RESUMEN
BACKGROUND: The aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over 1 to 2 years in people with painful medial knee osteoarthritis. METHODS: A longitudinal study was conducted within a randomised controlled trial, the "Long-term Evaluation of Glucosamine Sulfate" (LEGS study). Recruitment occurred in 2007-2009, with 1- and 2-year follow-up assessments by blinded assessors. Community-dwelling people with chronic knee pain (≥4/10) and medial tibiofemoral narrowing (but retaining >2mm medial joint space width) on radiographs were recruited. From 605 participants, follow-up data were available for 498 (82%, mean [sd] age 60 [8] years). Risk factors evaluated at baseline were pain, physical function, use of non-steroidal anti-inflammatory drugs (NSAIDs), statin use, not meeting physical activity guidelines, presence of Heberden's nodes, history of knee surgery/trauma, and manual occupation. Multivariable logistic regression analysis was conducted adjusting for age, sex, obesity, high blood pressure, allocation to glucosamine and chondroitin treatment, and baseline structural disease severity (Kellgren and Lawrence grade, joint space width, and varus alignment). Radiographic osteoarthritis progression was defined as joint space narrowing ≥0.5mm over 1 to 2 years (latest follow-up used where available). RESULTS: Radiographic osteoarthritis progression occurred in 58 participants (12%). Clinical factors independently associated with radiographic progression were the use of NSAIDs, adjusted odds ratios (OR) and 95% confidence intervals (CI) 2.05 (95% CI 1.1 to 3.8), and not meeting physical activity guidelines, OR 2.07 (95% CI 0.9 to 4.7). CONCLUSIONS: Among people with mild radiographic knee osteoarthritis, people who use NSAIDs and/or do not meet physical activity guidelines have a greater risk of radiographic osteoarthritis progression. TRIAL REGISTRATION: ClinicalTrials.gov , NCT00513422 . This original study trial was registered a priori, on August 8, 2007. The current study hypothesis arose before inspection of the data.
Asunto(s)
Articulación de la Rodilla , Osteoartritis de la Rodilla , Progresión de la Enfermedad , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Dolor , Factores de RiesgoRESUMEN
Atypical femur fractures (AFF) are a rare but serious complication of long-term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver-operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).
Asunto(s)
Conservadores de la Densidad Ósea , Fracturas del Fémur , Fracturas de Cadera , Anciano de 80 o más Años , Difosfonatos/efectos adversos , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fémur/diagnóstico por imagen , Humanos , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study aims to evaluate the prevalence and determinants of inadequate physical activity and excessive sedentary behaviour before and after total knee replacement. DESIGN, SETTING AND SUBJECTS: Secondary analysis was performed on data from a cohort of 422 adults (45-74 years), drawn from 12 public or private hospitals, undergoing primary unilateral or bilateral total knee replacement surgery. MAIN MEASURES: Questionnaires were used to determine the presence of inadequate physical activity and excessive sedentary behaviour before and 6 and 12 months after total knee replacement surgery. Knee pain, activity limitations, comorbidities, muscle strength, psychological well-being, fatigue, sleep and body mass index were measured/assessed as possible determinants of physical activity or sedentary behaviour. RESULTS: Before surgery, 77% ( n = 326) of the cohort participated in inadequate physical activity according to World Health Organization guidelines, and 60% ( n = 253) engaged in excessive sedentary behaviour. Twelve months after surgery, 53% ( n = 185) of the cohort engaged in inadequate physical activity and 45% ( n = 157) in excessive sedentary behaviour. Inadequate physical activity before surgery ( P = 0.02), obesity ( P = 0.07) and comorbidity score >6 ( P = 0.04) predicted inadequate physical activity 12 months after surgery. Excessive sedentary behaviour and activity limitations before surgery predicted excessive sedentary behaviour 12 months after surgery. CONCLUSION: Although there were improvements after total knee replacement, 12 months after surgery about half the cohort did not meet World Health Organization recommendations for activity. Pre-surgery assessment of physical activity, activity limitations, sedentary behaviour and body mass index is essential to identify patients at risk for long-term inactivity.
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Artroplastia de Reemplazo de Rodilla , Ejercicio Físico , Conducta Sedentaria , Anciano , Australia/epidemiología , Índice de Masa Corporal , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , PrevalenciaRESUMEN
OBJECTIVE: To evaluate the long-term benefit of providing a post-acute, outpatient group exercise program for patients following primary total knee replacement (TKR) surgery for osteoarthritis. METHODS: A multicenter randomized clinical trial was conducted in 12 Australian public and private hospital centers. A total of 422 participants, ages 45-75 years, were randomly allocated prior to hospital discharge to the post-acute group exercise program or to usual care and were assessed at 6 weeks, 6 months, and 12 months after surgery. The main outcomes were operated knee pain and activity limitations at 12 months using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Secondary outcomes included health-related quality of life (Short Form 12 health survey), knee extension and flexion strength, stair-climb power, 50-foot walk speed, and active knee range of motion. RESULTS: While both allocation groups achieved significant improvements in knee pain and activity limitations over the 12-month followup period, there were no significant differences in these main outcomes, or in the secondary physical performance measures, between the 2 treatment allocations. Twelve months after TKR, 69% and 72% of participants allocated to post-acute exercise and usual acute care, respectively, were considered to be treatment-responders. While population normative values for self-report measures of pain, activity limitation, and health-related quality of life were attained 12 months after TKR, marked deficits in physical performance measures remained. CONCLUSION: Providing access to a post-acute group exercise program did not result in greater reductions in long-term knee pain or activity limitations than usual care. Patients undergoing primary TKR retain marked physical performance deficits 12 months after surgery.
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Artroplastia de Reemplazo de Rodilla/rehabilitación , Terapia por Ejercicio/métodos , Osteoartritis de la Rodilla/cirugía , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Rango del Movimiento Articular , Recuperación de la Función , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the prevalence and determinants of clinically important fatigue before and up to 12 months after total knee replacement (TKR) surgery. METHODS: This study was a secondary analysis of a prospective cohort study conducted among 422 patients (ages 45-74 years) undergoing primary TKR for osteoarthritis (OA) who participated in the Maximum Recovery After Knee Replacement randomized clinical trial. Assessments were carried out before, and at 6 weeks, 6 months, and 12 months after surgery. Self-reported fatigue was assessed on a 10-cm visual analog scale. Patients also completed a number of questionnaires evaluating knee pain, activity limitations, psychological well-being, comorbidity, and physical activity. Linear regression analyses were conducted to explore 6- and 12-month cross-sectional and longitudinal associations with self-reported fatigue. RESULTS: Clinically important fatigue (≥6.7 of 10) was reported by 145 patients (34%) before surgery, decreasing to 14%, 12%, and 8% at 6 weeks, 6 months, and 12 months after surgery, respectively. In multivariate analyses, muscle strength was strongly associated with fatigue at 6 months, and knee pain, activity limitations, number of comorbidities, and lack of energy were strongly associated with fatigue at both 6 and 12 months after TKR surgery. Female sex, number of comorbidities, depression, and fatigue were all early predictors of fatigue 12 months after TKR. CONCLUSION: Among patients undergoing TKR for OA, clinically important fatigue is considerably prevalent both before and for at least 6 months after surgery. Identifying and addressing early predictors of ongoing fatigue has the potential to improve the quality of life following TKR surgery.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Fatiga/epidemiología , Fatiga/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Estudios Transversales , Autoevaluación Diagnóstica , Femenino , Humanos , Articulación de la Rodilla/cirugía , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Periodo Posoperatorio , Periodo Preoperatorio , Prevalencia , Estudios Prospectivos , Análisis de Regresión , Factores de Riesgo , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
OBJECTIVE: To determine the prevalence and burden of pain and activity limitations associated with retaining presurgery self-reported knee instability 6 months after total knee replacement (TKR) surgery and to identify early potentially modifiable risk factors for retaining knee instability in the operated knee after TKR surgery. METHODS: A secondary analysis was performed using measures obtained from 390 participants undergoing primary unilateral TKR and participating in a randomized clinical trial. Self-reported knee instability was measured using 2 items from the Activities of Daily Living Scale of the Knee Outcome Survey. Outcome measures were knee pain (range 0-20) and physical function (range 0-68) on the Western Ontario and McMaster Universities Arthritis Index (WOMAC), stair-climb power, 50-foot walk time, knee range of motion, and isometric knee flexion and extension strength. RESULTS: In this study, 72% of participants reported knee instability just prior to surgery, with 32% retaining instability in the operated knee 6 months after surgery. Participants retaining operated knee instability had significantly more knee pain and activity limitations 6 months after surgery, with mean ± SD WOMAC scores of 4.8 ± 3.7 and 17.5 ± 11.1, respectively, compared to participants without knee instability, with 2.9 ± 3.1 and 9.8 ± 9.2. The multivariable predictor model for retained knee instability included a high comorbidity score (>6), low stair-climb power (<150 watts), more pain in the operated knee (>7 of 20), and younger age (<60 years). CONCLUSION: Self-reported knee instability is highly prevalent before and after TKR surgery and is associated with a considerable burden of pain and activity limitation in the operated knee. Increasing lower extremity muscle power may reduce the risk of retaining knee instability after TKR surgery.
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Artroplastia de Reemplazo de Rodilla , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Autoinforme , Actividades Cotidianas , Anciano , Artralgia/diagnóstico , Artralgia/epidemiología , Artrometría Articular , Artroplastia de Reemplazo de Rodilla/efectos adversos , Australia/epidemiología , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Evaluación de la Discapacidad , Tolerancia al Ejercicio , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/epidemiología , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/epidemiología , Prevalencia , Estudios Prospectivos , Rango del Movimiento Articular , Recuperación de la Función , Factores de Riesgo , Autoeficacia , Factores de Tiempo , Resultado del Tratamiento , CaminataRESUMEN
OBJECTIVE: To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. METHODS: We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. RESULTS: At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. CONCLUSION: The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR.
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Atención Ambulatoria , Artroplastia de Reemplazo de Rodilla/rehabilitación , Terapia por Ejercicio/métodos , Servicios de Atención de Salud a Domicilio , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento ArticularRESUMEN
OBJECTIVE: To determine if the dietary supplements, glucosamine and/or chondroitin, result in reduced joint space narrowing (JSN) and pain among people with symptomatic knee osteoarthritis. METHODS: A double-blind randomised placebo-controlled clinical trial with 2-year follow-up. 605 participants, aged 45-75â years, reporting chronic knee pain and with evidence of medial tibio-femoral compartment narrowing (but retaining >2â mm medial joint space width) were randomised to once daily: glucosamine sulfate 1500â mg (n=152), chondroitin sulfate 800â mg (n=151), both dietary supplements (n=151) or matching placebo capsules (n=151). JSN (mm) over 2â years was measured from digitised knee radiographs. Maximum knee pain (0-10) was self-reported in a participant diary for 7â days every 2â months over 1â year. RESULTS: After adjusting for factors associated with structural disease progression (gender, body mass index (BMI), baseline structural disease severity and Heberden's nodes), allocation to the dietary supplement combination (glucosamine-chondroitin) resulted in a statistically significant (p=0.046) reduction of 2-year JSN compared to placebo: mean difference 0.10â mm (95% CI 0.002â mm to 0.20â mm); no significant structural effect for the single treatment allocations was detected. All four allocation groups demonstrated reduced knee pain over the first year, but no significant between-group differences (p=0.93) were detected. 34 (6%) participants reported possibly-related adverse medical events over the 2-year follow-up period. CONCLUSIONS: Allocation to the glucosamine-chondroitin combination resulted in a statistically significant reduction in JSN at 2â years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo. TRIAL REGISTRATION CLINICALTRIALSGOV IDENTIFIER: NCT00513422; http://www.clinicaltrials.gov.
Asunto(s)
Sulfatos de Condroitina/uso terapéutico , Suplementos Dietéticos , Glucosamina/uso terapéutico , Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/tratamiento farmacológico , Anciano , Progresión de la Enfermedad , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Radiografía , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine whether Tai Chi or hydrotherapy classes for individuals with chronic symptomatic hip or knee osteoarthritis (OA) result in measurable clinical benefits. METHODS: A randomized controlled trial was conducted among 152 older persons with chronic symptomatic hip or knee OA. Participants were randomly allocated for 12 weeks to hydrotherapy classes (n = 55), Tai Chi classes (n = 56), or a waiting list control group (n = 41). Outcomes were assessed 12 and 24 weeks after randomization and included pain and physical function (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (Medical Outcomes Study Short Form 12 Health Survey [SF-12], version 2), psychological well-being, and physical performance (Up and Go test, 50-foot walk time, timed stair climb). RESULTS: At 12 weeks, compared with controls, participants allocated to hydrotherapy classes demonstrated mean improvements (95% confidence interval) of 6.5 (0.4, 12.7) and 10.5 (3.6, 14.5) for pain and physical function scores (range 0-100), respectively, whereas participants allocated to Tai Chi classes demonstrated improvements of 5.2 (-0.8, 11.1) and 9.7 (2.8, 16.7), respectively. Both class allocations achieved significant improvements in the SF-12 physical component summary score, but only allocation to hydrotherapy achieved significant improvements in the physical performance measures. All significant improvements were sustained at 24 weeks. In this almost exclusively white sample, class attendance was higher for hydrotherapy, with 81% attending at least half of the available 24 classes, compared with 61% for Tai Chi. CONCLUSION: Access to either hydrotherapy or Tai Chi classes can provide large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA.