVN and secondary procedures were used as endpoints for analysis as well as clinical and radiologic outcomes. At the last follow-up, 33% of hips had radiologic signs of AVN. Those hips that had no ossific nucleus (ON) at the time of surgery had an odds ratio of developing AVN of 3.05 and a statistically significant association between the 2 variables, whereas open/closed or simultaneous/sequential reduction did not increase the risk for AVN. In addition, 45.8% of those hips required further surgery. The estimated odds ratio of needing additional surgery after simultaneous reduction was 4.04. Clinically, 79.2% of the hips were graded as McKay I, whereas radiologically only 38.8% were Severin I. The AVN rate in bilateral DDH treated surgically is greater than the rate noted in unilateral cases from the same institution undergoing identical protocols. There was no difference in AVN rates between simultaneous and sequential or between the first and second hip to be sequentially reduced. Presence of ON decreases the risk for AVN, suggesting that in bilateral cases, awaiting the appearance of the ON is an important tool to reduce the incidence of AVN. IV.

Acute unilateral hip pain in fibrodysplasia ossificans progressiva (FOP).

PubMed

Kaplan, Frederick S; Al Mukaddam, Mona; Pignolo, Robert J

2018-04-01

Flare-ups of the hips are among the most feared and disabling complications of fibrodysplasia ossificans progressiva (FOP) and are poorly understood. In order to better understand the nature of hip flare-ups in FOP, we evaluated 25 consecutive individuals with classic FOP (14 males, 11 females; 3-56years old, median age, 17years old) who presented with acute unilateral hip pain. All 25 individuals were suspected of having a flare-up of the hip based on clinical history and a favorable response to a four day course of high-dose oral prednisone. Ten individuals (40%) experienced rebound symptoms of pain and/or stiffness within seven days after discontinuation of prednisone and all ten subsequently developed heterotopic ossification (HO) or decreased mobility of the affected hip. None of the 14 individuals who experienced sustained relief of symptoms following a course of oral prednisone experienced HO or decreased mobility. Incidental radiographic findings at the time of presentation were multifactoral and included osteochondromas of the proximal femur (18/25; 72%), degenerative arthritis (17/25; 68%), developmental hip dysplasia (15/25; 60%), previously existing heterotopic ossification (12/25; 48%), intra-articular synovial osteochondromatosis (8/25; 32%) or traumatic fractures through pre-existing heterotopic bone (1/25; 4%). Developmental joint pathology may confound clinical evaluation of hip pain in FOP. The most useful modality for suspecting an ossification-prone flare-up of the hip was lack of sustained response to a brief course of oral prednisone. Evaluation of soft tissue edema by ultrasound or magnetic resonance imaging showed promise in identifying ossification-prone flare-ups and warrants further analysis in prospective studies. Copyright © 2017 Elsevier Inc. All rights reserved.

Hip pathology in Majewski osteodysplastic primordial dwarfism type II.

PubMed

Karatas, Ali F; Bober, Michael B; Rogers, Kenneth; Duker, Angela L; Ditro, Colleen P; Mackenzie, William G

2014-09-01

Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment. Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination. Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology. Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara. Level IV.

New guidelines for topical NSAIDs in the osteoarthritis treatment paradigm.

PubMed

Altman, Roy D

2010-12-01

Osteoarthritis (OA), the most common form of arthritis, often affects hands, hips, and knees and involves an estimated 26.9 million US adults. Women have a higher prevalence of OA, and the risk of developing OA increases with age, obesity, and joint malalignment. OA typically presents with pain and reduced function. Therapeutic programs are often multimodal and must take into account pharmaceutical toxicities and patient comorbidities. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with cardiovascular, gastrointestinal, and renal adverse events. Topical NSAIDs offer efficacy with reduced systemic drug exposure. This is a review of current guideline recommendations regarding the use of topical NSAIDs in OA of the hand and knee. Articles were identified by PubMed search (January 1, 2000 to May 21, 2010). Several current guidelines for management of OA recommend topical NSAIDs, indicating them as a safe and effective treatment. One guideline recommends that topical NSAIDs be considered as first-line pharmacologic therapy. A US guideline for knee OA recommends topical NSAIDs in older patients and in patients with increased gastrointestinal risk. The consensus across US and European OA guidelines is that topical NSAIDs are a safe and effective treatment for OA. Because the research base on topical NSAIDs for OA is small, guidelines will continue to evolve.

The orthopedic diseases of ancient Egypt.

PubMed

Fritsch, Klaus O; Hamoud, Heshem; Allam, Adel H; Grossmann, Alexander; Nur El-Din, Abdel-Halim; Abdel-Maksoud, Gomaa; Soliman, Muhammad Al-Tohamy; Badr, Ibrahim; Sutherland, James D; Sutherland, M Linda; Akl, Mahmoud; Finch, Caleb E; Thomas, Gregory S; Wann, L Samuel; Thompson, Randall C

2015-06-01

CT scanning of ancient human remains has the potential to provide insights into health and diseases. While Egyptian mummies have undergone CT scans in prior studies, a systematic survey of the orthopedic conditions afflicting a group of these ancient individuals has never been carried out. We performed whole body CT scanning on 52 ancient Egyptian mummies using technique comparable to that of medical imaging. All of the large joints and the spine were systematically examined and osteoarthritic (OA) changes were scored 0-4 using Kellgren and Lawrence classification. The cruciate ligaments and menisci could be identified frequently. There were much more frequent OA changes in the spine (25 mummies) than in the large joints (15 cases of acromioclavicular and/or glenohumeral joint OA changes, five involvement of the ankle, one in the elbow, four in the knee, and one in the hip). There were six cases of scoliosis. Individual mummies had the following conditions: juvenile aseptic necrosis of the hip (Perthes disease), stage 4 osteochondritis dissecans of the knee, vertebral compression fracture, lateral patella-femoral joint hyper-compression syndrome, severe rotator cuff arthropathy, rotator cuff impingement, hip pincer impingement, and combined fracture of the greater trochantor and vertebral bodies indicating obvious traumatic injury. This report includes the most ancient discovery of several of these syndromes. Ancient Egyptians often suffered painful orthopedic conditions. The high frequency of scoliosis merits further study. The pattern of degenerative changes in the spine and joints may offer insights into activity levels of these people. © 2015 Wiley Periodicals, Inc.

Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey.

PubMed

Grønhaug, Gudmund; Østerås, Nina; Hagen, Kåre Birger

2014-11-25

Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care. A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables. A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate. Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.

Co-expression of DKK-1 and Sclerostin in Subchondral Bone of the Proximal Femoral Heads from Osteoarthritic Hips.

PubMed

Zarei, Allahdad; Hulley, Philippa A; Sabokbar, Afsie; Javaid, M Kassim

2017-06-01

Osteoarthritis (OA) is a progressively degenerative joint disease influenced by structural and metabolic factors. There is growing evidence that subchondral bone is involved in both symptomatic and structural progression in OA. The Wnt pathway has been implicated in the progression of OA but the expression and function of the Wnt inhibitors, Dikkopf (DKK-1) and sclerostin (SOST), are unclear. We examined the regional distribution of DKK-1 and SOST in subchondral bone of the femoral head using resection specimens following arthroplasty in patients presenting with end-stage OA. Cylindrical cores for immunohistochemistry were taken through midpoint of full thickness cartilage defect, partial cartilage defect, through base of osteophyte and through macroscopically normal cartilage. Subchondral bone was thickest in cores taken from regions with full cartilage defect and thinnest in cores taken from osteophyte regions. In subchondral bone, expression of both DKK-1 and SOST was observed exclusively in osteocytes. Expression was highest in subchondral bone in cores taken from regions with partial but not full thickness cartilage defects. DKK-1 but not SOST was expressed by chondrocytes in cores with macroscopically normal cartilage. The current study describes the regional cellular distribution of SOST and DKK-1 in hip OA. Expression was highest in the osteocytes in bone underlying partial thickness cartilage defects. It is however not clear if this is a cause or a consequence of alterations in the overlying cartilage. However, it is suggestive of an active remodeling process which might be targeted by disease-modifying agents.

Clinical evaluation of the WOMAC 3.0 OA Index in numeric rating scale format using a computerized touch screen version.

PubMed

Theiler, R; Spielberger, J; Bischoff, H A; Bellamy, N; Huber, J; Kroesen, S

2002-06-01

The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index is a previously described self-administered questionnaire covering three domains: pain, stiffness and function. It has been validated in patients with osteoarthritis (OA) of the hip or knee in a paper-based format. To validate the WOMAC 3.0 using a numerical rating scale in a computerized touch screen format allowing immediate evaluation of the questionnaire. In the computed version cartoons, written and audio instruments were included in order facilitate application. Fifty patients, demographically balanced, with radiographically proven primary hip or knee OA completed the classical paper and the new computerized WOMAC version. Subjects were randomized either to paper format or computerized format first to balance possible order effects. The intra-class correlation coefficients for pain, stiffness and function values were 0.915, 0.745 and 0.940, respectively. The Spearman correlation coefficients for pain, stiffness and function were 0.88, 0.77 and 0.87, respectively. These data indicate that the computerized WOMAC OA index 3.0 is comparable to the paper WOMAC in all three dimensions. The computerized version would allow physicians to get an immediate result and if present a direct comparison with a previous exam. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion.

PubMed

Wang, Jian; Wang, Weici; Jin, Bi; Zhang, Yanrong; Xu, Ping; Xiang, Feixiang; Zheng, Yi; Chen, Juan; Sheng, Shi; Ouyang, Chenxi; Li, Yiqing

2016-01-01

Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV) in patients of carotid stenosis (CS) with or without contralateral carotid occlusion (CO) early after carotid endarterectomy (CEA). Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD) and Color Doppler Imaging (CDI) were performed before and early after CEA. Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA) and middle cerebral artery (MCA) on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA) retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA) of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO. Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

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

PubMed

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

2016-06-03

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. 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. 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?" 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 for at least some in the vast OA population. Joint Academy, a Web-based platform for OA therapy, has the potential to successfully deliver individualized online treatment to many patients with OA that presently lack access to treatment.

Early signs of osteoarthritis in professional ballet dancers: a preliminary study.

PubMed

Angioi, Manuela; Maffulli, Gayle D; McCormack, Moira; Morrissey, Dylan; Chan, Otto; Maffulli, Nicola

2014-09-01

To investigate a cohort of professional ballet dancers for evidence of early signs of osteoarthritis (OA). One radiologist and 1 orthopedic surgeon specialized in musculoskeletal disorders analyzed magnetic resonance imaging scans independently. University Teaching Hospital. Fifteen professional ballet dancers (4 males and 11 females; age range, 19-36 years) experiencing chronic pain in the hip, knee, spine, ankle, or foot joints. Presence of osteophytes, subchondral sclerosis, joint space narrowing, cysts, and bone marrow changes; the Kellgren and Lawrence scale was used to quantify the knee OA. In the knee, there was thinning and irregularity of the articular cartilage over the medial femoral condyle and bone marrow changes within the lateral femoral condyle. In the hip, there was a loss of joint space and a frayed labrum with deep recess. The first metatarsophalangeal joint showed evidence of osteophytic development. Early signs of OA, in different joints, were present in a small but highly selected cohort of professional ballet dancers. In future, prospective studies among a number of ballet companies should control for medical and natural history alongside the visual analysis of images and plain radiographs to confirm these preliminary results.

Hip pain onset in relation to cumulative workplace and leisure time mechanical load: a population based case-control study.

PubMed

Pope, D P; Hunt, I M; Birrell, F N; Silman, A J; Macfarlane, G J

2003-04-01

In an unselected community sample of adults, to assess the role and importance of exposure to mechanical factors both at work and leisure in the aetiology of hip pain. A population based prevalence case-control study. Cases and controls were identified from a population survey of 3847 subjects registered with two general practices in Cheshire, United Kingdom. All subjects received a postal questionnaire which inquired about hip pain during the past month. An occupational history was obtained, including exposure to each of seven physical demands. Information was also obtained on history of participation in eight common sporting activities. 88% of those invited to participate returned a completed questionnaire. The 352 subjects with hip pain were designated as cases, and the remaining 3002 subjects as controls. In people ever employed, hip pain was significantly associated with high cumulative workplace exposure (before onset) of walking long distances over rough ground, lifting/moving heavy weights, sitting for prolonged periods, walking long distances, frequent jumping between different levels, and standing for prolonged periods. Odds ratios (ORs) in the higher exposure categories ranged from 1.46 to 2.65. Cumulative exposure to three sporting activities was significantly associated with hip pain: track and field sports, jogging, and walking, with odds ratios varying between 1.57 to 1.94. On multivariate analysis three factors were independent predictors of hip pain onset: cumulative exposure of sitting for prolonged periods (higher exposure v not exposed: OR=1.82, 95% confidence interval (CI) 1.13 to 2.92), lifting weights >50 lb (23 kg) (OR=1.74, 95% CI 1.06 to 2.86) (both relating to the workplace), and walking as a leisure activity (OR=1.97, 95% CI 1.32 to 2.94). The population attributable risk associated with each of these activities was 21%, 13%, and 16%, respectively Cumulative exposure to some workplace and sporting "mechanical" risk factors for hip osteoarthritis (OA) appear to be related to hip pain in general-some (but not all) have previously been related to hip OA. Because these are common workplace or leisure time activities their attributable risk is high.

Performance Demands in Softball Pitching: A Comprehensive Muscle Fatigue Study.

PubMed

Corben, Jeffrey S; Cerrone, Sara A; Soviero, Julie E; Kwiecien, Susan Y; Nicholas, Stephen J; McHugh, Malachy P

2015-08-01

Monitoring pitch count is standard practice in minor league baseball but not in softball because of the perception that fast-pitch softball pitching is a less stressful motion. To examine muscle fatigue after fast-pitch softball performances to provide an assessment of performance demand. Descriptive laboratory study. Bilateral strength measurements (handheld dynamometer) were made on 19 female softball pitchers (mean age [±SD], 15.2 ± 1.2 years) before and after pitching a game (mean number of pitches, 99 ± 21; mean innings pitched, 5 ± 1). A total of 20 tests were performed on the dominant and nondominant sides: forearm (grip, wrist flexion/extension, pronation/supination, elbow flexion/extension), shoulder (flexion, abduction/adduction, external/internal rotation, empty can test), scapula (middle/lower trapezius, rhomboid), and hip (hip flexion/extension, abduction/adduction). Fatigue (percentage strength loss) was categorized based on bilateral versus unilateral presentation using paired t tests: bilateral symmetric (significant on dominant and nondominant and not different between sides), bilateral asymmetric (significant on dominant and nondominant but significantly greater on dominant), unilateral asymmetric (significant on dominant only and significantly greater than nondominant), or unilateral equivocal (significant on dominant only but not different from nondominant). Bilateral symmetric fatigue was evident for all hip (dominant, 19.3%; nondominant, 15.2%) and scapular tests (dominant, 19.2%; nondominant, 19.3%). In general, shoulder tests exhibited bilateral asymmetric fatigue (dominant, 16.9%; nondominant, 11.6%). Forearm tests were more variable, with bilateral symmetric fatigue in the elbow flexors (dominant, 22.5%; nondominant, 19.2%), and wrist flexors (dominant, 21.6%; nondominant, 19.0%), bilateral asymmetric fatigue in the supinators (dominant, 21.8%; nondominant, 15.5%), unilateral asymmetric fatigue in the elbow extensors (dominant, 22.1%; nondominant, 11.3%), and unilateral equivocal fatigue in the pronators (dominant, 18.8%; nondominant, 15.2%) and grip (dominant, 11.4%; nondominant, 6.6%). The mean (±SD) pitch velocity was 49 ± 4 mph, with a small loss of velocity from the first to last inning pitched (3.4% ± 5.0%, P < .01). Fast-pitch softball pitching resulted in profound bilateral fatigue in the hip and scapular muscles, with more selective fatigue in the shoulder and arm muscles. These findings emphasize the importance of strength in the proximal musculature to provide a stable platform for the arm to propel the ball. © 2015 The Author(s).

Pain conditions ranked by healthcare costs for members of a national health plan.

PubMed

Pasquale, Margaret K; Dufour, Robert; Schaaf, David; Reiners, Andrew T; Mardekian, Jack; Joshi, Ashish V; Patel, Nick C

2014-02-01

Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain-related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per-member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis (OA), childbirth, injuries, and non-hip, non-spine fractures (adjusted annual total costs for the commercial members were $119 million, $98 million, $69 million, $61 million, and $48 million, respectively). The top 5 conditions for Medicare members were OA, back pain, hip fractures, injuries, and non-hip, non-spine fractures (adjusted annual costs for the Medicare members were $327 million, $218 million, $117 million, $82 million, and $67 million, respectively). The conditions ranked highest for both per-member and total healthcare costs were hip fractures, childbirth, and non-hip, non-spine fractures. Among these, hip fractures in the Medicare member population had the highest mean cost per member (adjusted per-member cost was $21,058). Further examination specific to how pain is managed in these high-cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management. © 2013 Humana Inc. and Pfizer Inc. Pain Practice © 2013 World Institute of Pain.

Strategies for the prevention of knee osteoarthritis.

PubMed

Roos, Ewa M; Arden, Nigel K

2016-02-01

Osteoarthritis (OA) has been thought of as a disease of cartilage that can be effectively treated surgically at severe stages with joint arthroplasty. Today, OA is considered a whole-organ disease that is amenable to prevention and treatment at early stages. OA develops slowly over 10-15 years, interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases. Joint injury, obesity and impaired muscle function are modifiable risk factors amenable to primary and secondary prevention strategies. The strategies that are most appropriate for each patient should be identified, by selecting interventions to correct--or at least attenuate--OA risk factors. We must also choose the interventions that are most likely to be acceptable to patients, to maximize adherence to--and persistence with--the regimes. Now is the time to begin the era of personalized prevention for knee OA.

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

PubMed

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

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. 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. 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. Strategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient's environment in OA treatment.

Osteoarthritis Year in Review 2015: Clinical

PubMed Central

Sharma, Leena

2015-01-01

The purpose of this review is to highlight clinical research in osteoarthritis. A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms “osteoarthritis [All Fields] AND treatment [All Fields]” and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms “osteoarthritis [All Fields] AND epidemiology [All Fields]”, with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 148 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing. PMID:26707991

Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial.

PubMed

Lambert, Robert G W; Hutchings, Edna J; Grace, Michael G A; Jhangri, Gian S; Conner-Spady, Barbara; Maksymowych, Walter P

2007-07-01

To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebo-controlled trial. Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n = 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n = 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle. The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P = 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P = 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P = 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P = 0.005), and SF-36 physical component scores (P = 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups. This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification.

Inter-joint coordination strategies during unilateral stance following first-time, acute lateral ankle sprain: A brief report.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Delahunt, Eamonn

2015-07-01

This investigation combined measures of inter-joint coordination and stabilometry to evaluate eyes-open (condition 1) and eyes-closed (condition 2) static unilateral stance performance in a group of participants with an acute, first-time lateral ankle sprain injury in comparison to a control group. Sixty-six participants with an acute first-time lateral ankle sprain and 19 non-injured controls completed three 20-second unilateral stance task trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb 3-D kinematic data for similarity in the aim of establishing patterns of inter-joint coordination for these groups. Between-group analyses revealed significant differences in stance limb inter-joint coordination strategies for conditions 1 and 2. Injured participants displayed increases in ankle-hip linked coordination compared to controls in condition 1 (sagittal/frontal plane: 0.12 [0.09] vs 0.06 [0.04]; η(2)=.16) and condition 2 (sagittal/frontal plane: 0.18 [0.13] vs 0.08 [0.06]; η(2)=0.37). Participants with acute first-time lateral ankle sprain exhibit a hip-dominant coordination strategy for static unilateral stance compared to non-injured controls. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pain, range of motion and activity level as correlates of dynamic balance among elderly people with musculoskeletal disorder.

PubMed

Bello, A I; Ababio, E; Antwi-Baffoe, S; Seidu, M A; Adjei, D N

2014-12-01

Assessment of impairment and disability measures on dynamic balance status of elderly patients is well documented in the rehabilitation of neuromuscular disorders. Few studies however considered similar evaluation in musculoskeletal disorders. To determine the influence of pain, hip range of motion and level of activity on dynamic balance among elderly people with hip osteoarthritis (OA). Elderly patients with hip OA participated in the cross-sectional survey. The impairment measures were assessed using the visual analogue scale and double-arm universal goniometer whilst their levels of activity were assessed with the Barthel Index. Participants performed Turn-180 on two trials by taking steps clockwise and anti-clockwise round a sturdy arm chair. The total number of steps taken to complete each Turn- 180 was determined. Descriptive statistics were used to summarize data whilst Pearson moment correlation coefficient determined the correlations of the variables at 95% confidence interval. The study involved 87 participants comprising 40(46%) males and 47(54%) females. The age of the participants ranged from 60 to 74 years with a mean of 65.8±4.5 years. There was a positive and significant correlation (r=0.596; p<0.001) between the participants' pain and steps taken to complete Turn-180. The participants' hip flexibility and the level of activity were also significantly and inversely correlated with the performance of Turn-180. The dynamic balance of the sampled elderly patients was considerably influenced by pain, hip flexibility and level of activity, thereby putting premium on the assessment of the variables during musculoskeletal rehabilitation of elderly patients.

Identifying changes in gait waveforms following a strengthening intervention for women with knee osteoarthritis using principal components analysis.

PubMed

Brenneman, Elora C; Maly, Monica R

2018-01-01

Lower limb strengthening exercise is pivotal for the management of symptoms related to knee osteoarthritis (OA). Though improvement in clinical symptoms is well documented, concurrent changes in gait biomechanics are ill-defined. This may occur because discrete analyses miss changes following an intervention, analyses limited to the knee undermine potential mechanical trade-offs at other joints, or strengthening interventions not been designed based on biomechanical principles. The purpose of this study was to characterize differences in entire gait waveforms for sagittal plane ankle, knee, and hip angles and external moments; the knee adduction moment; and frontal plane hip angle and moment following 12-weeks of a previously designed novel lower limb strengthening program. Forty women with knee OA completed two laboratory visits: one at baseline and one immediately following intervention (follow-up). Self-report measures, strength, and gait analyses were completed at each visit. Principal components analyses were completed for sagittal angles and external moments at the ankle, knee, and hip joints, as well as frontal plane angle and moment for the hip. Participants improved self-report and strength (p≤0.004). Two significant, yet subtle differences in principal components were identified between baseline and follow-up waveforms (p<0.05) pertaining to the knee and hip sagittal external moments. The subtle changes in concert with the lack of differences in other joints and planes suggest the lower limb strengthening program does not translate to changes in the gait waveform. It is likely this program is improving symptoms without worsening mechanics. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking.

PubMed

Attias, M; Bonnefoy-Mazure, A; De Coulon, G; Cheze, L; Armand, S

2016-10-01

Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics. Copyright © 2016 Elsevier B.V. All rights reserved.

The Influence of Weather Conditions on Outdoor Physical Activity Among Older People With and Without Osteoarthritis in 6 European Countries.

PubMed

Timmermans, Erik J; van der Pas, Suzan; Dennison, Elaine M; Maggi, Stefania; Peter, Richard; Castell, Maria Victoria; Pedersen, Nancy L; Denkinger, Michael D; Edwards, Mark H; Limongi, Federica; Herbolsheimer, Florian; Sánchez-Martínez, Mercedes; Siviero, Paola; Queipo, Rocio; Schaap, Laura A; Deeg, Dorly J H

2016-12-01

Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from 6 European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition. The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations. Of the 2439 participants (65-85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median = 42.9, IQR = 20.0 to 83.1 versus Median = 51.4, IQR = 23.6 to 98.6; P < .01). In the full sample, temperature (B = 1.52; P < .001) and relative humidity (B = -0.77; P < .001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B = 1.98; P < .001) than in those with the condition (B = 0.48; P = .47). Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA.

Establishment of reference intervals for osteoarthritis-related soluble biomarkers: the FNIH/OARSI OA Biomarkers Consortium.

PubMed

Kraus, Virginia B; Hargrove, David E; Hunter, David J; Renner, Jordan B; Jordan, Joanne M

2017-01-01

To establish reference intervals for osteoarthritis (OA)-related biomarkers used in the Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium Project. A total of 129 'multijoint controls' were selected from 2722 African-American and Caucasian men and women in the Johnston County Osteoarthritis Project. The majority (79%) of those eligible (with biospecimens and baseline data) also had one or more follow-up evaluations 5-15 years later. Multijoint controls were selected to be free of radiographic hand, hip, knee and lumbar spine osteoarthritis (OA), to have no knee or hip symptoms, and minimal hand and spine symptoms at all available time points. Eighteen biomarkers were evaluated in serum (s) and/or urine (u) by ELISA. Reference intervals and partitioning by gender and race were performed with EP Evaluator software. Controls were 64% women, 33% African-Americans, mean age 59 years and mean body mass index 29 kg/m 2 . Three biomarkers were associated with age: sHyaluronan (positively), sN-terminal propeptide of collagen IIA (positively) and sCol2-3/4 C-terminal cleavage product of types I and II collagen (negatively). Exploratory analyses suggested that separate reference intervals may be warranted on the basis of gender for uC-terminal cross-linked telopeptide of type II collagen (uCTXII), sMatrix metalloproteinase-3, uNitrated type II collagen degradation fragment (uCol2-1 NO2) and sHyaluronan, and on the basis of race for uCTXII, sCartilage oligomeric matrix protein, sC-terminal cross-linked telopeptide of type I collagen and uCol2-1 NO2. To our knowledge, this represents the best and most stringent control group ever assayed for OA-related biomarkers. These well-phenotyped controls, representing a similar age demographic to that of the OA Initiative-FNIH main study sample, provide a context for interpretation of OA subject biomarker data. The freely available data set also provides a reference for future human studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The pubo-femoral distance decreases with Pavlik harness treatment for developmental dysplasia of the hip in newborns.

PubMed

Maranho, Daniel Augusto; Donati, Felipe Nunes; Dalto, Vitor Faeda; Nogueira-Barbosa, Marcello Henrique

2017-09-01

To evaluate the evolution of the ultrasonographic pubo-femoral distance (PFD) before and after Pavlik harness treatment for developmental dysplasia of the hip (DDH) in newborns. Twenty-five patients (16.7 ± 10.4 days; 19 females, six males) diagnosed with DDH and treated using the Pavlik harness were included. Eighteen patients had bilateral, and seven unilateral DDH, with a total of 43 dysplastic hips. The seven non-dysplastic hips in unilateral cases were used for comparison. The PFD was measured in the coronal and axial planes with the hip flexed to approximately 90°, before and after an average of 93 days of treatment. The femoral head coverage was assessed in the coronal plane, and correlated with PFD values. In dysplastic hips, the mean PFD decreased from 6.1 ± 1.8 mm to 3.0 ± 0.7 mm in the axial (adjusted difference, 2.9 mm; p < 0.01), and from 5.9 ± 2.0 to 3.0 ± 0.6 mm in the coronal plane (adjusted difference 2.7 mm; p < 0.01). The femoral head coverage increased from 30.8 to 62.1%, and the mean differences of femoral head coverage and PFD were significantly correlated (p < 0.001). There was no difference between treated dysplastic and non-dysplastic hips. There was high intra- and inter-observer agreement for PFD measurements. The PFD decreased significantly after DDH treatment using the Pavlik harness in newborns, and showed significant correlation with the femoral head coverage improvement. PFD might be a reliable tool for monitoring DDH treatment in newborns treated using the Pavlik harness.

Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2016-12-01

Ballet exposes the hip joint to repetitive loading in extreme ranges of movement and may predispose a dancer to pain and osteoarthritis (OA). The aims of this study were to compare the prevalence of cartilage defects in professional ballet dancers and athletes and to determine the relationship of clinical signs and symptoms. Forty-nine male and female, current and retired professional ballet dancers and 49 age- and sex-matched non-dancing athletes completed hip pain questionnaires, including the Copenhagen Hip and Groin Outcome Score (HAGOS), and underwent hip range of movement (ROM) testing and 3-Tesla magnetic resonance imaging to score cartilage defects (no defect, grade 1: focal partial defect and grade 2: diffuse or full thickness defect). Thirty (61 %) dancers and 27 (55 %) athletes had cartilage defects (p = 0.54). The frequency of grade 1 and 2 cartilage defects did not differ between dancers and athletes (p = 0.83). The frequency of cartilage defects was similar in male and female dancers (p = 0.34), and male and female athletes (p = 0.24). Cartilage defects were not related to history of hip pain (p = 0.34), HAGOS pain (p = 0.14), sports/rec (p = 0.15) scores or hip internal rotation ≤20° (p > 0.01). Cartilage defects were related to age in male dancers (p = 0.002). Ballet dancers do not appear to be at a greater risk of cartilage injury compared to non-dancing athletes. Male dancers develop cartilage defects at an earlier age than athletes and female dancers. Cartilage defects were not related to clinical signs and symptoms; thus, prospective studies are required to determine which cartilage defects progress to symptomatic hip OA.

Accuracy of femoral templating in reproducing anatomical femoral offset in total hip replacement.

PubMed

Davies, H; Foote, J; Spencer, R F

2007-01-01

Restoration of hip biomechanics is a crucial component of successful total hip replacement. Preoperative templating is recommended to ensure that the size and orientation of implants is optimised. We studied how closely natural femoral offset could be reproduced using the manufacturers' templates for 10 femoral stems in common use in the UK. A series of 23 consecutive preoperative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip was employed. The change in offset between the templated position of the best-fitting template and the anatomical centre of the hip was measured. The templates were then ranked according to their ability to reproduce the normal anatomical offset. The most accurate was the CPS-Plus (Root Mean Square Error 2.0 mm) followed in rank order by: C stem (2.16), CPT (2.40), Exeter (3.23), Stanmore (3.28), Charnley (3.65), Corail (3.72), ABG II (4.30), Furlong HAC (5.08) and Furlong modular (7.14). A similar pattern of results was achieved when the standard error of variability of offset was analysed. We observed a wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset. This variation was independent of the seniority of the observer. The templates of modern polished tapered stems with high modularity were best able to reproduce femoral offset. The current move towards digitisation of X-rays may offer manufacturers an opportunity to improve template designs in certain instances, and to develop appropriate computer software.

Transient osteoporosis of the hip in pregnancy associated with generalized low bone mineral density--a case report.

PubMed

Anai, Takanobu; Urata, Kenichirou; Mori, Atsue; Miyazaki, Fumiko; Okamoto, Sumiaki

2013-01-01

Transient osteoporosis of the hip (TOH) in pregnancy is characterized by severe pain in unilateral or bilateral hips and has been diagnosed as localized osteopenia. However, we evaluated a case of unilateral TOH with generalized profound osteoporosis involving both the hips and the lumbar vertebrae by dual-energy X-ray absorptiometry. The diagnosis was based on the clinical course and confirmed by magnetic resonance imaging. Three-dimensional helical computed tomography (3D-CT), which has not been used in patients with TOH, revealed a markedly thin bilateral proximal femoral cortex, particularly in the symptomatic femoral head. Despite the difference in the severity of bone destruction between the two femora, they both showed the same pattern of damage on 3D-CT. Furthermore, despite continuing treatment with the same dose of alendronate and calcitriol, a high rate of bone mineral density gain, involving both the femora and lumbar vertebrae, was limited to the early postpartum months. A majority of reported female patients with TOH are pregnant. Thus, the association between TOH and pregnancy was not considered to be fortuitous, and chemical or hormonal factors related to pregnancy may play an etiologic role in this disease. The possible etiologies of TOH in pregnancy are also discussed. © 2013 S. Karger AG, Basel.

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study.

PubMed

Bieler, Theresa; Magnusson, Stig Peter; Christensen, Helle Elisabeth; Kjaer, Michael; Beyer, Nina

2017-07-01

To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers. Seventy-two patients (60-87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63-82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy. The symptomatic extremity in patients was significantly (p < 0.05, paired t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8-17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p < 0.05) comparable to that found in patients, but had no asymmetry in leg extensor power. Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis. Implications for Rehabilitation Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present. Between-leg differences in leg extensor power (force × velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry. Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity. Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

PubMed Central

Fabio, Costa; Romualdo, Del Buono; Eugenio, Agrò Felice; Vittoradolfo, Tambone; Massimiliano, Vitali Andrea; Giovanna, Ricci

2017-01-01

Spinal anaesthesia is the most preffered anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8–T11 spinal cord ischaemia following L2–L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8–T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice. PMID:28439446

Exercise for osteoarthritis of the hip.

PubMed

Fransen, Marlene; McConnell, Sara; Hernandez-Molina, Gabriela; Reichenbach, Stephan

2014-04-22

Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence. To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and improved physical function and quality of life. We searched five databases from inception up to February 2013. All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group. Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals). We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants). Pooling the results of these 10 RCTs demonstrated that land-based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA.

Controlled, blinded force platform analysis of the effect of intraarticular injection of autologous adipose-derived mesenchymal stem cells associated to PRGF-Endoret in osteoarthritic dogs.

PubMed

Vilar, Jose M; Morales, Manuel; Santana, Angelo; Spinella, Giuseppe; Rubio, Mónica; Cuervo, Belen; Cugat, Ramón; Carrillo, Jose M

2013-07-02

Adipose-derived mesenchymal stem cell (ADMSC) therapy in regenerative medicine is a rapidly growing area of research and is currently also being used to treat osteoarthritis (OA). Force platform analysis has been consistently used to verify the efficacy of different therapeutic strategies for the treatment of OA in dogs, but never with AD-MSC.The aim of this study was to use a force platform to measure the efficacy of intraarticular ADMSC administration for limb function improvement in dogs with severe OA. Eight lame dogs with severe hip OA and a control group of 5 sound dogs were used for this study. Results were statistically analyzed to detect a significant increase in peak vertical force (PVF) and vertical impulse (VI) in treated dogs. Mean values of PVF and VI were significantly improved after treatment of the OA groups, reaching 53.02% and 14.84% of body weight, respectively, at day 180, compared with only 43.56% and 12.16% at day 0. This study objectively demonstrated that intraarticular ADMSC therapy resulted in reduced lameness due to OA.

Controlled, blinded force platform analysis of the effect of intraarticular injection of autologous adipose-derived mesenchymal stem cells associated to PRGF-Endoret in osteoarthritic dogs

PubMed Central

2013-01-01

Background Adipose-derived mesenchymal stem cell (ADMSC) therapy in regenerative medicine is a rapidly growing area of research and is currently also being used to treat osteoarthritis (OA). Force platform analysis has been consistently used to verify the efficacy of different therapeutic strategies for the treatment of OA in dogs, but never with AD-MSC. The aim of this study was to use a force platform to measure the efficacy of intraarticular ADMSC administration for limb function improvement in dogs with severe OA. Results Eight lame dogs with severe hip OA and a control group of 5 sound dogs were used for this study. Results were statistically analyzed to detect a significant increase in peak vertical force (PVF) and vertical impulse (VI) in treated dogs. Mean values of PVF and VI were significantly improved after treatment of the OA groups, reaching 53.02% and 14.84% of body weight, respectively, at day 180, compared with only 43.56% and 12.16% at day 0. Conclusion This study objectively demonstrated that intraarticular ADMSC therapy resulted in reduced lameness due to OA. PMID:23819757

Prospective associations of C-reactive protein (CRP) levels and CRP genetic risk scores with risk of total knee and hip replacement for osteoarthritis in a diverse cohort.

PubMed

Shadyab, A H; Terkeltaub, R; Kooperberg, C; Reiner, A; Eaton, C B; Jackson, R D; Krok-Schoen, J L; Salem, R M; LaCroix, A Z

2018-05-22

To examine associations of high-sensitivity C-reactive protein (CRP) levels and polygenic CRP genetic risk scores (GRS) with risk of end-stage hip or knee osteoarthritis (OA), defined as incident total hip (THR) or knee replacement (TKR) for OA. This study included a cohort of postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. Women were followed from baseline to date of THR or TKR, death, or December 31, 2014. Medicare claims data identified THR and TKR. Hs-CRP and genotyping data were collected at baseline. Three CRP GRS were constructed: 1) a 4-SNP GRS comprised of genetic variants representing variation in the CRP gene among European populations; 2) a multilocus 18-SNP GRS of genetic variants significantly associated with CRP levels in a meta-analysis of genome-wide association studies; and 3) a 5-SNP GRS of genetic variants significantly associated with CRP levels among African American women. In analyses conducted separately among each race and ethnic group, there were no significant associations of ln hs-CRP with risk of THR or TKR, after adjusting for age, body mass index, lifestyle characteristics, chronic diseases, hormone therapy use, and non-steroidal anti-inflammatory drug use. CRP GRS were not associated with risk of THR or TKR in any ethnic group. Serum levels of ln hs-CRP and genetically-predicted CRP levels were not associated with risk of THR or TKR for OA among a diverse cohort of women. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids.

PubMed

van Middelkoop, M; Arden, N K; Atchia, I; Birrell, F; Chao, J; Rezende, M U; Lambert, R G W; Ravaud, P; Bijlsma, J W; Doherty, M; Dziedzic, K S; Lohmander, L S; McAlindon, T E; Zhang, W; Bierma-Zeinstra, S M A

2016-07-01

To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials. Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study. Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points. This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes.

PubMed

Fransen, Marlene; Nairn, Lillias; Winstanley, Julie; Lam, Paul; Edmonds, John

2007-04-15

To determine whether Tai Chi or hydrotherapy classes for individuals with chronic symptomatic hip or knee osteoarthritis (OA) result in measurable clinical benefits. A randomized controlled trial was conducted among 152 older persons with chronic symptomatic hip or knee OA. Participants were randomly allocated for 12 weeks to hydrotherapy classes (n = 55), Tai Chi classes (n = 56), or a waiting list control group (n = 41). Outcomes were assessed 12 and 24 weeks after randomization and included pain and physical function (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (Medical Outcomes Study Short Form 12 Health Survey [SF-12], version 2), psychological well-being, and physical performance (Up and Go test, 50-foot walk time, timed stair climb). At 12 weeks, compared with controls, participants allocated to hydrotherapy classes demonstrated mean improvements (95% confidence interval) of 6.5 (0.4, 12.7) and 10.5 (3.6, 14.5) for pain and physical function scores (range 0-100), respectively, whereas participants allocated to Tai Chi classes demonstrated improvements of 5.2 (-0.8, 11.1) and 9.7 (2.8, 16.7), respectively. Both class allocations achieved significant improvements in the SF-12 physical component summary score, but only allocation to hydrotherapy achieved significant improvements in the physical performance measures. All significant improvements were sustained at 24 weeks. In this almost exclusively white sample, class attendance was higher for hydrotherapy, with 81% attending at least half of the available 24 classes, compared with 61% for Tai Chi. Access to either hydrotherapy or Tai Chi classes can provide large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA.

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial.

PubMed

Schencking, Martin; Wilm, Stefan; Redaelli, Marcus

2013-01-01

An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint. pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the "timed up and go" test were mainly improved within group 1 followed by groups 3 and 2. The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp's hydrotherapy, a larger sample size is necessary. NCT 00950326.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry.

PubMed

Brennan, Sharon L; Stanford, Tyman; Wluka, Anita E; Henry, Margaret J; Page, Richard S; Graves, Stephen E; Kotowicz, Mark A; Nicholson, Geoffrey C; Pasco, Julie A

2012-04-30

The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia. Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006-7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Females accounted for 46.9% of the 642 primary THR performed during 2006-7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70-79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review.

PubMed

Gay, C; Chabaud, A; Guilley, E; Coudeyre, E

2016-06-01

Highlight the role of patient education about physical activity and exercise in the treatment of hip and knee osteoarthritis (OA). Systematic literature review from the Cochrane Library, PubMed and Wiley Online Library databases. A total of 125 items were identified, including 11 recommendations from learned societies interested in OA and 45 randomized controlled trials addressing treatment education and activity/exercise for the treatment of hip and knee osteoarthritis. In the end, 13 randomized controlled trials and 8 recommendations were reviewed (1b level of evidence). Based on the analysis, it was clear that education, exercise and weight loss are the pillars of non-pharmacological treatments. These treatments have proven to be effective but require changes in patient behaviour that are difficult to obtain. Exercise and weight loss improve function and reduce pain. Education potentiates compliance to exercise and weight loss programs, thereby improving their long-term benefits. Cost efficiency studies have found a reduction in medical visits and healthcare costs after 12 months because of self-management programs. Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.

PubMed

Cochrane, T; Davey, R C; Matthes Edwards, S M

2005-08-01

To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis (OA) in older patients. A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment, to check design assumptions and delivery processes. The main study was a randomised controlled trial of the effectiveness of water-based exercise (treatment) compared with usual care (control) in older patients with hip and/or knee OA. The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments. Water exercise was delivered in public swimming pools in the UK. Physical function assessments were carried out in established laboratory settings. 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA took part in the preliminary study. A similar, but larger, group of 312 patients (196 women, 116 men) took part in the main study, randomised into control (159) and water exercise (153) groups. Control group patients received usual care with quarterly semi-structured telephone interview follow-up only. The intervention in the main study lasted for 1 year, with a further follow-up period of 6 months. Pain score on the Western Ontario and McMaster Universities OA index (WOMAC). Additional outcome measures were included to evaluate effects on quality of life, cost-effectiveness and physical function measurements. Short-term efficacy of water exercise in the management of lower limb OA was confirmed, with effect sizes ranging from 0.44 [95% confidence interval (CI) 0.03 to 0.85] on WOMAC pain to 0.76 (95% CI 0.33 to 1.17) on WOMAC physical function. Of 153 patients randomised to treatment, 82 (53.5%) were estimated to have complied satisfactorily with their treatment at the 1-year point. This had declined to 28 (18%) by the end of the 6-month follow-up period, during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment. High levels of co-morbidity were recorded in both groups. Nearly two thirds of all patients had a significant other illness in addition to their OA. Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period. Water exercise remained effective in the main study but overall effect size was small, on WOMAC pain at 1 year, a reduction of about 10% in group mean pain score. This had declined, and was non-significant, at 18 months. Mean cost difference estimates showed a saving in the water exercise group of pound123--175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality-adjusted life-year (QALY). Net reduction in pain was achieved at a net saving of pound135--175 per patient per annum and the ceiling valuation of pound580--740 per unit of WOMAC pain reduction was favourably low. Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA, and may be a useful adjunct in the management of hip and/or knee OA. The water-exercise programme produced a favourable cost--benefit outcome, using reduction in WOMAC pain as the measure of benefit. Further research is suggested into other similar public health interventions. Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare, as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way. More detailed research is required to develop a better understanding of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people, from both a provider and a participant perspective, the societal costs of the different approaches to the management of OA and longer term trends in outcome measures (costs and effects).

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol

PubMed Central

Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Haxby Abbott, J.; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S.

2015-01-01

Background Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. Objective The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist–instructed home exercise leads to greater reductions in pain and improvements in function. Design An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. Setting The study will be conducted in a community setting. Participants The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Intervention Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Measurements Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. Limitations A self-reported diagnosis of persistent hip pain will be used. Conclusions The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist–instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. PMID:26023213

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

PubMed

Bennell, Kim L; Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S

2015-10-01

Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. The study will be conducted in a community setting. The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. © 2015 American Physical Therapy Association.

The effectiveness of an exercise programme on dynamic balance in patients with medial knee osteoarthritis: A pilot study.

PubMed

Al-Khlaifat, Lara; Herrington, Lee C; Tyson, Sarah F; Hammond, Alison; Jones, Richard K

2016-10-01

Dynamic balance and quiet standing balance are decreased in knee osteoarthritis (OA), with dynamic balance being more affected. This study aimed to investigate the effectiveness of a group exercise programme of lower extremity muscles integrated with education on dynamic balance using the Star Excursion Balance test (SEBT) in knee OA. Experimental before-and-after pilot study design. Nineteen participants with knee OA attended the exercise sessions once a week for six weeks, in addition to home exercises. Before and after the exercise programme, dynamic balance was assessed using the SEBT in the anterior and medial directions in addition to hip and knee muscle strength, pain, and function. Fourteen participants completed the study. Dynamic balance on the affected side demonstrated significant improvements in the anterior and medial directions (p=0.02 and p=0.01, respectively). The contralateral side demonstrated significant improvements in dynamic balance in the anterior direction (p<0.001). However, balance in the medial direction did not change significantly (p=0.07). Hip and knee muscle strength, pain, and function significantly improved (p<0.05) after the exercise programme. This is the first study to explore the effect of an exercise programme on dynamic balance using the SEBT in knee OA. The exercise programme was effective in improving dynamic balance which is required in different activities of daily living where the patients might experience the risk of falling. This might be attributed to the improvement in muscle strength and pain after the exercise programme. Copyright © 2016 Elsevier B.V. All rights reserved.

DXA in the assessment of subchondral bone mineral density in knee osteoarthritis--A semi-standardized protocol after systematic review.

PubMed

Sepriano, Alexandre; Roman-Blas, Jorge A; Little, Robert D; Pimentel-Santos, Fernando; Arribas, Jose María; Largo, Raquel; Branco, Jaime C; Herrero-Beaumont, Gabriel

2015-12-01

Subchondral bone mineral density (sBMD) contributes to the initiation and progression of knee osteoarthritis (OA). Reliable methods to assess sBMD status may predict the response of specific OA phenotypes to targeted therapies. While dual-energy X-ray absorptiometry (DXA) of the knee can determine sBMD, no consensus exists regarding its methodology. Construct a semi-standardized protocol for knee DXA to measure sBMD in patients with OA of the knee by evaluating the varying methodologies present in existing literature. We performed a systematic review of original papers published in PubMed and Web of Science from their inception to July 2014 using the following search terms: subchondral bone, osteoarthritis, and bone mineral density. DXA of the knee can be performed with similar reproducibility values to those proposed by the International Society for Clinical Densitometry for the hip and spine. We identified acquisition view, hip rotation, knee positioning and stabilization, ROI location and definition, and the type of analysis software as important sources of variation. A proposed knee DXA protocol was constructed taking into consideration the results of the review. DXA of the knee can be reliably performed in patients with knee OA. Nevertheless, we found substantial methodological variation across previous studies. Methodological standardization may provide a foundation from which to establish DXA of the knee as a valid tool for identification of SB changes and as an outcome measure in clinical trials of disease modifying osteoarthritic drugs. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of weather conditions on outdoor physical activity among older people with and without osteoarthritis in six European countries

PubMed Central

Timmermans, Erik J; van der Pas, Suzan; Dennison, Elaine M; Maggi, Stefania; Peter, Richard; Castell, Maria Victoria; Pedersen, Nancy L; Denkinger, Michael D; Edwards, Mark H; Limongi, Federica; Herbolsheimer, Florian; Sánchez-Martínez, Mercedes; Siviero, Paola; Queipo, Rocio; Schaap, Laura A; Deeg, Dorly JH

2017-01-01

Objectives Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from six European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition. Methods The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations. Results Of the 2,439 participants (65-85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median=42.9, IQR=20.0-83.1 versus Median=51.4, IQR=23.6-98.6; p<0.01). In the full sample, temperature (B=1.52; p<0.001) and relative humidity (B=-0.77; p<0.001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B=1.98; p<0.001) than in those with the condition (B=0.48; p=0.47). Conclusions Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA. PMID:27633622

Racial differences in associations between baseline patterns of radiographic osteoarthritis and multiple definitions of progression of hip osteoarthritis: the Johnston County Osteoarthritis Project.

PubMed

Foley, Bridget; Cleveland, Rebecca J; Renner, Jordan B; Jordan, Joanne M; Nelson, Amanda E

2015-12-18

To identify baseline radiographic features that predict hip osteoarthritis (HOA) progression, and to explore differences in these associations by race. Radiographs from the community-based Johnston County OA Project were scored using Kellgren-Lawrence (KL) grade and for presence and location of joint space narrowing (JSN), osteophytes, and subchondral changes. Associations between these features and HOA progression (increase of at least 1 KL grade, interval hip replacement, range of motion [ROM, a reduction of ≥10° in internal rotation], or disability [increase of ≥0.2 in Health Assessment Questionnaire scores], or Any of these) were assessed using logistic regression, adjusting for age, gender, race, hip injury, BMI, education, smoking and follow-up time, accounting for multiple comparisons. Race interactions were assessed and analyses stratified as indicated. The sample (n = 1,422) included 40 % men and 26 % African American (AA) participants, with mean age 61 years and BMI 29 kg/m(2). The baseline frequency of radiographic hip OA (RHOA) between Caucasians and AAs was similar (23 %), although some radiographic features differed. AAs were more likely to have progression defined by ROM or disability or Any progression; Caucasians were more likely to have RHOA progression. JSN, subchondral sclerosis, and medial osteophytes were associated with increased RHOA progression overall; JSN was associated with disability progression only in AAs, while lateral osteophytes were associated with ROM progression only in Caucasians. AAs and Caucasians exhibited differences in the radiographic presentation and progression patterns of HOA, with AAs reporting progressive pain and disability, while Caucasians had more RHOA progression.

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.

Serum periostin is associated with prevalent knee osteoarthritis and disease incidence/progression in women: the OFELY study.

PubMed

Rousseau, J C; Sornay-Rendu, E; Bertholon, C; Garnero, P; Chapurlat, R

2015-10-01

Our aim was to investigate the relationships between serum periostin (POSTN) and both prevalence and incidence/progression of knee osteoarthritis (OA) in women. We investigated 594 women (62.7 ± 11.2 yr) from the OFELY cohort. Knee radiographs were scored according to the Kellgren & Lawrence (KL) grading system at baseline and 4 years later. Spine, hip and hand OA were assessed at baseline. Prevalent knee OA was defined by a KL score higher or equal in 2. Progression of KL was defined as an increase of the KL score ≥1 during the 4 years follow-up. Serum POSTN was measured at baseline by ELISA. By non-parametric tests, POSTN was significantly lower in 83 women with a KL score ≥2 at baseline, compared to those with a KL score <2 (n = 511; 1101 ± 300 vs 1181 ± 294 ng/ml, P = 0.002) after adjustment for age, body mass index (BMI), treatments and diseases, prevalent hand OA and prevalent lumbar spine OA. By logistic regression analyses, the odds-ratio of knee OA incidence/progression was significantly reduced by 21% (P = 0.043) for each quartile increase in serum POSTN at baseline, after adjustment for age, BMI, prevalent knee OA, prevalent hand OA and prevalent lumbar spine OA. We show for the first time that serum POSTN is associated with prevalence and the risk of development/progression of knee OA in women. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

PubMed

Reito, Aleksi; Elo, Petra; Nieminen, Jyrki; Puolakka, Timo; Eskelinen, Antti

2016-02-01

There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors. 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles. The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy. Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.

PubMed

Hauzeur, Jean-Philippe; Malaise, Michel; de Maertelaer, Viviane

2016-07-01

To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data. A prospective survey was conducted in a cohort of ONFH recruited from a dedicated clinic for osteonecrosis. The history of symptoms, medical management, and physical findings were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed: bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus fractured stage 3 versus stage 4. ONFH was bilateral in 63 %, especially in corticosteroid users and in sickle-cell cases. These patients were younger but had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 % of hips. The localization of this pain was variable, including in the groin, the buttocks, or diffused in the lower limbs. A limp was present in 50 % of the patients, only when one hip was painful. The physical examination of the hip was normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12 months, with inadequate medical management in 51 % of patients. In ONFH cases, no typical clinical pattern was found. The clinical presentation was very variable, sometimes having spine or knee symptoms with a normal physical examination of the hip. ONFH should be systematically suspected in cases of onset of pain in the pelvis, buttocks, groin, and lower limbs.

Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study).

PubMed

Johnsen, Marianne Bakke; Hellevik, Alf Inge; Baste, Valborg; Furnes, Ove; Langhammer, Arnulf; Flugsrud, Gunnar; Nordsletten, Lars; Zwart, John Anker; Storheim, Kjersti

2016-02-16

The relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort. Participants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45-59 and ≥60 years) and sex. A total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08-2.94) and men between 45-59 years (HR 1.53, 95 % CI 1.10-2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03-2.04). No measures of LPA were associated with TKR for men. In this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.

Patient information and emotional needs across the hip osteoarthritis continuum: a qualitative study.

PubMed

Brembo, Espen Andreas; Kapstad, Heidi; Eide, Tom; Månsson, Lukas; Van Dulmen, Sandra; Eide, Hilde

2016-03-12

Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time. As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients' need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach. The thematic analysis revealed a pattern of patients' information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option. Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies.

Neglected Posterior Dislocation of Hip in Children - A Case Report.

PubMed

Pal, Chandra Prakash; Kumar, Deepak; Sadana, Ashwani; Dinkar, Karuna Shankar

2014-01-01

Traumatic dislocation of the hip in children is a rare injury. We report the outcome of 2 patients of neglected hip dislocation which were treated by open reduction and internal fixation by k-wires. We treat 2 children both girls (one was of 4 years and other was 7 years of age). In both cases dislocation was unilateral and was not associated with any facture. Both cases were of posterior dislocation. in both cases open reduction and internal fixation was done by k wires. Hip spica was applied post operatively in both cases. The k wire was removed at 3 to 4 weeks. Patients were allowed to bear weight from gradual to full weight bearing after 6 weeks. We conclude that open reduction is a satisfactory treatment for neglected hip dislocation. It prevents not only deformity but also maintains limb length.

Effect of Full-Length Carbon Fiber Insoles on Lower Limb Kinetics in Patients With Midfoot Osteoarthritis: A Pilot Study.

PubMed

Yi, Taeim; Kim, Jung Hyun; Oh-Park, Mooyeon; Hwang, Ji Hye

2018-03-01

We investigated the effects of full-length carbon fiber (FCF) insoles on gait, muscle activity, kinetics, and pain in patients with midfoot osteoarthritis (OA). We enrolled 13 patients with unilateral midfoot OA (mild: Visual Analog Scale [VAS] range, 1-3; moderate, VAS range, 4-7) and healthy controls. All participants were asked to walk under two conditions: with and without FCF insole. The outcome measures were ground reaction force, quantitative gait parameters, electromyography activities and pain severity (VAS). In the patients with moderate midfoot OA, significantly longer gait cycle and higher muscle activity of lower limb during loading-response phase were observed while walking without FCF insoles. In the mild midfoot OA group, there was no significant difference in VAS score (without, 2.0 ± 1.0 vs. with, 2.0 ± 0.5) with FCF insole use. However, significantly reduced VAS score (without, 5.5 ± 1.4 vs. with, 2.0 ± 0.5) and muscle activity of the tibialis anterior and increased muscle activity of gastrocnemius were observed in the moderate midfoot OA group by using an FCF insole (P < 0.05). Full-length carbon fiber insoles can improve pain in individuals with moderate midfoot OA, which might be associated with changes in the kinetics and muscle activities of the lower limb. Taken together, the results of the present study suggest that FCF insoles may be used as a helpful option for midfoot OA.

Adiposity and hand osteoarthritis: the Netherlands Epidemiology of Obesity study

PubMed Central

2014-01-01

Introduction Obesity, usually characterized by the body mass index (BMI), is a risk factor for hand osteoarthritis (OA). We investigated whether adipose tissue and abdominal fat distribution are associated with hand OA. Methods The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort aged 45 to 65 years, including 5315 participants (53% women, median BMI 29.9 kg/m2). Fat percentage and fat mass (FM) (kg) were estimated using bioelectrical impedance analysis. The waist-to-hip ratio (WHR) was calculated. In 1721 participants, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) (cm2) were assessed using abdominal MR imaging. Hand OA was defined according to the ACR criteria. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the association of fat percentage, FM, WHR, VAT and SAT with hand OA using logistic regression analyses per standard deviation, stratified by sex and adjusted for age. Results Hand OA was present in 8% of men and 20% of women. Fat percentage was associated with hand OA in men (OR 1.34 (95% CI 1.11 to 1.61)) and women (OR 1.26 (1.05 to 1.51)), as was FM. WHR was associated with hand OA in men (OR 1.45 (1.13 to 1.85)), and to a lesser extent in women (OR 1.17 (1.00 to 1.36)). Subgroup analysis revealed that VAT was associated with hand OA in men (OR1.33 (1.01 to 1.75)). This association increased after additional adjustment for FM (OR 1.51 (1.13 to 2.03)). Conclusions Fat percentage, FM and WHR were associated with hand OA. VAT was associated with hand OA in men, suggesting involvement of visceral fat in hand OA. PMID:24447395

Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention

PubMed Central

Angst, F; Aeschlimann, A; Steiner, W; Stucki, G

2001-01-01

OBJECTIVE—To compare the responsiveness of the condition-specific Western Ontario and McMaster Universities osteoarthritis (OA) index (WOMAC) and the generic Short Form-36 (SF-36) in patients with OA of the legs undergoing a comprehensive inpatient rehabilitation intervention.
METHODS—A prospective follow up study of consecutively referred inpatients of a rehabilitation clinic was made. The patients included fulfilled the American College of Rheumatology criteria for knee or hip OA and underwent both passive and, particularly, active physical therapy for three to four weeks. Responsiveness assessment was performed using the standardised response mean (SRM), effect size, and Guyatt's responsiveness statistic between admission and discharge (end of rehabilitation) and then again between admission and three months later. For pain and function the SRMs were stratified by sex and OA joint. Effects were tested by the t test and SRMs of different scales were compared by the jack knife test.
RESULTS—At the three month follow up, complete data were obtained for 223 patients. In general, the three responsiveness statistics showed a similar order of responsiveness. For both instruments, the pain scales were more responsive than the function scales. The responsiveness of the pain scale of both instruments was comparable (SRM=0.723 for WOMAC and SRM=0.528 for SF-36 at the end of rehabilitation; SRM=0.377 for WOMAC and SRM=0.468 for SF-36 at the three month follow up). In the measurement of function, the WOMAC was significantly more responsive than the SF-36 (SRMs, end of rehabilitation: 0.628 v 0.249; three month follow up: 0.235 v −0.001). Responsiveness tended to be higher in women and in knee OA than in men and hip OA.
CONCLUSIONS—Both instruments, the WOMAC and the SF-36, capture improvement in pain in patients undergoing comprehensive inpatient rehabilitation intervention. Functional improvement can be detected better by the WOMAC than by the SF-36. All the other scales of both instruments were more weakly responsive.

 PMID:11502609

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial.

PubMed

Meuret, Pascal; Bouvet, Lionel; Villet, Benoit; Hafez, Mohamed; Allaouchiche, Bernard; Boselli, Emmanuel

2018-04-01

Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0-17 mg) compared with that in the GA group (36 mg, 21-57 mg). Intraoperative muscle relaxation and patients' and surgeons' satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.

Prevalence of sarcopenia in Germany and the corresponding effect of osteoarthritis in females 70 years and older living in the community: results of the FORMoSA study

PubMed Central

Kemmler, Wolfgang; Teschler, Marc; Goisser, Sabine; Bebenek, Michael; von Stengel, Simon; Bollheimer, Leo Cornelius; Sieber, Cornel C; Freiberger, Ellen

2015-01-01

Background Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort. Methods A total of 689 Caucasian females 18–35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews. Results Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m2), low gait speed (≤0.8 m/s), and low grip strength (<20 kg), the prevalence of sarcopenia in CD German females 70 years and older was 4.5% (70–79 years: 2.8% vs ≥80 years: 9.9%; P<0.001). Participants with OA at the hip and lower limbs (n=252) exhibited significantly higher rates of sarcopenia (OA: 9.1 vs non-OA: 3.5%). Of importance, anthropometric, demographic, health, and lifestyle parameters (except exercise participation) of our cohorts corresponded with Bavarian or German data for CD women 70 years+. Conclusion The prevalence of sarcopenia in CD German females 70 years+ is relatively low. However, participants with OA at the hip or lower limbs were at increased risk for sarcopenia. PMID:26491272

Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain.

PubMed

Lewis, Cara L; Loverro, Kari L; Khuu, Anne

2018-04-01

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

Sport injuries: a review of outcomes.

PubMed

Maffulli, Nicola; Longo, Umile Giuseppe; Gougoulias, Nikolaos; Caine, Dennis; Denaro, Vincenzo

2011-01-01

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

PubMed

Zhang, W; Moskowitz, R W; Nuki, G; Abramson, S; Altman, R D; Arden, N; Bierma-Zeinstra, S; Brandt, K D; Croft, P; Doherty, M; Dougados, M; Hochberg, M; Hunter, D J; Kwoh, K; Lohmander, L S; Tugwell, P

2008-02-01

To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.

The Role of the Caudal Superior Parietal Lobule in Updating Hand Location in Peripheral Vision: Further Evidence from Optic Ataxia

PubMed Central

Granek, Joshua A.; Pisella, Laure; Blangero, Annabelle; Rossetti, Yves; Sergio, Lauren E.

2012-01-01

Patients with optic ataxia (OA), who are missing the caudal portion of their superior parietal lobule (SPL), have difficulty performing visually-guided reaches towards extra-foveal targets. Such gaze and hand decoupling also occurs in commonly performed non-standard visuomotor transformations such as the use of a computer mouse. In this study, we test two unilateral OA patients in conditions of 1) a change in the physical location of the visual stimulus relative to the plane of the limb movement, 2) a cue that signals a required limb movement 180° opposite to the cued visual target location, or 3) both of these situations combined. In these non-standard visuomotor transformations, the OA deficit is not observed as the well-documented field-dependent misreach. Instead, OA patients make additional eye movements to update hand and goal location during motor execution in order to complete these slow movements. Overall, the OA patients struggled when having to guide centrifugal movements in peripheral vision, even when they were instructed from visual stimuli that could be foveated. We propose that an intact caudal SPL is crucial for any visuomotor control that involves updating ongoing hand location in space without foveating it, i.e. from peripheral vision, proprioceptive or predictive information. PMID:23071599

Effects of chronic cobalt and chromium exposure after metal‐on‐metal hip resurfacing: An epigenome‐wide association pilot study

PubMed Central

Steinberg, Julia; Shah, Karan M.; Gartland, Alison; Zeggini, Eleftheria

2017-01-01

ABSTRACT Metal‐on‐metal (MOM) hip resurfacing has recently been a popular prosthesis choice for the treatment of symptomatic arthritis, but results in the release of cobalt and chromium ions into the circulation that can be associated with adverse clinical effects. The mechanism underlying these effects remains unclear. While chromosomal aneuploidy and translocations are associated with this exposure, the presence of subtle structural epigenetic modifications in patients with MOM joint replacements remains unexplored. Consequently, we analyzed whole blood DNA methylation in 34 OA patients with MOM hip resurfacing (MOM HR) compared to 34 OA patients with non‐MOM total hip replacements (non‐MOM THR), using the genome‐wide Illumina HumanMethylation 450k BeadChip. No probes showed differential methylation significant at 5% false‐discovery rate (FDR). We also tested association of probe methylation levels with blood chromium and cobalt levels directly; there were no significant associations at 5% FDR. Finally, we used the “epigenetic clock” to compare estimated to actual age at sample for all individuals. We found no significant difference between MOM HR and non‐MOM THR, and no correlation of age acceleration with blood metal levels. Our results suggest the absence of large methylation differences systemically following metal exposure, however, larger sample sizes will be required to identify potential small effects. Any DNA methylation changes that may occur in the local periprosthetic tissues remain to be elucidated. © 2017 The Authors. Orthopaedic Research Society. Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:2323–2328, 2017. PMID:28098396

Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.

PubMed

Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt; Axe, Michael J; Buchanan, Thomas S; Snyder-Mackler, Lynn

2016-01-01

Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction. © 2015 The Author(s).

Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury

PubMed Central

Wellsandt, Elizabeth; Gardinier, Emily S.; Manal, Kurt; Axe, Michael J.; Buchanan, Thomas S.; Snyder-Mackler, Lynn

2015-01-01

Background Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Hypothesis Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Study Design Case-control study; Level of evidence, 3. Methods Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Results Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs −0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: −0.001 ± 0.032 N·m·s/kg·m [nonOA] vs −0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs −0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Conclusion Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction. PMID:26493337

Cultural adaptation and validation of a German version of the Arthritis Impact Measurement Scales (AIMS2).

PubMed

Rosemann, T; Szecsenyi, J

2007-10-01

To validate a translated and culturally adapted version of the Arthritis Impact Measurement Scale (AIMS) 2 in primary care patients with osteoarthritis (OA) of the hip and knee. The AIMS2 was translated into German and culturally adapted. The questionnaire then was administered to 220 primary care patients with OA of the knee or hip. Two hundred and nine questionnaires were returned and analysed. Test-retest reliability was tested in 50 randomly selected patients, of those 42 completed the questionnaire after 2 weeks for a second time. Item-scale correlations were reasonably good as well as the discriminative power of separate scales. The assessment of internal consistency reliability also revealed satisfactory values; Cronbach's alpha was 0.77 or higher for all scales. The test-retest reliability, estimated in an intraclass correlation coefficient (ICC), exceeded 0.90, except the "social activities" scale (0.87). Since only patients with OA of the lower limb were enrolled, substantial floor effects occurred in the "arm function" (28.2%) and the "hand and finger function" scale (29.2%). The principal factor analysis confirmed the postulated three-factor structure with a physical, physiological and social dimension, explaining 48.5%, 13.9% and 6.8% of the variation, respectively. External validity was assessed by calculating correlations to the Western Ontario and MacMaster (WOMAC) osteoarthritis questionnaire a pain visual analogue scale (VAS) and the Kellgren score as well as to disease duration. Spearman's "R" achieved satisfactory values for the corresponding WOMAC scales and the pain-VAS. Correlations with disease duration as well as with the radiological grading were low. The GERMAN-AIMS2 is a reliable and valid instrument to assess the quality of life (QoL) in primary care patients suffering from OA.

Scale invariance and longitudinal stability of the Physical Functioning Western Ontario and MacMaster Universities Osteoarthritis Index using the Rasch model.

PubMed

Ayala, Alba; Bilbao, Amaia; Garcia-Perez, Sonia; Escobar, Antonio; Forjaz, Maria João

2018-03-01

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measures the quality of life of patients with osteoarthritis (OA), and there is a specific scale for the physical functioning dimension, the short version with seven items WOMAC-pf. This study describes the application of the Rasch model to explore scale invariance and response stability of the WOMAC-pf short version across affected joint and over time. A sample of 884 patients with OA, from 15 hospitals in Spain, completed the WOMAC-pf before surgery (baseline) and at 3, 6 and 12 months post-surgery of hip or knee. The invariance by joint was explored through the differential item functioning (DIF) analysis of the Rasch model using baseline data, and time stability (DIF by time) were evaluated in stack data (each participant is represented four times, one by time point). Mean age of the patients was of 69.13 years (SD 10.01), 59.3% of them were women (n = 524), 59.2% had knee OA (n = 523) and 40.8% hip OA (n = 361). Item "putting on socks" showed DIF by joint and time. Fit to the Rasch model using stack data improved when this item was removed. Good reliability for individual use, local independency and unidimensionality of the models were confirmed. WOMAC-pf 7-item short version was invariant over time and joint when item "putting on socks" was removed. Researchers should carefully evaluate this item as it presents problems in scale invariance and stability, which could affect results when comparing data by joint or when computing change scores.

Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health.

PubMed

Botha-Scheepers, S; Riyazi, N; Kroon, H M; Scharloo, M; Houwing-Duistermaat, J J; Slagboom, E; Rosendaal, F R; Breedveld, F C; Kloppenburg, M

2006-11-01

Using the International Classification of Functioning, Disability and Health as framework, we evaluated modifying effects of illness perceptions and mental health on the association between impairments in body structures and functions due to osteoarthritis (OA) and limitation in activities in the lower extremities. Self-reported limitation in activities was assessed by the Western Ontario and McMaster Universities OA index (WOMAC) function subscale in 316 patients with knee or hip pain or evidence of OA on knee or hip radiographs. Body structures and functions were evaluated during clinical and radiological assessments. Illness perceptions and mental health were assessed with the revised Illness Perception Questionnaire (IPQ-R) and the mental component summary score of the RAND 36-item Health Survey, respectively. For each patient an expected WOMAC function score was calculated, using an equation based on a multivariate model of the association of body structures and functions with limitation in activities. The median (interquartile) self-reported WOMAC function score was 22.2 (9.6-43.5). Ninety-one patients reported more and 120 patients reported less limitation in activities than expected. Patients with lumbar spine degeneration, physical or exercise therapy and high IPQ-R identity, consequences and chronic timeline scores had an increased risk to report more limitation in activities than the expected range. Low IPQ-R identity, consequences and emotional representation scores and better mental health were associated with reporting less limitation in activities than the expected range. Illness perceptions and mental health modify the association between self-reported limitation in activities and calculated limitation in activities based on impairments in body structures and functions due to OA.

Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project.

PubMed

Goode, A P; Nelson, A E; Kraus, V B; Renner, J B; Jordan, J M

2017-10-01

To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR = 1.31 (95% 1.03, 1.67)) of having FOA only, while, a one unit higher lnuCTX-II level was associated with 84% higher relative risk ratio (RRR = 1.84 (95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Digital templating for THA: a simple computer-assisted application for complex hip arthritis cases.

PubMed

Hafez, Mahmoud A; Ragheb, Gad; Hamed, Adel; Ali, Amr; Karim, Said

2016-10-01

Total hip arthroplasty (THA) is the standard procedure for end-stage arthritis of the hip. Its technical success relies on preoperative planning of the surgical procedure and virtual setup of the operative performance. Digital hip templating is one methodology of preoperative planning for THA which requires a digital preoperative radiograph and a computer with special software. This is a prospective study involving 23 patients (25 hips) who were candidates for complex THA surgery (unilateral or bilateral). Digital templating is done by radiographic assessment using radiographic magnification correction, leg length discrepancy and correction measurements, acetabular component and femoral component templating as well as neck resection measurement. The overall accuracy for templating the stem implant's exact size is 81%. This percentage increased to 94% when considering sizing within 1 size. Digital templating has proven effective, reliable and essential technique for preoperative planning and accurate prediction of THA sizing and alignment.

The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH).

PubMed

Čustović, Svemir; Šadić, Sahmir; Vujadinović, Aleksandar; Hrustić, Asmir; Jašarević, Mahir; Čustović, Amer; Krupić, Ferid

2018-08-01

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

Meniscus Induced Cartilaginous Damage and Non-linear Gross Anatomical Progression of Early-stage Osteoarthritis in a Canine Model

PubMed Central

Kahn, David; Mittelstaedt, Daniel; Matyas, John; Qu, Xiangui; Lee, Ji Hyun; Badar, Farid; Les, Clifford; Zhuang, Zhiguo; Xia, Yang

2016-01-01

Background: The predictable outcome of the anterior cruciate ligament transection (ACLT) canine model, and the similarity to naturally occurring osteoarthritis (OA) in humans, provide a translatable method for studying OA. Still, evidence of direct meniscus-induced cartilaginous damage has not been identified, and gross-anatomical blinded scoring of early-stage OA has not been performed. Objective: A gross anatomical observation and statistical analysis of OA progression to determine meniscus induced cartilaginous damage, to measure the macroscopic progression of OA, and to address matters involving arthroscopic and surgical procedures of the knee. Method: Unblinded assessment and blinded scoring of meniscal, tibial, femoral, and patellar damage were performed for control and at four time points following unilateral ACLT: 3-week (N=4), 8-week (N=4), 12-week (N=5), and 25-week (N=4). Mixed-model statistics illustrates damage (score) progression; Wilcoxon rank-sum tests compared time-point scores; and Wilcoxon signed-rank tests compared ACLT and contralateral scores, and meniscus and tibia scores. Result: Damage was manifest first on the posterior aspect of the medial meniscus and subsequently on the tibia and femur, implying meniscal damage can precede, coincide with, and aggravate cartilage damage. Damage extent varied chronologically and was dependent upon the joint component. Meniscal damage was evident at 3 weeks and progressed through 25-weeks. Meniscal loose bodies corresponded to tibial cartilage damage location and extent through 12 weeks, followed by cartilage repair activity after complete meniscal degeneration. Conclusion: This study provides additional information for understanding OA progression, identifying OA biomarkers, and arthroscopic and meniscectomy procedures. PMID:28144379

Intra-Articular Hyaluronic Acid Compared to Traditional Conservative Treatment in Dogs with Osteoarthritis Associated with Hip Dysplasia

PubMed Central

Carapeba, Gabriel O. L.; Cavaleti, Poliana; Brinholi, Rejane B.

2016-01-01

The purpose of this study was to compare the efficacy of the intra-articular (IA) hyaluronic acid injection to traditional conservative treatment (TCT) in dogs with osteoarthritis (OA) induced by hip dysplasia. Sixteen dogs were distributed into two groups: Hyal: IA injection of hyaluronic acid (5–10 mg), and Control: IA injection with saline solution (0.5–1.0 mL) in combination with a TCT using an oral nutraceutical (750–1000 mg every 12 h for 90 days) and carprofen (2.2 mg/kg every 12 h for 15 days). All dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form (HCPI and CPBI) at the same time. The data were analyzed using unpaired t test, ANOVA, and Tukey's test (P < 0.05). Compared with baseline, lower scores were observed in both groups over the 90 days in the veterinarian evaluation, HCPI, and CPBI (P < 0.001). The Hyal group exhibited lower scores from 15 to 90 and 60 to 90 days, in the CBPI and in the veterinarian evaluation, respectively, compared to the Control group. Both treatments reduced the clinical signs associated with hip OA. However, more significant results were achieved with intra-articular hyaluronic acid injection. PMID:27847523

The Fate of Iliopsoas Muscle in the Long-term Follow-up After Open Reduction of Developmental Dysplasia of the Hip by Medial Approach. Part 1: MRI Evaluation.

PubMed

Yilmaz, Serdar; Aksahin, Ertugrul; Duran, Semra; Bicimoglu, Ali

2017-09-01

There has been little information about the long-term status of the iliopsoas, which is the main flexor of the hip, after iliopsoas tenotomy in the treatment of developmental dysplasia of the hip (DDH). The aim of this study was to assess the status of the iliopsoas muscle and other flexors and extensors of the hip in long-term follow-up with magnetic resonance imaging after complete iliopsoas tenotomy in patients with unilateral DDH treated with open reduction with a medial approach. The study included 20 patients who underwent open reduction with a medial approach for unilateral DDH and had long-term follow-up. Magnetic resonance imaging assessment of iliopsoas, rectus femoris, tensor fasia lata, sartorius, and gluteus maximus muscles was applied and the muscles of the hip that was operated on were compared with the unoperated hip. In addition, the iliopsoas muscle was examined for reattachment and the effect of reattachment was evaluated. The mean age at the time of operation was 10.53±3.61 months (range, 5 to 18 mo), and mean follow-up was 16.65±2.16 years (range, 13 to 20 y). Spontaneous reattachment of the iliopsoas was observed in 18 patients (90%), either in the lesser trochanter (65%) or the superior part of it (25%). There was no significant difference between the hips that were operated on and those that were not with regard to the mean cross-sectional areas (CSA) of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles. The CSA of the tensor fascia lata, rectus femoris, sartorius, and gluteus maximus muscles showed no significant difference (P>0.05); however, CSA of iliopsoas muscle was significantly reduced in the operated hip (P<0.001). Although the iliopsoas tendon was atrophied after complete iliopsoas tenotomy, it was reattached in 90% of the patients spontaneously in long-term follow-up. There was no statistically significant compensatory hypertrophy in any muscles in response to iliopsoas atrophy. Level IV-Therapeutic.

Rehabilitation interventions for pain and disability in osteoarthritis.

PubMed

Iversen, Maura Daly

2012-03-01

Osteoarthritis (OA) results in progressive destruction of articular cartilage and bone at the joint margins, leading to impairments extending far beyond the synovial joint. Rehabilitation interventions that target specific impairments and activity restrictions can help restore independence and promote healthy living. Such interventions include exercise, physical modalities (ice, heat, ultrasonography), manual techniques (mobilization and manipulation), and assistive devices. The predominance of evidence on the effects of rehabilitation interventions for knee and hip OA suggest that they afford modest pain relief, reduced disability, and improved function. Research is needed to identify the modes of exercise and the effective doses for relief of symptoms and functional limitations.

Osteonecrosis of the hip in patients with aplastic anemia.

PubMed Central

Park, Jeongmi; Jun, Jeongsu; Kim, Yongsik; Lee, Jongwook; Kim, Chunchu; Hahn, Seongtae

2002-01-01

The incidence and clinical and magnetic resonance imaging features of osteonecrosis of the hip were evaluated in patients with aplastic anemia. Two hundred and forty-one patients with aplastic anemia were examined using MR imaging of bone marrow during the five years from 1994 to 1998. Osteonecrosis of the hip was observed on MR imaging in nineteen (15 males and 4 females, mean age 35 yr) of the 241 patients. It was present in both hips in 14 patients, and there were five cases with unilateral occurrence, with a total of 33 involved hips. All except for five hips with associated bone marrow edema revealed increased fatty marrow conversion in the proximal femoral metaphysis. In nine patients, osteonecrosis was detected without any pain. Five patients already had osteonecrosis before any medication was administered. Twelve patients received antilymphocyte globulin, and seven patients received a low dose of steroids before the MR diagnosis of osteonecrosis. Osteonecrosis of the hip frequently develops in patients with aplastic anemia (7.9%), associated with fatty marrow conversion of the proximal femoral metaphysis. PMID:12483006

Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study.

PubMed

Abolghasemian, Mansour; Samiezadeh, Saeid; Jafari, Davood; Bougherara, Habiba; Gross, Allan E; Ghazavi, Mohammad T

2013-06-01

To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force. Copyright © 2013 Elsevier Inc. All rights reserved.

Pain related inflammation analysis using infrared images

NASA Astrophysics Data System (ADS)

Bhowmik, Mrinal Kanti; Bardhan, Shawli; Das, Kakali; Bhattacharjee, Debotosh; Nath, Satyabrata

2016-05-01

Medical Infrared Thermography (MIT) offers a potential non-invasive, non-contact and radiation free imaging modality for assessment of abnormal inflammation having pain in the human body. The assessment of inflammation mainly depends on the emission of heat from the skin surface. Arthritis is a disease of joint damage that generates inflammation in one or more anatomical joints of the body. Osteoarthritis (OA) is the most frequent appearing form of arthritis, and rheumatoid arthritis (RA) is the most threatening form of them. In this study, the inflammatory analysis has been performed on the infrared images of patients suffering from RA and OA. For the analysis, a dataset of 30 bilateral knee thermograms has been captured from the patient of RA and OA by following a thermogram acquisition standard. The thermograms are pre-processed, and areas of interest are extracted for further processing. The investigation of the spread of inflammation is performed along with the statistical analysis of the pre-processed thermograms. The objectives of the study include: i) Generation of a novel thermogram acquisition standard for inflammatory pain disease ii) Analysis of the spread of the inflammation related to RA and OA using K-means clustering. iii) First and second order statistical analysis of pre-processed thermograms. The conclusion reflects that, in most of the cases, RA oriented inflammation affects bilateral knees whereas inflammation related to OA present in the unilateral knee. Also due to the spread of inflammation in OA, contralateral asymmetries are detected through the statistical analysis.

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial

PubMed Central

Meuret, Pascal; Bouvet, Lionel; Villet, Benoit; Hafez, Mohamed; Allaouchiche, Bernard

2018-01-01

Objective Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. Methods We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. Results The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0–17 mg) compared with that in the GA group (36 mg, 21–57 mg). Intraoperative muscle relaxation and patients’ and surgeons’ satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. Conclusion This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery. PMID:29744247

Clinical study on the unloading effect of hip bracing on gait in patients with hip osteoarthritis.

PubMed

Nérot, Agathe; Nicholls, Micah

2017-04-01

Internal hip abduction moment is a major indicator for hip loading. A new hip bracing concept was designed to unload the cartilaginous area in hip osteoarthritis via an abduction and external rotation force intended to alter the weight bearing area and reduce compression through the joint. To assess the effect of a novel brace on hip rotation in the transverse and coronal planes and on the hip abduction moment. Repeated measures. Gait analysis was performed on 14 subjects with unilateral symptomatic hip osteoarthritis. Pain, joint motion, moments and vertical ground reaction force were compared between the braced and the unbraced (control), randomly assigned, conditions. Nine participants felt an immediate reduction in pain while walking with the hip brace. Peak hip abduction moment significantly decreased on the osteoarthritis side ( p = 0.017). Peak hip adduction ( p = 0.004) and internal rotation ( p = 0.0007) angles significantly decreased at stance with the brace. Wearing the brace would appear to reduce the compressive joint reaction force at the femuroacetabular interface as indicated by a reduction in internal hip abduction moment along with immediate pain reduction in nine participants. Further long-term studies are warranted. Clinical relevance The brace rotates the hip in the transverse and coronal planes, possibly resulting in a decrease in load through the diseased area of cartilage. In some patients, an immediate decrease in pain was experienced. The brace offers an alternative solution for hip osteoarthritis patients not ready for a hip replacement.

Osteoarthritis in Latin America: Study of Demographic and Clinical Characteristics in 3040 Patients.

PubMed

Reginato, Anthony M; Riera, Humberto; Vera, Mariflor; Torres, Adrian R; Espinosa, Rolando; Esquivel, Jorge A; Felipe, Oscar Jair; Blas, Jorge Roman; Rillo, Oscar; Papasidero, Silvia; Souto, Renee; Rossi, Cesar; Molina, José F; Ballesteros, Francisco; Radrigan, Francisco; Guibert, Marlene; Chico, Araceli; Gil, María L; Camacho, Walter; Urioste, Lorena; Garcia, Abraham K; Iraheta, Isa; Gutierrez, Carmen E; Duarte, Margarita; Castañeda, Oswaldo; Coimbra, Ibsen; Muñoz Louis, Roberto; Reveille, John; Quintero, Maritza

2015-12-01

Latin America is a heterogeneous region made up of different populations, cultures, latitudes, altitudes, and immigrants from different areas and ethnic groups. The purpose of this study is to describe the clinical and demographic profile of patients with osteoarthritis (OA) evaluated by a selected group of rheumatologists in 13 Latin American countries. A descriptive, observational, cross-sectional study was conducted in 13 Latin American countries of patients with symptomatic OA. Data were collected over a 3-month period using an ad hoc questionnaire to evaluate the clinical and demographic features of OA seen by rheumatologists. Among the 3040 patients, their average age was 62.5 years, and female-to-male ratio was 4.8:1. Patients with body mass index of greater than 30 kg/m or obesity was found in 38.2%. Approximately 88% had primary OA. Joints with OA were as follows: knee 31.2%, hand 9.5%, hand and knee 22.9%, proximal and distal interphalangeal joints (erosive OA) 6.5%, axial 6.6%, and hip 1.3%. Approximately 88.5% had radiographic severity of grade 2 or 3 on Kellgren-Lawrence scale (0-4). Nonsteroidal anti-inflammatory drugs were the predominant OA treatment included in combinations with glucosamine sulfate/chondroitin and viscosupplementation. Associated comorbidities included hypertension (39%), obesity (36.3%), diabetes mellitus (12%), and without comorbidity (12.7%). This is 1 of the largest population studies that evaluated the characteristics of OA in 3040 patients evaluated by rheumatologists in 13 Latin American countries. This study provides important data for each Latin American country to develop new health care planning in management of OA.

Osteoarthritis year in review 2016: imaging.

PubMed

Boesen, M; Ellegaard, K; Henriksen, M; Gudbergsen, H; Hansen, P; Bliddal, H; Bartels, E M; Riis, R G

2017-02-01

The current narrative review covers original research related to imaging in osteoarthritis (OA) in humans published in English between April 1st 2015 and March 31st 2016, in peer reviewed journals available in Medline via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/). Relevant studies in humans, subjectively decided by the authors, contributing significantly to the OA imaging field, were selected from an extensive Medline search using the terms "Osteoarthritis" in combination with "MRI", "Imaging", "Radiography", "X-rays", "Ultrasound", "Computed tomography", "Nuclear medicine", "PET-CT", "PET-MRI", "Scintigraphy", "SPECT". Publications were sorted according to relevance for the OA imaging research community with an emphasis on high impact special interest journals using the software for systematic reviews www.covidence.org. An overview of newly published studies compared to studies reported previous years is presented, followed by a review of selected imaging studies of primarily knee, hip and hand OA focussing on (1) results for detection of OA and OA-related pathology (2) studies dealing with treatments and (3) studies focussing on prognosis of disease progression or joint replacement. A record high number of 1420 articles were published, among others, of new technologies and tools for improved morphological and pathophysiological understanding of OA-related changes in joints. Also, imaging data were presented of monitoring treatment effect and prognosis of OA progression, primarily using established radiographic, magnetic resonance imaging (MRI), and ultrasound (US) methods. Imaging continues to play an important role in OA research, where several exciting new technologies and computer aided analysis methods are emerging to complement the conventional imaging approaches. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Optimal haptic feedback control of artificial muscles

NASA Astrophysics Data System (ADS)

Chen, Daniel; Besier, Thor; Anderson, Iain; McKay, Thomas

2014-03-01

As our population ages, and trends in obesity continue to grow, joint degenerative diseases like osteoarthritis (OA) are becoming increasingly prevalent. With no cure currently in sight, the only effective treatments for OA are orthopaedic surgery and prolonged rehabilitation, neither of which is guaranteed to succeed. Gait retraining has tremendous potential to alter the contact forces in the joints due to walking, reducing the risk of one developing hip and knee OA. Dielectric Elastomer Actuators (DEAs) are being explored as a potential way of applying intuitive haptic feedback to alter a patient's walking gait. The main challenge with the use of DEAs in this application is producing large enough forces and strains to induce sensation when coupled to a patient's skin. A novel controller has been proposed to solve this issue. The controller uses simultaneous capacitive self-sensing and actuation which will optimally apply a haptic sensation to the patient's skin independent of variability in DEAs and patient geometries.

Familial osteochondritis dissecans associated with early osteoarthritis and disproportionate short stature.

PubMed

Stattin, E-L; Tegner, Y; Domellöf, M; Dahl, N

2008-08-01

Familial osteochondritis dissecans (OCD) is a rare disorder characterised by disturbed chondro-skeletal development, disproportionate growth and deformation of the skeleton. We identified a five-generation family with 15 living affected members from Northern Sweden. The disorder was diagnosed with a case definition of OCD in at least one joint. Main clinical findings consisted of OCD in knees and/or hips and/or elbows, disproportionate short stature and early osteoarthritis (OA). There were no radiological indications of epiphyseal dysplasia. Anthropometric measurements of affected individuals showed short stature, a high ratio between sitting height and total height, a relatively normal arm span and head circumference. In 12 of 15 cases, onset was during late childhood or adolescence and OA had developed in seven of those patients. Our observation suggests that OA is a frequent complication in familial OCD even though the lesions appear before closure of physis.

The independent and combined effects of intensive weight loss and exercise training on bone mineral density in overweight and obese, older adults with osteoarthritis

PubMed Central

Beavers, Daniel P.; Beavers, Kristen M.; Loeser, Richard F.; Walton, Nicole R.; Lyles, Mary F.; Nicklas, Barbara J.; Shapses, Sue A.; Newman, Jovita J.; Messier, Stephen P.

2014-01-01

Objective To determine the effects of dietary-induced weight loss (D) and weight loss plus exercise (D+E) compared to exercise alone (E) on bone mineral density (BMD) in older adults with knee osteoarthritis (OA). Design Data come from 284 older (66.0±6.2 years), overweight/obese (BMI 33.4±3.7 kg/m2), adults with knee OA enrolled in the Intensive Diet and Exercise for Arthritis (IDEA) study. Participants were randomized to 18 months of walking and strength training (E; n=95), dietary-induced weight loss targeting 10% of baseline weight (D; n=88) or a combination of the two (D+E; n=101). Body weight and composition (DXA), regional BMD, were obtained at baseline and 18 months. Results E, D, and D+E groups lost 1.3±4.5 kg, 9.1±8.6 kg and 10.4±8.0 kg, respectively (p<0.01). Significant treatment effects were observed for BMD in both hip and femoral neck regions, with the D and D+E groups showing similar relative losses compared to E (both p<0.01). Despite reduced BMD, fewer overall participants had T-scores indicative of osteoporosis after intervention (9 at 18 months vs. 10 at baseline). Within the D and D+E groups, changes in hip and femoral neck, but not spine, BMD correlated positively with changes in body weight (r=0.21 and 0.54 respectively, both p=<0.01). Conclusions Weight loss via an intensive dietary intervention, with or without exercise, results in bone loss at the hip and femoral neck in overweight and obese, older adults with OA. Although the exercise intervention did not attenuate weight loss associated reductions in BMD, classification of osteoporosis and osteopenia remained unchanged. PMID:24742955

Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.

PubMed

Svehlík, Martin; Kraus, Tanja; Steinwender, Gerhard; Zwick, Ernst B; Linhart, Wolfgang E

2012-06-01

Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip. Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall. Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them. The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.

The discrepancy between recommendations and clinical practice for viscosupplementation in osteoarthritis: mind the gap!

PubMed

Migliore, A; Bizzi, E; Herrero-Beaumont, J; Petrella, R J; Raman, R; Chevalier, X

2015-04-01

Recently AAOS, ACR and OARSI revised their recommendations for the management of knee osteoarthritis (OA) and for hand, knee and hip joints. During ISIAT (International Symposium on Intra-Articular Treatments) 2013 round table on recommendations about the use of intra-articular Hyaluronic Acid (IAHA) in OA, several considerations were elaborated by the ISIAT Technical Expert Panel (TEP) regarding discrepancy between recommendations and clinical practice. The ISIAT TEP gathered the following eight suggestions regarding the drawing of recommendations on the use of IAHA in OA and its comparison with other treatments. It is necessary to merge data coming from both RCTs and registers. Only studies with a strong level of evidence should be taken into account. A common threshold of efficacy should be assessed for comparing treatments. Evaluation of hard outcomes is essential. The effect size of placebo as comparator should be attentively considered in RCTs. Particular attention should be given to different phenotypes of OA that may possibly respond differently to each treatment. Compliance and long-term side effects of different therapeutic approaches should be evaluated. Pharmacoeconomic evaluation should be performed on the long term.

Outcome after cementless total hip arthroplasty for arthritic hip in patients with residual poliomyelitis: a case series.

PubMed

Cho, Yoon J; Lee, Choong H; Chun, Young S; Rhyu, Kee H

2016-09-29

In this case series, we investigated the outcome of cementless total hip arthroplasty (THA) for advanced hip osteoarthritis in patients with residual poliomyelitis to evaluate its clinical usefulness for these patients. 11 unilateral cementless primary THA were performed to arthritic hips in patients with residual poliomyelitis. 7 were in paralytic and 4 were in nonparalytic limbs. The mean follow-up duration was 79.9 months. Retrospective clinical evaluations with various scores and radiological evaluations were made. Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Short-form (SF)-36 physical scales were significantly improved after the surgery. However, UCLA activity score and SF-36 mental scale were not. Because of remaining leg length discrepancies, all but 1 noted a residual limp. In nonparalytic hip, functional acetabular cup inclination during weight bearing significantly increased from installed inclination. Other than 1 case of posterior dislocation, no complications were observed. Although the overall result itself is excellent, THA for these patients cannot improve limp, physical activity and mental status. Surgeons should be aware of the change of the inclination of acetabular cup during mobilisation, especially for THA in contralateral hip.

Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period.

PubMed

Harato, Kengo; Yoshida, Hiroki

2015-01-14

Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at the time of the surgery, synovial fluid was collected into syringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann-Whitney U-test for patients' age and categorical variables were analyzed by chi-square test or Fisher's exact test. A total of 30 patients presented symptomatic knee effusion at the time of the surgery. In patients with knee effusion, numbers of intertrochanteric fracture, radiographic knee OA, and postoperative knee pain were significantly large compared to those without effusion. In terms of synovial fluid analysis, calcium pyrophosphate dihydrate crystals were observed in 80% of patients with knee effusion. From our study, approximately 63% of patients with knee effusion at the time of the surgery had postoperative knee pain. In addition, this effusion was basically related to pseudogout.

Targeted physiotherapy for patellofemoral joint osteoarthritis: A protocol for a randomised, single-blind controlled trial

PubMed Central

Crossley, Kay M; Vicenzino, Bill; Pandy, Marcus G; Schache, Anthony G; Hinman, Rana S

2008-01-01

Background The patellofemoral joint (PFJ) is one compartment of the knee that is frequently affected by osteoarthritis (OA) and is a potent source of OA symptoms. However, there is a dearth of evidence for compartment-specific treatments for PFJ OA. Therefore, this project aims to evaluate whether a physiotherapy treatment, targeted to the PFJ, results in greater improvements in pain and physical function than a physiotherapy education intervention in people with symptomatic and radiographic PFJ OA. Methods 90 people with PFJ OA (PFJ-specific history, signs and symptoms and radiographic evidence of PFJ OA) will be recruited from the community and randomly allocated into one of two treatments. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of physiotherapy (8 individual sessions over 12 weeks, as well as a home exercise program 4 times/week) compared to a physiotherapist-delivered OA education control treatment (8 individual sessions over 12 weeks). Physiotherapy treatment will consist of (i) quadriceps muscle retraining; (ii) quadriceps and hip muscle strengthening; (iii) patellar taping; (iv) manual PFJ and soft tissue mobilisation; and (v) OA education. Resistance and dosage of exercises will be tailored to the participant's functional level and clinical state. Primary outcomes will be evaluated by a blinded examiner at baseline, 12 weeks and 9 months using validated and reliable pain, physical function and perceived global effect scales. All analyses will be conducted on an intention-to-treat basis using linear mixed regression models, including respective baseline scores as a covariate, subjects as a random effect, treatment condition as a fixed factor and the covariate by treatment interaction. Conclusion This RCT is targeting PFJ OA, an important sub-group of knee OA patients, with a specifically designed conservative intervention. The project's outcome will influence PFJ OA rehabilitation, with the potential to reduce the personal and societal burden of this increasing public health problem. Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12608000288325 PMID:18793446

Osteoarthritis and the Tactical Athlete: A Systematic Review

PubMed Central

Cameron, Kenneth L.; Driban, Jeffrey B.; Svoboda, Steven J.

2016-01-01

Objective: Although tactical athletes (eg, military service members, law enforcement personnel, fire fighters) are exposed to several known risk factors, it remains unclear if they are at increased risk for osteoarthritis (OA). The purpose of this systematic review was to investigate the association between serving as a tactical athlete and the incidence and prevalence of OA. Data Sources: We completed a comprehensive systematic literature search in November 2014 using 12 bibliographic databases (eg, PubMed, Ovid, SportDiscus) supplemented with manual searches of reference lists. Study Selection: Studies were included if they met the following criteria: (1) an aim of the study was to investigate an association between tactical athletes and OA; (2) the outcome measure was radiographic OA, clinical OA, total joint replacement, self-reported diagnosis of OA, or placement on a waiting list for a total joint replacement; (3) the study design was a cohort study; and (4) the study was written in English. Data Extraction: One investigator extracted data from articles that met all inclusion criteria (eg, group descriptions, measures of disease burden, source of nonexposed controls). Data Synthesis: Twelve articles met the inclusion criteria and described retrospective cohort studies. Firefighters, active-duty military service members, and veteran military parachutists consistently had a higher incidence or prevalence of knee, hip, or any OA diagnosis (4 studies). Active-duty pilots and veteran military parachutists may have a higher prevalence of spine OA, but this was not statistically significant (2 studies). Occupational risk factors for OA among tactical athletes include rank and branch of military service. The risk of OA among individuals who completed mandatory national military service remains unclear (6 studies). Conclusions: The incidence of OA among tactical athletes appears to be significantly higher when compared with nonexposed controls. Further research is needed to specifically identify modifiable risk factors within this high-risk population to develop and implement effective risk-reduction strategies. PMID:27115044

Can We Predict Those With Osteoarthritis Who Will Worsen Following a Chronic Disease Management Program?

PubMed

Eyles, Jillian P; Mills, Kathryn; Lucas, Barbara R; Williams, Matthew J; Makovey, Joanna; Teoh, Laurence; Hunter, David J

2016-09-01

To identify predictors of worsening symptoms and overall health of the treated hip or knee joint following 26 weeks of a nonsurgical chronic disease management program for hip and knee osteoarthritis (OA) and to examine the consistency of these predictors across 3 definitions of worsening. This prospective cohort study followed 539 participants of the program for 26 weeks. The 3 definitions of worsening included symptomatic worsening based on change in the Western Ontario and McMaster Universities Osteoarthritis Index Global score (WOMAC-G) measuring pain, stiffness, and function; a transition scale that asked about overall health of the treated hip or knee joint; and a composite outcome including both. Multivariate logistic regression models were constructed for the 3 definitions of worsening. Complete data were available for 386 participants: mean age was 66.3 years, 69% were female, 85% reported knee joint pain as primary symptom (signal joint), 46% were waitlisted for total joint arthroplasty (TJA). TJA waitlist status, signal joint, 6-Minute Walk Test (6MWT), depressive symptoms, pain, and age were independently associated with at least 1 definition of worsening. TJA waitlist status and 6MWT remained in the multivariate models for the transition and composite definitions of worsening. Participants reporting worsening on the transition scale did not consistently meet the WOMAC-G definition of worsening symptoms. TJA waitlist status was predictive of the composite definition of worsening, a trend apparent for the transition definition. However, variables that predict worsening remain largely unknown. Further research is required to direct comprehensive and targeted management of patients with hip and knee OA. © 2016, American College of Rheumatology.

Weight change following knee and hip joint arthroplasty-a six-month prospective study of adults with osteoarthritis.

PubMed

Teichtahl, Andrew J; Quirk, Emma; Harding, Paula; Holland, Anne E; Delany, Clare; Hinman, Rana S; Wluka, Anita E; Liew, Susan M; Cicuttini, Flavia M

2015-06-07

Inconsistent findings of weight change following total knee (TKA) and hip (THA) arthroplasty may largely be attributable to heterogeneous cohorts and varied definitions of weight loss. This study examined weight change following TKA and THA for osteoarthritis (OA). 64 participants with hip or knee OA were recruited from orthopaedic joint arthroplasty waiting lists at a single major Australian public hospital between March and October 2011. The Short Form (SF) 12 survey was used to assess baseline physical and mental functioning. 49 participants completed 6 month follow-up (20 from the THA group and 29 from the TKA group). The majority of subjects lost weight (>0 kg) 6 months following THA (70 %) and TKA (58.6 %). When at least a 5 % reduction in total body weight was used to define clinically significant weight loss, the proportion of people with weight loss was 37.9 % for TKA and 25 % for THA. Greater weight loss occurred 6 months following TKA compared with THA (7.2 % versus 3.7 % of body weight; p = 0.04). Worse pre-operative physical functioning (SF-12) was associated with greater weight loss following TKA (β = 0.22 kg, 95 % CI 0.02-0.42 kg; p = 0.04). Most people lost weight (>0 kg) 6 months following TKA and THA and a considerable proportion of people achieved ≥5 % loss of body weight. The magnitude of weight loss was greater following TKA than THA, with worse pre-operative function being a predictor of more weight loss. Further attention to weight management is required to assist a greater number of people to achieve a larger magnitude of weight loss following knee and hip joint arthroplasty.

Direct and indirect markers of cartilage metabolism in synovial fluid obtained from dogs with hip dysplasia and correlation with clinical and radiographic variables.

PubMed

Fujita, Yukihiro; Hara, Yasushi; Nezu, Yoshinori; Yamaguchi, Shinya; Schulz, Kurt S; Tagawa, Masahiro

2005-12-01

To compare activities of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and matrix metalloproteinase (MMP)-3 and contents of sulfated glycosaminoglycan (S-GAG) in joint fluid obtained from dogs with hip dysplasia (HD) and clinically normal dogs, evaluate correlations among these markers in joint fluid obtained from dogs with HD, and evaluate correlations between each marker and clinical and radiographic variables. Animals-26 dogs with HD (clinical group) and 43 clinically normal Beagles (control group). Joint fluid was aseptically collected from the hip joints of all dogs. For each dog in the clinical group, age, duration of lameness, radiographic osteoarthritis (OA) score, and Norberg angle in each affected joint were recorded. Activities of IL-1beta, IL-6, TNF-alpha, and MMP-3 and S-GAG contents were measured. Values were compared between groups by use of Mann-Whitney U tests, and the Spearman rank correlation test was used to evaluate correlations among markers and between each marker and clinical or radiographic variables. Values of all markers were significantly higher for the clinical group, compared with values for the control group. There was a moderate positive correlation between lameness duration and IL-6 activity and a strong negative correlation between the Norberg angle and IL-1beta activity. Analysis of our results indicated that there was a significant increase in markers of OA in dogs with HD. Activities of IL-1beta and IL-6 in joint fluid of dogs with HD may be influenced by the severity of laxity in the hip joint and lameness duration, respectively.

Psychometric properties of the OARSI/OMERACT osteoarthritis pain and functional impairment scales: ICOAP, KOOS-PS and HOOS-PS.

PubMed

Ruyssen-Witrand, A; Fernandez-Lopez, C J; Gossec, L; Anract, P; Courpied, J P; Dougados, M

2011-01-01

To evaluate the psychometric properties of the OARSI-OMERACT questionnaires in comparison to the existing validated scales. Consecutive hip or knee osteoarthritis patients consulting in an orthopedic department were enrolled in the study. Data collected were pain using the Intermittent and Constant Osteoarthritis Pain (ICOAP), a Numeric Rating Scale (NRS), the Western Ontario McMaster Universities' Osteoarthritis Index (WOMAC) pain subscale, the Lequesne pain subscale; functional impairment using the Knee disability and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), the Hip disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS), a NRS, the WOMAC function sub-scale, the Lequesne function subscale. Validity was assessed by calculating the Spearman's correlation coefficient between all the scales. Reliability was assessed in out-patients with stable disease comparing the data collected within 2 weeks using the intra-class correlation coefficient (ICC). Responsiveness was assessed on the data from hospitalised patients prior to and 12 weeks after a total joint replacement (TJR) using the standardised response mean. Three hundred patients (mean age=68 years, females=62%, hip OA=57%) were included. There was a moderate to good correlation between ICOAP, KOOS-PS, HOOS-PS and the WOMAC, NRS and Lequesne scales. Reliability of the ICOAP hip OA HOOS-PS and KOOS-PS was good (ICC range 0.80-0.81) whereas it was moderate for knee ICOAP (ICC=0.65). Responsiveness of the ICOAP, KOOS-PS and HOOS-PS 12 weeks after TJR was comparable to responsiveness of other scales (SRM range: 0.54-1.82). The psychometric properties of the ICOAP, KOOS-PS and HOOS-PS were comparable to those of the WOMAC, Lequesne and NRS.

Interlimb symmetry of dynamic knee joint stiffness and co-contraction is maintained in early stage knee osteoarthritis.

PubMed

Collins, A T; Richardson, R T; Higginson, J S

2014-08-01

Individuals with knee OA often exhibit greater co-contraction of antagonistic muscle groups surrounding the affected joint which may lead to increases in dynamic joint stiffness. These detrimental changes in the symptomatic limb may also exist in the contralateral limb, thus contributing to its risk of developing knee osteoarthritis. The purpose of this study is to investigate the interlimb symmetry of dynamic knee joint stiffness and muscular co-contraction in knee osteoarthritis. Muscular co-contraction and dynamic knee joint stiffness were assessed in 17 subjects with mild to moderate unilateral medial compartment knee osteoarthritis and 17 healthy control subjects while walking at a controlled speed (1.0m/s). Paired and independent t-tests determined whether significant differences exist between groups (p<0.05). There were no significant differences in dynamic joint stiffness or co-contraction between the OA symptomatic and OA contralateral group (p=0.247, p=0.874, respectively) or between the OA contralateral and healthy group (p=0.635, p=0.078, respectively). There was no significant difference in stiffness between the OA symptomatic and healthy group (p=0.600); however, there was a slight trend toward enhanced co-contraction in the symptomatic knees compared to the healthy group (p=0.051). Subjects with mild to moderate knee osteoarthritis maintain symmetric control strategies during gait. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interlimb symmetry of dynamic knee joint stiffness and co-contraction is maintained in early stage knee osteoarthritis

PubMed Central

Collins, A.T.; Richardson, R.T.; Higginson, J.S.

2014-01-01

Individuals with knee OA often exhibit greater co-contraction of antagonistic muscle groups surrounding the affected joint which may lead to increases in dynamic joint stiffness. These detrimental changes in the symptomatic limb may also exist in the contralateral limb, thus contributing to its risk of developing knee osteoarthritis. The purpose of this study is to investigate the interlimb symmetry of dynamic knee joint stiffness and muscular co-contraction in knee osteoarthritis. Muscular co-contraction and dynamic knee joint stiffness were assessed in 17 subjects with mild to moderate unilateral medial compartment knee osteoarthritis and 17 healthy control subjects while walking at a controlled speed (1.0 m/s). Paired and independent t-tests determined whether significant differences exist between groups (p < 0.05). There were no significant differences in dynamic joint stiffness or co-contraction between the OA symptomatic and OA contralateral group (p = 0.247, p = 0.874, respectively) or between the OA contralateral and healthy group (p = 0.635, p = 0.078, respectively). There was no significant difference in stiffness between the OA symptomatic and healthy group (p = 0.600); however, there was a slight trend toward enhanced co-contraction in the symptomatic knees compared to the healthy group (p = 0.051). Subjects with mild to moderate knee osteoarthritis maintain symmetric control strategies during gait. PMID:24768278

The effects of age and type of carrying task on lower extremity kinematics

PubMed Central

Gillette, Jason C.; Stevermer, Catherine A.; Miller, Ross H.; Meardon, Stacey A.; Schwab, Charles V.

2009-01-01

The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity kinematics during carrying tasks. Forty-two participants in four age groups (8-10 years, 12-14 years, 15-17 years, and adults) carried loads of 0%, 10%, and 20% body weight (BW) in large or small buckets unilaterally and bilaterally. Reflective markers were tracked to determine total joint ROM and maximum joint angles during the stance phase of walking. Maximum hip extension, hip adduction, and hip internal rotation angles were significantly greater for each of the child/adolescent age groups as compared to adults. In addition, maximum hip internal rotation angles significantly increased when carrying a 20% BW load. The observation that the 8-10 year old age group carried the lightest absolute loads and still displayed the highest maximum hip internal rotation angles suggests a particular necessity in setting carrying guidelines for the youngest children. PMID:20191410

Transient osteoporosis of pregnancy of the bilateral hips in twin gestation: a case series.

PubMed

Reese, Maria E; Fitzgerald, Colleen; Hynes, Christina

2015-01-01

Transient osteoporosis of pregnancy has been described as a rare, self-limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Rehabilitation interventions for pain and disability in osteoarthritis: a review of interventions including exercise, manual techniques, and assistive devices.

PubMed

Iversen, Maura Daly

2012-01-01

Osteoarthritis (OA) results in progressive destruction of articular cartilage and bone at the joint margins, leading to impairments extending far beyond the synovial joint. Rehabilitation interventions that target specific impairments and activity restrictions can help restore independence and promote healthy living. Such interventions include exercise, physical modalities (ice, heat, ultrasonography), manual techniques (mobilization and manipulation), and assistive devices. The predominance of evidence on the effects of rehabilitation interventions for knee and hip OA suggest that they afford modest pain relief, reduced disability, and improved function. Research is needed to identify the modes of exercise and the effective doses for relief of symptoms and functional limitations.

A longitudinal study to explain the pain-depression link in older adults with osteoarthritis.

PubMed

Hawker, Gillian A; Gignac, Monique A M; Badley, Elizabeth; Davis, Aileen M; French, Melissa R; Li, Ye; Perruccio, Anthony V; Power, J Denise; Sale, Joanna; Lou, Wendy

2011-10-01

To evaluate whether osteoarthritis (OA) pain determines depressed mood, taking into consideration fatigue and disability and controlling for other factors. In a community cohort with hip/knee OA, telephone interviews assessed OA pain and disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), fatigue (Multidimensional Fatigue Symptom Inventory), depressed mood (Center for Epidemiologic Studies Depression Scale), and covariates (demographics, self-rated health, comorbidity, pain coping, pain catastrophizing, and social support) at 3 time points over 2 years. Drawing on previous research, a path model was developed to test the interrelationships among the key concepts (pain, depression, fatigue, disability) over time, controlling for covariates. The baseline mean age was 75.4 years; 78.5% of the subjects were women, 37.2% were living alone, and 15.5% had ≥3 comorbid conditions. WOMAC scores indicated moderate OA symptoms and disability. From the final model with 529 subjects, adjusting for covariates, we found that current OA pain strongly predicted future fatigue and disability (both short and long term), that fatigue and disability in turn predicted future depressed mood, that depressed mood and fatigue were interrelated such that depressed mood exacerbated fatigue and vice versa, and that fatigue and disability, but not depressed mood, led to worsening of OA pain. Controlling for other factors, OA pain determined subsequent depressed mood through its effect on fatigue and disability. These effects led to worsening of pain and disability over time. These results support the need for improved pain management in OA to prevent or attenuate the downstream effects of pain on disability and mood. Copyright © 2011 by the American College of Rheumatology.

Vibratory sense deficits in patients with symptomatic femoroacetabular impingement

PubMed Central

Farkas, G.J.; Shakoor, N.; Cvetanovich, G.L.; Fogg, L.F.; Orías, A.A. Espinoza; Nho, S.J.

2016-01-01

Objective: Sensory deficits, measured through vibratory perception threshold (VPT), have been recognized in hip and knee osteoarthritis (OA), but have not been evaluated in femoroacetabular impingement (FAI), thought to be a pre-OA condition. This study aimed to assess VPT in symptomatic FAI pre- and 6-months post-arthroscopy vs. controls. Methods: FAI patients and controls were assessed for VPT at the first metatarsophalangeal joint. Pain was assessed using a visual analog pain scale. FAI participants were evaluated again 6-months after surgery for FAI. Differences between groups and pre- and post- surgery were evaluated with independent and paired sample t-tests, respectively. Secondary analysis was performed using repeated-measures ANOVA to evaluate the effect of pain and time since surgery on VPT pre- and post-operatively. Results: No differences in age and BMI were seen between groups (p>0.05). Reduced VPT (higher value is worse) was evident in the pre- (8.0±3.9V, t=2.81, p=0.009) and post-operative (6.8±2.8V, t=2.34, p=0.027) patients compared to controls (4.7±1.3V). After hip arthroscopy, there was a trend toward improved VPT (t=1.97, p=0.068). Preoperative and 6-months postoperative pain and time since surgery were not found to influence VPT (F-ratio≥0.00, p≥0.427). Conclusion: Sensory deficits were observed in FAI patients both before and 6-months after hip arthroscopy. PMID:26944822

Do patients with knee osteoarthritis perform sit-to-stand motion efficiently?

PubMed

Anan, Masaya; Shinkoda, Koichi; Suzuki, Kentaro; Yagi, Masahide; Ibara, Takuya; Kito, Nobuhiro

2015-02-01

The sit-to-stand motion (STS) is a frequently executed activity that is affected by weakness in the quadriceps femoris muscle and knee joint pain in patients with knee osteoarthritis (OA). We investigated whether patients with knee OA can efficiently perform STS through mechanical energy transfer assessments. Participants were 20 women with knee OA and 17 age-matched asymptomatic controls. The center of mass (COM), segment angles, joint moments, and powers during STS were measured. The negative mechanical work in the proximal portion of the shank, negative mean powers in the distal portion of the pelvis and proximal portion of the shank, and the positive mean power in the proximal and distal portions of the thigh were significantly lower in the knee OA group than in the control group. Patients with knee OA primarily performed thoracic forward lean movement, shifting their COM closer to the base of support provided by the feet alone, in an attempt to achieve stability at and after buttocks-off. However, control ability, which generates and absorbs kinetic energy quickly, was not enhanced in these patients, and their motion was unable to increase absorption of the mechanical energy in hip extensors and reduce the load on knee extensors. Furthermore, STS in patients with knee OA had reduced energy absorption in the knee extensors from the shank forward lean movement after buttocks-off, had reduced knee extensor efficiency, and made greater use of physiological energy. These findings suggest that, from the standpoint of mechanical energy transfer, patients with knee OA do not perform STS efficiently. Copyright © 2014 Elsevier B.V. All rights reserved.

Reduction of metal artifacts from unilateral hip arthroplasty on dual-energy CT with metal artifact reduction software.

PubMed

Yue, Dong; Fan Rong, Cheng; Ning, Cai; Liang, Hu; Ai Lian, Liu; Ru Xin, Wang; Ya Hong, Luo

2018-07-01

Background The evaluation of hip arthroplasty is a challenge in computed tomography (CT). The virtual monochromatic spectral (VMS) images with metal artifact reduction software (MARs) in spectral CT can reduce the artifacts and improve the image quality. Purpose To evaluate the effects of VMS images and MARs for metal artifact reduction in patients with unilateral hip arthroplasty. Material and Methods Thirty-five patients underwent dual-energy CT. Four sets of VMS images without MARs and four sets of VMS images with MARs were obtained. Artifact index (AI), CT number, and SD value were assessed at the periprosthetic region and the pelvic organs. The scores of two observers for different images and the inter-observer agreement were evaluated. Results The AIs in 120 and 140 keV images were significantly lower than those in 80 and 100 keV images. The AIs of the periprosthetic region in VMS images with MARs were significantly lower than those in VMS images without MARs, while the AIs of pelvic organs were not significantly different. VMS images with MARs improved the accuracy of CT numbers for the periprosthetic region. The inter-observer agreements were good for all the images. VMS images with MARs at 120 and 140 keV had higher subjective scores and could improve the image quality, leading to reliable diagnosis of prosthesis-related problems. Conclusion VMS images with MARs at 120 and 140 keV could significantly reduce the artifacts from hip arthroplasty and improve the image quality at the periprosthetic region but had no obvious advantage for pelvic organs.

A Study to Determine the Best Method of Caring for Certain Short-Stay Surgical Patients at Reynolds Army Community Hospital

DTIC Science & Technology

1988-09-01

Perineoplasty Vaginal cyst, cautery Vaginal web, excision Surgical Patients 95 ORTHOPEDIC Arthrodesis of phalanges Arthroscopy Bone biopsy Bunionectomy...Manipulation of shoulder, knee, or hip Mass excision with scar revision Meniscectomy (if done through arthroscopy ) Metatarsal head, excision unilateral

Reliability and Validity of the Hip Stability Isometric Test (HipSIT): A New Method to Assess Hip Posterolateral Muscle Strength.

PubMed

Almeida, Gabriel Peixoto Leão; das Neves Rodrigues, Helena Larissa; de Freitas, Bruno Wesley; de Paula Lima, Pedro Olavo

2017-12-01

Study Design Cross-sectional study. Background The Hip Stability Isometric Test (HipSIT) evaluates the strength of the hip posterolateral stabilizers in a position that favors greater activation of the gluteus maximus and gluteus medius and lower activation of the tensor fascia lata. Objectives To check the validity and reliability of the HipSIT and to evaluate the HipSIT in women with patellofemoral pain (PFP). Methods The HipSIT was evaluated with a handheld dynamometer. During testing, the participants were sidelying, with their legs positioned at 45° of hip flexion and 90° of knee flexion. Participants were instructed to raise the knee of the upper leg while keeping the upper and lower heels in contact. To establish reliability and validity, 49 women were tested with the HipSIT by 2 different evaluators on day 1, and then again 7 days later. The strength of the hip extensors, abductors, and external rotators was also evaluated. Twenty women with unilateral PFP were also evaluated. Results The HipSIT has excellent intrarater and interrater reliability. The standard error of measurement was 0.01 kgf/kg, and the minimal detectable change was 0.036 kgf/kg. The HipSIT showed good validity in isolated hip abduction, external rotation, and extension (P<.01). Women with PFP showed a 10% deficit in the HipSIT results for the symptomatic limb (P = .01). Conclusion The HipSIT showed excellent interrater and intrarater reliability, moderate to good validity in women, and was able to identify strength deficits in women with PFP. J Orthop Sports Phys Ther 2017;47(12):906-913. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7274.

Osteoarthritis of the temporo-mandibular joint in free-living Soay sheep on St Kilda.

PubMed

Arthur, Colin; Watt, Kathryn; Nussey, Daniel H; Pemberton, Josephine M; Pilkington, Jill G; Herman, Jeremy S; Timmons, Zena L; Clements, Dylan N; Scott, Philip R

2015-01-01

Osteoarthritis (OA) is a common degenerative disease of synovial joints with the potential to cause pathology and welfare issues in both domestic and wild ruminants. Previous work has identified OA of the elbow joint in domestic sheep, but the prevalence of OA of the jaw and in particular the temporomandibular joint (TMJ) has not been previously reported. Following up a previous report of a single case of TMJ OA in a free-living population of Soay sheep on St Kilda in the Outer Hebrides, an archive of 2736 jaw bones collected from this population between 1985 and 2010 was surveyed. Evidence of TMJ OA was found in 35 sheep. Of these, 15 cases were unilateral (11 right side, 4 left side) and the remaining 20 were bilateral. TMJ pathology was much more common in females than males: only 3/35 cases were in males, with overall prevalence at 2.3% for females and 0.2% in males. Radiographic examination of TMJ with OA revealed extensive bone re-modelling with osteophytosis, particularly of the condyle of the mandible. There was a highly significant age-dependence in TMJ OA incidence among age classes: 30/35 cases occurred in geriatric sheep (aged 7 years or more; 11.1% prevalence within this age class), four in adults (2-6 years old; 0.9% prevalence), one in yearlings (0.3% prevalence) and none in lambs. The low incidence in males was confounded by sex differences in longevity: while 18% of females sampled died in the geriatric age class, only 2% of males did so. Although the low prevalence of the pathology limited the ability to test its association with other traits, it was possible to examine relationships with reproductive performance measures amongst geriatric females with and without TMJ OA. Although there were trends towards lower fecundity and lower lamb birth weight in the breeding season prior to death, these were not statistically significant. Copyright © 2014 Elsevier Ltd. All rights reserved.

Association of Beta-Blocker Use With Less Prevalent Joint Pain and Lower Opioid Requirement in People With Osteoarthritis.

PubMed

Valdes, Ana M; Abhishek, Abhishek; Muir, Kenneth; Zhang, Weiya; Maciewicz, Rose A; Doherty, Michael

2017-07-01

Recent findings suggest that β-adrenergic blockers have antinociceptive properties. The aim of this study was to compare levels of large-joint pain between those taking adrenergic blockers and those taking other antihypertensive medications. Data from the Genetics of Osteoarthritis and Lifestyle (GOAL) study, a secondary-care cohort of osteoarthritis (OA) patients, were used. Joint pain was assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores in 873 individuals with symptomatic hip and/or knee OA and hypertension, who were taking ≥1 prescription antihypertensive medications. The association between adrenergic blocker prescription and at least moderate joint pain (WOMAC score <75) and use of prescription analgesics was examined using binary logistic regression. Analyses were adjusted for age, sex, body mass index, knee or hip OA, history of joint replacement (at other joints), anxiety, and depression. The use of β-adrenergic blockers was associated with lower WOMAC pain scores and with a lower prevalence of joint pain after adjustment for demographic variables and comorbidity (adjusted odds ratio [OR adj ] for pain 0.68 [95% confidence interval (95% CI) 0.51, 0.92]; P < 0.011). No associations with pain were observed with use of alpha-blockers (OR adj for pain 0.94 [95% CI 0.55, 1.58]) or with any other class of antihypertensive medications. Prescription of beta-blockers was also associated negatively with opioid use (OR adj for opioids 0.73 [95% CI 0.54, 0.98]; P < 0.037) and with the use of prescription analgesics in general (OR adj for analgesics 0.74 [95% CI 0.56, 0.94]; P < 0.032). The use of beta-blockers is associated with less joint pain and a lower use of opioids and other analgesics in individuals with symptomatic large-joint OA. This observation needs to be confirmed by other studies. © 2016, American College of Rheumatology.

The effects of floor incline on lower extremity biomechanics during unilateral landing from a jump in dancers.

PubMed

Pappas, Evangelos; Orishimo, Karl F; Kremenic, Ian; Liederbach, Marijeanne; Hagins, Marshall

2012-05-01

Retrospective studies have suggested that dancers performing on inclined ("raked") stages have increased injury risk. One study suggests that biomechanical differences exist between flat and inclined surfaces during bilateral landings; however, no studies have examined whether such differences exist during unilateral landings. In addition, little is known regarding potential gender differences in landing mechanics of dancers. Professional dancers (N = 41; 14 male, 27 female) performed unilateral drop jumps from a 30 cm platform onto flat and inclined surfaces while extremity joint angles and moments were identified and analyzed. There were significant joint angle and moment effects due to the inclined flooring. Women had significantly decreased peak ankle dorsiflexion and hip adduction moment compared with men. Findings of the current study suggest that unilateral landings on inclined stages create measurable changes in lower extremity biomechanical variables. These findings provide a preliminary biomechanical rationale for differences in injury rates found in observational studies of raked stages.

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

Retention of Human-Induced Pluripotent Stem Cells (hiPS) With Injectable HA Hydrogels for Vocal Fold Engineering.

PubMed

Imaizumi, Mitsuyoshi; Li-Jessen, Nicole Y K; Sato, Yuka; Yang, David T; Thibeault, Susan L

2017-04-01

One prospective treatment option for vocal fold scarring is regeneration with an engineered scaffold containing induced pluripotent stem cells (iPS). In the present study, we investigated the feasibility of utilizing an injectable hyaluronic acid (HA) scaffold encapsulated with human-iPS cell (hiPS) for regeneration of vocal folds. Thirty athymic nude rats underwent unilateral vocal fold injury. Contralateral vocal folds served as uninjured controls. Hyaluronic acid hydrogel scaffold, HA hydrogel scaffold containing hiPS, and HA hydrogel scaffold containing hiPS with epidermal growth factor (EGF) were injected in both vocal folds immediately after surgery. One and 2 weeks after injection, larynges were excised for histology, immunohistochemistry, and fluorescence in situ hybridization (FISH). Presence of HA hydrogel was confirmed in vocal folds 1 and 2 weeks post injection. The FISH analysis confirmed the presence and viability of hiPS in the injected vocal folds. Histological results demonstrated that vocal folds injected with HA hydrogel scaffold containing EGF demonstrated less fibrosis than those with HA hydrogel only. Human-iPS survived in injured rat vocal folds. The HA hydrogel with hiPS and EGF ameliorated the fibrotic response. Additional work is necessary to optimize hiPS differentiation and further confirm the safety of hiPS for clinical applications.

Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy?

PubMed

Tsai, Tsung-Yuan; Dimitriou, Dimitris; Li, Jing-Sheng; Kwon, Young-Min

2016-06-01

The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique. Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared. Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group. This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Effect of intraarticular inoculation of mesenchymal stem cells in dogs with hip osteoarthritis by means of objective force platform gait analysis: concordance with numeric subjective scoring scales.

PubMed

Vilar, Jose M; Cuervo, Belen; Rubio, Monica; Sopena, Joaquín; Domínguez, Juan M; Santana, Angelo; Carrillo, Jose M

2016-10-07

Subjective pain assessment scales have been widely used for assessing lameness in response to pain, but the accuracy of these scales has been questioned. To assess scale accuracy, 10 lame, presa Canario dogs with osteoarthritis (OA) associated with bilateral hip dysplasia were first treated with mesenchymal stem cells. Then, potential lameness improvement was analyzed using two pain scales (Bioarth and visual analog scale). These data were compared with similar data collected using a force platform with the same animals during a period of 6 months after treatment. The F test for intraclass correlation showed that concordance in pain/lameness scores between the 2 measuring methodologies was not significant (P value ≥ 0.9213; 95 % confidence interval, -0.56, 0.11). Although subjective pain assessment showed improvement after 6 months, force platform data demonstrated those same animals had returned to the initial lameness state. Use of pain assessment scales to measure lameness associated with OA did not have great accuracy and concordance when compared with quantitative force platform gait analysis.

Defining Flare in Osteoarthritis of the Hip and Knee: A Systematic Literature Review - OMERACT Virtual Special Interest Group.

PubMed

Cross, Marita; Dubouis, Ludovic; Mangin, Matthieu; Hunter, David J; March, Lyn; Hawker, Gillian; Guillemin, Francis

2017-12-01

Beyond the exacerbation of pain in describing a flare in osteoarthritis (OA), patients and health professionals add other elements that deserve to be fully elucidated, such as effusion, swelling, and mobility limitation. To define and conceptualize the construct flare in OA, the objective was to identify the key variables, or symptoms, that worsen, and to clarify how these variables are described in the literature by patients and clinicians. A systematic review of the literature was conducted in Medline and PsychINFO. In brief, the search terms used were "osteoarthritis," "knee," "hip," and "flare." Specific characteristics of included studies were identified, including the type of study design, type of flare assessed, how the flare developed, and what definition of flare was used, including whether the definition was based on qualitative or quantitative analysis. Pain was the major factor in the definition of flare within these studies. Four components of flare were identified: pain, other factors, composite criteria, and global assessment. While the majority of studies reported flare as an increase in pain using standardized outcome measures, only 1 study reported the antecedents and consequences of a pain flare using qualitative methods. The use of flare as an outcome or inclusion criterion in rheumatology trials is a common occurrence; however, this review highlights the wide variation in the definitions of OA flare currently in use and the emphasis on the measurement of pain. This variation in definition does not allow for direct comparison between trials and limits interpretation of evidence.

Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study.

PubMed

Holla, Jasmijn F M; van der Leeden, Marike; Knol, Dirk L; Roorda, Leo D; Hilberdink, Wim K H A; Lems, Willem F; Steultjens, Martijn P M; Dekker, Joost

2015-01-01

It has been hypothesized that pain and low vitality lead to an increase in avoidance of activities in persons with early symptomatic knee osteoarthritis (OA), and that avoidance of activities leads to an increase in activity limitations. The present study aimed to evaluate these hypotheses. Baseline, 2-year, and 5-year followup data of 828 participants from the Cohort Hip and Cohort Knee Study with early symptomatic knee OA were used. Autoregressive generalized estimating equations and linear regression models were used to analyze the longitudinal and cross-sectional associations between self-reported knee pain, vitality, pain-related avoidance of activities, and activity limitations. The models were adjusted for the covariates age, sex, education level, body mass index, comorbidity, radiographic severity, and hip pain. In longitudinal analyses, knee pain and vitality predicted a subsequent increase in avoidance of activities. Pain-related avoidance of activities predicted a subsequent increase in activity limitations; however, this relationship lost statistical significance (P = 0.089) after adjustment for covariates. Cross-sectional analyses showed strong relationships between knee pain, low vitality, pain-related avoidance of activities, and activity limitations at all time points. In persons with early symptomatic knee OA, knee pain and low vitality lead to a subsequent increase in avoidance of activities. Pain-related avoidance of activities is related to activity limitations at inception of symptoms, but also years later. Therefore, it can be recommended to monitor and target avoidance of activities at various stages of the disease. Copyright © 2015 by the American College of Rheumatology.

Relationship of unilateral total hip arthroplasty (THA) to contralateral and ipsilateral knee joint degeneration - a longitudinal 3T MRI study from the Osteoarthritis Initiative (OAI).

PubMed

Jungmann, P M; Nevitt, M C; Baum, T; Liebl, H; Nardo, L; Liu, F; Lane, N E; McCulloch, C E; Link, T M

2015-07-01

To evaluate the association of prevalent unilateral total hip arthroplasty (THA) with worsening of degenerative knee abnormalities and clinical outcomes in the ipsilateral and contralateral knee. Both knees of 30 individuals in the Osteoarthritis Initiative (OAI) with unilateral THA (n = 14 left, n = 16 right) at baseline were assessed at baseline and at 4-year follow-up for Whole-organ MR Imaging Scores (WORMS), cartilage T2 relaxation times (only available for right knees), Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores and upper leg isometric strength. Right knees of 30 individuals without THA were analyzed as controls. Contralateral knees were compared to ipsilateral knees with paired t-tests and to control knees with multivariate regression analysis adjusting for covariates. In paired analyses, compared to ipsilateral knees, contralateral knees had higher WORMS total (P = 0.008) and cartilage scores (P = 0.007) at baseline. Over 4 years contralateral knees worsened more on WORMS total score (P = 0.008). Cartilage T2 values were higher in knees contralateral to the THA (baseline, P = 0.02; follow-up, P < 0.001). Contralateral knees had greater declines in knee extension strength (P = 0.04) and had a trend for greater worsening in WOMAC pain, stiffness, function and total scores (P = 0.04-0.09). Similar results were found comparing contralateral knees with control knees in multivariate regression models. Prevalent unilateral THA is associated with an greater progression of degenerative findings for the knee contralateral to THA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Association of incident symptomatic hip osteoarthritis with differences in hip shape by active shape modeling: the Johnston County Osteoarthritis Project.

PubMed

Nelson, Amanda E; Liu, Felix; Lynch, John A; Renner, Jordan B; Schwartz, Todd A; Lane, Nancy E; Jordan, Joanne M

2014-01-01

To investigate hip shape by active shape modeling (ASM) as a potential predictor of incident radiographic hip osteoarthritis (RHOA) and symptomatic hip osteoarthritis (SRHOA). All hips developing RHOA from baseline (Kellgren/Lawrence [K/L] grade 0/1) to mean 6-year followup (K/L grade ≥2, 190 hips) and 1:1 control hips (K/L grade 0/1 at both times, 192 hips) were included. Proximal femur shape was defined on baseline anteroposterior pelvis radiographs and submitted to ASM, producing a mean shape and continuous variables representing independent modes of shape variation. Mode scores (n = 14, explaining 95% of shape variance) were simultaneously included in logistic regression models with incident RHOA and SRHOA as dependent variables, adjusted for intraperson correlations, sex, race, body mass index (BMI), baseline K/L grade, and/or symptoms. We evaluated 382 hips from 342 individuals: 61% women and 83% white, with mean age 62 years and mean BMI 29 kg/m(2) . Several modes differed by sex and race, but no modes were associated with incident RHOA overall. Among men only, modes 1 and 2 were significantly associated (for a 1-SD decrease in mode 1 score: odds ratio [OR] 1.7 [95% confidence interval (95% CI) 1.1-2.5] and for a 1-SD increase in mode 2 score: OR 1.5 [95% CI 1.0-2.2]) with incident RHOA. A 1-SD decrease in mode 2 or 3 score increased the odds of SRHOA by 50%. This study confirms other reports that variations in proximal femur shape have a modest association with incident hip OA. The observation of proximal femur shape associations with hip symptoms requires further investigation. Copyright © 2014 by the American College of Rheumatology.

Fatigue in osteoarthritis: a qualitative study

PubMed Central

Power, J Denise; Badley, Elizabeth M; French, Melissa R; Wall, Angela J; Hawker, Gillian A

2008-01-01

Background Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA. Methods In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached. Results Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses. Conclusion Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact. PMID:18452607

OARSI-OMERACT definition of relevant radiological progression in hip/knee osteoarthritis.

PubMed

Ornetti, P; Brandt, K; Hellio-Le Graverand, M-P; Hochberg, M; Hunter, D J; Kloppenburg, M; Lane, N; Maillefert, J-F; Mazzuca, S A; Spector, T; Utard-Wlerick, G; Vignon, E; Dougados, M

2009-07-01

Joint space width (JSW) evaluated in millimeters on plain X-rays is the currently optimal recognized technique to evaluate osteoarthritis (OA) structural progression. Data obtained can be presented at the group level (e.g., mean+/-standard deviation of the changes). Such presentation makes difficult the interpretation of the clinical relevance of the reported results. Therefore, a presentation at the individual level (e.g., % progressors) seems more attractive but requires to determining a cut-off. Several methodologies have been proposed to define cut-offs in JSW: arbitrary chosen cut-off, cut-off based on the validity to predict a relevant end-point such as the requirement of total articular replacement or cut-off based on the measurement error such as smallest detectable difference (SDD). The objective of this OARSI-OMERACT initiative was to define a cut-off evaluated in millimeters on plain X-rays above which a change in JSW could be considered as relevant in patients with hip and knee OA. The first step consisted in a systematic literature research performed using Medline database up to July 2007 to obtain all manuscripts published between 1990 and 2007 reporting a cut-off value in JSW evaluated in millimeters at either the knee or hip level. The second step consisted in a consensus based on the best knowledge of the 11 experts with the support of the available evidence. Among the 506 articles selected by the search, 47 articles reported cut-off of JSW in millimeters. There was a broad heterogeneity in cut-off values, whatever the methodologies or the OA localization considered (e.g., from 0.12 to 0.84 mm and from 0.22 to 0.78 mm for Knee (seven studies) and hip (seven studies), respectively when considering the data obtained based on the reliability). Based on the data extracted in the literature, the expert committee proposed a definition of relevant change in JSW based on plain X-rays, on an absolute change of JSW in millimeters and on the measurement error e.g., calculation of the SDD using the Bland and Altman technique. The results of the analysis of JSW should be expressed in terms of a dichotomous variable (e.g., progressors yes/no): a patient with a change in JSW during the study over such SDD will fulfill the definition of "progressor". Moreover, the pilot study aimed at evaluating the measurement error should be designed to reflect the different characteristics of the primary study in which the analysis of the radiological findings will be based on (patient's characteristics, centers characteristics, readers). This initiative based on both an Evidence Based Medicine (Systematic Literature Research) and Expert Opinion approach resulted in a proposal of definition of relevant radiological progression in OA to be used as end-point in clinical trials and also recommendations on the conduct of the reliability study allowing such definition.

Tribological performance of the biological components of synovial fluid in artificial joint implants

NASA Astrophysics Data System (ADS)

Ghosh, Subir; Choudhury, Dipankar; Roy, Taposh; Moradi, Ali; Masjuki, H. H.; Pingguan-Murphy, Belinda

2015-08-01

The concentration of biological components of synovial fluid (such as albumin, globulin, hyaluronic acid, and lubricin) varies between healthy persons and osteoarthritis (OA) patients. The aim of the present study is to compare the effects of such variation on tribological performance in a simulated hip joint model. The study was carried out experimentally by utilizing a pin-on-disk simulator on ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) hip joint implants. The experimental results show that both friction and wear of artificial joints fluctuate with the concentration level of biological components. Moreover, the performance also varies between material combinations. Wear debris sizes and shapes produced by ceramic and polyethylene were diverse. We conclude that the biological components of synovial fluid and their concentrations should be considered in order to select an artificial hip joint to best suit that patient.

Biomechanical differences between unilateral and bilateral landings from a jump: gender differences.

PubMed

Pappas, Evangelos; Hagins, Marshall; Sheikhzadeh, Ali; Nordin, Margareta; Rose, Donald

2007-07-01

To determine the effect of landing type (unilateral vs. bilateral) and gender on the biomechanics of drop landings in recreational athletes. This study used a repeated measures design to compare bilateral and unilateral landings in male and female athletes. A repeated measures multivariate analysis of variance (type of landing*gender) was performed on select variables. Biomechanics laboratory. Sixteen female and 16 male recreational athletes. Kinetic, kinematic, and electromyographic (EMG) data were collected on participants while performing bilateral and unilateral landings from a 40-cm platform. Compared to bilateral landings, subjects performed unilateral landings with increased knee valgus, decreased knee flexion at initial contact, decreased peak knee flexion, decreased relative hip adduction, and increased normalized EMG of the rectus femoris, medial hamstrings, lateral hamstrings, and medial gastrocnemius (P < 0.005). During both types of landing, females landed with increased knee valgus and normalized vertical ground reaction force (VGRF) compared to males (P < 0.009), however, the interaction of landing type*gender was not significant (P = 0.29). Compared to bilateral landings, male and female recreational athletes performed unilateral landings with significant differences in knee kinematic and EMG variables. Female athletes landed with increased knee valgus and VGRF compared to males during both types of landing.

Evaluation of Spine Health and Spine Mechanics in Servicemembers with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2015-10-01

of proximal compensations (e.g., hip-hiking) to assist with toe clearance (Michaud et al., 2000), or simply because these individuals feel more...related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. Journal of orthopaedic trauma 23(7), 525-530

Delayed onset of changes in soma action potential genesis in nociceptive A-beta DRG neurons in vivo in a rat model of osteoarthritis

PubMed Central

Wu, Qi; Henry, James L

2009-01-01

Background Clinical data on osteoarthritis (OA) suggest widespread changes in sensory function that vary during the progression of OA. In previous studies on a surgically-induced animal model of OA we have observed that changes in structure and gene expression follow a variable trajectory over the initial days and weeks. To investigate mechanisms underlying changes in sensory function in this model, the present electrophysiological study compared properties of primary sensory nociceptive neurons at one and two months after model induction with properties in naïve control animals. Pilot data indicated no difference in C- or Aδ-fiber associated neurons and therefore the focus is on Aβ-fiber nociceptive neurons. Results At one month after unilateral derangement of the knee by cutting the anterior cruciate ligament and removing the medial meniscus, the only changes observed in Aβ-fiber dorsal root ganglion (DRG) neurons were in nociceptor-like unresponsive neurons bearing a hump on the repolarization phase; these changes consisted of longer half width, reflecting slowed dynamics of AP genesis, a depolarized Vm and an increased AP amplitude. At two months, changes observed were in Aβ-fiber high threshold mechanoreceptors, which exhibited shorter AP duration at base and half width, shorter rise time and fall time, and faster maximum rising rate/maximum falling rate, reflecting accelerated dynamics of AP genesis. Conclusion These data indicate that Aβ nociceptive neurons undergo significant changes that vary in time and occur later than changes in structure and in nociceptive scores in this surgically induced OA model. Thus, if changes in Aβ-fiber nociceptive neurons in this model reflect a role in OA pain, they may relate to mechanisms underlying pain associated with advanced OA. PMID:19785765

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

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

2016-01-01

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. 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). 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. 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.

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

Return to work and workplace activity limitations following total hip or knee replacement.

PubMed

Sankar, A; Davis, A M; Palaganas, M P; Beaton, D E; Badley, E M; Gignac, M A

2013-10-01

Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Decrease in local volumetric bone mineral density (vBMD) in osteoarthritic joints is associated with the increase in cartilage damage: a pQCT study

NASA Astrophysics Data System (ADS)

Tamaddon, Maryam; Chen, Shen Mao; Vanaclocha, Leyre; Hart, Alister; El-Husseiny, Moataz; Henckel, Johann; Liu, Chaozong

2017-11-01

Osteoarthritis (OA) is the most common type of arthritis and a major cause of disability in the adult population. It affects both cartilage and subchondral bone in the joints. There has been some progress in understanding the changes in subchondral bone with progression of osteoarthritis. However, local changes in subchondral bone such as microstructure or volumetric bone mineral density in connection with the defect in cartilage are relatively unexplored. To develop an effective treatment for progression of OA, it is important to understand how the physical environment provided by the subchondral bone affects the overlying cartilage. In this study we examined the volumetric bone mineral density (vBMD) distribution in the osteoarthritic joint tissues obtained from total hip replacement surgeries due to osteoarthritis, using peripheral quantitative CT (pQCT). It was found that there is a significant decrease in volumetric bone mineral density, which co-localises with the damage in the overlying cartilage. This was not limited to the subchondral bone immediately adjacent to the cartilage defect but continued in the layers below. Bone resorption and cyst formation in the OA tissues were also detected. We observed that the bone surrounding subchondral bone cysts exhibited much higher volumetric bone mineral density than that of the surrounding bones. PQCT was able to detect significant changes in vBMD between OA and non-OA samples, as well as between areas of different cartilage degeneration, which points to its potential as a technique for detection of early OA.

Alarmins S100A8/S100A9 aggravate osteophyte formation in experimental osteoarthritis and predict osteophyte progression in early human symptomatic osteoarthritis.

PubMed

Schelbergen, R F P; de Munter, W; van den Bosch, M H J; Lafeber, F P J G; Sloetjes, A; Vogl, T; Roth, J; van den Berg, W B; van der Kraan, P M; Blom, A B; van Lent, P L E M

2016-01-01

Alarmins S100A8 and S100A9 are major products of activated macrophages regulating cartilage damage and synovial activation during murine and human osteoarthritis (OA). In the current study, we investigated whether S100A8 and S100A9 are involved in osteophyte formation during experimental OA and whether S100A8/A9 predicts osteophyte progression in early human OA. OA was elicited in S100A9-/- mice in two experimental models that differ in degree of synovial activation. Osteophyte size, S100A8, S100A9 and VDIPEN neoepitope was measured histologically. Chondrogenesis was induced in murine mesenchymal stem cells in the presence of S100A8. Levels of S100A8/A9 were determined in plasma of early symptomatic OA participants of the Cohort Hip and Cohort Knee (CHECK) cohort study and osteophytes measured after 2 and 5 years. Osteophyte size was drastically reduced in S100A9-/- mice in ligaments and at medial femur and tibia on days 21 and 42 of collagenase-induced OA, in which synovial activation is high. In contrast, osteophyte size was not reduced in S100A9-/- mice during destabilised medial meniscus OA, in which synovial activation is scant. S100A8 increased expression and activation of matrix metalloproteinases during micromass chondrogenesis, thereby possibly increasing cartilage matrix remodelling allowing for larger osteophytes. Interestingly, early symptomatic OA participants of the CHECK study with osteophyte progression after 2 and 5 years had elevated S100A8/A9 plasma levels at baseline, while C-reactive protein, erythrocyte sedimentation rate and cartilage oligomeric matrix protein were not elevated at baseline. S100A8/A9 aggravate osteophyte formation in experimental OA with high synovial activation and may be used to predict osteophyte progression in early symptomatic human OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effects of Imbalanced Muscle Loading on Hip Joint Development and Maturation

PubMed Central

Ford, Caleb A.; Nowlan, Niamh C.; Thomopoulos, Stavros; Killian, Megan L.

2017-01-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. PMID:27391299

Measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis: a systematic review.

PubMed

Kroman, S L; Roos, E M; Bennell, K L; Hinman, R S; Dobson, F

2014-01-01

To systematically appraise the evidence on measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis (OA). Electronic searches were performed in MEDLINE, CINAHL, Scopus and SPORTDiscus in May 2013. Two reviewers independently rated the measurement properties using the 4-point COSMIN checklist. Best evidence synthesis was made using COSMIN quality, consistency and direction of findings and sample size. Twenty of 2736 papers were eligible for inclusion and 24 different performance-based outcome measures knee or obese populations were evaluated. No tests related to hip populations were included. Twenty-five measurement properties including reliability (nine studies), construct validity (hypothesis testing) (nine studies), measurement error (three studies), structural validity (two studies), interpretability (one study) and responsiveness (one study) were evaluated. A positive rating was given to 12.5% (30/240) of all possible measurement ratings. Tests were grouped into two categories based on the population characteristics. The one-legged hop for distance, followed by the 6-m timed hop and cross over hop for distance were the best-rated tests for the knee-injured population. Whereas the 6-min walk test was the only included test for the obese population. This review highlights the many gaps in knowledge about the measurement properties of performance-based outcome measures for young and middle-aged people known to be at high risk of hip and/or knee OA. There is a need for consensus on which outcome measures should be used and/or combined when assessing physical function in this population. Further good quality research is required. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Influence of high glucose and advanced glycation end-products (ages) levels in human osteoblast-like cells gene expression.

PubMed

Miranda, Cristina; Giner, Mercè; Montoya, M José; Vázquez, M Angeles; Miranda, M José; Pérez-Cano, Ramón

2016-08-31

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of osteoporotic fracture. Several factors have been identified as being potentially responsible for this risk, such as alterations in bone remodelling that may have been induced by changes in circulating glucose or/and by the presence of non-oxidative end products of glycosylation (AGEs). The aim of this study is to assess whether such variations generate a change in the gene expression related to the differentiation and osteoblast activity (OPG, RANKL, RUNX2, OSTERIX, and AGE receptor) in primary cultures of human osteoblast-like cells (hOB). We recruited 32 patients; 10 patients had osteoporotic hip fractures (OP group), 12 patients had osteoporotic hip fractures with T2DM (T2DM group), and 10 patients had hip osteoarthritis (OA group) with no osteoporotic fractures and no T2DM. The gene expression was analyzed in hOB cultures treated with physiological glucose concentration (4.5 mM) as control, high glucose (25 mM), and high glucose plus AGEs (2 μg/ml) for 24 h. The hOB cultures from patients with hip fractures presented slower proliferation. Additionally, the hOB cultures from the T2DM group were the most negatively affected with respect to RUNX2 and OSX gene expression when treated solely with high glucose or with high glucose plus AGEs. Moreover, high levels of glucose induced a major decrease in the RANKL/OPG ratio when comparing the OP and the T2DM groups to the OA group. Our data indicates an altered bone remodelling rate in the T2DM group, which may, at least partially, explain the reduced bone strength and increased incidence of non-traumatic fractures in diabetic patients.

Hyaline cartilage calcification of the first metatarsophalangeal joint is associated with osteoarthritis but independent of age and BMI.

PubMed

Hubert, Jan; Hawellek, Thelonius; Hischke, Sandra; Bertrand, Jessica; Krause, Matthias; Püschel, Klaus; Rüther, Wolfgang; Niemeier, Andreas

2016-11-15

Hyaline cartilage calcification (CC) is associated with osteoarthritis (OA) in hip and knee joints. The first metatarsophalangeal joint (1 st MTPJ) is frequently affected by OA, but it is unclear if CC occurs in the 1 st MTPJ. The aim of the present study was to analyze the prevalence of CC of the 1 st MTPJ in the general population by high-resolution digital contact radiography (DCR) and to determine its association with histological OA severity, age and body mass index (BMI). 168 metatarsal heads of 84 donors (n = 47 male, n = 37 female; mean age 62.73 years, SD ±18.8, range 20-93) were analyzed by DCR for the presence of CC. Histological OA grade (hOA) by OARSI was analyzed in the central load-bearing zone of the first metatarsal head (1 st MH). Structural equation modeling (SEM) was performed to analyze the interrelationship between CC, hOA, age and BMI. The prevalence of CC of 1 st MH was 48.8 % (41/84) (95 %-CI [37.7 %, 60.0 %]), independent of the affected side (p = 0.42), gender (p = 0.41) and BMI (p = 0.51). The mean amount of CC of one MH correlated significantly with that of the contralateral side (r s  = 0.4, 95 %-CI [0.26, 0.52], p < 0.001). The mean amount of CC (in % of total cartilage area) of the MH correlated significantly with the severity of hOA (r s  = 0.51, 95 %-CI [0.32, 0.65], p < 0.001). SEM revealed significant associations between CC and hOA (r = 0.74, p < 0.001) and between hOA and age (β = 0.62, p = 0.001), but not between CC and age (p = 0.15). There was no significant influence of BMI on either CC (p = 0.37) or hOA (p = 0.16). The observation that CC of the 1 st MH is significantly associated with the severity of OA but independent of age and BMI, suggests an intimate relationship between CC and the pathogenesis of OA, the exact nature of which will have to be explored by future studies.

Cost-Effectiveness of Total Hip and Knee Replacements for the Australian Population with Osteoarthritis: Discrete-Event Simulation Model

PubMed Central

Higashi, Hideki; Barendregt, Jan J.

2011-01-01

Background Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. Methodology/Principal Findings We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs) averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively) under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively). However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. Conclusions/Significance Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements. PMID:21966520

The quantitative and functional relation between insulin-like growth factor-I (IGF) and IGF-binding proteins during human osteoarthritis.

PubMed

Morales, Teresa I

2008-04-01

A previous hypothesis stated that during osteoarthritis (OA) increased insulin-like growth factor (IGF) binding proteins (IGFBPs) sequester IGFs and limit their access to the cell. The objective of this article was to test this by: (1) quantifying IGF and IGFBP-3 as well as their ratios in human OA cartilages, and (2) measuring the metabolic responses of diseased cartilage to IGF-I and its IGFBP-insensitive analogs. Knee or hip OA cartilages were staged for OA by histology. Cartilage slices were either extracted for assays of IGF proteins, or maintained intact as organ cultures. Proteoglycan (PG) metabolism +/- IGFs was measured by use of the (35)S-sulfate precursor. IGFBP-3 (ng/mg protein) was weakly correlated with OA score by regression analysis (R(2) = 0.122; p = 0.040; n = 35). IGF-I (ng/mg protein) was constant across all OA groups (ANOVA; p = .428, n = 18) and the IGF-I/IGFBP-3 ratios were > 1 in most samples. All OA cartilages responded to hrIGF-I by increasing PG synthesis [average 2.29-fold +/- 0.55 (+/-SD) at saturation, n = 12] irrespective of OA score. The des (1-3) IGF-I analog (which lacks the three N-terminal amino acids) had similar maximal effects (average 2.23-fold stimulation +/- 0.71, n = 10), but it was more effective in two out of three samples at suboptimal doses. The effect of hrIGF-I, des (1-3) IGF-I, or the B-chain analog on degradation was minimal. In summary, catabolism was insensitive to IGF-I, and this was probably not due to IGFBPs. By contrast, IGF-I exerted a robust stimulation of anabolism at sufficiently high doses, even though IGFBPs could tone down the ligand effect at low doses. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

PubMed

Hiligsmann, Mickaël; Cooper, Cyrus; Guillemin, Francis; Hochberg, Marc C; Tugwell, Peter; Arden, Nigel; Berenbaum, Francis; Boers, Maarten; Boonen, Annelies; Branco, Jaime C; Maria-Luisa, Brandi; Bruyère, Olivier; Gasparik, Andrea; Kanis, John A; Kvien, Tore K; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Pinedo-Villanueva, Rafael; Pinto, Daniel; Reiter-Niesert, Susanne; Rizzoli, René; Rovati, Lucio C; Severens, Johan L; Silverman, Stuart; Reginster, Jean-Yves

2014-12-01

General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

RNA sequencing reveals target genes of temporomandibular joint osteoarthritis in rats after the treatment of low-intensity pulsed ultrasound.

PubMed

He, Dong; An, Yanxin; Li, Yanhua; Wang, Jing; Wu, Gaoyi; Chen, Lei; Zhu, Guoxiong

2018-06-06

To explore the potential molecular mechanism of low-intensity pulsed ultrasound (LIPUS) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA), and identify the target genes for therapy of TMJ-OA. Rat TMJ-OA was induced by unilateral occlusal trauma (UOT). At 8 weeks, the experimental group rats were treated by LIPUS for 4 weeks (5 days every week). The cartilage was examined by histological techniques. Gene expression profile in control, placebo and LIPUS-treated group were measured by RNA sequencing (RNA-Seq). Gene oncology (GO) and kyoto encyclopedia of genes and genomes (KEGG) annotated were performed and ten differentially expressed genes (DEGs) were further validated in another individual by quantitative real-time polymerase chain reaction (qRT-PCR). Per-2, a circadian rhythm gene, was further confirmed by western blot. TMJ-OA model was successfully established in rats through UOT. LIPUS played a positive role in attenuating the retrogression of cartilage. The cartilage lesion was determined by HE and Safranin-O staining. A significant and bran-new gene profile of 58 mRNAs was obtained from the RNA-Seq (LIPUS-treated/placebo) and generated approximately 30GB data. Annotation, functional classification and pathway of the data were analyzed based on GO and KEGG database and ten candidate DEGs were identified. Some of these genes were proved to be related to OA, such as matrix-degrading enzyme (ADAMTS-8), complement (C1qa, C3, C5aR1). Some were reported for the first time in TMJ-OA, such as circadian gene (Per-2, Dbp, Npas2 and Arntl). According to the results of qRT-PCR validation, the sequencing data was with a high degree of credibility. The circadian gene Per-2 was up-regulated by LIPUS in TMJ-OA on the mRNA and protein level. This study reveals the potential therapeutic genes related to TMJ-OA. Especially the circadian Per-2 gene was detected up-regulated by the treatment of LIPUS. It provides us a precious, new target OA-related gene and further investigation of gene-function will provide us new insights in understanding the potential mechanical underling TMJ-OA. Copyright © 2017. Published by Elsevier B.V.

The unmet needs of Aboriginal Australians with musculoskeletal pain: A mixed method systematic review.

PubMed

Lin, Ivan B; Bunzli, Samantha; Mak, Donna B; Green, Charmaine; Goucke, Roger; Coffin, Juli; O'Sullivan, Peter B

2017-12-15

Musculoskeletal pain (MSP) conditions are the biggest cause of disability and internationally, Indigenous peoples experience a higher burden. There are conflicting reports about Aboriginal Australians and MSP. We conducted a systematic review to describe the prevalence, associated factors, impacts, care access, health care experiences, and factors associated with MSP among Aboriginal Australians. A systematic search of quantitative and qualitative scientific and grey literature (PROSPERO number: CRD42016038342). Articles were appraised using the Mixed Methods Appraisal Tool. Due to study heterogeneity a narrative synthesis was conducted. Of 536 articles identified, 18 were included (14 quantitative, 4 qualitative), of high (n=11), medium (n=2) and low (n=5) quality. Prevalences of MSP in Aboriginal populations were similar to or slightly higher than the non-Aboriginal population (prevalence rate ratio 1.1 for back pain, 1.2-1.5 for osteoarthritis (OA), 1.0-2.0 for rheumatoid arthritis). Aboriginal people accessed primary care for knee or hip OA at around half the rate of non-Aboriginal people, and were less than half as likely to have knee or hip replacement surgery. Communication difficulties with health practitioners were the main reason why Aboriginal people with MSP choose not to access care. No articles reported interventions. Findings provide preliminary evidence of an increased MSP burden amongst Aboriginal Australians and, particularly for OA, a mismatch between the disease burden and access to health care. To increase accessibility, health services should initially focus on improving Aboriginal patients' experiences of care, in particular by improving patient-practitioner communication. Implications for care and research are outlined. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

PubMed

Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-08-01

To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with <2 years of complete data prior to TKR or THR were excluded, as were those with evidence of other conditions for which TKR or THR may be performed (e.g., rheumatoid arthritis). We then examined patterns of health care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

Biomechanical Effects of Prefabricated Foot Orthoses and Rocker‐Sole Footwear in Individuals With First Metatarsophalangeal Joint Osteoarthritis

PubMed Central

Auhl, Maria; Tan, Jade M.; Levinger, Pazit; Roddy, Edward; Munteanu, Shannon E.

2016-01-01

Objective To evaluate the effects of prefabricated foot orthoses and rocker‐sole footwear on spatiotemporal parameters, hip and knee kinematics, and plantar pressures in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods. A total of 102 people with first MTP joint OA were randomly allocated to receive prefabricated foot orthoses or rocker‐sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in‐shoe plantar pressure measurement system. Results Spatiotemporal/kinematic and plantar pressure data were available from 88 and 87 participants, respectively. The orthoses had minimal effect on spatiotemporal or kinematic parameters, while the rocker‐sole footwear resulted in reduced cadence, percentage of the gait cycle spent in stance phase, and sagittal plane hip range of motion. The orthoses increased peak pressure under the midfoot and lesser toes. Both interventions significantly reduced peak pressure under the first MTP joint, and the rocker‐sole shoes also reduced peak pressure under the second through fifth MTP joints and heel. When the effects of the orthoses and rocker‐sole shoes were directly compared, there was no difference in peak pressure under the hallux, first MTP joint, or heel; however, the rocker‐sole shoes exhibited lower peak pressure under the lesser toes, second through fifth MTP joints, and midfoot. Conclusion Prefabricated foot orthoses and rocker‐sole footwear are effective at reducing peak pressure under the first MTP joint in people with first MTP joint OA, but achieve this through different mechanisms. Further research is required to determine whether these biomechanical changes result in improvements in symptoms. PMID:26640157

Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

PubMed

Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

2014-12-01

Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

Bilateral and Unilateral Asymmetries of Isokinetic Strength and Flexibility in Male Young Professional Soccer Players

PubMed Central

Daneshjoo, Abdolhamid; Rahnama, Nader; Mokhtar, Abdul Halim; Yusof, Ashril

2013-01-01

This study investigated bilateral and unilateral asymmetries of strength and flexibility in male young professional soccer players. Thirty-six soccer players (age: 18.9 ± 1.4 years) participated in this study. A Biodex Isokinetic Dynamometer was used to assess the hamstring and quadriceps strength at selected speeds of 60°/s, 180°/s and 300°/s. Hip joint flexibility was measured using a goniometer. No difference was observed in conventional strength ratio, dynamic control ratio and fast/slow speed ratio between the dominant and non-dominant legs (p>0.05). All but one of the players (97.2%) had musculoskeletal abnormality (bilateral imbalance > 10%) in one or more specific muscle groups. The dominant leg had greater hip joint flexibility compared with the non-dominant leg (108.8 ± 10.7° versus 104.6 ± 9.8°, respectively). The findings support the hypothesis that physical performance and movement pattern experienced during soccer playing may negatively change the balance of strength in both legs (bilateral strength balance), but not on the same leg of the young male professional soccer players. The results can be helpful for trainers and coaches to decide whether the players need to improve their balance and strength which in turn may prevent injury. It is suggested that in professional soccer training, quadriceps and hamstrings muscle strength, as well as hip joint flexibility should not be overlooked. PMID:23717354

EMG of the hip adductor muscles in six clinical examination tests.

PubMed

Lovell, Gregory A; Blanch, Peter D; Barnes, Christopher J

2012-08-01

To assess activation of muscles of hip adduction using EMG and force analysis during standard clinical tests, and compare athletes with and without a prior history of groin pain. Controlled laboratory study. 21 male athletes from an elite junior soccer program. Bilateral surface EMG recordings of the adductor magnus, adductor longus, gracilis and pectineus as well as a unilateral fine-wire EMG of the pectineus were made during isometric holds in six clinical examination tests. A load cell was used to measure force data. Test type was a significant factor in the EMG output for all four muscles (all muscles p < 0.01). EMG activation was highest in Hips 0 or Hips 45 for adductor magnus, adductor longus and gracilis. EMG activation for pectineus was highest in Hips 90. Injury history was a significant factor in the EMG output for the adductor longus (p < 0.05), pectineus (p < 0.01) and gracilis (p < 0.01) but not adductor magnus. For force data, clinical test type was a significant factor (p < 0.01) with Hips 0 being significantly stronger than Hips 45, Hips 90 and Side lay. BMI (body mass index) was a significant factor (p < 0.01) for producing a higher force. All other factors had no significant effect on the force outputs. Hip adduction strength assessment is best measured at hips 0 (which produced most force) or 45° flexion (which generally gave the highest EMG output). Muscle EMG varied significantly with clinical test position. Athletes with previous groin injury had a significant fall in some EMG outputs. Copyright © 2011 Elsevier Ltd. All rights reserved.

Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss: a cross-sectional study

PubMed Central

Krupenevich, Rebecca L.; Pruziner, Alison L.; Wolf, Erik J.; Schnall, Barri L.

2017-01-01

Background Individuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss. Methods Cross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW). Results Peak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters. Discussion Assuming these data are reflective of joint loading experienced in daily life, they support a “mechanical overloading” hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted. PMID:28168120

Reflections about Osteoarthritis and Curcuma longa

PubMed Central

Akuri, Marina Cristina; Barbalho, Sandra Maria; Val, Raíssa Meira; Guiguer, Elen Landgraf

2017-01-01

Osteoarthritis (OA) is a chronic inflammatory degenerative process that affects joints such as the hands, hips, shoulders, feet, spine, and especially knees in millions of people worldwide. Some authors have shown that Curcuma longa components may exhibit benefic effects in the treatment of degenerative diseases as OA. This plant belongs to the family Zingiberaceae and it is popularly known as turmeric or saffron. This review intended to perform a retrospective search to identify studies involving humans and animal models. This review was based on articles linking OA and C. longa. Databases as Medline, Science Direct, and Lilacs were consulted and a retrospective search was carried out in order to identify studies involving humans and animal models. The curcuminoids from C. longa exhibit actions at different locations in the pathogenesis of OA once it may play an important role as anti-inflammatory, down-regulating enzymes as phospholipase A2, cyclooxygenase-2, and lipoxygenases, and reducing tumor necrosis factor-alpha-and interleukins such as interleukin-1β (IL-1β), IL-6, and IL-8. They also act as inducer of apoptosis in synoviocytes, decreasing the inflammation process and may also reduce the synthesis of reactive oxygen species. For these reasons, new pharmaceutical technology and pharmacological studies should be proposed to determine the dose, the best delivery vehicle, pharmaceutical formulation and route of administration of this plant so its use as an adjunct in the treatment of OA may become a reality in clinical practice. PMID:28503046

Bone morphotypes of the varus and valgus knee.

PubMed

Thienpont, E; Schwab, P E; Cornu, O; Bellemans, J; Victor, J

2017-03-01

Coronal deformity correction with total knee arthroplasty (TKA) is an important feature in the treatment of osteoarthritis (OA). The hypothesis of this study was that bone morphology would be different in varus and valgus deformity, both before osteoarthritis development as well as during and after the disease process of OA. Retrospective study with measurements on preoperative and postoperative full leg standing radiographs of 96 patients who underwent TKA. The included patients were selected for this study because they had an OA knee on one side and a non-arthritic knee on the contralateral side presenting the same type of alignment as the to-be-operated knee (varus or valgus alignment on both sides). The control group of 46 subjects was a group of patients with neutral mechanical alignment who presented for ligamentous problems. A single observer measured mechanical alignment, anatomical alignment, anatomical-mechanical femoral angle and intra-articular bone morphology parameters with an accuracy of 1°. Varus OA group has less distal femoral valgus (mLDFA 89°) than control group (87°) and valgus OA group (mLDFA 85°). Varus OA group has same varus obliquity as control group (MPTA 87°) but more than valgus OA group (MPTA 90°). Joint Line Congruency Angle (JLCA) is 3°open on lateral side in varus and medially open in valgus OA group (2°). The non-arthritic valgus group presents a constitutional mechanical valgus of 184° Hip-Knee-Ankle (HKA) angle. Varus deformity in OA as measured with an HKA angle (HKA) <177° is a combination of distal femoral wear, tibial varus obliquity and lateral joint line opening. Valgus deformity in OA with an HKA > 183° is a combination of femoral distal joint line obliquity and wear combined with medial opening due to medial collateral ligament stretching. The clinical importance of bone morphotype analysis is that it shows the intra-articular potential of alignment correction when mechanical axis cuts are performed. Bone morphology in varus and valgus deformity is different before and after osteoarthritis. Perpendicular cuts to mechanical axes do not necessarily lead to neutral mechanical axis. Constitutional mechanical valgus was observed as 184° HKA angle before the development of OA. Level IV study.

A test of prospect theory.

PubMed

Feeny, David; Eng, Ken

2005-01-01

Prospect theory (PT) hypothesizes that people judge states relative to a reference point, usually assumed to be their current health. States better than the reference point are valued on a concave portion of the utility function; worse states are valued on a convex portion. Using prospectively collected utility scores, the objective is to test empirically implications of PT. Osteoarthritis (OA) patients undergoing total hip arthroplasty periodically provided standard gamble scores for three OA hypothetical states describing mild, moderate, and severe OA as well as their subjectively defined current state (SDCS). Our hypothesis was that most patients improved between the pre- and postsurgery assessments. According to PT, scores for hypothetical states previously > SDCS but now < SDCS should be lower at the postsurgery assessment. Fourteen patients met the criteria for testing the hypothesis. Predictions were confirmed for 0 patients; there was no change or mixed results for 6 patients (42.9 percent); and scores moved in the direction opposite to that predicted by PT for 8 patients (57.1 percent). In general, the direction and magnitude of the changes in hypothetical-state scores do not conform to the predictions of PT.

The effect of variation in interpretation of the La Trobe radiographic foot atlas on the prevalence of foot osteoarthritis in older women: the Chingford general population cohort.

PubMed

McQueen, Peter; Gates, Lucy; Marshall, Michelle; Doherty, Michael; Arden, Nigel; Bowen, Catherine

2017-01-01

The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour. Foot radiographs of all remaining participants ( n  = 218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as 'missing'. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints. When radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3-74.3%) than Technique 2 (17.9-46.3%) and lower with a wider range (18.3-74.3%) than Technique 3 (39.9-79.4%). The three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies.

Addressing obesity in the management of knee and hip osteoarthritis - weighing in from an economic perspective.

PubMed

Flego, Anna; Dowsey, Michelle M; Choong, Peter F M; Moodie, Marj

2016-05-26

Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA). So there is increasing interest from a public health perspective in addressing obesity in the management of OA. While evidence of the efficacy of intereventions designed to address obesity in OA populations continues to grow, little is known about their economic credentials. The aim of this study is to conduct a scoping review of: (i) the published economic evidence assessing the economic impact of obesity in OA populations; (ii) economic evaluations of interventions designed to explicitly address obesity in the prevention and management of OA in order to determine which represent value for money. Besides describing the current state of the literature, the study highlights research gaps and identifies future research priorities. In July 2014, a search of the peer reviewed literature, published in English, was undertaken for the period January 1975 - July 2014 using Medline Complete (Ebscohost), Embase, Econlit, Global Health, Health Economics Evaluation Database (HEED), all Cochrane Library databases as well as the grey literature using Google and reference lists of relevant studies. A combination of key search terms was used to identify papers assessing the economic impact of obesity in OA or economic evaluations conducted to assess the efficiency of obesity interventions for the prevention or management of OA. 14 studes were identified; 13 were cost burden studies assessing the impact of obesity as a predictor for higher costs in Total Joint Arthroplasty (TJA) patients and one a cost-effectiveness study of an intervention designed to address obesity in the managment of mild to moderate OA patients. The majority of the economic studies conducted are cost burden studies. While there is some evidence of the association between severe obesity and excess hospital costs for TJA patients, heterogeneity in studies precludes definitive statements about the strength of the association. With only one economic evaluation to inform policy and practice, there is a need for future research into the cost-effectiveness of obesity interventions designed both for prevention or management of OA along the disease spectrum and over the life course.

Experimentally induced cam impingement in the sheep hip.

PubMed

Siebenrock, Klaus A; Fiechter, Ruth; Tannast, Moritz; Mamisch, Tallal C; von Rechenberg, Brigitte

2013-04-01

Sheep hips have a natural non-spherical femoral head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoro-acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam-type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non-operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38-weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam-type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273-280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012-1018), can be reproduced. This experimental sheep model can be used to study cam-type FAI. Copyright © 2012 Orthopaedic Research Society.

Radiographic Risk Factors for Contralateral Rupture in Dogs with Unilateral Cranial Cruciate Ligament Rupture

PubMed Central

Chuang, Connie; Ramaker, Megan A.; Kaur, Sirjaut; Csomos, Rebecca A.; Kroner, Kevin T.; Bleedorn, Jason A.; Schaefer, Susan L.; Muir, Peter

2014-01-01

Background Complete cranial cruciate ligament rupture (CR) is a common cause of pelvic limb lameness in dogs. Dogs with unilateral CR often develop contralateral CR over time. Although radiographic signs of contralateral stifle joint osteoarthritis (OA) influence risk of subsequent contralateral CR, this risk has not been studied in detail. Methodology/Principal Findings We conducted a retrospective longitudinal cohort study of client-owned dogs with unilateral CR to determine how severity of radiographic stifle synovial effusion and osteophytosis influence risk of contralateral CR over time. Detailed survival analysis was performed for a cohort of 85 dogs after case filtering of an initial sample population of 513 dogs. This population was stratified based on radiographic severity of synovial effusion (graded on a scale of 0, 1, and 2) and severity of osteophytosis (graded on a scale of 0, 1, 2, and 3) of both index and contralateral stifle joints using a reproducible scoring method. Severity of osteophytosis in the index and contralateral stifles was significantly correlated. Rupture of the contralateral cranial cruciate ligament was significantly influenced by radiographic OA in both the index and contralateral stifles at diagnosis. Odds ratio for development of contralateral CR in dogs with severe contralateral radiographic stifle effusion was 13.4 at one year after diagnosis and 11.4 at two years. Odds ratio for development of contralateral CR in dogs with severe contralateral osteophytosis was 9.9 at one year after diagnosis. These odds ratios were associated with decreased time to contralateral CR. Breed, age, body weight, gender, and tibial plateau angle did not significantly influence time to contralateral CR. Conclusion Subsequent contralateral CR is significantly influenced by severity of radiographic stifle effusion and osteophytosis in the contralateral stifle, suggesting that synovitis and arthritic joint degeneration are significant factors in the disease mechanism underlying the arthropathy. PMID:25254499

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed

Porter, David; Michael, Shona; Kirkwood, Craig

2007-12-01

To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Cross-sectional observational study. Posture management services in three centres in the UK. Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. A total of 747 participants were included in the study, aged 6-80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P=0.007), hips subluxed on the left (P=0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P=0.03) were observed. The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed Central

Michael, Shona; Kirkwood, Craig

2008-01-01

Objective: To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Design: Cross-sectional observational study. Setting: Posture management services in three centres in the UK. Subjects: Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Main measures: Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. Results: A total of 747 participants were included in the study, aged 6–80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P < 0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P = 0.007), hips subluxed on the left (P = 0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P = 0.03) were observed. Conclusions: The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed. PMID:18042604

Effects of imbalanced muscle loading on hip joint development and maturation.

PubMed

Ford, Caleb A; Nowlan, Niamh C; Thomopoulos, Stavros; Killian, Megan L

2017-05-01

The mechanical loading environment influences the development and maturation of joints. In this study, the influence of imbalanced muscular loading on joint development was studied using localized chemical denervation of hip stabilizing muscle groups in neonatal mice. It was hypothesized that imbalanced muscle loading, targeting either gluteal muscles or quadriceps muscles, would lead to bilateral hip joint asymmetry, as measured by acetabular coverage, femoral head volume and bone morphometry, and femoral-acetabular shape. The contralateral hip joints as well as age-matched, uninjected mice were used as controls. Altered bone development was analyzed using micro-computed tomography, histology, and image registration techniques at postnatal days (P) 28, 56, and 120. This study found that unilateral muscle unloading led to reduced acetabular coverage of the femoral head, lower total volume, lower bone volume ratio, and lower mineral density, at all three time points. Histologically, the femoral head was smaller in unloaded hips, with thinner triradiate cartilage at P28 and thinner cortical bone at P120 compared to contralateral hips. Morphological shape changes were evident in unloaded hips at P56. Unloaded hips had lower trabecular thickness and increased trabecular spacing of the femoral head compared to contralateral hips. The present study suggests that decreased muscle loading of the hip leads to altered bone and joint shape and growth during postnatal maturation. Statement of Clinical Significance: Adaptations from altered muscle loading during postnatal growth investigated in this study have implications on developmental hip disorders that result from asymmetric loading, such as patients with limb-length inequality or dysplasia. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1128-1136, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Postmenopausal women with osteoarthritis and osteoporosis show different ultrastructural characteristics of trabecular bone of the femoral head.

PubMed

Shen, Yun; Zhang, Zi-Ming; Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

2009-04-09

Osteoporosis (OP) and osteoarthritis (OA) are public health diseases affecting the quality of life of the elderly, and bring about a heavy burden to the society and family of patients. It has been debated whether or not there is an inverse relationship between these two disorders. To compare the exact difference in bone tissue structure between osteoporosis and osteoarthritis, we observed the ultrastructure of trabecular bone from the femoral heads using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). A total of 15 femoral head specimens from postmenopausal women were collected during the procedures of total or hemi hip replacement (OP, n = 8; OA, n = 7). The morphologic structure of the trabecular bone, collagen fibers, resorption lacuna and osteoblasts were observed. Under SEM, osteoporotic trabeculae appeared to be thinning, tapering, breaking and perforating. A number of resorption lacunae of various shapes were seen on the surface of the trabeculum. The collagen fibers of lacuna were resorbed. On occasion, naked granular bone crystals could be found. In the OA group, the trabecular bone looked thick with integrated structure. Reticular and granular new bone could be found. The trabeculum was covered by well-arranged collagen fibers around the resorption lacuna. In the OP group, under TEM, marginal collagen fibers were observed to be aligned loosely with enlarged spaces. A few inactive osteoblasts and no inflammatory cells were seen. In the OA group, the collagen fibers inside the trabeculum were arranged in a dense manner with many active osteoblasts and inflammatory cells infiltrating the matrix. We found significant differences in the trabecular bone, collagen fibers, lacunae and osteoblasts between postmenopausal women with OP and OA. These findings support the hypothesis that there is an inverse relationship between OP and OA.

Postmenopausal women with osteoarthritis and osteoporosis show different ultrastructural characteristics of trabecular bone of the femoral head

PubMed Central

Shen, Yun; Zhang, Zi-Ming; Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

2009-01-01

Background Osteoporosis (OP) and osteoarthritis (OA) are public health diseases affecting the quality of life of the elderly, and bring about a heavy burden to the society and family of patients. It has been debated whether or not there is an inverse relationship between these two disorders. Methods To compare the exact difference in bone tissue structure between osteoporosis and osteoarthritis, we observed the ultrastructure of trabecular bone from the femoral heads using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). A total of 15 femoral head specimens from postmenopausal women were collected during the procedures of total or hemi hip replacement (OP, n = 8; OA, n = 7). The morphologic structure of the trabecular bone, collagen fibers, resorption lacuna and osteoblasts were observed. Results Under SEM, osteoporotic trabeculae appeared to be thinning, tapering, breaking and perforating. A number of resorption lacunae of various shapes were seen on the surface of the trabeculum. The collagen fibers of lacuna were resorbed. On occasion, naked granular bone crystals could be found. In the OA group, the trabecular bone looked thick with integrated structure. Reticular and granular new bone could be found. The trabeculum was covered by well-arranged collagen fibers around the resorption lacuna. In the OP group, under TEM, marginal collagen fibers were observed to be aligned loosely with enlarged spaces. A few inactive osteoblasts and no inflammatory cells were seen. In the OA group, the collagen fibers inside the trabeculum were arranged in a dense manner with many active osteoblasts and inflammatory cells infiltrating the matrix. Conclusion We found significant differences in the trabecular bone, collagen fibers, lacunae and osteoblasts between postmenopausal women with OP and OA. These findings support the hypothesis that there is an inverse relationship between OP and OA. PMID:19356253

A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.

PubMed

Nelson, Amanda E; Allen, Kelli D; Golightly, Yvonne M; Goode, Adam P; Jordan, Joanne M

2014-06-01

Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

Cross-Sectional Contrast Between Individuals With Foot/Ankle vs Knee Osteoarthritis for Obesity and Low Education on Health-Related Quality of Life.

PubMed

Perruccio, Anthony V; Gandhi, Rajiv; Lau, Johnny T C; Syed, Khalid A; Mahomed, Nizar N; Rampersaud, Y Raja

2016-01-01

Improving health-related quality of life (HRQoL) necessitates an understanding of the influence of patient characteristics on, and interrelationship among, HRQoL domains. In osteoarthritis (OA), these associations have predominantly been examined in hip/knee populations. We investigated whether there were differences in these associations between foot/ankle and knee OA samples. Individuals seeking orthopedic care for foot/ankle or knee OA completed a questionnaire pre-consultation, including HRQoL domains (bodily pain [BP], physical [PF] and social functioning [SF], and mental [MH] and general health [GH]), obesity, comorbidity, and sociodemographic characteristics. Associations were examined via stratified path analysis (foot/ankle vs knee). Foot/ankle: n = 180, mean age = 55 (range: 25 to 82), 52% female. Knee: n = 253, mean age = 62 (range: 26 to 92), 51% female. The interrelationship among HRQoL domains was generally similar between groups. However, the influence of patient characteristics differed. Low educational status was associated with worse scores for GH, MH, and SF in the foot/ankle group, whereas no significant effects were found in the knee group. Obesity was associated with worse scores for SF, BP, and GH in the foot/ankle compared to the knee group. Patient characteristics explained considerably more of the variation in domain scores in the foot/ankle group. There are significant differences in the impact of patient characteristics on HRQoL domains in foot/ankle versus knee OA patients. Therefore, a universal approach to patient education/intervention to improve HRQoL in lower-extremity OA is not likely to achieve optimal results. Based on these findings, we recommend joint-specific patient education, with a particular emphasis on patient characteristics among the foot/ankle OA population. Level III, retrospective comparative study. © The Author(s) 2015.

Sick leave in Sweden before and after total joint replacement in hip and knee osteoarthritis patients.

PubMed

Stigmar, Kjerstin; Dahlberg, Leif E; Zhou, Caddie; Jacobson Lidgren, Helena; Petersson, Ingemar F; Englund, Martin

2017-04-01

Background and purpose - Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA). Patients and methods - Using registers from southern Sweden, we identified hip and knee OA patients aged 40-59 years who had a THR or TKR in the period 2004-2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated. Results - The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12-17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4-7% during the entire study period. Interpretation - A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery.

Non-surgical care in patients with hip or knee osteoarthritis is modestly consistent with a stepped care strategy after its implementation.

PubMed

Smink, Agnes J; Bierma-Zeinstra, Sita M A; Schers, Henk J; Swierstra, Bart A; Kortland, Joke H; Bijlsma, Johannes W J; Teerenstra, Steven; Voorn, Theo B; Dekker, Joost; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M

2014-08-01

To improve the management of hip or knee osteoarthritis (OA), a stepped care strategy (SCS) has been developed that presents the optimal sequence for care in three steps. This study evaluates the extent to which clinical practice is consistent with the strategy after implementation and identifies determinants of SCS-consistent care. A 2-year observational prospective cohort study. General practices in the region of Nijmegen in the Netherlands. Three hundred and thirteen patients with hip or knee OA and their general practitioner (GP). Multifaceted interventions were developed to implement the strategy. Consistency between clinical practice and the strategy was examined regarding three aspects of care: (i) timing of radiological assessment, (ii) sequence of non-surgical treatment options and (iii) making follow-up appointments. Out of the 212 patients who reported to have had an X-ray, 92 (44%) received it in line with the SCS. The sequence of treatment was inconsistent with the SCS in 58% of the patients, which was mainly caused by the underuse of lifestyle advice and dietary therapy. In 57% of the consultations, the patient reported to have been advised to make a follow-up appointment. No determinants that influenced all three aspects of care were identified. Consistency with the SCS was found in about half of the patients for each of the three aspects of care. Health care can be further optimized by encouraging GP s to use X-rays more appropriately and to make more use of lifestyle advice, dietary therapy and follow-up appointments. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values

PubMed Central

Tso, Peggy; Walker, Kevin; Mahomed, Nizar; Coyte, Peter C.; Rampersaud, Y. Raja

2012-01-01

Background Demand for surgery to treat osteoarthritis (OA) of the hip, knee and spine has risen dramatically. Whereas total hip (THA) and total knee arthroplasty (TKA) have been widely accepted as cost-effective, spine surgeries (decompression, decompression with fusion) to treat degenerative conditions remain underfunded compared with other surgeries. Methods An incremental cost–utility analysis comparing decompression and decompression with fusion to THA and TKA, from the perspective of the provincial health insurance system, was based on an observational matched-cohort study of prospectively collected outcomes and retrospectively collected costs. Patient outcomes were measured using short-form (SF)-36 surveys over a 2-year follow-up period. Utility was modelled over the lifetime, and quality-adjusted life years (QALYs) were determined. We calculated the incremental cost per QALY gained by estimating mean incremental lifetime costs and QALYs of surgery compared with medical management of each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses were also conducted. Results The lifetime incremental cost:utility ratios (ICURs) discounted at 3% were $5321 per QALY for THA, $11 275 per QALY for TKA, $2307 per QALY for spinal decompression and $7153 per QALY for spinal decompression with fusion. The sensitivity analyses did not alter the ranking of the lifetime ICURs. Conclusion In appropriately selected patients with leg-dominant symptoms secondary to focal lumbar spinal stenosis who have failed medical management, the lifetime ICUR for surgical treatment of lumbar spinal stenosis is similar to those of THA and TKA for the treatment of OA. PMID:22630061

Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study.

PubMed

Carling, Malin S; Jeppsson, Anders; Eriksson, Bengt I; Brisby, Helena

2015-03-28

There is a high prevalence of blood product transfusions in orthopedic surgery. The reported prevalence of red blood cell transfusions in unselected patients undergoing hip or knee replacement varies between 21% and 70%. We determined current blood loss and transfusion prevalence in total hip and knee arthroplasty when tranexamic acid was used as a routine prophylaxis, and further investigated potential predictors for excessive blood loss and transfusion requirement. In total, 193 consecutive patients undergoing unilateral hip (n = 114) or knee arthroplasty (n = 79) were included in a prospective observational study. Estimated perioperative blood loss was calculated and transfusions of allogeneic blood products registered and related to patient characteristics and perioperative variables. Overall transfusion rate was 16% (18% in hip patients and 11% in knee patients, p = 0.19). Median estimated blood loss was significantly higher in hip patients (984 vs 789 mL, p < 0.001). Preoperative hemoglobin concentration was the only independent predictor of red blood cell transfusion in hip patients while low hemoglobin concentration, body mass index, and operation time were independent predictors for red blood cell transfusion in knee patients. The prevalence of red blood cell transfusion was lower than previously reported in unselected total hip or knee arthroplasty patients. Routine use of tranexamic acid may have contributed. Low preoperative hemoglobin levels, low body mass index, and long operation increase the risk for red blood cell transfusion.

Test-Retest Reliability of Innovated Strength Tests for Hip Muscles

PubMed Central

Meyer, Christophe; Corten, Kristoff; Wesseling, Mariska; Peers, Koen; Simon, Jean-Pierre; Jonkers, Ilse; Desloovere, Kaat

2013-01-01

The burden of hip muscles weakness and its relation to other impairments has been well documented. It is therefore a pre-requisite to have a reliable method for clinical assessment of hip muscles function allowing the design and implementation of a proper strengthening program. Motor-driven dynamometry has been widely accepted as the gold-standard for lower limb muscle strength assessment but is mainly related to the knee joint. Studies focusing on the hip joint are less exhaustive and somewhat discrepant with regard to optimal participants position, consequently influencing outcome measures. Thus, we aimed to develop a standardized test setup for the assessment of hip muscles strength, i.e. flexors/extensors and abductors/adductors, with improved participant stability and to define its psychometric characteristics. Eighteen participants performed unilateral isokinetic and isometric contractions of the hip muscles in the sagittal and coronal plane at two separate occasions. Peak torque and normalized peak torque were measured for each contraction. Relative and absolute measures of reliability were calculated using the intraclass correlation coefficient and standard error of measurement, respectively. Results from this study revealed higher levels of between-day reliability of isokinetic/isometric hip abduction/flexion peak torque compared to existing literature. The least reliable measures were found for hip extension and adduction, which could be explained by a less efficient stabilization technique. Our study additionally provided a first set of reference normalized data which can be used in future research. PMID:24260550

Guillain-Barré Syndrome presenting as unilateral hip pain in a child.

PubMed

Neocleous, Charalambos; Diakolios, Konstandinos; Adramerina, Alkistis; Varveris, Evangelos; Tsioni, Vasiliki; Machairidou, Konstandina

2015-01-01

The aim of this report is to highlight the importance of close observation and follow-up in children who present with an acutely irritable hip. This is because hip pain is a symptom of not only benign but also severe conditions. Thus, at the time of the initial presentation, hip pain can be misdiagnosed. This report serves as an example for a wide range of doctors such as orthopaedic surgeons, paediatricians, emergency room physicians or primary care physicians, because these are the first-line doctors who treat patients with a painful hip. We herein present a three-year-old child who was admitted to our hospital with pain in the right leg and initially diagnosed with transient synovitis of the hip. An additional examination two days later, after severe deterioration of the clinical picture, revealed that our patient was actually suffering from Guillain-Barré syndrome. Failure to diagnose Guillain-Barré syndrome and initiating prompt treatment is potentially life-threatening. Clinicians should be aware that hip pain could be the presenting complaint of Guillain-Barré syndrome, a syndrome that has many clinical features. Even when all the clinical and laboratory findings indicate a benign condition, Guillain- Barré syndrome should still be considered. Therefore, close observation and follow-up in children who present with an acutely irritable hip is highly recommended. In this way, the potentially catastrophic consequences of more severe conditions can be avoided. Copyright © 2015 by Academy of Sciences and Arts of Bosnia and Herzegovina.

A method to investigate the biomechanical alterations in Perthes' disease by hip joint contact modeling.

PubMed

Salmingo, Remel Alingalan; Skytte, Tina Lercke; Traberg, Marie Sand; Mikkelsen, Lars Pilgaard; Henneberg, Kaj-Åge; Wong, Christian

2017-01-01

Perthes' disease is a destructive hip joint disorder characterized by malformation of the femoral head in young children. While the morphological changes have been widely studied, the biomechanical effects of these changes still need to be further elucidated. The objective of this study was to develop a method to investigate the biomechanical alterations in Perthes' disease by finite element (FE) contact modeling using MRI. The MRI data of a unilateral Perthes' case was obtained to develop the three-dimensional FE model of the hip joint. The stress and contact pressure patterns in the unaffected hip were well distributed. Elevated concentrations of stress and contact pressure were found in the Perthes' hip. The highest femoral cartilage von Mises stress 3.9 MPa and contact pressure 5.3 MPa were found in the Perthes' hip, whereas 2.4 MPa and 4.9 MPa in the healthy hip, respectively. The healthy bone in the femoral head of the Perthes' hip carries additional loads as indicated by the increase of stress levels around the necrotic-healthy bone interface. Identifying the biomechanical changes, such as the location of stress and contact pressure concentrations, is a prerequisite for the preoperative planning to obtain stress relief for the highly stressed areas in the malformed hip. This single-patient study demonstrated that the biomechanical alterations in Perthes' disease can be evaluated individually by patient-specific finite element contact modeling using MRI. A multi-patient study is required to test the strength of the proposed method as a pre-surgery planning tool.

Inter-joint coordination strategies during unilateral stance 6-months following first-time lateral ankle sprain.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Delahunt, Eamonn

2015-02-01

Longitudinal analyses of participants with a history of lateral ankle sprain are lacking. This investigation combined measures of inter-joint coordination and stabilometry to evaluate eyes-open (condition 1) and eyes-closed (condition 2) static unilateral stance performance in a group of participants, 6-months after they sustained an acute, first-time lateral ankle sprain in comparison to a control group. Sixty-nine participants with a 6-month history of first-time lateral ankle sprain and 20 non-injured controls completed three 20-second unilateral stance task trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb 3-dimensional kinematic data for similarity in the aim of establishing patterns of lower-limb inter-joint coordination. The fractal dimension of the stance limb centre of pressure path was also calculated. Between-group analyses revealed significant differences in stance limb inter-joint coordination strategies for conditions 1 and 2, and in the fractal dimension of the centre-of-pressure path for condition 2 only. Injured participants displayed increases in ankle-hip linked coordination compared to controls in condition 1 (sagittal/frontal plane: 0.15 [0.14] vs 0.06 [0.04]; η(2)=.19; sagittal/transverse plane: 0.14 [0.11] vs 0.09 [0.05]; η(2)=0.14) and condition 2 (sagittal/frontal plane: 0.15 [0.12] vs 0.08 [0.06]; η(2)=0.23), with an associated decrease in the fractal dimension of the centre-of-pressure path (injured limb: 1.23 [0.13] vs 1.36 [0.13]; η(2)=0.20). Participants with a 6-month history of first-time lateral ankle sprain exhibit a hip-dominant coordination strategy for static unilateral stance compared to non-injured controls. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

PubMed

Kongsgaard, M; Aagaard, P; Roikjaer, S; Olsen, D; Jensen, M; Langberg, H; Magnusson, S P

2006-08-01

Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. Patellar tendon strain was significantly greater (P<0.05) during the squat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (P<0.001, P<0.05). Normalized mean electromyography amplitudes of the knee extensor muscles were significantly greater during the decline compared to the standard squats (P<0.05). Hamstring and calf muscle mean electromyography did not differ, respectively, between standard and decline squats. The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature.

PubMed

Kamaruzaman, Hanin; Kinghorn, Philip; Oppong, Raymond

2017-05-10

The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies. A systematic review was conducted for the period 2004 to 2016. Electronic databases were searched to identify both trial and model based economic evaluation studies that evaluated surgical interventions for knee and hip osteoarthritis. A total of 23 studies met the inclusion criteria and an assessment of these studies showed that total knee arthroplasty (TKA), and total hip arthroplasty (THA) showed evidence of cost-effectiveness and improvement in quality of life of the patients when compared to non-operative and non-surgical procedures. On the other hand, even though delaying TKA and THA may lead to some cost savings in the short-run, the results from the study showed that this was not a cost-effective option. TKA and THA are cost-effective and should be recommended for the management of patients with end stage/severe knee and hip OA. However, there needs to be additional studies to assess the cost-effectiveness of other surgical interventions in order for definite conclusions to be reached.

Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial.

PubMed

Østerås, Nina; van Bodegom-Vos, Leti; Dziedzic, Krysia; Moseng, Tuva; Aas, Eline; Andreassen, Øyvor; Mdala, Ibrahim; Natvig, Bård; Røtterud, Jan Harald; Schjervheim, Unni-Berit; Vlieland, Thea Vliet; Hagen, Kåre Birger

2015-12-02

Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8-12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model. A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants' treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER). The results from the present study will add to the current knowledge on tailored strategies, which aims to improve the uptake of evidence-based OA care recommendations and improve the quality of OA care in primary health care. The new knowledge can be used in national and international initiatives designed to improve the quality of OA care. ClinicalTrials.gov NCT02333656.

The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.

PubMed

Piuzzi, Nicolas S; Ng, Mitchell; Chughtai, Morad; Khlopas, Anton; Ng, Kenneth; Mont, Michael A; Muschler, George F

2018-07-01

The use of stem-cell therapies for the treatment of various musculoskeletal conditions, especially knee osteoarthritis (OA), is rapidly expanding, despite only low-level evidence to support its use. Centers offering these therapies are often marketing and charging patients out-of-pocket costs for such services. Therefore, the purpose of this study was to determine the current marketed: (1) prices and (2) clinical efficacy of stem-cell therapies for knee OA. This was a prospective cross-sectional study which queried 317 U.S. centers that offered direct-to-consumer stem-cell therapies for musculoskeletal conditions. A total of 273 of 317 centers were successfully contacted via phone or e-mail, using a simulated 57-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the marketed prices and clinical efficacy. Centers generally reported the proportion of patients who had "good results" or "symptomatic improvement." The mean price of a unilateral (same-day) stem-cell knee injection was $5,156 with a standard deviation of $2,446 (95% confidence interval [CI]: $4,550-5,762, n  = 65). The mean proportion of claimed clinical efficacy was 82% with a standard deviation of 9.6% (95% CI: 79.0-85.5%, n  = 36). Most American stem-cell centers offer therapies for knee OA. The cost of these therapies averages about $5,000 per injection, and centers claim that 80% of the patients had "good results" or "symptomatic improvement," denoting a gap between what is documented in the published literature and the marketing claims. These findings offer both patients and physicians insight into the current stem-cell market for knee OA. We hope that with this information, providers can more optimally make patients aware of discrepancies between what is being marketed versus the current evidence-based landscape of these therapies for knee OA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Autologous Bone Marrow Concentrate in a Sheep Model of Osteoarthritis: New Perspectives for Cartilage and Meniscus Repair.

PubMed

Desando, Giovanna; Giavaresi, Gianluca; Cavallo, Carola; Bartolotti, Isabella; Sartoni, Federica; Nicoli Aldini, Nicolò; Martini, Lucia; Parrilli, Annapaola; Mariani, Erminia; Fini, Milena; Grigolo, Brunella

2016-06-01

Cell-based therapies are becoming a valuable tool to treat osteoarthritis (OA). This study investigated and compared the regenerative potential of bone marrow concentrate (BMC) and mesenchymal stem cells (MSC), both engineered with Hyaff(®)-11 (HA) for OA treatment in a sheep model. OA was induced via unilateral medial meniscectomy. Bone marrow was aspirated from the iliac crest, followed by concentration processes or cell isolation and expansion to obtain BMC and MSC, respectively. Treatments consisted of autologous BMC and MSC seeded onto HA. The regenerative potential of bone, cartilage, menisci, and synovia was monitored using macroscopy, histology, immunohistochemistry, and micro-computed tomography at 12 weeks post-op. Data were analyzed using the general linear model with adjusted Sidak's multiple comparison and Spearman's tests. BMC-HA treatment showed a greater repair ability in inhibiting OA progression compared to MSC-HA, leading to a reduction of inflammation in cartilage, meniscus, and synovium. Indeed, the decrease of inflammation positively contributed to counteract the progression of fibrotic and hypertrophic processes, known to be involved in tissue failure. Moreover, the treatment with BMC-HA showed the best results in allowing meniscus regeneration. Minor healing effects were noticed at bone level for both cell strategies; however, a downregulation of subchondral bone thickness (Cs.Th) was found in both cell treatments compared to the OA group in the femur. The transplantation of BMC-HA provided the best effects in supporting regenerative processes in cartilage, meniscus, and synovium and at less extent in bone. On the whole, both MSC and BMC combined with HA reduced inflammation and contributed to switch off fibrotic and hypertrophic processes. The observed regenerative potential by BMC-HA on meniscus could open new perspectives, suggesting its use not only for OA care but also for the treatment of meniscal lesions, even if further analyses are necessary to confirm its healing potential at long-term follow-up.

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

PubMed Central

Gaida, J; Cook, J; Bass, S; Austen, S; Kiss, Z

2004-01-01

Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. Objectives: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. Methods: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180°/s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. Results: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07). Conclusions: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers. PMID:15388543

Identification of suitable reference genes in bone marrow stromal cells from osteoarthritic donors.

PubMed

Schildberg, Theresa; Rauh, Juliane; Bretschneider, Henriette; Stiehler, Maik

2013-11-01

Bone marrow stromal cells (BMSCs) are key cellular components for musculoskeletal tissue engineering strategies. Furthermore, recent data suggest that BMSCs are involved in the development of Osteoarthritis (OA) being a frequently occurring degenerative joint disease. Reliable reference genes for the molecular evaluation of BMSCs derived from donors exhibiting OA as a primary co-morbidity have not been reported on yet. Hence, the aim of the study was to identify reference genes suitable for comparative gene expression analyses using OA-BMSCs. Passage 1 bone marrow derived BMSCs were isolated from n=13 patients with advanced stage idiopathic hip osteoarthritis and n=15 age-matched healthy donors. The expression of 31 putative reference genes was analyzed by quantitative reverse transcription polymerase chain reaction (qRT-PCR) using a commercially available TaqMan(®) assay. Calculating the coefficient of variation (CV), mRNA expression stability was determined and afterwards validated using geNorm and NormFinder algorithms. Importin 8 (IPO8), TATA box binding protein (TBP), and cancer susceptibility candidate 3 (CASC3) were identified as the most stable reference genes. Notably, commonly used reference genes, e.g. beta-actin (ACTB) and beta-2-microglobulin (B2M) were among the most unstable genes. For normalization of gene expression data of OA-BMSCs the combined use of IPO8, TBP, and CASC3 gene is recommended. © 2013.

Long-Term Safety and Efficacy of Fulranumab in Patients With Moderate-to-Severe Osteoarthritis Pain: A Phase II Randomized, Double-Blind, Placebo-Controlled Extension Study.

PubMed

Sanga, Panna; Katz, Nathaniel; Polverejan, Elena; Wang, Steven; Kelly, Kathleen M; Haeussler, Juergen; Thipphawong, John

2017-04-01

To evaluate the long-term safety and efficacy of fulranumab in patients with knee or hip pain caused by moderate-to-severe chronic osteoarthritis (OA). In this phase II double-blind, placebo-controlled extension study, patients who were randomized in equal proportions to receive subcutaneous doses of either placebo or fulranumab (1 mg every 4 weeks, 3 mg every 8 weeks, 3 mg every 4 weeks, 6 mg every 8 weeks, or 10 mg every 8 weeks) in the 12-week double-blind efficacy phase and who completed this double-blind efficacy phase were eligible to continue the dosage throughout a 92-week double-blind extension phase, followed by a 24-week posttreatment follow-up period. Safety assessments included evaluation of treatment-emergent adverse events (TEAEs), pre-identified AEs of interest, and joint replacements. Efficacy assessments included changes from baseline to the end of the double-blind extension phase in scores on the patient's global assessment and the pain and physical function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index. Overall, 401 of the 423 patients who completed the 12-week double-blind efficacy phase entered the extension study. Long-term sustained improvements were observed in all efficacy parameters following fulranumab treatment (1 mg every 4 weeks, 3 mg every 4 weeks, and 10 mg every 8 weeks) as compared with placebo. Similar percentages of patients in both groups experienced TEAEs (88% taking placebo and 91% taking fulranumab; all phases). Across all fulranumab groups, arthralgia (21%) and OA (18%) (e.g., exacerbation of OA pain) were the most common TEAEs. The most common serious TEAEs were the requirement for knee (10%) and hip (7%) arthroplasty, with 80% occurring during the posttreatment follow-up period. Neurologic-related TEAEs (28%; all phases) were generally mild-to-moderate. Overall, 81 joint replacements were performed in 71 patients (8 [11%] receiving placebo and 63 [89%] receiving fulranumab); 15 patients (21%) had rapid progression of OA (RPOA). All cases of RPOA occurred in fulranumab-treated patients who were concurrently receiving nonsteroidal antiinflammatory drugs and occurred in joints with preexisting OA. Long-term treatment with fulranumab was generally well-tolerated and efficacious. RPOA was observed as a safety signal. Future studies are warranted to demonstrate whether the risk of RPOA can be reduced in patients taking fulranumab. © 2016, American College of Rheumatology.

A Phase IIIb, Multicentre, Randomised, Parallel-Group, Placebo-Controlled, Double-Blind Study to Investigate the Efficacy and Safety of OROS Hydromorphone in Subjects with Moderate-to-Severe Chronic Pain Induced by Osteoarthritis of the Hip or the Knee

PubMed Central

Vojtaššák, Jozef; Vojtaššák, Jozef; Jacobs, Adam; Rynn, Leonie; Waechter, Sandra; Richarz, Ute

2011-01-01

Background. Opioid analgesics are included in treatment guidelines for the symptomatic management of osteoarthritis (OA). Starting with a low dose of opioid and slowly titrating to a higher dose may help avoid intolerable side effects. Methods. Subjects aged ≥40 years, with moderate to severe pain induced by OA of the hip or knee not adequately controlled by previous non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol treatment, were enrolled. Subjects received OROS hydromorphone 4 mg or placebo once-daily. The dose was titrated every 3-4 days in case of unsatisfactory pain control during the 4-week titration phase. A 12 week maintenance phase followed. The primary efficacy endpoint was the change in “pain on average” measured on the Brief Pain Inventory (BPI) scale from baseline to the end of the maintenance phase. Results. 139 subjects received OROS hydromorphone and 149 subjects received placebo. All efficacy endpoints showed similar improvements from baseline to end of study in the 2 groups. The safety results were consistent with the safety profile of OROS hydromorphone. Conclusion.The study did not meet the primary endpoint; although many subjects' pain was not adequately controlled at inclusion, their pain may have improved with continued paracetamol or NSAID treatment. PMID:22110921

An open-label six-month extension study to investigate the safety and efficacy of an extract of Artemisia annua for managing pain, stiffness and functional limitation associated with osteoarthritis of the hip and knee.

PubMed

Hunt, Sheena; Stebbings, Simon; McNamara, Debra

2016-10-28

This six-month single-centre open-label extension study, conducted at the University of Otago, Dunedin, follows from a previously published 12-week pilot double-blind randomised placebo-controlled study of dietary supplement, Arthrem® (ART) in patients with osteoarthritis (OA) of the hip or knee. The pilot double-blind study showed that treatment with ART 150 mg twice-daily was associated with clinically relevant pain reduction. The extension study aims were to assess longer-term safety and efficacy during six months' treatment following the pilot trial. Patients who completed the pilot double-blind study had the option to continue on open-label treatment with ART for a further six months. Safety was assessed by adverse event monitoring and laboratory tests at three and six months. Efficacy was assessed at three and six months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC®). Thirty-four patients entered the optional extension and 28 completed six months' treatment. ART was well tolerated when taken for up to nine months. Improvements in WOMAC® efficacy parameters reported in the double-blind phase of the study were maintained over six months. ART appears to be a safe and effective alternative for managing the symptoms of OA over an extended period.

Multi-language translation and cross-cultural adaptation of the OARSI/OMERACT measure of intermittent and constant osteoarthritis pain (ICOAP).

PubMed

Maillefert, J F; Kloppenburg, M; Fernandes, L; Punzi, L; Günther, K-P; Martin Mola, E; Lohmander, L S; Pavelka, K; Lopez-Olivo, M A; Dougados, M; Hawker, G A

2009-10-01

To conduct a multi-language translation and cross-cultural adaptation of the Intermittent and Constant OsteoArthritis Pain (ICOAP) questionnaire for hip and knee osteoarthritis (OA). The questionnaires were translated and cross-culturally adapted in parallel, using a common protocol, into the following languages: Czech, Dutch, French (France), German, Italian, Norwegian, Spanish (Castillan), North and Central American Spanish, Swedish. The process was conducted following five steps: (1)--independent translation into the target language by two or three persons; (2)--consensus meeting to obtain a single preliminary translated version; (3)--backward translation by an independent bilingual native English speaker, blinded to the English original version; (4)--final version produced by a multidisciplinary consensus committee; (5)--pre-testing of the final version with 10-20 target-language-native hip and knee OA patients. The process could be followed and completed in all countries. Only slight differences were identified in the structure of the sentences between the original and the translated versions. A large majority of the patients felt that the questionnaire was easy to understand and complete. Only a few minor criticisms were expressed. Moreover, a majority of patients found the concepts of constant pain and pain that comes and goes to be of a great pertinence and were very happy with the distinction. The ICOAP questionnaire is now available for multi-center international studies.

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

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

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

2014-10-17

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. 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. 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 available to guideline makers issuing recommendations addressing HA and THA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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 available to guideline makers issuing recommendations addressing HA and THA. PMID:25326208

Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee.

PubMed

Toda, Y; Segal, N; Kato, A; Yamamoto, S; Irie, M

2001-12-01

To assess the efficacy of a lateral wedge insole with elastic strapping of the subtalar joint for conservative treatment of osteoarthritis (OA) of the knee. The efficacy of a novel insole with elastic subtalar strapping and a traditional shoe insert wedge insole was compared. Ninety female outpatients with OA of the knee were treated with wedge insoles for 8 weeks. Randomization was performed according to birth date. Standing radiographs with unilateral insole use were used to analyze the femorotibial and talar tilt angles for each patient with and without their respective insole. Visual analog scale (VAS) score for subjective knee pain at the final assessment was compared with that at baseline in both groups. Participants wearing the elastically strapped insole (n = 46) had significantly decreased femorotibial angle (p < 0.0001) and talar tilt angle (p = 0.005) and significantly improved VAS pain score (p = 0.045) in comparison with baseline assessments. These significant differences were not found in the group with the inserted insole (n = 44). The novel strapped insole leads to valgus angulation of the talus, resulting in correction of the femorotibial angle in patients with knee OA with varus deformity, and may have a therapeutic effect similar to that of high tibial osteotomy.

Asynchronous slipped capital femoral epiphysis in a patient with a seizure disorder: case report and review of the literature.

PubMed

Patterson, Diana C; Price, Andrew E

2018-05-01

Debate remains about the appropriate treatment of the asymptomatic side following treatment of a unilateral slipped capital femoral epiphysis (SCFE). A 12-year-old boy with a seizure disorder presented with an unstable SCFE on the left hip following a seizure. He underwent percutaneous pinning of the left only. At 8 months postoperatively, he returned with an unstable slip of the right hip, again following a seizure. No literature discussing the treatment of patients with risk of SCFE and seizure disorders was identified. Further study may identify an increased incidence of contralateral slip following an initial slip in this population. If a greater risk exists, contralateral prophylactic fixation at time of index surgery may be indicated.

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

PubMed

Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

Naproxen Induces Type X Collagen Expression in Human Bone-Marrow-Derived Mesenchymal Stem Cells Through the Upregulation of 5-Lipoxygenase

PubMed Central

Alaseem, Abdulrahman M.; Madiraju, Padma; Aldebeyan, Sultan A.; Noorwali, Hussain; Antoniou, John

2015-01-01

Several studies have shown that type X collagen (COL X), a marker of late-stage chondrocyte hypertrophy, is expressed in mesenchymal stem cells (MSCs) from osteoarthritis (OA) patients. We recently found that Naproxen, but not other nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen, Celebrex, Diclofenac), can induce type X collagen gene (COL10A1) expression in bone-marrow-derived MSCs from healthy and OA donors. In this study we determined the effect of Naproxen on COL X protein expression and investigated the intracellular signaling pathways that mediate Naproxen-induced COL10A1 expression in normal and OA hMSCs. MSCs of OA patients were isolated from aspirates from the intramedullary canal of donors (50–80 years of age) undergoing hip replacement surgery for OA and were treated with or without Naproxen (100 μg/mL). Protein expression and phosphorylation were determined by immunoblotting using specific antibodies (COL X, p38 mitogen-activated protein kinase [p38], phosphorylated-p38, c-Jun N-terminal kinase [JNK], phosphorylated-JNK, extracellular signal-regulated kinase [ERK], and phosphorylated-ERK). Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the expression of COL10A1 and Runt-related transcription factor 2 gene (Runx2). Our results show that Naproxen significantly stimulated COL X protein expression after 72 h of exposure both in normal and OA hMSCs. The basal phosphorylation of mitogen-activated protein kinases (MAPKs) (ERK, JNK, and p38) in OA hMSCs was significantly higher than in normal. Naproxen significantly increased the MAPK phosphorylation in normal and OA hMSCs. NSAID cellular effects include cyclooxygenase, 5-lipoxygenase, and p38 MAPK signaling pathways. To investigate the involvement of these pathways in the Naproxen-induced COL10A1 expression, we incubated normal and OA hMSCs with Naproxen with and without inhibitors of ERK (U0126), JNK (BI-78D3), p38 (SB203580), and 5-lipoxygenase (MK-886). Our results showed that increased basal COL10A1 expression in OA hMSCs was significantly suppressed in the presence of JNK and p38 inhibitors, whereas Naproxen-induced COL10A1 expression was suppressed by 5-lipoxygenase inhibitor. This study shows that Naproxen induces COL X both at transcriptional and translational levels in normal and OA hMSCs. Elevated basal COL10A1 expression in OA hMSCs is probably through the activation of MAPK pathway and Naproxen-induced COL10A1 expression is through the increased 5-lipoxygenase signaling. PMID:25091567

The Influence of Weather Conditions on Joint Pain in Older People with Osteoarthritis: Results from the European Project on OSteoArthritis.

PubMed

Timmermans, Erik J; Schaap, Laura A; Herbolsheimer, Florian; Dennison, Elaine M; Maggi, Stefania; Pedersen, Nancy L; Castell, Maria Victoria; Denkinger, Michael D; Edwards, Mark H; Limongi, Federica; Sánchez-Martínez, Mercedes; Siviero, Paola; Queipo, Rocio; Peter, Richard; van der Pas, Suzan; Deeg, Dorly J H

2015-10-01

This study examined whether daily weather conditions, 3-day average weather conditions, and changes in weather conditions influence joint pain in older people with osteoarthritis (OA) in 6 European countries. Data from the population-based European Project on OSteoArthritis were used. The American College of Rheumatology classification criteria were used to diagnose OA in older people (65-85 yrs). After the baseline interview, at 6 months, and after the 12-18 months followup interview, joint pain was assessed using 2-week pain calendars. Daily values for temperature, precipitation, atmospheric pressure, relative humidity, and wind speed were obtained from local weather stations. Multilevel regression modelling was used to examine the pain-weather associations, adjusted for several confounders. The study included 810 participants with OA in the knee, hand, and/or hip. After adjustment, there were significant associations of joint pain with daily average humidity (B = 0.004, p < 0.01) and 3-day average humidity (B = 0.004, p = 0.01). A significant interaction effect was found between daily average humidity and temperature on joint pain. The effect of humidity on pain was stronger in relatively cold weather conditions. Changes in weather variables between 2 consecutive days were not significantly associated with reported joint pain. The associations between pain and daily average weather conditions suggest that a causal relationship exist between joint pain and weather variables, but the associations between day-to-day weather changes and pain do not confirm causation. Knowledge about the relationship between joint pain in OA and weather may help individuals with OA, physicians, and therapists to better understand and manage fluctuations in pain.

An ex vivo model in human femoral heads for histopathological study and resonance frequency analysis of dental implant primary stability.

PubMed

Hernández-Cortés, Pedro; Monje, Alberto; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Mesa, Francisco; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David; O'Valle, Francisco

2014-01-01

This study was designed to explore relationships of resonance frequency analysis (RFA)-assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.

High Bone Mass is associated with bone-forming features of osteoarthritis in non-weight bearing joints independent of body mass index.

PubMed

Gregson, C L; Hardcastle, S A; Murphy, A; Faber, B; Fraser, W D; Williams, M; Davey Smith, G; Tobias, J H

2017-04-01

High Bone Mass (HBM) is associated with (a) radiographic knee osteoarthritis (OA), partly mediated by increased BMI, and (b) pelvic enthesophytes and hip osteophytes, suggestive of a bone-forming phenotype. We aimed to establish whether HBM is associated with radiographic features of OA in non-weight-bearing (hand) joints, and whether such OA demonstrates a bone-forming phenotype. HBM cases (BMD Z-scores≥+3.2) were compared with family controls. A blinded assessor graded all PA hand radiographs for: osteophytes (0-3), joint space narrowing (JSN) (0-3), subchondral sclerosis (0-1), at the index Distal Interphalangeal Joint (DIPJ) and 1st Carpometacarpal Joint (CMCJ), using an established atlas. Analyses used a random effects logistic regression model, adjusting a priori for age and gender. Mediating roles of BMI and bone turnover markers (BTMs) were explored by further adjustment. 314 HBM cases (mean age 61.1years, 74% female) and 183 controls (54.3years, 46% female) were included. Osteophytes (grade≥1) were more common in HBM (DIPJ: 67% vs. 45%, CMCJ: 69% vs. 50%), with adjusted OR [95% CI] 1.82 [1.11, 2.97], p=0.017 and 1.89 [1.19, 3.01], p=0.007 respectively; no differences were seen in JSN. Further adjustment for BMI failed to attenuate ORs for osteophytes in HBM cases vs. controls; DIPJ 1.72 [1.05, 2.83], p=0.032, CMCJ 1.76 [1.00, 3.06], p=0.049. Adjustment for BTMs (concentrations lower amongst HBM cases) did not attenuate ORs. HBM is positively associated with OA in non-weight-bearing joints, independent of BMI. HBM-associated OA is characterised by osteophytes, consistent with a bone-forming phenotype, rather than JSN reflecting cartilage loss. Systemic factors (e.g. genetic architecture) which govern HBM may also increase bone-forming OA risk. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Transient peripartum osteoporosis of the femoral head in first and third pregnancy.

PubMed

Truszczyńska, Aleksandra; Walczak, Piotr; Rapała, Kazimierz

2012-01-01

The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient-a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Hip Strength in Patients with Quadriceps Strength Deficits after ACL Reconstruction.

PubMed

Bell, David R; Trigsted, Stephanie M; Post, Eric G; Walden, Courtney E

2016-10-01

Quadriceps strength deficits persist for years after anterior cruciate ligament (ACL) reconstruction, and patients with these deficits often shift torque demands away from the knee extensors to the hip during functional tasks. However, it is not clear how quadriceps strength deficits may affect hip strength. Therefore, the purpose of this study was to investigate differences in lower extremity strength in individuals with ACL reconstruction with differing levels of quadriceps strength asymmetry. Isometric strength was recorded bilaterally in 135 participants (73 control and 62 with unilateral ACL reconstruction, time from surgery = 30.9 ± 17.6 months) from the knee extensors and flexors, hip extensors and abductors, and hip internal and external rotator muscle groups. Symmetry indices (limb symmetry index (LSI)) were created based on quadriceps strength, and subjects with ACL reconstruction were subdivided (high quadriceps (LSI ≥ 90%), n = 37; low quadriceps (LSI < 85%), n = 18). Individual group (control vs high quadriceps vs low quadriceps) by limb (reconstructed/nondominant vs healthy/dominant) repeated-measures ANOVA was used to compare strength (%BW) for each of the six joint motions of interest (knee extensors/flexors, hip abductors/extensors/external, and internal rotators) while controlling for time from surgery. An interaction was observed for quadriceps strength (P < 0.001), and the reconstructed limb in the low quadriceps group was weaker than all other limbs. A main effect for group was observed with the low quadriceps group having greater hip extension (P = 0.007) strength in both limbs compared with the other groups. Knee flexion strength was weaker in the reconstructed limb of the high quadriceps group (P = 0.047) compared with all other groups and limbs. Individuals with ACL reconstruction and involved limb quadriceps weakness have greater hip extension strength in both limbs compared with patients with bilateral strength symmetry and controls.

PHYTOCHROME KINASE SUBSTRATE1 Regulates Root Phototropism and Gravitropism1[C][W][OA

PubMed Central

Boccalandro, Hernán E.; De Simone, Silvia N.; Bergmann-Honsberger, Ariane; Schepens, Isabelle; Fankhauser, Christian; Casal, Jorge J.

2008-01-01

Light promotes the expression of PHYTOCHROME KINASE SUBSTRATE1 (PKS1) in the root of Arabidopsis thaliana, but the function of PKS1 in this organ is unknown. Unilateral blue light induced a negative root phototropic response mediated by phototropin 1 in wild-type seedlings. This response was absent in pks1 mutants. In the wild type, unilateral blue light enhanced PKS1 expression in the subapical region of the root several hours before bending was detectable. The negative phototropism and the enhanced PKS1 expression in response to blue light required phytochrome A (phyA). In addition, the pks1 mutation enhanced the root gravitropic response when vertically oriented seedlings were placed horizontally. The negative regulation of gravitropism by PKS1 occurred even in dark-grown seedlings and did not require phyA. Blue light also failed to induce negative phototropism in pks1 under reduced gravitational stimulation, indicating that the effect of pks1 on phototropism is not simply the consequence of the counteracting effect of enhanced gravitropism. We propose a model where the background level of PKS1 reduces gravitropism. After a phyA-dependent increase in its expression, PKS1 positively affects root phototropism and both effects contribute to negative curvature in response to unilateral blue light. PMID:18024556

Reliability and validity of functional performance tests in dancers with hip dysfunction.

PubMed

Kivlan, Benjamin R; Carcia, Christopher R; Clemente, F Richard; Phelps, Amy L; Martin, Robroy L

2013-08-01

Quasi-experimental, repeated measures. Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region. NINETEEN FEMALE DANCERS (AGE: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined. Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = -4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = -0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = -0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = -1.84, p=0.08) were not statistically different between sides. The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers. 3b. Non-consecutive cohort study.

RELIABILITY AND VALIDITY OF FUNCTIONAL PERFORMANCE TESTS IN DANCERS WITH HIP DYSFUNCTION

PubMed Central

Carcia, Christopher R.; Clemente, F. Richard; Phelps, Amy L.; Martin, RobRoy L.

2013-01-01

Study Design: Quasi-experimental, repeated measures. Purpose/Background: Functional performance tests that identify hip joint impairments and assess the effect of intervention have not been adequately described for dancers. The purpose of this study was to examine the reliability and validity of hop and balance tests among a group of dancers with musculoskeletal pain in the hip region. Methods: Nineteen female dancers (age: 18.90±1.11 years; height: 164.85±6.95 cm; weight: 60.37±8.29 kg) with unilateral hip pain were assessed utilizing the cross-over reach, medial triple hop, lateral triple hop, and cross-over hop tests on two occasions, 2 days apart. Test-retest reliability and comparisons between the involved and uninvolved side for each respective test were determined. Results: Intra-class correlation coefficients for the functional performance tests ranged from 0.89-0.96. The cross-over reach test had a SEM of 2.79 cm and a MDC of 7.73 cm. The medial and lateral triple hop tests had SEM values of 7.51 cm and 8.17 cm, and MDC values of 20.81 cm and 22.62 cm, respectively. The SEM was 0.15 seconds and the MDC was 0.42 seconds for the cross-over hop test. Performance on the medial triple hop test was significantly less on the involved side (370.21±38.26 cm) compared to the uninvolved side (388.05±41.49 cm); t(18) = −4.33, p<0.01. The side-to-side comparisons of the cross-over reach test (involved mean=61.68±10.9 cm; uninvolved mean=61.69±8.63 cm); t(18) = −0.004, p=0.99, lateral triple hop test (involved mean=306.92±35.79 cm; uninvolved mean=310.68±24.49 cm); t(18) = −0.55, p=0.59, and cross-over hop test (involved mean=2.49±0.34 seconds; uninvolved mean= 2.61±0.42 seconds; t(18) = −1.84, p=0.08) were not statistically different between sides. Conclusion: The functional performance tests used in this study can be reliably performed on dancers with unilateral hip pain. The medial triple hop test was the only functional performance test with evidence of validity in side-to-side comparisons. These results suggest that the medial triple hop test may be a reliable and valid functional performance test to assess impairments related to hip pain among dancers. Level of Evidence: 3b. Non-consecutive cohort study PMID:24175123

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study.

PubMed

Eitzen, Ingrid; Fernandes, Linda; Nordsletten, Lars; Risberg, May Arna

2012-12-20

Existent biomechanical studies on hip osteoarthritic gait have primarily focused on the end stage of disease. Consequently, there is no clear consensus on which specific gait parameters are of most relevance for hip osteoarthritis patients with mild to moderate symptoms. The purpose of this study was to explore sagittal plane gait characteristics during the stance phase of gait in hip osteoarthritis patients not eligible for hip replacement surgery. First, compared to healthy controls, and second, when categorized into two subgroups of radiographic severity defined from a minimal joint space of ≤/>2 mm. Sagittal plane kinematics and kinetics of the hip, knee and ankle joint were calculated for total joint excursion throughout the stance phase, as well as from the specific events initial contact, midstance, peak hip extension and toe-off following 3D gait analysis. In addition, the Western Ontario and McMaster Universities Osteoarthritis Index, passive hip range of motion, and isokinetic muscle strength of hip and knee flexion and extension were included as secondary outcomes. Data were checked for normality and differences evaluated with the independent Student's t-test, Welch's t-test and the independent Mann-Whitney U-test. A binary logistic regression model was used in order to control for velocity in key variables. Fourty-eight hip osteoarthritis patients and 22 controls were included in the final material. The patients walked significantly slower than the controls (p=0.002), revealed significantly reduced joint excursions of the hip (p<0.001) and knee (p=0.011), and a reduced hip flexion moment at midstance and peak hip extension (p<0.001). Differences were primarily manifested during the latter 50% of stance, and were persistent when controlling for velocity. Subgroup analyses of patients with minimal joint space ≤/>2 mm suggested that the observed deviations were more pronounced in patients with greater radiographic severity. The biomechanical differences were, however, not reflected in self-reported symptoms or function. Reduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms, not eligible for total hip replacement. Consequently, these variables should be considered as key features in studies regarding hip osteoarthritic gait at all stages of disease. Subgroup analyses of patients with different levels of radiographic OA further generated the hypothesis that the observed characteristics were more pronounced in patients with a minimal joint space ≤2 mm.

Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol

PubMed Central

2012-01-01

Background Knee osteoarthritis (OA) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability. Many people with knee OA also experience co-morbidities that further add to the OA burden. Uptake of and adherence to physical activity recommendations is suboptimal in this patient population, leading to poorer OA outcomes and greater impact of associated co-morbidities. This pragmatic randomised controlled trial will investigate the clinical- and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA. Methods/Design 168 people with clinically diagnosed knee OA will be recruited from the community in metropolitan and regional areas and randomly allocated to physiotherapy only, or physiotherapy plus nurse-delivered telephone coaching. Physiotherapy involves five treatment sessions over 6 months, incorporating a home exercise program of 4–6 exercises (targeting knee extensor and hip abductor strength) and advice to increase daily physical activity. Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia (HCA) Model of Health Change to provide behaviour change support. The telephone coaching intervention aims to maximise adherence to the physiotherapy program, as well as facilitate increased levels of participation in general physical activity. The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months. Secondary outcomes include physical activity levels, quality-of-life, and potential moderators and mediators of outcomes including self-efficacy, pain coping and depression. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 and 18 months. Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12612000308897 PMID:23231928

Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis.

PubMed

Beumer, Lucy; Wong, Jennie; Warden, Stuart J; Kemp, Joanne L; Foster, Paul; Crossley, Kay M

2016-04-01

To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA). A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term; 4-12 months=medium term and; >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores. 19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control. Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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-results. PMID:26932142

Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness.

PubMed

Abbott, J H; Robertson, M C; Chapple, C; Pinto, D; Wright, A A; Leon de la Barra, S; Baxter, G D; Theis, J-C; Campbell, A J

2013-04-01

To evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee. In this 2 × 2 factorial randomized controlled trial, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee OA were randomly allocated to receive manual physiotherapy (n = 54), multi-modal exercise physiotherapy (n = 51), combined exercise and manual physiotherapy (n = 50), or no trial physiotherapy (n = 51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation. Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0-240. Intention to treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 (95% confidence interval (CI) 9.2-47.8) for usual care plus manual therapy, 16.4 (-3.2 to 35.9) for usual care plus exercise therapy, and 14.5 (-5.2 to 34.1) for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy (P = 0.027). Physical performance test outcomes favoured the exercise therapy group. Manual physiotherapy provided benefits over usual care, that were sustained to 1 year. Exercise physiotherapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the two therapies. Australian New Zealand Clinical Trials Registry ACTRN12608000130369. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis.

PubMed

Farrokhi, Shawn; Jayabalan, Prakash; Gustafson, Jonathan A; Klatt, Brian A; Sowa, Gwendolyn A; Piva, Sara R

2017-07-01

To evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA). Twenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions. A significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain. Walking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain. Copyright © 2017. Published by Elsevier B.V.

Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients.

PubMed

Chen, Hui; Lowe, Alan A; Strauss, Arthur M; de Almeida, Fernanda Riberiro; Ueda, Hiroshi; Fleetham, John A; Wang, Bangkang

2008-05-01

Oral appliances (OAs) have been used to treat obstructive sleep apnea (OSA) patients for decades. However, detailed dental side effects in long-term OA cases analyzed with an accurate three-dimensional (3D) measurement tool have seldom been reported. The purpose of this study is to evaluate dental side effects in five OSA patients, who had used a tongue retaining device (TRD) (with occasional other OA wear) for an average of 6 years and 4 months. The baseline and follow-up orthodontic study models were measured with a newly developed MicroScribe-3DX analysis system. High compliance of TRD wear was confirmed in all cases and different patterns and amounts of dental changes were observed. The most common appliance-induced dental changes included anterior and/or unilateral posterior open-bites and reduced anterior overjets. It was hypothesized that there might be two possible mechanisms for the TRD side effects--one is the forward pressure of the tongue upon the anterior dental arch and the other is the lateral pressure of the tongue upon the posterior arch. Considerations to correct the TRD dental side effects should be guided by these different mechanisms of the tongue on the dental arch. Possible solutions to minimize occlusal changes and maximize the benefits for OSA patients are also discussed.

Expanded clinical spectrum of spondylocarpotarsal synostosis syndrome and possible manifestation in a heterozygous father.

PubMed

Mitter, Diana; Krakow, Deborah; Farrington-Rock, Claire; Meinecke, Peter

2008-03-15

We report on a 5-year-old boy with spondylocarpotarsal synostosis (SCT) syndrome who presents with disproportionate short stature, thoracic scoliosis, pes planus, dental enamel hypoplasia, unilateral conductive hearing loss and mild facial dysmorphisms. Radiographs showed abnormal segmentation of the spine with block vertebrae and carpal synostosis. In addition to the typical phenotype of SCT syndrome, he showed pronounced delay of carpal bone age and bilateral epiphyseal dysplasia of the proximal femora. The patient's father has mild short stature and unilateral hip dysplasia. Molecular studies of the filamin B gene (FLNB) revealed a homozygous mutation in the index patient while both parents were heterozygous for the mutation. In this report we expand the phenotype of SCT syndrome in a patient with a causal FLNB mutation. (c) 2008 Wiley-Liss, Inc.

Definition of osteoarthritis on MRI: results of a Delphi exercise.

PubMed

Hunter, D J; Arden, N; Conaghan, P G; Eckstein, F; Gold, G; Grainger, A; Guermazi, A; Harvey, W; Jones, G; Hellio Le Graverand, M P; Laredo, J D; Lo, G; Losina, E; Mosher, T J; Roemer, F; Zhang, W

2011-08-01

Despite a growing body of Magnetic Resonance Imaging (MRI) literature in osteoarthritis (OA), there is little uniformity in its diagnostic application. We envisage in the first instance the definition requiring further validation and testing in the research setting before considering implementation/feasibility testing in the clinical setting. The objective of our research was to develop an MRI definition of structural OA. We undertook a multistage process consisting of a number of different steps. The intent was to develop testable definitions of OA (knee, hip and/or hand) on MRI. This was an evidence driven approach with results of a systematic review provided to the group prior to a Delphi exercise. Each participant of the steering group was allowed to submit independently up to five propositions related to key aspects in MRI diagnosis of knee OA. The steering group then participated in a Delphi exercise to reach consensus on which propositions we would recommend for a definition of structural OA on MRI. For each round of voting, ≥60% votes led to include and ≤20% votes led to exclude a proposition. After developing the proposition one of the definitions developed was tested for its validity against radiographic OA in an extant database. For the systematic review we identified 25 studies which met all of our inclusion criteria and contained relevant diagnostic measure and performance data. At the completion of the Delphi voting exercise 11 propositions were accepted for definition of structural OA on MRI. We assessed the diagnostic performance of the tibiofemoral MRI definition against a radiographic reference standard. The diagnostic performance for individual features was: osteophyte C statistic=0.61, for cartilage loss C statistic=0.73, for bone marrow lesions C statistic=0.72 and for meniscus tear in any region C statistic=0.78. The overall composite model for these four features was a C statistic=0.59. We detected good specificity (1) but less optimal sensitivity (0.46) likely due to detection of disease earlier on MRI. We have developed MRI definition of knee OA that requires further formal testing with regards their diagnostic performance (especially in datasets of persons with early disease), before they are more widely used. Our current analysis suggests that further testing should focus on comparisons other than the radiograph, that may capture later stage disease and thus nullify the potential for detecting early disease that MRI may afford. The propositions are not to detract from, nor to discourage the use of traditional means of diagnosing OA. Copyright © 2011 Osteoarthritis Research Society International. All rights reserved.

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

PubMed

Tenforde, Adam S; Shull, Pete B; Fredericson, Michael

2012-05-01

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders in Singapore.

PubMed

Teng, Monica; Zhou, Hui Jun; Lin, Liang; Lim, Pang Hung; Yeo, Doreen; Goh, Suzanne; Tjan, Soon Yin; Lim, Boon Peng

2018-03-09

The study evaluated the cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders (MSDs) in Singapore. A decision-analytic model was constructed to compare the cost-effectiveness of hydrotherapy to land-based therapy over 3 months from societal perspective. Target population comprised patients with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), total hip replacement (THR) and total knee replacement (TKR). Subgroup analyses were carried out to determine the cost-effectiveness of hydrotherapy in individual MSDs. Relative treatment effects were obtained through a systematic review of published data. Compared to land-based therapy, hydrotherapy was associated with an incremental cost-effectiveness ratio (ICER) of SGD 27 471 per quality-adjusted life-year (QALY) gained, which was below the willingness-to-pay threshold of SGD 70 000 per QALY (one gross domestic product per capita in Singapore in 2015). For the respective MSDs, hydrotherapy were dominant (more effective and less costly) in THR and TKR, cost-effective for LBP and RA, and not cost-effective for OA. Treatment adherence and cost of hydrotherapy were key drivers to the ICER values. Hydrotherapy was a cost-effective rehabilitation compared to land-based therapy for a population with MSDs in Singapore. However, the benefit of hydrotherapy was not observed in patients with OA.

Abdominal adiposity is the main determinant of the C-reactive response to injury in subjects undergoing inguinal hernia repair

PubMed Central

2013-01-01

Background Obesity and serum C-reactive protein (CRP) (a sensitive marker of inflammatory activity) are associated with most chronic diseases. Abdominal adiposity along with age is the strongest determinant of baseline CRP levels in healthy subjects. The mechanism of the association of serum CRP with disease is uncertain. We hypothesized that baseline serum CRP is a marker of inflammatory responsiveness to injury and that abdominal adiposity is the main determinant of this responsiveness. We studied the effect of abdominal adiposity, age and other environmental risk factors for chronic disease on the CRP response to a standardised surgical insult, unilateral hernia repair to not only test this hypothesis but to inform the factors which must be taken into account when assessing systemic inflammatory responses to surgery. Methods 102 male subjects aged 24-94 underwent unilateral hernia repair by a single operator. CRP was measured at 0, 6, 24 and 48 hrs. Response was defined as the peak CRP adjusted for baseline CRP. Results Age and waist:hip ratio (WHR) were associated both with basal CRP and CRP response with similar effect sizes after adjustment for a wide-range of covariates. The adjusted proportional difference in CRP response per 10% increase in WHR was 1.50 (1.17-1.91) p = 0.0014 and 1.15(1.00-1.31) p = 0.05 per decade increase in age. There was no evidence of important effects of other environmental cardiovascular risk factors on CRP response. Conclusion Waist:hip ratio and age need to be considered when studying the inflammatory response to surgery. The finding that age and waist:hip ratio influence baseline and post-operative CRP levels to a similar extent suggests that baseline CRP is a measure of inflammatory responsiveness to casual stimuli and that higher age and obesity modulate the generic excitability of the inflammatory system leading to both higher baseline CRP and higher CRP response to surgery. The mechanism for the association of baseline CRP and waist:hip ratio to chronic disease outcomes could be through this increase in inflammatory system excitability. PMID:23391158

Manual calf massage and passive ankle motion reduce the incidence of deep vein thromboembolism after total hip arthroplasty.

PubMed

Imai, Norio; Ito, Tomoyuki; Suda, Ken; Miyasaka, Dai; Endo, Naoto

2017-07-01

Venous thromboembolism is one of the general complications following total hip arthroplasty, wherein various preventive treatments have been recommended. Several studies reported that venous thromboembolism incidence after total hip arthroplasty was similar in patients who were administered prophylaxis with a conventional mechanical procedure alone, and those who were administered pharmacological anticoagulation therapy. Therefore, the optimum methods of prophylaxis are still controversial. The purpose of this study was to investigate whether manual calf massage and passive ankle motion could lower the risk for venous thromboembolism after total hip arthroplasty. We retrospectively reviewed the data of 126 consecutive patients undergoing elective primary unilateral total hip arthroplasty wherein manual calf massage and passive ankle motion were performed after the surgery at our hospitals between January and October 2014. The 138 patients of the control group underwent total hip arthroplasty using the same surgical approach and pre- and postoperative protocols without this mechanical prophylaxis between January and December 2013. This mechanical prophylaxis was performed simultaneously 30 times during approximately 10 s; these procedures were repeated thrice immediately after total hip arthroplasty. Duplex ultrasonography was performed to observe the veins of both legs in all the patients on postoperative day 7. The incidence of deep vein thrombosis was 6.52% and 0.79% in the control and manual calf massage and passive ankle motion groups, respectively. The odds ratio for the manual calf massage and passive ankle motion groups was 8.72. Performing this mechanical prophylaxis reduced the incidence of venous thromboembolism after total hip arthroplasty. This mechanical prophylaxis is not only simple and easy, but is also safe and inexpensive. We therefore recommend that manual calf massage and passive ankle motion be performed in patients who will undergo total hip arthroplasty, if deep vein thrombosis does not exist before the surgery. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Photobiomodulation therapy (PBMT) on acute pain and inflammation in patients who underwent total hip arthroplasty-a randomized, triple-blind, placebo-controlled clinical trial.

PubMed

Langella, Luciana Gonçalves; Casalechi, Heliodora Leão; Tomazoni, Shaiane Silva; Johnson, Douglas Scott; Albertini, Regiane; Pallotta, Rodney Capp; Marcos, Rodrigo Labat; de Carvalho, Paulo de Tarso Camillo; Leal-Junior, Ernesto Cesar Pinto

2018-06-16

When conservative treatments fail, hip osteoarthritis (OA), a chronic degenerative disease characterized by cartilage wear, progressive joint deformity, and loss of function, can result in the need for a total hip arthroplasty (THA). Surgical procedures induced tissue trauma and incite an immune response. Photobiomodulation therapy (PBMt) using low-level laser therapy (LLLT) and/or light-emitting diode therapy (LEDT) has proven effective in tissue repair by modulating the inflammatory process and promoting pain relief. Therefore, the aim of this study was to analyze the immediate effect of PBMt on inflammation and pain of patients undergoing total hip arthroplasty. The study consisted of 18 post-surgical hip arthroplasty patients divided into two groups (n = 9 each) placebo and active PBMt who received one of the treatments in a period from 8 to 12 h following THA surgery. PBMt (active or placebo) was applied using a device consisting of nine diodes (one super-pulsed laser of 905 nm, four infrared LEDs of 875 nm, and four red LEDs 640 nm, 40.3 J per point) applied to 5 points along the incision. Visual analog scale (VAS) and blood samples for analysis of the levels of the cytokines TNF-α, IL-6, and IL-8 were recorded before and after PBMt application. The values for the visual analog scale as well as those in the analysis of TNF-α and IL-8 serum levels decreased in the active PBMt group compared to placebo-control group (p < 0.05). No decrease was observed for IL-6 levels. We conclude that PBMt is effective in decreasing pain intensity and post-surgery inflammation in patients receiving total hip arthroplasty.

Preliminary validation of 2 magnetic resonance image scoring systems for osteoarthritis of the hip according to the OMERACT filter.

PubMed

Maksymowych, Walter P; Cibere, Jolanda; Loeuille, Damien; Weber, Ulrich; Zubler, Veronika; Roemer, Frank W; Jaremko, Jacob L; Sayre, Eric C; Lambert, Robert G W

2014-02-01

Development of a validated magnetic resonance image (MRI) scoring system is essential in hip OA because radiographs are insensitive to change. We assessed the feasibility and reliability of 2 previously developed scoring methods: (1) the Hip Inflammation MRI Scoring System (HIMRISS) and (2) the Hip Osteoarthritis MRI Scoring System (HOAMS). Six readers (3 radiologists, 3 rheumatologists) participated in 2 reading exercises. In Reading Exercise 1, MRI of the hip of 20 subjects were read at a single time point followed by further standardization of methodology. In Reading Exercise 2, MRI of the hip of 18 subjects from a randomized controlled trial, assessed at 2 timepoints, and 27 subjects from a cross-sectional study were read for HIMRISS and HOAMS bone marrow lesions (BML) and synovitis. Reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics. Both methods were considered feasible. For Reading 1, HIMRISS ICC were 0.52, 0.61, 0.70, and 0.58 for femoral BML, acetabular BML, effusion, and total scores, respectively; and for HOAMS, summed BML and synovitis ICC were 0.52 and 0.46, respectively. For Reading 2, HIMRISS and HOAMS ICC for BML and synovitis-effusion improved substantially. Interobserver reliability for change scores was 0.81 and 0.71 for HIMRISS femoral and HOAMS summed BML, respectively. Responsiveness and discrimination was moderate to high for synovitis-effusion. Significant associations were noted between BML or synovitis scores and Western Ontario and McMaster Universities Osteoarthritis Index pain scores for baseline values (p ≤ 0.001). The BML and synovitis-effusion components of both HIMRISS and HOAMS scoring systems are feasible and reliable, and should be validated further.

FK506 protects against articular cartilage collagenous extra-cellular matrix degradation.

PubMed

Siebelt, M; van der Windt, A E; Groen, H C; Sandker, M; Waarsing, J H; Müller, C; de Jong, M; Jahr, H; Weinans, H

2014-04-01

Osteoarthritis (OA) is a non-rheumatologic joint disease characterized by progressive degeneration of the cartilage extra-cellular matrix (ECM), enhanced subchondral bone remodeling, activation of synovial macrophages and osteophyte growth. Inhibition of calcineurin (Cn) activity through tacrolimus (FK506) in in vitro monolayer chondrocytes exerts positive effects on ECM marker expression. This study therefore investigated the effects of FK506 on anabolic and catabolic markers of osteoarthritic chondrocytes in 2D and 3D in vitro cultures, and its therapeutic effects in an in vivo rat model of OA. Effects of high and low doses of FK506 on anabolic (QPCR/histochemistry) and catabolic (QPCR) markers were evaluated in vitro on isolated (2D) and ECM-embedded chondrocytes (explants, 3D pellets). Severe cartilage damage was induced unilaterally in rat knees using papain injections in combination with a moderate running protocol. Twenty rats were treated with FK506 orally and compared to twenty untreated controls. Subchondral cortical and trabecular bone changes (longitudinal microCT) and macrophage activation (SPECT/CT) were measured. Articular cartilage was analyzed ex vivo using contrast enhanced microCT and histology. FK506 treatment of osteoarthritic chondrocytes in vitro induced anabolic (mainly collagens) and reduced catabolic ECM marker expression. In line with this, FK506 treatment clearly protected ECM integrity in vivo by markedly decreasing subchondral sclerosis, less development of subchondral pores, depletion of synovial macrophage activation and lower osteophyte growth. FK506 protected cartilage matrix integrity in vitro and in vivo. Additionally, FK506 treatment in vivo reduced OA-like responses in different articular joint tissues and thereby makes Cn an interesting target for therapeutic intervention of OA. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Side Differences of Thigh Muscle Cross-Sectional Areas and Maximal Isometric Muscle Force in Bilateral Knees with the Same Radiographic Disease Stage, but Unilateral Frequent Pain – Data from the Osteoarthritis Initiative

PubMed Central

Sattler, Martina; Dannhauer, Torben; Hudelmaier, Martin; Wirth, Wolfgang; Sänger, Alexandra M.; Kwoh, C. Kent; Hunter, David J.; Eckstein, Felix

2012-01-01

Objective To determine whether anatomical thigh muscle cross-sectional areas (MCSAs) and strength differ between osteoarthritis (OA) knees with frequent pain compared with contralateral knees without pain, and to examine the correlation between MCSAs and strength in painful versus painless knees. Methods 48 subjects (31 women; 17 men; age 45–78 years) were drawn from 4796 Osteoarthritis Initiative (OAI) participants, in whom both knees displayed the same radiographic stage (KLG2 or 3), one with frequent pain (most days of the month within the past 12 months) and the contralateral one without pain. Axial MR images were used to determine MCSAs of extensors, flexors and adductors at 35% femoral length (distal to proximal) and in two adjacent 5 mm images. Maximal isometric extensor and flexor forces were used as provided from the OAI data base. Results Painful knees showed 5.2% lower extensor MCSAs (p=0.00003; paired t-test), and 7.8% lower maximal extensor muscle forces (p=0.003) than contra-lateral painless knees. There were no significant differences in flexor forces, or flexor and adductor MCSAs (p>0.39). Correlations between force and MCSAs were similar in painful and painless OA knees (0.44

Intra-articular injection of a nutritive mixture solution protects articular cartilage from osteoarthritic progression induced by anterior cruciate ligament transection in mature rabbits: a randomized controlled trial

PubMed Central

Park, Yoo-Sin; Lim, Si-Woong; Lee, Il-Hoon; Lee, Tae-Jin; Kim, Jong-Sung; Han, Jin Soo

2007-01-01

Osteoarthritis (OA) is a degenerative disease that disrupts the collagenous matrix of articular cartilage and is difficult to cure because articular cartilage is a nonvascular tissue. Treatment of OA has targeted macromolecular substitutes for cartilage components, such as hyaluronic acid or genetically engineered materials. However, the goal of the present study was to examine whether intra-articular injection of the elementary nutrients restores the matrix of arthritic knee joints in mature animals. A nutritive mixture solution (NMS) was composed of elementary nutrients such as glucose or dextrose, amino acids and ascorbic acid. It was administered five times (at weeks 6, 8, 10, 13 and 16) into the unilateral anterior cruciate ligament transected knee joints of mature New Zealand White rabbits, and the effect of NMS injection was compared with that of normal saline. OA progression was histopathologically evaluated by haematoxylin and eosin staining, by the Mankin grading method and by scanning electron microscopy at week 19. NMS injection decreased progressive erosion of articular cartilage overall compared with injection of normal saline (P < 0.01), and nms joints exhibited no differences relative to normal cartilage that had not undergone transection of the anterior cruciate ligament, as assessed using the mankin grading method. Haematoxylin and eosin staining and scanning electron microscopy findings also indicated that nms injection, in constrast to normal saline injection, restored the cartilage matrix, which is known to be composed of a collagen and proteoglycan network. thus, nms injection is a potent treatment that significantly retards oa progression, which in turn prevents progressive destruction of joints and functional loss in mature animals. PMID:17257416

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador

PubMed Central

Schlegelmilch, Michael; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Background Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. Methods We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. Results The average lifetime QALYs (95% CI) gained were 1.46 (1.4–1.5), 2.5 (2.4–2.6), and 2.9 (2.7–3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. Conclusion THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care. PMID:29403664

Canine total hip replacement using a cementless threaded cup and stem: a review of 55 cases.

PubMed

Denny, H R; Linnell, M; Maddox, T W; Comerford, E J

2018-06-01

To determine the long-term results and complications associated with the Helica ® cementless hip endoprosthesis system. Retrospective study of 55 consecutive Helica total hip replacements performed between January 2010 and February 2015. A total of 55 total hip replacements were performed in 50 dogs; 45 dogs had unilateral hip replacements, and five had staged bilateral replacements. A total of 23 first-generation short femoral stems were implanted in 22 dogs, of which nine cases (39%) experienced complications and 19 (86%) recovered satisfactorily when revisions were included; 31 second-generation femoral stems were implanted in 28 dogs, of which 10 cases (32%) experienced complications, and 26 (93%) made satisfactory recoveries, including revisions. In 36 dogs for which data were available, postoperative Liverpool Osteoarthritis in Dogs scores were significantly reduced compared to preoperative scores. Complications occurred in a total of 19 cases (34·5%; 95% confidence interval: 22 to 47·1%); the most common was aseptic loosening of the femoral stem [11 cases (20%; 95% confidence interval: 9·4 to 30·6%)]. Following multivariable analysis, no risk factors were identified for overall complications, but there was a significant association of implant type (first-generation short stem) with loosening (odds ratio 4·9, 95% confidence interval: 1·1 to 22·1, P=0·034). This study found the Helica hip endoprosthesis system to be effective in the management of hip dysplasia and osteoarthritis in dogs. Aseptic loosening of the femoral stem remains the most common complication but appears to have been significantly reduced with the introduction of the second-generation stem. © 2018 British Small Animal Veterinary Association.

Does the Hip Capsule Remain Closed After Hip Arthroscopy With Routine Capsular Closure for Femoroacetabular Impingement? A Magnetic Resonance Imaging Analysis in Symptomatic Postoperative Patients.

PubMed

Weber, Alexander E; Kuhns, Benjamin D; Cvetanovich, Gregory L; Lewis, Paul B; Mather, Richard C; Salata, Michael J; Nho, Shane J

2017-01-01

The purpose of this study was to examine the hip capsule in a subset of symptomatic patients who underwent capsular closure during hip arthroscopy. All patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) with routine capsular closure between January 1, 2012, and December 31, 2015, were eligible. Only patients with unilateral surgery and a postoperative magnetic resonance imaging (MRI; ordered for persistent symptoms) were included. Four independent reviewers evaluated each hip capsule for thickness and the absence or presence of defects. During the study, 1,463 patients had hip arthroscopy for FAI with routine capsular closure, and 53 (3.6%) underwent a postoperative MRI. Fourteen of the 53 were excluded owing to revision status or additional procedures. The final study population included 39 patients (23 female patients and 16 male patients), with an average patient age of 31.7 ± 11.4 years and an average body mass index of 23.3 ± 2.9. There were 3 (7.5%) capsular defects, and the intraclass correlation coefficient (ICC) was 0.82. The operative hip capsule was significantly thicker in the zone of capsulotomy, and subsequent repair as compared with the unaffected, contralateral hip capsule (5.0 ± 1.2 mm vs 4.6 ± 1.4 mm; P = .02), ICC 0.83. Additionally, males had thicker hip capsules as compared with their female counterparts, on the operative side (5.4 ± 1.1 mm vs 4.5 ± 1.2 mm; P = .02) and the nonoperative side (4.8 ± 1.6 mm vs 4.1 ± 0.9 mm; P = .08). In a subset of symptomatic patients after hip arthroscopy for FAI, the majority (92.5%) of the repaired hip capsules remained closed at greater than 1 year of follow-up. The hip capsule adjacent to the capsulotomy and subsequent repair is thickened compared with the same location on the contralateral, nonoperative hip. Aside from gender, patient-related and FAI-related factors do not correlate with capsular thickness nor do they seem to correlate with the propensity to develop a capsular defect. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis: study protocol of a randomized controlled trial.

PubMed

Kloek, Corelien J J; Bossen, Daniël; Veenhof, Cindy; van Dongen, Johanna M; Dekker, Joost; de Bakker, Dinny H

2014-08-08

Exercise therapy in patients with hip and/or knee osteoarthritis is effective in reducing pain, increasing physical activity and physical functioning, but costly and a burden for the health care budget. A web-based intervention is cheap in comparison to face-to-face exercise therapy and has the advantage of supporting in home exercises because of the 24/7 accessibility. However, the lack of face-to-face contact with a professional is a disadvantage of web-based interventions and is probably one of the reasons for low adherence rates. In order to combine the best of two worlds, we have developed the intervention e-Exercise. In this blended intervention face-to-face contacts with a physical therapist are partially replaced by a web-based exercise intervention. The aim of this study is to investigate the short- (3 months) and long-term (12 months) (cost)-effectiveness of e-Exercise compared to usual care physical therapy. Our hypothesis is that e-Exercise is more effective and cost-effective in increasing physical functioning and physical activity compared to usual care. This paper presents the protocol of a prospective, single-blinded, multicenter cluster randomized controlled trial. In total, 200 patients with OA of the hip and/or knee will be randomly allocated into either e-Exercise or usual care (physical therapy). E-Exercise is a 12-week intervention, consisting of maximum five face-to-face physical therapy contacts supplemented with a web-based program. The web-based program contains assignments to gradually increase patients' physical activity, strength and stability exercises and information about OA related topics. Primary outcomes are physical activity and physical functioning. Secondary outcomes are health related quality of life, self-perceived effect, pain, tiredness and self-efficacy. All measurements will be performed at baseline, 3 and 12 months after inclusion. Retrospective cost questionnaires will be sent at 3, 6, 9 and 12 months and used for the cost-effectiveness and cost-utility analysis. This study is the first randomized controlled trial in the (cost)-effectiveness of a blended exercise intervention for patients with osteoarthritis of the hip and/or knee. The findings will help to improve the treatment of patients with osteoarthritis. NTR4224.

Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls.

PubMed

Wörner, Tobias; Sigurðsson, Haraldur B; Pålsson, Anders; Kostogiannis, Ioannis; Ageberg, Eva

2017-01-01

This study aimed to evaluate patient-reported outcomes as well as lower extremity and trunk muscle function in patients with long-standing hip and groin pain, in comparison with matched, healthy controls. It was hypothesized that patients with long-standing hip and groin pain would report more deficiency on the Copenhagen Hip and Groin Outcome Score (HAGOS) and have worse outcomes on performance-based measures than healthy controls. Nineteen patients with long-standing hip and groin pain and 19 healthy, activity level-, age-, gender-, and weight-matched controls were assessed with the HAGOS for self-reported outcomes, and a parallel squat (w/kg), single-leg triple jump (cm), single-leg rise (n), barbell roll-out (% of height), and plank test (s) for performance-based measures. Independent sample t test was performed to assess between-group differences. The paired t test was used to analyse between-limb differences in unilateral performance tasks. The patients had worse scores than the controls in all HAGOS subscales (p ≤ 0.001), while no statistically significant differences were observed for any performance measure between groups or between symptomatic and non-symptomatic limbs. Despite significant self-reported functional limitations on the HAGOS, there were no significant differences between groups in performance-based strength or power measures. The results of this study highlight the need to identify performance-based measures, sensitive to functional deficiencies in patients with long-standing hip and groin pain in order to complement the clinical picture obtained by patient-reported outcomes such as the HAGOS. III.

In vivo implant fixation of carbon fiber-reinforced PEEK hip prostheses in an ovine model.

PubMed

Nakahara, Ichiro; Takao, Masaki; Bandoh, Shunichi; Bertollo, Nicky; Walsh, William R; Sugano, Nobuhiko

2013-03-01

Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions. Copyright © 2012 Orthopaedic Research Society.

Postural asymmetries in young adults with cerebral palsy.

PubMed

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-11-01

The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Cross-sectional data of 102 people (63 males, 39 females; age range 19-23 y, median 21 y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman's correlation. At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (r(s) =0.48), sitting (r(s) =0.40), standing (r(s) =0.41), and inability to change position: supine (r(s) =0.60), sitting (r(s) =0.73), and standing (r(s) =0.64). Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. © 2013 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Postural asymmetries in young adults with cerebral palsy

PubMed Central

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-01-01

Aim The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Methods Cross-sectional data of 102 people (63 males, 39 females; age range 19–23y, median 21y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman’s correlation. Results At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (rs=0.48), sitting (rs=0.40), standing (rs=0.41), and inability to change position: supine (rs=0.60), sitting (rs=0.73), and standing (rs=0.64). Conclusions Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. This article is commented on by Novak on page 974 of this issue. PMID:23834239

Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study.

PubMed

Hunt, M A; Takacs, J

2014-07-01

To examine the feasibility of a 10-week gait modification program in people with medial tibiofemoral knee osteoarthritis (OA), and to assess changes in clinical and biomechanical outcomes. Fifteen people with medial knee OA completed 10 weeks of gait modification focusing on increasing toe-out angle during stance 10° compared to their self-selected angle measured at baseline. In addition to adherence and performance difficulty outcomes, knee joint symptoms (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and total score, numerical rating scale (NRS) of pain), and knee joint loading during gait (late stance peak knee adduction moment (KAM)) were assessed. Participants were able to perform the toe-out gait modification program with minimal to moderate difficulty, and exhibited significant increases in self-selected toe-out angle during walking (P < 0.001). Joint discomfort was reported by five participants (33%) in the hip or knee joints, though none lasted longer than 2 weeks. Participants reported statistically significant reductions in WOMAC pain (P = 0.02), NRS pain (P < 0.001), WOMAC total score (P = 0.02), and late stance KAM (P = 0.04). These preliminary findings suggest that toe-out gait modification is feasible in people with medial compartment knee OA. Preliminary changes in clinical and biomechanical outcomes provide the impetus for conducting larger scale studies of gait modification in people with knee OA to confirm these findings. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

PubMed Central

Lee, Kyung-Jae; Bae, Ki-Cheor; Cho, Chul-Hyun; Kwon, Doo-Hyun

2009-01-01

Background This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. Methods Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. Results There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. Conclusions The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty. PMID:19885051

Motion of the center of gravity of the body in clinical evaluation of gait.

PubMed

Tesio, L; Civaschi, P; Tessari, L

1985-04-01

The motion of the center of gravity during walking was analyzed in five hemiplegic subjects and eleven subjects affected by unilateral hip arthritis. In the hemiplegic subjects and 6 subjects with hip arthritis the transfer between kinetic and potential energy (with a passive pendular motion) was found to be 9-95% greater during the step performed on the affected limb ("pathological" step); as a consequence, the muscular work done during this step was 7-81% of the work done during the step performed on the second limb ("normal" step). Qualitatively similar gait anomalies were recorded in all hemiplegic subjects with hypertonus of the paretic limb: these subjects had to lift the spastic limb as a whole during the normal step, with the consequence that the center of gravity was lifted 0.6-3 cm more than during the pathological step. In contrast, various motor patterns were found in patients with hip arthritis. During the pathological step the center of gravity reached a height 0.5-3 cm greater in 7 subjects, 1 cm smaller in one subject, and about the same height reached during the normal step in 3 subjects. This was consistent with the various motor deficits caused by hip arthritis.

Quantitative measurement and analysis for detection and treatment planning of developmental dysplasia of the hip

NASA Astrophysics Data System (ADS)

Liu, Xin; Lu, Hongbing; Chen, Hanyong; Zhao, Li; Shi, Zhengxing; Liang, Zhengrong

2009-02-01

Developmental dysplasia of the hip is a congenital hip joint malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Conventionally, physicians made diagnoses and treatments only based on findings from two-dimensional (2D) images by manually calculating clinic parameters. However, anatomical complexity of the disease and the limitation of current standard procedures make accurate diagnosis quite difficultly. In this study, we developed a system that provides quantitative measurement of 3D clinical indexes based on computed tomography (CT) images. To extract bone structure from surrounding tissues more accurately, the system firstly segments the bone using a knowledge-based fuzzy clustering method, which is formulated by modifying the objective function of the standard fuzzy c-means algorithm with additive adaptation penalty. The second part of the system calculates automatically the clinical indexes, which are extended from 2D to 3D for accurate description of spatial relationship between femurs and acetabulum. To evaluate the system performance, experimental study based on 22 patients with unilateral or bilateral affected hip was performed. The results of 3D acetabulum index (AI) automatically provided by the system were validated by comparison with 2D results measured by surgeons manually. The correlation between the two results was found to be 0.622 (p<0.01).

Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

PubMed

Hara, Daisuke; Hamai, Satoshi; Fukushi, Jun-Ichi; Kawaguchi, Ken-Ichi; Motomura, Goro; Ikemura, Satoshi; Komiyama, Keisuke; Nakashima, Yasuharu

2017-09-01

Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. Case-control study; Level of evidence, 3. The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4. Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.

Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years.

PubMed

Mardones, Rodrigo; Via, Alessio Giai; Rivera, Alvaro; Tomic, Alexander; Somarriva, Marcelo; Wainer, Mauricio; Camacho, Daniel

2016-01-01

The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2-9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series.

Pelvic magnetic resonance imaging angioanatomy of the arterial blood supply to the penis in suspected prostate cancer patients.

PubMed

Thai, Cao Tan; Karam, Ibrahim Michel; Nguyen-Thi, Phi Linh; Lefèvre, Frédéric; Hubert, Jacques; Felblinger, Jacques; Eschwège, Pascal

2015-05-01

To describe the internal pudendal artery (IPA) and accessory pudendal artery (APA) detected by magnetic resonance (MR) angiography to help surgeons to find and preserve them during radical prostatectomy (RP). Constrast-enhanced MR 3.0 T angiography of the pelvis were performed in 111 male patients suspected diagnosis of prostate cancer (PCa), and describe the penile arterial blood supply. There are three patterns of the arterial blood supply to the penis (IPA and/or APA) accounting for 51.4%, 46.8% and 1.8% of cases, respectively. About the accessory pudendal artery (APA): 54/111 (48.6%) patients had APA with five different branching patterns, they were type I (APA bilateral symmetry): 17 (31.5%); type II (APA bilateral asymmetry): 1 (1.9%); type III (APA unilateral lateral): 13 (24%); type IV (APA unilateral apical): 21 (38.9%); type V (APA unilateral mix): 2 (3.7%). APA origin were from inferior epigastric artery (IEA): 7 (9.5%); from inferior vesical artery (IVA): 32 (43.2%); from obturator artery (OA): 35 (47.3%). A precise angioanatomic evalutation of arteries destined to the penis by MR angiography pre-operation for male pelvic organs will help surgeons to preserve them and contributes to reduce the erectile dysfunction after these procedures. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Epidemiology and Demographics of Hip Dysplasia

PubMed Central

Loder, Randall T.; Skopelja, Elaine N.

2011-01-01

The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing. PMID:24977057

Joint contact forces can be reduced by improving joint moment symmetry in below-knee amputee gait simulations.

PubMed

Koelewijn, Anne D; van den Bogert, Antonie J

2016-09-01

Despite having a fully functional knee and hip in both legs, asymmetries in joint moments of the knee and hip are often seen in gait of persons with a unilateral transtibial amputation (TTA), possibly resulting in excessive joint loading. We hypothesize that persons with a TTA can walk with more symmetric joint moments at the cost of increased effort or abnormal kinematics. The hypothesis was tested using predictive simulations of gait. Open loop controls of one gait cycle were found by solving an optimization problem that minimizes a combination of walking effort and tracking error in joint angles, ground reaction force and gait cycle duration. A second objective was added to penalize joint moment asymmetry, creating a multi-objective optimization problem. A Pareto front was constructed by changing the weights of the objectives and three solutions were analyzed to study the effect of increasing joint moment symmetry. When the optimization placed more weight on moment symmetry, walking effort increased and kinematics became less normal, confirming the hypothesis. TTA gait improved with a moderate increase in joint moment symmetry. At a small cost of effort and abnormal kinematics, the peak hip extension moment in the intact leg was decreased significantly, and so was the joint contact force in the knee and hip. Additional symmetry required a significant increase in walking effort and the joint contact forces in both hips became significantly higher than in able-bodied gait. Copyright © 2016 Elsevier B.V. All rights reserved.

Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee.

PubMed

Salaffi, F; Leardini, G; Canesi, B; Mannoni, A; Fioravanti, A; Caporali, R; Lapadula, G; Punzi, L

2003-08-01

The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test. All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

Outcomes of total hip arthroplasty: a study of patients one year postsurgery.

PubMed

Trudelle-Jackson, Elaine; Emerson, Roger; Smith, Sue

2002-06-01

Ex post facto research using prospective analysis of differences between the involved hip and uninvolved hip. To assess outcomes of total hip arthroplasty (THA) by comparing range of motion (ROM), muscle strength, and postural stability in the surgical hip to those of the uninvolved hip 1 year postsurgery. An additional objective was to assess degree of relationship among ROM, strength, and postural stability impairments to a measure of self-assessed function. Most patients who have THA receive physical therapy that consists mainly of self-care instructions and an exercise protocol that emphasizes mobility during the acute phase of recovery. But, outcomes of THA 1 year postsurgery indicate that current physical therapy programs used during the acute phase of recovery do not effectively restore physical and functional performance. Subjects consisted of 11 women and 4 men (mean age +/- standard deviation = 62 +/- 8 years) with unilateral THA performed 1 year prior to data collection. Assessment variables consisted of self-assessment of function and measures of postural stability, muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for self-assessment of function. Three separate repeated measures MANOVA were used to compare the involved side to the uninvolved side in measures of postural stability, strength, and ROM. The Spearman's rho was used to assess degree of association between the subjects' score of self-assessed function and impairments in strength and postural stability. Measures of postural stability were significantly lower (P < or = 0.01) on the side of the replaced hip. Differences in strength values between the involved and uninvolved sides were not statistically significant. Correlations between scores of self-assessed function and hip abductor and knee extensor strength were statistically significant (r = 0.56, P < or = 0.03). Self-assessed function was not significantly correlated to postural stability impairments. The brief postsurgical rehabilitation program received by patients with THA may not be sufficient. A second phase of rehabilitation implemented 4 months or more after surgery that emphasizes weight bearing and postural stability may be advisable.

Relationship between Lateral Femoral Bowing and Varus Knee Deformity Based on Two-Dimensional Assessment of Side-to-Side Differences.

PubMed

Cho, Myung-Rae; Lee, Young Sik; Choi, Won-Kee

2018-03-01

The objective was to evaluate the relationship between side-to-side differences of lateral femoral bowing and varus knee deformity based on two-dimensional (2D) assessment in unilateral total knee arthroplasty (TKA). A total of 143 patients with varus knee osteoarthritis who underwent unilateral TKA were enrolled. We evaluated the side-to-side differences of the frontal lower limb alignment by assessing lateral femoral bowing, anatomical medial distal femoral angle, and anatomical medial proximal tibial angle (aMPTA). The average values of all anatomical indices were significantly different between the operated side and the non-operated side (p＜0.05). The side-to-side difference in hip knee ankle (HKA) angle had a statistically significant correlation with that in lateral femoral bowing (intraclass correlation coefficient, 0.259; p=0.002) and that in aMPTA. Linear regression analysis showed 0.199° of side-to-side difference in lateral femoral bowing was associated with 1° of side-to-side difference in bilateral HKA angle. The side-to-side difference in lateral femoral bowing showed a tendency to increase in proportion to varus knee deformity based on 2D assessment in unilateral TKA patients.

A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol

PubMed Central

Gløersen, Marthe; Mulrooney, Elisabeth; Hammer, Hilde Berner; Slatkowsky-Christensen, Barbara; Faraj, Karwan; Isaksen, Thore; Neogi, Tuhina; Kvien, Tore K; Magnusson, Karin; Haugen, Ida Kristin

2017-01-01

Introduction We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms. Methods and analysis The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes. Ethics and dissemination The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals. Trial registration number NCT03083548; Pre-results. PMID:28947452

An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

PubMed Central

Hernández-Cortés, Pedro; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David

2014-01-01

Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies. PMID:24995307

A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol.

PubMed

Gløersen, Marthe; Mulrooney, Elisabeth; Mathiessen, Alexander; Hammer, Hilde Berner; Slatkowsky-Christensen, Barbara; Faraj, Karwan; Isaksen, Thore; Neogi, Tuhina; Kvien, Tore K; Magnusson, Karin; Haugen, Ida Kristin

2017-09-24

We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms. The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes. The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals. NCT03083548; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers.

PubMed

Ellenbecker, Todd S; Ellenbecker, Gail A; Roetert, E Paul; Silva, Rogerio Teixeira; Keuter, Greg; Sperling, Fabio

2007-08-01

Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

The role of knee alignment in disease progression and functional decline in knee osteoarthritis.

PubMed

Sharma, L; Song, J; Felson, D T; Cahue, S; Shamiyeh, E; Dunlop, D D

2001-07-11

Knee osteoarthritis (OA) is a leading cause of disability in older persons. Few risk factors for disease progression or functional decline have been identified. Hip-knee-ankle alignment influences load distribution at the knee; varus and valgus alignment increase medial and lateral load, respectively. To test the hypotheses that (1) varus alignment increases risk of medial knee OA progression during the subsequent 18 months, (2) valgus alignment increases risk of subsequent lateral knee OA progression, (3) greater severity of malalignment is associated with greater subsequent loss of joint space, and (4) greater burden of malalignment is associated with greater subsequent decline in physical function. Prospective longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago, Ill. A total of 237 persons recruited from the community with primary knee OA, defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity; 230 (97%) completed the study. Progression of OA, defined as a 1-grade increase in severity of joint space narrowing on semiflexed, fluoroscopically confirmed knee radiographs; change in narrowest joint space width; and change in physical function between baseline and 18 months, compared by knee alignment at baseline. Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression, adjusting for age, sex, and body mass index (adjusted odds ratio [OR], 4.09; 95% confidence interval [CI], 2.20-7.62). Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression (adjusted OR, 4.89; 95% CI, 2.13-11.20). Severity of varus correlated with greater medial joint space loss during the subsequent 18 months (R = 0.52; 95% CI, 0.40-0.62 in dominant knees), and severity of valgus correlated with greater subsequent lateral joint space loss (R = 0.35; 95% CI, 0.21-0.47 in dominant knees). Having alignment of more than 5 degrees (in either direction) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees, after adjusting for age, sex, body mass index, and pain. This is, to our knowledge, the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression, that valgus alignment increases risk of lateral OA progression, that burden of malalignment predicts decline in physical function, and that these effects can be detected after as little as 18 months of observation.

The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study.

PubMed

Umapathy, Hema; Bennell, Kim; Dickson, Chris; Dobson, Fiona; Fransen, Marlene; Jones, Graeme; Hunter, David J

2015-07-07

Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge for persons with OA regarding the many different treatments available to them. Our objective was to evaluate outcomes after usage of a Web-based resource called My Joint Pain that contains tailored, evidence-based information and tools aimed to improve self-management of OA on self-management and change in knowledge. A quasi-experimental design was used to evaluate the My Joint Pain website intervention over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments, and progress-tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed both baseline and 12-month questionnaires (users: n=104; nonusers: n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity, positive and active engagement in life, emotional distress, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t tests were used to compare changes between groups for the heiQ and chi-square tests to identify changes within and between groups from baseline to 12 months for each OAQI item. Baseline demographics between groups were similar for gender (152/195, 77.9% female), age (mean 60, SD 9 years) and body mass index (mean 31.1, SD 6.8 kg/m(2)). With the exception of health service navigation, mean effect sizes from all other heiQ domains showed a positive trend for My Joint Pain users compared to the nonusers, although the differences between groups did not reach statistical significance. Within-group changes also showed improvements among the users of the My Joint Pain website for self-management (absolute change score=15%, P=.03), lifestyle (absolute change score=16%, P=.02), and physical activity (absolute change score=11%, P=.04), with no significant improvements for the nonusers. Following 12 months of exposure to the website, there were significant improvements for users compared to nonusers in self-management (absolute change score 15% vs 2%, P=.001) and weight reduction (absolute change scores 3% vs -6%, P=.03) measured on the OAQI. The My Joint Pain Web resource does not significantly improve overall heiQ, but does improve other important aspects of quality of care in people with hip and/or knee OA. Further work is required to improve engagement with the website and the quality of information delivered in order to provide a greater impact.

On the detection of early osteoarthritis by quantitative microscopic imaging

NASA Astrophysics Data System (ADS)

Mittelstaedt, Daniel John

Articular cartilage is a thin layer of connective tissue that protects the ends of bones in diarthroidal joints. Cartilage distributes mechanical forces during daily movement throughout its unique depth-dependent structure. The extracellular matrix (ECM) of cartilage primarily contains water, collagen, and glycosaminoglycan (GAG). The collagen fibers are intertwined with negatively charged GAG and surround the cells (i.e. chondrocytes) in cartilage. Degradation to the ECM reduces the load bearing properties of cartilage which can be initiated by injury (e.g. anterior cruciate ligament (ACL) rupture) or disease (e.g. osteoarthritis (OA)). Magnetic resonance imaging (MRI) and x-ray computed tomography (CT) are noninvasive imaging techniques that are increasingly being used in the clinical detection of cartilage degradation. The aim of the first project in this dissertation was to quantify and compare the depth-dependent GAG concentration from healthy and biochemically degraded humeral ex vivo articular cartilage using quantitative contrast enhanced micro-computed tomography (qCECT) at high resolution. The second project in this dissertation was aimed to measure the topographical and depth-dependent GAG concentration using qCECT and delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) from the medial tibia cartilage three weeks after unilateral ACL transection which is an animal model of OA (i.e. modified Pond-Nuki model). These GAG measurements were correlated with a biochemical method, inductively couple plasma optical emission spectrometry, to compare the degradation on the medial tibia between the OA and contralateral cartilage. The third project in this dissertation used the same cartilage specimens as in project two to investigate the change in T2 due to OA and the effect on T2 from a contrast agent. Furthermore, the change in T2 relaxation was investigated from static unconfined compression with correlations by biomechanical measurements. These studies demonstrate the ability to use two quantitative microscopic imaging techniques, microCT and microMRI, to detect microscopic changes in collagen and GAG from healthy, biochemically degraded, and early OA cartilage. The capability for microscopic imaging to detect alterations at the earliest stages of OA will ultimately improve the understanding of degradation and may help aid in the detection for the prevention of disease and repair of damaged cartilage.

Insufficient acetabular version increases blood metal ion levels after metal-on-metal hip resurfacing.

PubMed

Hart, Alister J; Skinner, John A; Henckel, Johann; Sampson, Barry; Gordon, Fabiana

2011-09-01

Many factors affect the blood metal ion levels after metal-on-metal (MOM) hip arthroplasty. The main surgically adjustable variable is the amount of coverage of the head provided by the cup which is a function of the inclination and version angles. However, most studies have used plain radiographs which have questionable precision and accuracy, particularly for version and large diameter metal heads; further, these studies do not simultaneously assess version and inclination. Thus the relationship between version and blood metal ions levels has not been resolved. We determined whether cup inclination and version influence blood metal ion levels while adjusting for age at assessment, gender, body mass index, horizontal femoral offset, head size, manufacturer hip type, and Oxford hip score. We prospectively followed 100 individuals (51 females, 49 males) with unilateral MOM hip resurfacing who underwent clinical assessment, CT scanning, and blood metal ion measurement. Multiple regression analysis was used to determine which variables were predictors of blood metal ion levels and to model the effect of these variables. Only cup inclination, version angles, and gender influenced blood cobalt or chromium levels. Cobalt and chromium levels positively correlated with inclination angle and negatively correlated with version angle. The effect of changes in version angle was less than for inclination angle. Based on our observations, we developed a formula to predict the effect of these parameters on metal ion levels. Our data suggest insufficient cup version can cause high blood metal ions after MOM hip arthroplasty. We were unable to show that excessive version caused high levels. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Can Arthroplasty Stem INfluence Outcome? (CASINO): a randomized controlled equivalence trial of 125 mm versus 150 mm Exeter V40 stems in total hip arthroplasty.

PubMed

Hamilton, David F; Ohly, Nicholas E; Gaston, Paul

2018-04-16

The use of shorter length femoral stems during total hip arthroplasty has been suggested to accommodate wider patient femoral geometry and offer maximal bone preservation. However, cemented short-stem designs may increase the risk of varus stem malalignment and influence patient outcomes. CASINO is a multi-centre randomised equivalence trial that will recruit 220 patients undergoing total hip arthroplasty for osteoarthritis at two NHS hospitals in Scotland. Patients will be aged 45-80, undergoing unilateral primary hip arthroplasty, with no plan for contralateral procedure within the study timeframe, and able to comply with the protocol. Participants will be randomised to receive either a short (125 mm) or a standard (150 mm) Exeter V40 stem. The Contemporary acetabular component will be used in all cases. All implants will be cemented. Patient pain, function and satisfaction will be assessed using change from baseline measurement in Oxford Hip Score, Forgotten Joint Score, EQ-5D, pain numerical rating scores, and patient satisfaction questionnaire at baseline and at 1 and 2 years following surgery. Radiographic assessment will evaluate stem position and will be appraised by independent reviewers. Patients will be blind to implant allocation. Stem length may be associated with outcome; however, we can find no randomised trial in which researchers investigated the effect of stem length on patient outcome following cemented total hip arthroplasty. The aim of this trial is to determine if the use of short cemented stems offers equivalent patient outcomes to those achieved following surgery with standard length stems. International Standard Randomised Controlled Trial Number, ISRCTN13154542 , Registered on 30 June 2017.

Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial.

PubMed

Austin, Matthew S; Urbani, Brian T; Fleischman, Andrew N; Fernando, Navin D; Purtill, James J; Hozack, William J; Parvizi, Javad; Rothman, Richard H

2017-04-19

The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty. We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks. The control group received the standard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks. Functional outcomes were measured using validated instruments including the Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) preoperatively, at 1 month postoperatively, and at 6 to 12 months postoperatively. Of 120 randomized patients, 108 were included in the final analysis. Ten patients (19%) were randomized to unsupervised home exercise and 20 patients (37%) were randomized to formal outpatient therapy crossed over between groups. There was no significant difference in any of the measured functional outcomes between patients receiving formal therapy (n = 54) and those participating in unsupervised home exercise (n = 54) at any time point (HHS, p = 0.82; WOMAC, p = 0.80; and SF-36 physical health, p = 0.90). This randomized trial suggests that unsupervised home exercise is both safe and efficacious for a majority of patients undergoing total hip arthroplasty, and formal physical therapy may not be required. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty-Clinical Outcome, Metal Ion Levels, and Radiologic Findings.

PubMed

Mikkelsen, Rasmus T; Fløjstrup, Marianne; Lund, Christian; Kjærsgaard-Andersen, Per; Skjødt, Thomas; Varnum, Claus

2017-09-01

Modular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA. Thirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles. The MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively). More patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant. Copyright © 2017 Elsevier Inc. All rights reserved.

[Treatment of adult avascular necrosis of femoral head by transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone].

PubMed

Yu, Zhiliang; Zhang, Ning; Yang, Yi; Wang, Bin; Gao, Shuo; Zhao, Xiaoyong

2013-07-01

To investigate the effectiveness of transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone for the treatment of adult avascular necrosis of the femoral head (ANFH). A retrospective analysis was made on the clinical data of 685 patients (803 hips) with ANFH, who underwent iliac bone flap transplantation with deep iliac circumflex vessels and cancellous bone between March 2002 and January 2010. There were 489 males (580 hips) and 196 females (223 hips) with a mean age of 40.4 years (range, 18-63 years), including 567 unilateral cases (303 left hips and 264 right hips) and 118 bilateral cases. The causes of ANFH included alcohol-induced in 223 cases, steroid-induced in 179 cases, alcohol + steroid-induced in 21 cases, traumatic in 136 cases, acetabular dysplasia in 8 cases, bone cyst in 5 cases, septic arthritis in 2 cases, joint tuberculosis in 3 cases, rheumatoid arthritis in 5 cases, and idiopathic in 103 cases. According to Steinberg staging, 211 hips were rated as stage II, 513 hips as stage III, and 79 hips as stage IV. The preoperative Harris hip score was 60.30 +/- 7.02. Fat necrosis occurred in 2 cases after operation, primary healing of incision was obtained in the other cases; delayed infection, lower extremity deep vein thrombosis, and pulmonary embolism occurred in 2 cases, respectively. All patients were followed up 36-60 months (mean, 49 months). Harris hip score at last follow-up (83.50 +/- 7.31) was significantly higher than that at preoperation (t= -2 266.980, P=0.000), and the scores were significantly higher than those at preoperation in different stages (P < 0.05). The results were excellent in 523 hips, good in 185 hips, fair in 65 hips, and poor in 30 hips, and the excellent and good rate was 88.2%. X-ray examination showed bone fusion of transplanted bone flap and bone graft with an average of 4.2 months (range, 3-6 months); according to Steinberg staging, imaging stable rate was 78.3% (629/803) at last follow-up. Iliac bone flap transplantion with deep iliac circumflex vessels and cancellous bone has the advantages of complete decompression of the femoral head, exact flap blood supply, improved blood supply of the femoral head, new support for the femoral head, and participation of osteoinductive effect for the treatment of adult ANFH, so it is an effective treatment for the retention of the femoral head.