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1.
Aust J Gen Pract ; 49(7): 444-446, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600002

RESUMO

BACKGROUND: Joint replacement surgery is a highly effective treatment option for patients with severe osteoarthritis (OA) of the hip and knee when other treatments have failed. Unfortunately, as a result of the COVID-19 pandemic, a temporary suspension of non-urgent elective surgery was implemented. Thousands of patients currently awaiting hip and knee replacements have been affected. Many of these patients will present to their general practitioners for symptom management during this interim period. OBJECTIVE: The purpose of this article is to summarise current recommendations for the non-operative management of patients with symptomatic OA. DISCUSSION: Non-operative treatment modalities for OA include education, lifestyle modification and exercise, mass reduction, physiotherapy, orthoses, psychology, pharmaceuticals and injections. Multimodal therapy is required for patients with severe symptoms. A number of useful online resources are presented, as access to public allied health services may be limited because of the COVID-19 pandemic.


Assuntos
Tratamento Conservador/métodos , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/métodos , Osteoartrite do Quadril , Osteoartrite do Joelho , Pandemias , Pneumonia Viral , Avaliação de Sintomas/métodos , Austrália/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Conduta Expectante/métodos
2.
Value Health ; 23(3): 379-387, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197734

RESUMO

OBJECTIVES: To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA). METHODS: A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R2, mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient. RESULTS: The preferred models were a GLM with Pain2+Pain3+Function+Pain·Function as covariates and a beta model with Pain3+Function+Function2+Function3 as covariates. The adjusted R2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death. CONCLUSION: To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available.


Assuntos
Artralgia/diagnóstico , Avaliação da Deficiência , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores de Tempo
3.
Arthritis Care Res (Hoboken) ; 72(2): 149-162, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31908149

RESUMO

OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.


Assuntos
Fundações/normas , Articulação da Mão , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Guias de Prática Clínica como Assunto/normas , Reumatologia/normas , Analgésicos/administração & dosagem , Gerenciamento Clínico , Terapia por Exercício/métodos , Terapia por Exercício/normas , Articulação da Mão/patologia , Humanos , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Estados Unidos/epidemiologia
4.
Qual Life Res ; 29(6): 1509-1519, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31912357

RESUMO

PURPOSE: Previous research reported conflicting findings regarding the association of sociodemographic and clinical variables with expectations for surgical outcomes. The current study aimed to identify and characterize different subgroups of osteoarthritis patients with respect to amount and level of expectations, and to examine factors that are associated with expectations. METHODS: Hip and knee patients (n = 287) completed a questionnaire 1 week post consultation. Linear regression analyses were performed to examine whether sociodemographic (e.g., age, sex) and clinical factors (e.g., pain, function) were associated with expectations. Latent class analysis (LCA) was used to identify different subgroups and the step 3 method was conducted to assess subgroup characteristics. RESULTS: Mean age of patients was 70 years (SD = 8) and 57% of patients was female. Most improvement was expected in walking ability and pain relief. Higher expectations were associated with younger age, male sex, and functional disability. Both hip and knee patients could be classified into three subgroups. These subgroups differed significantly on pain and other symptoms, and functional disability. CONCLUSION: Both hip and knee patients reported pain and other osteoarthritis symptoms and functional disability and consequently had high expectations in these areas for treatment outcomes. Higher expectations were characterized by more pain, more symptoms and more functional disability. These insights could guide physicians in the discussion of expectations during consultation.


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Qualidade de Vida/psicologia , Idoso , Feminino , Humanos , Masculino , Resultado do Tratamento
5.
Arthritis Care Res (Hoboken) ; 72(2): 201-207, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31325229

RESUMO

OBJECTIVE: To compare the effectiveness of education (ED) plus home exercise (HE) and ED plus supervised exercise (SE) according to information provided by the Better Management of Patients With Osteoarthritis (BOA) Registry, a nationally implemented rehabilitation program for patients with hip and knee osteoarthritis (OA). In addition, we investigated whether or not the effect of the treatments differed based on the joint affected by OA (hip versus knee). METHODS: We included 38,030 participants from the BOA Registry with knee or hip OA who were treated with either ED, HE, or SE. The effect of the 3 treatment options on the pain intensity reduction (range 0-10) immediately postintervention and at 12 months was estimated using a mixed-effects model adjusted for age, sex, body mass index, affected joint (hip or knee), pain at baseline, comorbidity, and level of education. RESULTS: The participants undergoing HE or SE experienced a greater pain reduction compared to participants who received ED, both after the treatment (group mean change for ED -0.91 [95% confidence interval (95% CI) -1.15, -0.68], for HE -1.06 [95% CI -1.10, -1.01], and for SE -1.12 [95% CI -1.15, -1.08]) and at 12 months (group mean change for ED -0.58 [95% CI -0.87, -0.30], for HE -0.82 [95% CI -0.87, -0.76], and for SE -0.82 [95% CI -0.86, -0.77]). Patients with knee OA who underwent HE or SE improved more compared to patients with hip OA at both follow-ups. CONCLUSION: In primary care, HE and SE lead to similar reductions in pain intensity but are more effective than ED alone. In addition, people with knee OA benefit more from HE and SE than people with hip OA.


Assuntos
Terapia por Exercício/métodos , Serviços de Assistência Domiciliar , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Educação de Pacientes como Assunto/métodos , Sistema de Registros , Idoso , Bases de Dados Factuais/tendências , Gerenciamento Clínico , Terapia por Exercício/tendências , Feminino , Serviços de Assistência Domiciliar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/métodos , Educação de Pacientes como Assunto/tendências
6.
JAMA ; 322(23): 2323-2333, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846019

RESUMO

Importance: Hip osteoarthritis (OA) is a common cause of pain and disability. Objective: To identify the clinical findings that are most strongly associated with hip OA. Data Sources: Systematic search of MEDLINE, PubMed, EMBASE, and CINAHL from inception until November 2019. Study Selection: Included studies (1) quantified the accuracy of clinical findings (history, physical examination, or simple tests) and (2) used plain radiographs as the reference standard for diagnosing hip OA. Data Extraction and Synthesis: Studies were assigned levels of evidence using the Rational Clinical Examination scale and assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. Data were extracted using individual hips as the unit of analysis and only pooled when findings were reported in 3 or more studies. Main Outcomes and Measures: Sensitivity, specificity, and likelihood ratios (LRs). Results: Six studies were included, with data from 1110 patients and 1324 hips, of which 509 (38%) showed radiographic evidence of OA. Among patients presenting to primary care physicians with hip or groin pain, the affected hip showed radiographic evidence of OA in 34% of cases. A family history of OA, personal history of knee OA, or pain on climbing stairs or walking up slopes all had LRs of 2.1 (sensitivity range, 33%-68%; specificity range, 68%-84%; broadest LR range: 95% CI, 1.1-3.8). To identify patients most likely to have OA, the most useful findings were squat causing posterior pain (sensitivity, 24%; specificity, 96%; LR, 6.1 [95% CI, 1.3-29]), groin pain on passive abduction or adduction (sensitivity, 33%; specificity, 94%; LR, 5.7 [95% CI, 1.6-20]), abductor weakness (sensitivity, 44%; specificity, 90%; LR, 4.5 [95% CI, 2.4-8.4]), and decreased passive hip adduction (sensitivity, 80%; specificity, 81%; LR, 4.2 [95% CI, 3.0-6.0]) or internal rotation (sensitivity, 66%; specificity, 79%; LR, 3.2 [95% CI, 1.7-6.0]) as measured by a goniometer or compared with the contralateral leg. The presence of normal passive hip adduction was most useful for suggesting the absence of OA (negative LR, 0.25 [95% CI, 0.11-0.54]). Conclusions and Relevance: Simple tests of hip motion and observing for pain during that motion were helpful in distinguishing patients most likely to have OA on plain radiography from those who will not. A combination of findings efficiently detects those most likely to have severe hip OA.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico , Exame Físico , Radiografia , Diagnóstico Diferencial , Feminino , Articulação do Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Dor/etiologia , Amplitude de Movimento Articular , Sensibilidade e Especificidade
7.
BMC Musculoskelet Disord ; 20(1): 507, 2019 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-31679508

RESUMO

INTRODUCTION: The video Animated Activity Questionnaire (AAQ) was developed to assess the impact of lower limb osteoarthritis (OA) on daily functional activities. The objective of the study was to compare the video and the HOOS/KOOS paper questionnaires and to assess the effect of order of administration. MATERIAL AND METHODS: Patients recruited in the KHOALA cohort were randomized in two groups: AAQ questionnaire first (AAQ-first group) and HOOS (hip)/KOOS (knee) questionnaire first (H/KOOS-first group). Within group differences between AAQ and HOOS/KOOS scores were compared using a Student t-test. The Spearman correlation coefficient between AAQ score and HOOS/KOOS score was calculated in each group then compared, using Fisher z-transformation. RESULTS: Among 200 randomized patients, 188 (65.8 years, 66.0% women) completed the questionnaires: 99 in the AAQ-first group and 89 in the H/KOOS-first group. The AAQ score was 85.9 (SD: 13.7) in the AAQ-first versus 87.8 (SD: 13.1) in the H/KOOS-first group (p = 0.34). The H/KOOS score was 72.5 (SD: 21.2) in the AAQ-first versus 73.5 (SD: 18.4) in the H/KOOS-first group (p = 0.71). The Spearman correlation coefficient between AAQ and H/KOOS in the AAQ-first was 0.84[0.77-0.89] and 0.73[0.61-0.81] in H/KOOS-first group. These correlations differed between groups significantly (p = 0.02). CONCLUSION: This study found video AAQ and paper HOOS/KOOS questionnaire highly correlated, with a moderate but significant effect of order administration of video and paper questionnaires evidencing a stronger correlation when the videos were viewed first.


Assuntos
Avaliação da Deficiência , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/normas , Inquéritos e Questionários/normas , Gravação em Vídeo/normas , Atividades Cotidianas/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/psicologia , Medição da Dor/métodos , Distribuição Aleatória , Gravação em Vídeo/métodos
8.
Lakartidningen ; 1162019 Oct 21.
Artigo em Sueco | MEDLINE | ID: mdl-31638711

RESUMO

Coxartrosis is a common cause of hip pain among the elderly population. Avascular necrosis (AVN), also known as osteonecrosis, is a disease that most commonly affects the femoral head as a result of decreased blood supply to the bone. The etiology and pathogenesis is still unclear, but there are various traumatic and atraumatic factors that have been suggested as risk factors for AVN. However, almost half of the patients present none of these risk factors. Compared to coxartrosis, AVN typically occurs in a younger population. Initially it can be difficult to differ between these conditions. Plain film radiographic findings are absent in early stages of AVN, but magnetic resonance imaging (MRI) can provide early diagnosis. Thereby, MRI is the golden standard of noninvasive diagnostic evaluation. We present a patient with bilateral AVN that initially was diagnosed with coxartrosis.


Assuntos
Necrose da Cabeça do Fêmur , Osteoartrite do Quadril , Idoso , Artralgia/etiologia , Erros de Diagnóstico , Necrose da Cabeça do Fêmur/complicações , Necrose da Cabeça do Fêmur/diagnóstico , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/diagnóstico por imagem , Radiografia
9.
Int J Rheum Dis ; 22(12): 2108-2118, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31651091

RESUMO

OBJECTIVES: To examine the association between body composition and osteoarthritis (OA). METHODS: An extensive literature review was performed to identify studies that examined the association between body composition and OA. The mean difference (MD), odds ratio (OR), relative risk (RR) and corresponding 95% confidence intervals (CIs) were determined using RevMan statistical software. RESULTS: A total of 19 studies were included. The combined MD showed the fat mass of the subjects with knee OA was higher than that of the control group (MD 4.38, 95% CI: 2.84-5.92). Both fat mass and fat mass percentage were positively associated with knee OA (ORs ranged from 1.49, 95% CI: 1.15-1.92, to 2.37, 95% CI: 1.18-4.74). Similar findings were observed in hip and hand joints as well (ORs ranged from 1.20, 95% CI: 1.08-1.32, to 1.87, 95% CI: 1.11-3.15), and such results were also confirmed by most cohort studies of knee and hip OA (RRs ranged from 0.98, 95% CI: 0.95-1.01, to 3.60, 95% CI: 2.60-5.00). Lean mass was also positively associated with knee OA (OR 1.48, 95% CI: 1.13-1.94). However, lean mass percentage was negatively associated with knee OA (OR 0.65, 95% CI: 0.46-0.92). CONCLUSIONS: Both fat mass and fat mass percentage were likely to be risk factors for knee, hip and hand OA. Similarly, lean mass also seemed to be a risk factor for knee OA, while lean mass percentage seemed to be a protective factor.


Assuntos
Composição Corporal , Articulação da Mão/fisiopatologia , Articulação do Quadril/fisiopatologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Adiposidade , Feminino , Humanos , Masculino , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco
10.
Iowa Orthop J ; 39(1): 95-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413682

RESUMO

Background: Revision hip arthroscopy often serves as a measure for a failed primary hip arthroscopy procedure. The purpose of this study was to examine the rate, timing, and risk factors for revision hip arthroscopy using a large national database. Methods: The Humana administrative claims dataset was reviewed from 2007 through the second quarter of 2015 to identify patients undergoing hip arthroscopy using Current Procedural Terminology (CPT) codes and laterality modifiers. Patients with subsequent ipsilateral revision hip arthroscopy were identified and the rate and timing of these revisions determined. Subgroup analysis was performed to determine effects of gender, age, body mass index (BMI), osteoarthritis diagnosis, and specific hip arthroscopy procedure on revision rates. Results: There were 1807 hip arthroscopy procedures identified with a revision rate of 4% (total of 72 procedures). Of the revision procedures, 43% occurred within 6 months after the index procedure, and 86% occurred within 18 months. Age < 50 years was the only significant predictor of revision hip arthroscopy (OR 2.03, CI 1.173.53) with an even distribution across younger age groups. An osteoarthritis diagnosis, gender, and BMI did not represent significant risk factors for revision (OR 0.87, 0.98, 0.9 and CI 0.5-1.51, CI 0.6-1.59, CI 0.37-2.12, respectively). Chondroplasty was the most common procedure leading to revision (46%) followed by labral repair (37%). The most common revision procedures were chondroplasty (44%) followed by femoroplasty (38%). Conclusions: Overall, 4% of hip arthroscopy procedures underwent revision arthroscopy over the 8-year period. Revision was associated with age < 50, and revisions were most frequently performed for femoroacetabular impingement. The majority of revisions occurred within 18 months after the index procedure.Level of Evidence: IV.


Assuntos
Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Osteoartrite do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Fatores Etários , Artroscopia/métodos , Bases de Dados Factuais , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Prognóstico , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento
11.
Bone Joint J ; 101-B(8): 902-909, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362559

RESUMO

AIMS: This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. PATIENTS AND METHODS: A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. RESULTS: Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. CONCLUSION: The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902-909.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/fisiopatologia , Osteoartrite do Quadril/diagnóstico , Pelve/fisiopatologia , Amplitude de Movimento Articular , Coluna Vertebral/fisiopatologia , Idoso , Feminino , Quadril/fisiopatologia , Humanos , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Estudos Prospectivos , Sensibilidade e Especificidade
12.
BMC Musculoskelet Disord ; 20(1): 365, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391043

RESUMO

BACKGROUND: This study describes how patients with knee or hip osteoarthritis (OA), scheduled for arthroplasty, characterize their pain qualitatively and quantitatively and investigates whether differences exist in pain expression between younger and older patients, and between men and women. METHODS: One hundred eight patients scheduled for a joint arthroplasty completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Hip Disability and Osteoarthritis Outcome Score (HOOS) and a health-related quality of life question. Pain was assessed using the visual analogue scale (VAS), KOOS/HOOS and the Pain-o-Meter (POM) consisting of 12 sensory and 11 affective words (POM-Words). Frequency of analgesics use was assessed and preoperative radiographs were graded. ANOVA was used to test differences in pain expression with age (< 65 vs. ≥65 years), sex, and affected joint as independent factors. RESULTS: Patients < 65 years of age used more affective words (POM) and words with higher affective intensity (median scores 8 (3-39), 5.5 (2-27) respectively), than older patients, despite having less radiographically advanced OA. They also reported more symptoms (KOOS/HOOS) than older patients. However, pain ratings, as measured by VAS and KOOS/HOOS pain, did not differ between younger and older adults. Women reported more frequent analgesics use (45.7 and 26.5% respectively) and rated their pain higher than men (mean POM-VAS = 42 (SD 24) and 31 (SD 19); respectively). No differences existed between sexes for sensory or affective POM-Words, or radiographic grade of OA. With age and sex as independent factors, a significant difference between knee and hip OA remained for sensory POM-words intensity scores. CONCLUSIONS: Younger adults scheduled for arthroplasty expressed pain using more affective words and words with higher intensity and had less radiographically advanced OA than older adults. However, VAS and KOOS/HOOS pain subscales could not distinguish the difference in pain expression. Thus, the POM may be a valuable tool for assessment of pain.


Assuntos
Artralgia/diagnóstico , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor/métodos , Índice de Gravidade de Doença , Fatores Etários , Idoso , Artralgia/psicologia , Artroplastia de Quadril , Artroplastia do Joelho , Estudos Transversais , Estudos de Viabilidade , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medição da Dor/psicologia , Período Pré-Operatório , Qualidade de Vida , Fatores Sexuais , Inquéritos e Questionários
13.
Orthop Traumatol Surg Res ; 105(5): 937-942, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31255501

RESUMO

BACKGROUND: Pre-operative 3D planning based on computed tomography (CT) imaging is used to optimise the restitution of normal hip anatomy during primary total hip arthroplasty (THA). Although CT planning has been proven effective and reproducible, its influence on long-term THA outcomes is unknown. In this 10-year follow-up study of patients managed with the same technique of CT-planned primary anatomical THA, the objectives were to assess femoral implant survival, long-term functional outcomes, 10-year outcomes of titanium modular femoral necks, and associations with the dislocation rate. Hypothesis Pre-operative CT planning of primary THA ensures achievement of the NICE criterion of a lower than 5% femoral revision rate within 10 years. MATERIAL AND METHODS: The study included 61 patients (61 hips) managed between 2004 and 2007 by CT-planned primary THA via the posterior approach, with an uncemented anatomical femoral component (SPS®, Symbios); when deemed necessary by the surgeon to restore normal anatomy, a titanium modular femoral neck was used (35/61 patients). After 10 years, 17 patients had died and 3 were lost to follow-up, leaving 41 patients with a mean age of 76 years (range, 60-91 years) for re-evaluation. Clinical outcomes were assessed by determining the Harris Hip Score (HHS) and the Postel-Merle d'Aubigné (PMA) score, which were compared to baseline values. Radiographs were evaluated using the AGORA Roentgenographic Assessment system (ARA). RESULTS: The 10-year femoral component survival rate was 96% (95%CI, 88;99%). Revision was required in 4 patients, to treat delayed peri-prosthetic fractures (n=2) or to correct initial cup malposition (n=2). No changes occurred from 2010 to last follow-up in the mean HHS (90 [95%CI, 84;95] and 91 [95%CI, 77;96], respectively) or mean PMA score (16 [95%CI, 14;17] and 15.5 [95%CI, 14;16.5], respectively). The mean ARA score was 5.2 (range, 3-6) at last follow-up. No complications related to the use of modular femoral necks were recorded. Dislocation occurred in 2 patients, but in neither was the pre-operative plan followed during surgery. DISCUSSION: The SPS® stem produced good 10-year clinical and radiographic outcomes. No patients experienced complications related to use of a titanium modular femoral neck. The restoration of anatomical hip geometry made possible by pre-operative CT planning provided sustained clinical improvements with a low complication rate. LEVEL OF EVIDENCE: IV, retrospective observational cohort study.


Assuntos
Artroplastia de Quadril/métodos , Fêmur/cirurgia , Previsões , Prótese de Quadril , Imageamento Tridimensional , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Desenho de Prótese , Estudos Retrospectivos , Titânio
14.
Int J Rheum Dis ; 22(9): 1607-1615, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31328413

RESUMO

OBJECTIVE: We performed a systematic review and meta-analysis from randomized controlled trials to examine the efficacy and safety of avocado-soybean unsaponifiables (ASU) in patients with hip or knee osteoarthritis (OA). DATA SOURCES: Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials. STUDY SELECTION: Original studies were randomized placebo-controlled trials evaluating the effect of orally administered ASU on knee or hip OA symptoms using the Lequesne index, visual analog scale (VAS) and/or joint space width (JSW). DATA EXTRACTION: Meta-analysis was conducted using a random-effects model and generic inverse variance method. Heterogeneity was tested using the I2 statistic index. DATA SYNTHESIS: Avocado-soybean unsaponifiables therapy had a significant reduction on pain by VAS assessment (weighted mean difference [WMD]: -9.64 mm, 95% CI: -17.43, -1.84; P = .02; I2  = 92%). A subanalysis according to the type of OA showed that ASU significantly decreased both VAS and Lequesne index in knee OA (WMD: -17.36, 95% CI: -25.91, -8.82; P < .0001; I2  = 87% and WMD: -2.33, 95% CI: -2.88, -1.78; P < .00001; I2  = 18%, respectively) but not in hip OA. Finally, ASU supplementation showed no significant differences for adverse events compared to placebo (relative risk: 1.02, 95% CI: 0.83, 1.25; P = .88; I2  = 0%). CONCLUSION: Results of this meta-analysis suggest a beneficial effect of ASU treatment in symptomatic knee OA but not in hip OA. Additionally, adverse events were similar in patients receiving ASU therapy or placebo.


Assuntos
Antirreumáticos/uso terapêutico , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Persea/química , Extratos Vegetais/uso terapêutico , Óleos Vegetais/química , Óleo de Soja/química , Idoso , Antirreumáticos/efeitos adversos , Antirreumáticos/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Extratos Vegetais/efeitos adversos , Extratos Vegetais/isolamento & purificação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
J Orthop Surg (Hong Kong) ; 27(2): 2309499019861225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284813

RESUMO

BACKGROUND: This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation. METHODS: The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated. RESULTS: The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant (p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined (p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant (p = 0.001). CONCLUSION: Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/métodos , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Pelve/diagnóstico por imagem , Acetábulo/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Postura , Radiografia
16.
BMC Musculoskelet Disord ; 20(1): 324, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299929

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, principally affecting the older population. Highly prevalent, disabling diseases such as osteoarthritis strain the capacity of health systems, and can result in unmet need for services. The Joint Clinic was initiated to provide secondary care consultations and access to outpatient services for people with advanced hip or knee osteoarthritis, who were referred by their general practitioner for orthopaedic consultation but not offered an orthopaedic specialist appointment. METHODS: This longitudinal programme evaluation comprised four components: a proof-of-concept evaluation; an implementation evaluation; a process evaluation; and an outcomes evaluation. Interviews and surveys of general practitioners, staff, and patients were conducted pre- and post-implementation. Interviews were transcribed, and thematic analysis was completed. In addition, Joint Clinic patient visits and outcomes were reviewed. RESULTS: One hundred and eleven primary care physicians (GPs) and 66 patients were surveyed, and 28 semi-structured interviews of hospital staff and GPs were conducted. Proof of concept was satisfied. Interim and final implementation evaluations indicated adherence to the concept model, high levels of acceptance of and confidence in the programme and its staff, and timely completion within budget. Process evaluation revealed positive impacts of the programme and positive stakeholder perceptions, with some weaknesses in communication to the outer context of primary care. The Joint Clinic saw a total of 637 patient visits during 2 years of operation. Unmet need was reduced by 90%. Patient and referring physician satisfaction was high. Hospital management confirmed that the programme will continue. CONCLUSIONS: This evaluation indicates that the Joint Clinic concept model is fit for purpose, functioned well within the organisation, and achieved its primary objective of reducing unmet need of secondary care consultation for those suffering advanced hip or knee osteoarthritis.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida
17.
BMC Musculoskelet Disord ; 20(1): 307, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31253128

RESUMO

BACKGROUND: Mental health has been shown to improve after total hip arthroplasty (THA). Little is known about the role of pain and function in this context. We assessed whether change in mental health was associated with improvement in pain and function 1 year post-surgery. METHODS: This prospective study included patients enrolled in a THA registry from 2010 to 2014. We examined the mental component score (MCS) before and 1 year post-surgery, and 1-year change, in association with Western Ontario McMaster Universities (WOMAC) pain and function scores. All scores were normalized, ranging from 0 to 100 (larger score indicating better outcome). Analyses were adjusted for potential confounders. RESULTS: Our study included 610 participants, of which 53% were women. Descriptive statistics are as follows: the average (SD) for age (years) was 68.5 (11.8), and for BMI was 26.9 (4.9). In addition, the MCS average (SD) at baseline was 44.7 (11.2), and at 1-year after THA was 47.5 (10.5). The average change from baseline to 1-year post-THA in MCS was 2.8 (95% CI: 1.9, 3.6), for an effect size of 0.26. As for the WOMAC pain score, the average change from baseline to 1-year post-THA was 44.2 (95%CI: 42.4, 46.0), for an effect size of 2.5. The equivalent change in WOMAC function was 38.1 (95% CI: 36.2, 40.0), for an effect size of 2.0. Results from multivariable analysis controlling for covariates showed that an improvement of 10 points in the 1-year change in pain score resulted in a 0.78 point (95%: CI 0.40, 1.26) increase in the 1-year change in MCS, whereas a 10-point improvement in the 1-year change in function was associated with a 0.94 point (95% CI: 0.56, 1.32) increase. CONCLUSIONS: Mental health significantly improved from baseline to 1-year post-THA. Greater improvement in pain and function was associated with greater improvement in mental health 1 year post-THA.


Assuntos
Artralgia/cirurgia , Artroplastia de Quadril , Saúde Mental , Osteoartrite do Quadril/cirurgia , Idoso , Artralgia/diagnóstico , Artralgia/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/psicologia , Medição da Dor , Período Pós-Operatório , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
18.
Arthroscopy ; 35(7): 2051-2060.e13, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31208918

RESUMO

PURPOSE: To determine patient-specific factors that can be used to predict the presence of severe articular cartilage damage in the hip in patients without osteoarthritis. METHODS: The prevalence of severe (Outerbridge grade III or IV) cartilage damage to the acetabulum and femoral head was prospectively recorded at hip arthroscopy. Patients who underwent primary hip arthroscopic surgery between 2006 and 2016 performed by a single surgeon were included. Patients were excluded if they underwent previous hip surgery, had poor-quality radiographs, were younger than 16 years at the time of surgery, or had a minimal joint space of 2 mm or less. The relation between severe cartilage damage and preoperative patient characteristics was examined using multivariable logistic regression analysis with restricted cubic splines. RESULTS: Of the 2,396 hips presenting for hip arthroscopy, 995 (41%) had severe cartilage damage to the acetabulum and 257 (11%) had severe cartilage damage to the femoral head. Older age was a significant risk factor for severe cartilage damage both to the acetabulum (χ2 = 69.5, P < .001) and to the femoral head (χ2 = 53.9, P < .001). An age of 45 years was associated with a 1.96 (95% confidence interval, 1.54-2.49) increase in the odds of severe acetabular cartilage damage and a 3.94 (95% confidence interval, 2.61-5.94) increase in the odds of severe femoral head cartilage damage relative to an age of 20 years. Male sex was associated with severe cartilage damage to the acetabulum (χ2 = 66.7, P < .001), and a lower center-edge angle was a significant risk factor for severe cartilage damage to the femoral head (χ2 = 78.5, P < .001). Predictive nomograms were established for severe cartilage lesions. CONCLUSIONS: The primary risk factors for severe hip cartilage damage were older age for both the femoral head and acetabulum; a lower center-edge angle and larger Tönnis angle for the femoral head; and male sex, body mass index, alpha angle, and joint space for the acetabulum. The likelihood of cartilage damage to the hip can be estimated clinically using a prediction nomogram. LEVEL OF EVIDENCE: Level III, cross-sectional study.


Assuntos
Artroscopia/métodos , Cartilagem Articular/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/diagnóstico , Articulação do Quadril/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Radiografia , Fatores de Risco , Adulto Jovem
19.
BMC Musculoskelet Disord ; 20(1): 283, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200691

RESUMO

BACKGROUND: Reductions in lower extremity muscle strength, size and quality and increased fat content have been reported in advanced hip osteoarthritis (OA). Whether these differences are also evident at earlier stages of the disease and the extent to which they might develop over time is unclear. The main purpose of this 12-month exploratory prospective study was to compare changes in muscle and fat characteristics in individuals with mild-to-moderate hip OA and healthy controls. METHODS: Fourteen individuals with mild-to-moderate symptomatic and radiographic hip OA (n = 9 unilateral; n = 5 bilateral), and 15 healthy controls similar in age and sex without symptoms or radiographic hip OA were assessed at baseline and at 12-month follow-up. Maximal voluntary isometric strength of the hip and knee muscle groups was assessed using an isokinetic dynamometer. Lower extremity lean and fat mass were assessed using dual-energy x-ray absorptiometry, and thigh muscle and fat areas and thigh muscle density were assessed using peripheral quantitative computed tomography. RESULTS: Knee extension (p = 0.01), hip extension (p < 0.01), hip flexion (p = 0.03), and hip abduction (p < 0.01) strength, lower extremity lean mass (p < 0.01), thigh muscle area (p = 0.03), and thigh muscle density (p < 0.01) were significantly lower in hip OA compared to controls. Hip extension (p < 0.05), hip flexion (p = 0.03), and hip abduction (p = 0.03) strength significantly declined over the follow-up period in the hip OA group. CONCLUSIONS: Pre-existing deficits in hip muscle strength in individuals with mild-to-moderate hip OA were accentuated over 12-months, though no changes in symptoms or joint structure were observed. A longer follow-up period is required to establish whether strength deficits drive clinical and structural decline in these patients. Interventions to prevent or slow declines in strength may be relevant in the management of mild-to-moderate hip OA.


Assuntos
Tecido Adiposo/fisiopatologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Amplitude de Movimento Articular , Atividades Cotidianas , Tecido Adiposo/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Músculo Esquelético/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Coxa da Perna , Tomografia Computadorizada por Raios X
20.
Orthop Traumatol Surg Res ; 105(5): 923-930, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31178409

RESUMO

The direct anterior approach to the hip is judged to be difficult and even after many solutions, such as special operating tables, have been proposed to perform it, in some reports the complication rate remains high. The complications reported are nerve lesions, dislocation, muscles damages, intraoperative fractures. We describe a modification of the anterior approach, undertaken keeping the patient in lateral decubitus, in order to gain a better range of leg movement and a significant reduction of the force applied to the retractors, the technique was named ALDI (anterior lateral decubitus intermuscular) approach. The surgeon starts behind the patient as in all the other traditional approaches, to maintain unchanged the acetabular view and the dexterity in cup implantation. For the femoral preparation, he moves in front of the patient to have a better visualization. In a series of 150 patients, with a mean operative time of 51.38minutes (range, 40-112), we had no intraoperative fractures, one (0.6%) lateral femoral cutaneous nerve temporary neurapraxia, one (0.8%) posttraumatic dislocation four years after the operation and, no revisions for aseptic loosening or infection. At the 5 years follow-up, the mean Oxford Hip score was 45.2 (range, 38-48; SD 2.6), the mean Harris Hip Score was 96,7 (range, 76-100; SD 2.8), and the mean UCLA score was 7 (range, 5-10; SD 1.4). The possibility to always obtain the optimal position of the surgical window with reduced tension on the muscles, and the unchanged initial surgeon position, could make the ALDI approach the ideal technique for the surgeons that decide to perform an anterior approach.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Prótese de Quadril , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Luxação do Quadril/prevenção & controle , Fraturas do Quadril/prevenção & controle , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mesas Cirúrgicas , Duração da Cirurgia , Osteoartrite do Quadril/diagnóstico , Radiografia , Resultado do Tratamento , Adulto Jovem
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