EQ-5D-5L utilities per health states in Spanish population with knee or hip osteoarthritis.

BACKGROUND: The objective of this study was to obtain utilities by means of EQ-5D-5L for different health states in patients with knee osteoarthritis (KOA) or hip osteoarthritis (HOA) in Spain, and to compare these values with those used in foreign studies with the aim of discussing their transferability for their use in economic evaluations conducted in Spain. METHODS: Primary study: Observational prospective study of KOA or HOA patients in Spain. Sociodemographic and clinical characteristics were collected to characterize the sample. Utilities were elicited using the EQ-5D-5L questionnaire. ANOVA and bivariable analyses were conducted to identify differences between health states. LITERATURE REVIEW: Using the bibliographic databases NSH EED and CEA Registry, we conducted searches of model-based cost utilities analyses of technologies in KOA or HOA patients. Health states and utilities were extracted and compared with values obtained from the Spanish sample. RESULTS: Three hundred ninety-seven subjects with KOA and 361 subjects with HOA were included, with average utilities of 0.544 and 0.520, respectively. In both samples, differences were found in utilities according to level of pain, stiffness and physical function (WOMAC) and severity of symptoms (Oxford scales), so that the worst the symptoms, the lower the utilities. The utilities after surgery were higher than before surgery. Due to limitations from our study related to sample size and observational design, it was not possible to estimate utilities for approximately half the health states included in the published models because they were directly related to specific technologies. For almost 100% of health states of the selected studies we obtained very different utilities from those reported in the literature. CONCLUSIONS: To our knowledge this is the first article with detailed utilities estimated using the EQ-5D-5L in Spain for KOA and HOA patients. In both populations, utilities are lower for worse health states in terms of level of pain, stiffness and physical function according to WOMAC, and according to the Oxford scales. Most utilities obtained from the Spanish sample are lower than those reported in the international literature. Further studies estimating utilities from local populations are required to avoid the use of foreign sources in economic evaluations.

Reduced patellofemoral and walking pain with mobile-bearing vs. fixed-bearing total knee replacements: a mid-term prospective analytic study.

OBJECTIVE: Total knee replacement (TKR) is the standard treatment for advanced stage knee osteoarthritis. The introduction of the mobile-bearing (MB) design has given rise to a series of theoretical advantages compared to fixed-bearing (FB) implants, although current literature does not reveal significant differences between the designs. The aim of this study was to estimate the clinical results of 2 cemented total knee prosthetic designs: an MB and an FB design. METHODS: A series of patients with similar clinical and radiographic characteristics were treated consecutively with 100 FB followed by 94 MB implants. Patients were evaluated radiographically and clinically. RESULTS: Statistically significant differences were found in terms of pain at 5 years in favor of MB prostheses (p=0.006). The "pain on ascending/descending stairs" category on the KSS score showed improvement at 5 years for the MB design (p=0.003). MB implants showed better results in terms of ability to ascend/descend stairs at five years (p=0.002). With regards to the patients' ability to walk, there were differences at 1 year (p=0.020) and at 5 years (p=0.021) in favor of MB implants. CONCLUSION: At a mean follow-up of 5 years, significant differences were observed in the MB prosthesis in terms of postoperative pain, ability to ascend/descend stairs, and patellofemoral pain.

Osteochondromas around the ankle: Report of a case and literature review.

INTRODUCTION: An osteochondroma or exostosis is a benign bone tumour consisting of a bony outgrowth covered by a cartilage cap that occurs commonly in the metaphysis of long bones, mainly the distal femur, proximal tibia and proximal humerus. PRESENTATION OF CASE: We describe an unusual case of a distal tibia osteochondroma affecting the lateral malleolus of a young girl. DISCUSSION: Most osteochondromas are asymptomatic and seen incidentally during radiographic examination. Osteochondromas are rarely localized in the foot and ankle. CONCLUSION: Although most of the osteochondromas in children should be treated conservatively until skeletal maturity, those affecting the distal tibia or fibula should be treated with surgical excision in order to prevent ankle deformity, syndesmotic lesions or even fracture due to the expanding nature of this benign tumour.