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1.
Bone Joint J ; 103-B(8): 1345-1350, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334049

RESUMO

AIMS: The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA). METHODS: PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm. RESULTS: In both groups, excellent agreement between the two methods was obtained, with ICC of 0.99 and SEm 0.3° for Group I, and ICC 0.99 and SEm 0.4° for Group II. The intraobserver reproducibility was excellent for both methods in both groups, with an ICC of at least 0.97 and SEm not exceeding 0.8°. The study also revealed excellent interobserver reliability for both methods in both groups, with ICC 0.99 and SEm 0.5° or less. CONCLUSION: Either the femoral heads or acetabular domes can be used to define the bicoxofemoral axis on the lateral standing radiographs of the spine for measuring PI and PT in patients with idiopathic unilateral or bilateral hip OA. Cite this article: Bone Joint J 2021;103-B(8):1345-1350.


Assuntos
Cabeça do Fêmur/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/fisiopatologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura , Estudos Prospectivos , Adulto Jovem
2.
J Sports Sci Med ; 20(2): 284-290, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34211321

RESUMO

The objective of the study was to establish the prevalence of clinical hip osteoarthritis in current and former professional footballers and to explore its consequences on hip function and health-related quality of life (HRQoL). A cross-sectional study by means of questionnaire was conducted among current and former professional footballers fulfilling the following inclusion criteria: (1) male (2) active or retired professional footballer (3) member of FIFPRO (Football Players Worldwide) (4) between 18 and 50 years old (5) could read and understand texts in French, Spanish, or English. Controls (matched for: gender, age, body weight and height) were also recruited. The main outcome measures were clinical hip osteoarthritis, hip function and HRQoL. Questionnaires were sent to 2,500 members of which 1,401 participated (1,000 current and 401 former professional footballers). Fifty-two controls were recruited. Prevalence of hip osteoarthritis was 2% among current and 8% among former professional footballers. Hip function was significantly (p ≤ 0.001) lower in both types of footballers with hip osteoarthritis than in footballers without hip osteoarthritis and controls. Current and former professional footballers with hip osteoarthritis reported significantly lower physical health scores (p = 0.032, p = 0.002) than those without. Hip osteoarthritis led to a significantly lower score in the physical (p = 0.004) and mental (p = 0.014) component of HRQoL in former footballers compared to the controls, while in current footballers only the physical component was significantly (p = 0.012) lower compared to the controls. Hip osteoarthritis has a higher prevalence in former than in current professional footballers and impacts hip function and HRQoL negatively.


Assuntos
Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/psicologia , Qualidade de Vida , Futebol/lesões , Adulto , Estudos Transversais , Inquéritos Epidemiológicos , Quadril/fisiopatologia , Humanos , Masculino , Análise por Pareamento , Osteoartrite do Quadril/fisiopatologia , Prevalência
3.
Motor Control ; 25(3): 502-518, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098529

RESUMO

This study aimed to investigate the hip sway and the relationship between the center of pressure (CoP) and kinematic parameters regarding the time series scaling component α in patients with hip osteoarthritis (OA) during a one-leg standing task. The scaling exponent α, SD, hip sway maximal acceleration change, and balance performance, which was measured using CoP parameters, were compared between hip OA and control groups during a one-leg standing task. The relationships between balance performance with CoP parameters and kinematic parameters were investigated with the regression analysis. In the hip OA group, the scaling exponent α was smaller in the medial-lateral direction, and the SD and maximal amount of change in hip sway acceleration were larger in the anterior-posterior direction in the hip OA group. In this group, the CoP parameters were significantly associated with α in the medial-lateral direction (negatively) and in the anterior-posterior direction (positively). In the hip OA group, hip sway adaptability in the medial-lateral direction was limited, while the anterior-posterior direction showed greater movement.


Assuntos
Osteoartrite do Quadril , Equilíbrio Postural , Humanos , Perna (Membro) , Movimento , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/fisiopatologia , Posição Ortostática
4.
J Ayub Med Coll Abbottabad ; 33(2): 315-321, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137552

RESUMO

BACKGROUND: Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS: PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different combinations. Standardized mean difference (SMD) in VAS for pain relief and Lequesne index for functional outcomes while risk ratio (RR) for complications was used for data pooling. RESULTS: Four studies comprising 185 and 189 patients in HMWHA and control groups were included, respectively. SMD for VAS and Lequesne index was -0.056 and -0.114, respectively while RR for complication was 0.879. CONCLUSIONS: Intra-articular HMWHA injection provided pain relief, functional improvement, and no severe complications on immediate short term basis. However, the results do not favor treatment with HMWHA over other treatment methods. Randomized trials are further necessary to provide data regarding comparisons between HMWHA for hip osteoarthritis concerning clinicians' convenience, compliance, duration of relief, and cost-effectiveness.


Assuntos
Ácido Hialurônico/administração & dosagem , Osteoartrite do Quadril/tratamento farmacológico , Viscossuplementos/administração & dosagem , Idoso , Humanos , Ácido Hialurônico/química , Injeções Intra-Articulares , Peso Molecular , Osteoartrite do Quadril/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Escala Visual Analógica
5.
Acta Orthop Traumatol Turc ; 55(1): 42-47, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33650510

RESUMO

OBJECTIVE: This study aims to develop and evaluate a simple tool for daily practice that might allow a rough estimate of individual braking performance (brake response time, BRT) of patients with osteoarthritis or those with arthroplasty of the knee or hip. METHODS: In this cross-sectional study, we examined 162 patients (72 men, 90 women; mean age = 64±12.8 years) who suffered from osteoarthritis of the knee (n=45) or hip (n=64) or who underwent a total hip (n=37) or knee (n=16) arthroplasty. BRT of each patient was measured in a brake simulator. The results were compared to demographic data, various clinical tests, and pain surveys. From these data, a multiple linear regression model was developed. RESULTS: From the observed correlations, the regression model consisted of age (correlation with BRT τ=0.176, p=0.001), sex (τ=0.361, p<0.001), Hau's step test (τ=-0.345, p<0.001), and the pain dimension of the Hip disability/Knee injury and Osteoarthritis Outcome Score (τ=-0.265, p<0.001). We, therefore, suggested the following formula: BRTest = 634.8 - (8.8 x Hau) + 119.2 (for women) + (3.0 x age) - (1.3 x H/KOOS Pain). The above-mentioned variables contributed significantly to the prediction of BRT and could achieve a multiple R² adj of 0.31. The model leaves a residual standard error (i.e., SD of the residuals) of 158.4 ms, which is superior to a model without predictors; F (4.140)=16.8, p<0.001. CONCLUSION: Our evaluated regression model offers an uncertainty which is comparable to the one based on a fixed time period after surgery or a defined pathologic condition. The high variability even within a single patient over several brake simulator measurements makes it unlikely for a model to be generated solely based on clinical testing. Taking the available data in literature into account, we advise caution when formulating a real-time- or condition-based recommendation. We rather suggest being aware of risk factors that might lead to impaired BRT to sensitize patients to their impaired ability to drive. We identify such risk factors, namely old age, female sex, impaired musculoskeletal function, as tested in Hau's step test, and high levels of pain. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Exame para Habilitação de Motoristas , Osteoartrite do Quadril , Osteoartrite do Joelho , Desempenho Físico Funcional , Complicações Pós-Operatórias , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Análise de Regressão , Medição de Risco
6.
Arch Phys Med Rehabil ; 102(5): 959-966, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33567336

RESUMO

OBJECTIVE: To investigate the short-term effects of dry needling (DN) on physical function, pain, and hip muscle strength in patients with hip osteoarthritis (OA). DESIGN: A double-blind, placebo-control, randomized controlled trial. SETTING: Private practice physiotherapy clinic. PARTICIPANTS: Patients with unilateral hip OA (N=45) were randomly allocated to a DN group, sham DN group, or control group. INTERVENTIONS: Patients in the DN and sham groups received 3 treatment sessions. Three active myofascial trigger points (MTrPs) were treated in each session with DN or a sham needle procedure. The treatment was applied in active MTrPs of the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus minimus muscles. MAIN OUTCOME MEASURES: Physical function was assessed with the Western Ontario and McMaster Universities (WOMAC) physical function subscale, the timed Up and Go test, and the 40-meter self-paced walk test. Intensity of hip pain related to physical function was evaluated using the visual analog scale and WOMAC pain subscale. The maximal isometric force of hip muscles was recorded with a handheld dynamometer. RESULTS: Significant group by time interactions were shown for physical function, pain, and hip muscle force variables. Post hoc tests revealed a significant reduction in hip pain and significant improvements in physical function and hip muscle strength in the DN group compared with the sham and control groups. The DN group showed within- and between-groups large effect sizes (d>0.8). CONCLUSIONS: DN therapy in active MTrPs of the hip muscles reduced pain and improved hip muscle strength and physical function in patients with hip OA. DN in active MTrPs of the hip muscles should be considered for the management of hip OA.


Assuntos
Agulhamento Seco/métodos , Força Muscular/fisiologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/terapia , Manejo da Dor/métodos , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Teste de Caminhada
7.
Knee ; 29: 78-85, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33582594

RESUMO

OBJECTIVES: Physical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA. METHODS: Cross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. RESULTS: 49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 ± 7.25 and 21.19 ± 6.16, 14 ± 6.4 and 15 ± 5.0, and 66 ± 10.5 and 68 ± 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (ß 0.028; 95%CI:0.007-0.048, ß0.041; 95%CI:0.010-0.071). Also, better general QoL was associated with the %PA (ß 0.040, 95%CI:0.007-0.073). No other associations were found. CONCLUSION: Whereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA.


Assuntos
Artralgia/fisiopatologia , Exercício Físico/fisiologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Qualidade de Vida , Acelerometria/instrumentação , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Medição da Dor , Caminhada/fisiologia
8.
JAMA Netw Open ; 4(2): e210254, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33635329

RESUMO

Importance: Preoperative and postoperative exercise interventions are commonly used in patients with total hip arthroplasty despite a lack of established efficacy. Objective: To explore clinical outcomes associated with exercise training before and after hip arthroplasty. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Google Scholar were searched from their inception to March 2020. Reference lists of included trials and related reviews were also searched. Study Selection: Randomized clinical trials of land-based exercise interventions before or after total hip arthroplasty were included. Data Extraction and Synthesis: This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was independently performed in duplicate. Random-effects meta-analyses with restricted maximum likelihood were performed for pooling the data. Main Outcomes and Measures: The primary prespecified outcome was self-reported physical function. Secondary prespecified outcomes were self-reported pain intensity, quality of life, gait speed, lower body muscle strength, lower body flexibility, anxiety, hospital length of stay, and adverse events. Results: A total of 32 randomized clinical trials with 1753 patients were included in the qualitative synthesis, and 26 studies with 1004 patients were included in the meta-analysis. Compared with usual care or no or minimal intervention, postoperative exercise training was not associated with improved self-reported physical function, with a moderate level of certainty, at 4 weeks (standardized mean difference [SMD], 0.01; 95% CI, -0.18 to 0.20), 12 weeks (SMD, -0.08; 95% CI, -0.23 to 0.07) and 26 weeks (SMD, -0.04; 95% CI, -0.31 to 0.24) postoperatively, and low level of certainty at 1 year after surgical treatment (SMD, 0.01; 95% CI, -0.09 to 0.12). For preoperative exercise interventions, there was no association of exercised training with self-reported physical function compared with the control at the 12-week (SMD, -0.14; 95% CI, -0.61 to 0.32) or 1-year follow-ups (SMD, 0.01; 95% CI, -0.37 to 0.40) with very low certainty, and no association with length of stay (mean difference, -0.21; 95% CI, -0.74 to 0.31) at moderate certainty. Results for postoperative hip muscle strength were rated at very low certainty, with no statistical significance. Meta-analysis could not be performed for other outcomes. Conclusions and Relevance: This systematic review and meta-analysis found low- to moderate-quality evidence that postoperative exercise interventions were not associated with improved self-reported physical function compared with usual care or no or minimal intervention. Furthermore, there was very low-quality evidence that preoperative exercise programs were not associated with higher self-reported physical function and hospital length of stay compared with usual care or no or minimal intervention.


Assuntos
Artroplastia de Quadril/reabilitação , Terapia por Exercício/métodos , Osteoartrite do Quadril/cirurgia , Exercício Pré-Operatório , Ansiedade/psicologia , Humanos , Tempo de Internação , Força Muscular , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Dor , Desempenho Físico Funcional , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Amplitude de Movimento Articular , Velocidade de Caminhada
9.
JAMA ; 325(6): 568-578, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560326

RESUMO

Importance: Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA. Observations: Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing. Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury. Persons with OA have more comorbidities and are more sedentary than those without OA. The reduced physical activity leads to a 20% higher age-adjusted mortality. Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. Radiographic indicators include marginal osteophytes and joint space narrowing. The cornerstones of OA management include exercises, weight loss if appropriate, and education-complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications. Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. Opiates should be avoided. Clinical trials have shown promising results for compounds that arrest structural progression (eg, cathepsin K inhibitors, Wnt inhibitors, anabolic growth factors) or reduce OA pain (eg, nerve growth factor inhibitors). Persons with advanced symptoms and structural damage are candidates for total joint replacement. Racial and ethnic disparities persist in the use and outcomes of joint replacement. Conclusions and Relevance: Hip and knee OA are highly prevalent and disabling. Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Corticosteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia de Substituição , Progressão da Doença , Exercício Físico , Prótese de Quadril , Humanos , Injeções Intra-Articulares , Prótese do Joelho , Imageamento por Ressonância Magnética , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , Perda de Peso
10.
Gait Posture ; 85: 151-156, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33578307

RESUMO

BACKGROUND: Osteoarthritis (OA) can hinder physical activity in older adults for reasons that are not fully understood. Functional barriers may exist such as reduced muscle strength around the affected joint, potentially affecting physical activity. Aging-associated declines in energy capacity may also be exacerbated by OA. These factors may work together to influence physical activity in people with OA. RESEARCH QUESTION: Our objective was to evaluate the combined role of walking energetics and hip abductor strength on physical activity in older women with hip OA. METHODS: We evaluated 30 women with moderately symptomatic hip OA (61 ± 10 yrs; 30.7 ± 4.9 kg/m2) in this cross-sectional observational study. We measured physical activity using the UCLA activity score and quantified activity frequency and intensity using accelerometers worn for seven days (7 ± 2 days). We used a portable oxygen exchange system to measure energy used during walking at preferred speeds (relative to total energy capacity assessed using a six-minute walk test) and a dynamometer to measure hip abductor strength. We used Pearson correlations and regression analysis to test our hypotheses. RESULTS: Greater energy used during walking was associated with lower self-reported physical activity (R=-0.626, p < 0.001), more sedentary time (R = 0.567, p = 0.002), and less light activity time (R=-0.644, p < 0.001). Lower hip abductor strength was associated with lower self-reported physical activity (R = 0.406, p = 0.039). While there was no association between hip abductor strength and energy used during walking, together these variables predicted 55.5 % of the variance in self-reported physical activity. SIGNIFICANCE: Results suggest intervention targets to promote physical activity in this population.


Assuntos
Metabolismo Energético/fisiologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Comportamento Sedentário , Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Quadril/fisiopatologia , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Osteoartrite do Quadril/psicologia , Estudos Prospectivos , Caminhada/psicologia
11.
Rheumatology (Oxford) ; 60(7): 3352-3359, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33452525

RESUMO

OBJECTIVE: To describe the impact of OA on health-related quality of life (HRQoL) in the forms of health state utilities (HSUs) and health-dimension scores, and to compare the longitudinal changes in HRQoL for people with and without OA, using an Australian population-based longitudinal cohort. METHODS: Participants of the Tasmanian Older Adult Cohort with data on OA diagnosis and HRQoL were included [interviewed at baseline (n = 1093), 2.5 years (n = 871), 5 years (n = 760) and 10 years (n = 562)]. HRQoL was assessed using the Assessment of Quality of Life four-dimensions and analysed using multivariable linear mixed regressions. RESULTS: Compared with participants without OA, HSUs for those with OA were 0.07 (95% confidence interval: 0.09, 0.05) units lower on average over 10 years. HSUs for participants with knee and/or hip OA were similar to those with other types of OA at the 2.5 year follow-up and then diverged, with HSUs of the former being up to 0.09 units lower than the latter. Those with OA had lower scores for psychological wellness, independent living and social relationships compared with those without OA. Independent living and social relationships were mainly impacted by knee and/or hip OA, with the effect on the former increasing over time. CONCLUSION: Interventions to improve HRQoL should be tailored to specific OA types, health dimensions, and times. Support for maintaining psychological wellness should be provided, irrespective of OA type and duration. However, support for maintaining independent living could be more relevant to knee and/or hip OA patients living with the disease for longer.


Assuntos
Vida Independente , Relações Interpessoais , Saúde Mental , Osteoartrite/fisiopatologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite/psicologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Fatores de Tempo
12.
Acta Orthop ; 92(3): 274-279, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33410360

RESUMO

Background and purpose - Several surgical approaches are used in primary total hip arthroplasty (THA). In this randomized controlled trial we compared gait, risk of fall, self-reported and clinical measurements between subjects after direct superior approach (DSA) versus posterolateral approach (PL) for THA.Patients and methods - Participants with DSA (n = 22; age 74 [SD 8.9]) and PL (n = 23; age 72 [7.7]) underwent gait analysis, risk of fall assessment and Timed Up and Go Test (TUG) before (PRE), 1 month (T1) and 3 months after (T3) surgery. Data on bleeding and surgical time was collected.Results - DSA resulted in longer surgical times (90 [14] vs. 77 [20] min) but lower blood loss (149 [66] vs. 225 [125] mL) than PL. DSA had lower risk of fall at T3 compared with T1 and higher TUG scores at T3 compared with T1 and PRE. PL improved balance at T3 compared with T1 and PRE. Spatiotemporal gait parameters improved over time for both DSA and PL with no inter-group differences, whereas DSA, regarding hip rotation range of motion, showed lower values at T3 and T1 compared with PRE and, furthermore, this group had lower values at T1 and T3 compared with PL. All foregoing comparisons are statistically signficant (p < 0.05)Interpretation - DSA showed longer surgical time and lower blood loss compared with PL and early improvements in TUG, spatiotemporal, and kinematic gait parameters, highlighting rapid muscle strength recovery.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Artroplastia de Quadril/métodos , Marcha/fisiologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteoartrite do Quadril/complicações , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Autorrelato , Fatores de Tempo , Resultado do Tratamento
13.
Orthopedics ; 44(2): 111-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33416895

RESUMO

Osteoarthritis of the hip and knee is known to affect sexual activity. For patients with osteoarthritis, pain during sexual activity can lead to decreased quality of life and other associated health issues. The authors designed a prospective study to evaluate the effect of total hip arthroplasty and total knee arthroplasty on the psychosocial and physical aspects of sexuality pre- and postoperatively. Between April 2009 and December 2011, patients received questionnaires in the mail preoperatively. They were asked to return the preoperative questionnaire before surgery and the postoperative questionnaire 6 months after surgery. Data were analyzed to evaluate the psychosocial and physical aspects of sexuality and participants' subjective assessment of their appearance. Preoperatively, 91% and 67% of patients reported psychosocial and physical issues, respectively. After the arthroplasty procedure, 84% (P<.001) and 47% (P<.001) of patients reported improvement psychosocially and physically, respectively. Of the patients, 16% reported that arthroplasty adversely affected sexual function, with their predominant fear being joint damage (63%). A greater number of women and patients undergoing hip procedures reported improvement in sexual activity after surgery compared with men (P=.02) and patients undergoing knee procedures (P=.002). Both hip and knee osteoarthritis and arthroplasty had a significant effect on overall sexual function-psychosocially, physically, and in terms of patients' assessment of their external appearance-with higher rates of improvement seen after hip arthroplasty. Because of the effect of osteoarthritis and arthroplasty on sexual function, this topic should be addressed both pre- and postoperatively. [Orthopedics. 2021;44(2):111-116.].


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Recuperação de Função Fisiológica , Comportamento Sexual/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
14.
J Orthop Surg Res ; 16(1): 46, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430904

RESUMO

BACKGROUND: Most of the studies assessing the corrective posterior total hip arthroplasty (THA) mainly focused on the mini-incision approach. Studies exploring the short external rotator sparing approach are rare. Therefore, this study aimed to compare the effectiveness of standard posterior approach and short external rotator sparing approach. METHODS: This prospective observational study included 126 patients who underwent THA in June 2017-June 2018. Patients were assigned to standard (standard posterior approach) and corrective (short external rotator sparing approach) groups based on the surgical method. Surgical data were recorded postoperatively. Postoperative hip joint recovery was assessed using the times to ambulation and independent stair use, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris score, and Oxford hip score (OHS) at 2 and 8 postoperative weeks. The visual analog scale (VAS) was used for postoperative pain assessment. RESULTS: Postoperative changes of creatine kinase (CK), myoglobin, CRP, and prosthesis position were similar in both groups (P > 0.05). However, intraoperative blood loss (P < 0.001) and postoperative 6-h drainage volume (P = 0.03), hospital stay, blood transfusion rate, and times to ambulation and independent stair use were significantly reduced in the corrective group. Postoperatively, Oxford, and WOMAC scores significantly decreased in both groups. After surgery, the VAS score was more overtly decreased in the corrective group compared with the standard group. CONCLUSIONS: This study concluded that the less invasive short external rotator sparing approach for THA caused less damage, reducing perioperative blood loss, shortening functional recovery time, maintaining prosthesis stability, and improving postoperative pain.


Assuntos
Artroplastia de Quadril/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tratamentos com Preservação do Órgão/métodos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento
15.
Physiother Theory Pract ; 37(4): 486-496, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31257979

RESUMO

Background: Patients' access to movement experiences is implemented in the evaluation tool Body Awareness Rating Scale - Movement Quality and Experience, with its two intertwined parts: 1) the physiotherapist's observations of movement quality; and 2) the patient's descriptions of immediate movement experiences.Objective: To study movement experiences and reflections described by patients diagnosed with hip osteoarthritis when guided to explore simple daily-life movements in this particular evaluation context.Design: An explorative qualitative study with open-ended questions following each of the 12 movements integrated into the evaluation.Methods: 35 participants diagnosed with hip osteoarthritis were included; 28 women and 7 men, aged 23-78 years. Their descriptions were audiotaped, transcribed verbatim and analyzed in accordance with qualitative content analysis.Results: The patients described experiences of a dynamic adaptation of movement strategies based on sensations from the moving body. Two interrelated categories of movement awareness were identified: 1) Experienced movement challenges, including three sub-categories; a) Lack of contact, b) Movement changed by symptoms, and c) Compensational movement habits, and 2) Movement components promoting well-being, including three sub-categories; a) Integrating balance, breathing and awareness into movement, b) Small, simple, soft and safe movements, and c) A taste of own movement resources for daily life.Conclusions: The Body Awareness Rating Scale - Movement Quality and Experience provides a platform for patients to become aware of and describe their movement habits and resources in own words, intertwined with the physiotherapist movement observations. Derived descriptions reflect a patient perspective to be implemented in therapy.


Assuntos
Conscientização/fisiologia , Movimento/fisiologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
16.
Sci Rep ; 10(1): 20892, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33262447

RESUMO

This study designed to evaluate the effect of nutraceutical supplementation on pain intensity and physical function in patients with knee/hip OA. The MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, Google Scholar, Science direct, and ProQuest in addition to SID, Magiran, and Iranmedex were searched up to March 2020. Records (n = 465) were screened via the PICOS criteria: participants were patients with hip or knee OA; intervention was different nutritional supplements; comparator was any comparator; the outcome was pain intensity (Visual analogue scale [VAS]) and physical function (Western Ontario and McMaster Universities Arthritis [WOMAC] index); study type was randomized controlled trials. The random effects model was used to pool the calculated effect sizes. The standardized mean difference (SMD) of the outcome changes was considered as the effect size. The random effects model was used to combine the effect sizes. Heterogeneity between studies was assessed by Cochran's (Q) and I2 statistics. A total of 42 RCTs were involved in the meta-analysis. Nutritional supplementation were found to improve total WOMAC index (SMD = - 0.23, 95% CI - 0.37 to - 0.08), WOMAC pain (SMD = - 0.36, 95% CI - 0.62 to - 0.10) and WOMAC stiffness (SMD = - 0.47, 95% CI - 0.71 to - 0.23) subscales and VAS (SMD = - 0.79, 95% CI - 1.05 to - 0.05). Results of subgroup analysis according to the supplementation duration showed that the pooled effect size in studies with < 10 months, 10-20 months and > 20 months supplementation duration were 0.05, 0.27, and 0.36, respectively for WOMAC total score, 0.14, 0.55 and 0.05, respectively for WOAMC pain subscale, 0.59, 0.47 and 0.41, respectively for WOMAC stiffness subscale, 0.05, 0.57 and 0.53, respectively for WOMAC physical function subscale and 0.65, 0.99 and 0.12, respectively for VAS pain. The result suggested that nutraceutical supplementation of patients with knee/hip OA may lead to an improvement in pain intensity and physical function.


Assuntos
Suplementos Nutricionais , Pessoas com Deficiência , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Feminino , Humanos , Masculino , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Escala Visual Analógica
17.
J Bone Joint Surg Am ; 102(Suppl 2): 3-7, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-32947596

RESUMO

Prearthritic hip disease is challenging to define, diagnose, and treat. The mechanically abnormal hip, which has not yet suffered irreversible damage but will do so if its abnormal mechanics are not corrected, can be considered to be in a prearthritic stage. A conundrum regarding the treatment of many patients with a variety of hip diseases involving a hip at mechanical risk is that the best opportunity for preventing progressive osteoarthritis lies in the period before symptoms are severe enough to demand treatment solely on that basis. It is difficult to institute treatment for a minimally symptomatic but at-risk hip because of the multitude of variables that affect symptoms and hip longevity. Input from an established team of multiple hip experts with varying areas of expertise is ideal. Shared decision-making is highly effective in this prearthritic situation of high patient sensitivity. The cornerstone of treatment of the prearthritic hip is the correction of the problematic mechanical abnormality. As methods of analysis and treatment methods evolve and as long-term outcomes of treatments become understood, the role of intervention during the prearthritic stage of hip disease is likely to increase.


Assuntos
Osteoartrite do Quadril/diagnóstico , Quadril/patologia , Quadril/fisiopatologia , Quadril/cirurgia , Humanos , Osteoartrite do Quadril/patologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Sintomas Prodrômicos
18.
Adv Ther ; 37(9): 3985-3999, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32729010

RESUMO

INTRODUCTION: To evaluate, from the patient's perspective, the burden of pain associated with hip/knee osteoarthritis (OA) in the USA and selected European Union (EU) countries. METHODS: Data were drawn from the 2017 global Adelphi OA Disease Specific Programme™ (DSP). Patients with hip/knee OA were stratified based on pain intensity and the presence/absence of current opioid use. Outcomes included Western Ontario and McMaster Universities Osteoarthritis Index scores, functional limitations, unmet treatment needs, Charlson Comorbidity Index, relevant comorbid conditions, the 5-dimension 5-level EuroQol, and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem. Bivariate testing compared outcomes using patients with no/mild pain without opioid use as the reference group. RESULTS: The study population comprised 2170 patients (US: n = 623 [28.7%]; EU: n = 1547 [71.3%]) with knee (54.9%), hip (24.6%), or knee/hip (20.5%) OA. Mean (SD) age was 66.4 (11.2) years. Patients had no/mild pain without opioid use (39.6%), no/mild pain with opioid use (10.2%), moderate/severe pain without opioid use (30.6%), and moderate/severe pain with opioid use (19.7%). Compared with the reference group, patients with moderate/severe pain reported significantly (p < 0.05) higher functional limitations, greater use of ≥ 3 treatments and treatment dissatisfaction, reduced quality of life, and impaired work productivity and activity. The burden was highest with moderate/severe pain with opioid use. Results were generally similar in the US and EU cohorts. CONCLUSIONS: The results from this multinational cross-sectional study indicate that the impact of OA pain is multidimensional, worsened by increasing pain intensity, and may not be adequately addressed by current treatment strategies.


Assuntos
Analgésicos Opioides/uso terapêutico , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Dor/psicologia , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso , Estudos Transversais , União Europeia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Estados Unidos/epidemiologia
19.
Gait Posture ; 80: 339-346, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32603886

RESUMO

BACKGROUND: Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks. RESEARCH QUESTION: Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults? METHODS: Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks. RESULTS: Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task. SIGNIFICANCE: For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation.


Assuntos
Nádegas/fisiologia , Músculo Esquelético/fisiologia , Osteoartrite do Quadril/fisiopatologia , Coxa da Perna/fisiologia , Adulto , Estudos de Casos e Controles , Eletromiografia , Feminino , Marcha , Articulação do Quadril/fisiologia , Humanos , Masculino
20.
Knee Surg Sports Traumatol Arthrosc ; 28(8): 2435-2443, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32556438

RESUMO

PURPOSE: The purpose of this study was to evaluate pain, functional impairment, mental health, and daily activity in patients with end-stage hip and knee osteoarthritis (OA) during the COVID-19 lockdown. METHODS: The study included 63 patients, with hip or knee OA, who had been scheduled for arthroplasty that was postponed because of COVID-19. Patients were evaluated by telephone interviews during the first week after lockdown, in the fourth week, and again at the end of the lockdown. Patients rated their pain level on the basis of a visual analog scale (VAS) and completed WOMAC, SF-12 and Tegner activity scale (TAS) questionnaires. RESULTS: VAS and WOMAC scores increased significantly during lockdown, while physical activity significantly decreased. At the final evaluation, VAS and WOMAC showed a significant negative correlation with TAS. The SF-12 subscale scores showed a significant decrease of the physical component during the lockdown, while the mental component remained largely unchanged. Patients with knee OA showed a faster progress of pain compared to those with hip OA. 50 patients (79%) stated they wished to have arthroplasty as soon as possible. CONCLUSION: The COVID-19 lockdown had a significant impact on pain, joint function, physical function, and physical activity in patients with end-stage hip and knee OA. LEVEL OF EVIDENCE: II (Prospective cohort study).


Assuntos
Artralgia/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Atividade Motora/fisiologia , Osteoartrite do Quadril/cirurgia , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/fisiopatologia , Áustria/epidemiologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/fisiopatologia , Medição da Dor , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , SARS-CoV-2 , Inquéritos e Questionários , Escala Visual Analógica
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