المؤلفون: Mass, Hanna¹ (AUTHOR), Katz, Jeffrey N.^1,2,3,4 (AUTHOR) jnkatz@bwh.harvard.edu

المصدر: Skeletal Radiology. Nov2023, Vol. 52 Issue 11, p2045-2055. 11p.

مصطلحات موضوعية: *OSTEOARTHRITIS, *KNEE osteoarthritis, *KNEE pain, *MENISCUS injuries, *PATHOLOGY, *OLDER people, *AGE groups

مستخلص: Importance: Knee osteoarthritis (OA) is a common cause of pain and disability in older persons, affecting approximately 14 million individuals in the USA. Meniscal damage is also common in this age group with a prevalence of 35% in a middle-aged and older community sample and 82% in persons with evidence of radiographic knee osteoarthritis. This paper systematically reviews evidence on the association of meniscal pathology and incident radiographic knee OA. Observations: We included 15 articles, published between 2013 and 2021, assessing the relationship between meniscal pathology and OA incidence (Fig. 1). The menisci are crucial load-bearing structures, and the resulting increase in biomechanical stress due to meniscal damage increases the risk for OA development. While some discrepancies are present in the literature, a clinically meaningful association has been generally established between the presence of a meniscal tear or meniscal extrusion and subsequent development of incident OA. Of note, larger radial tears as well as complex and more severe tears exhibit the strongest association with the development of incident OA. The relationship between other features of meniscal morphology—such as meniscal volume and meniscal coverage—and incident OA is less clearly documented. Conclusions and relevance: The early detection of meniscal pathology can be used to trigger preventative and therapeutic strategies designed to avert or delay knee OA in this at-risk population. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.^1,2 jnkatz@bwh.harvard.edu, Betensky, Daniel¹

المصدر: Journal of Bone & Joint Surgery, American Volume. 2/7/2024, Vol. 106 Issue 3, p177-179. 3p.

المؤلفون: Bedard, Nicholas A.¹, Katz, Jeffrey N.^2,3,4,5, Losina, Elena^2,5,6, Opare-Addo, Maame B.², Kopp, Paul T.²

المصدر: Journal of Bone & Joint Surgery, American Volume. 2022Supplement, Vol. 104, p39-46. 8p.

مصطلحات موضوعية: *DATABASES, *ACQUISITION of data

مستخلص: Abstract: "Big data" refers to a growing field of large database research. Administrative data, a subset of big data, includes information from insurance claims, electronic medical records, and registries that can be useful for investigating novel research questions. While its use provides salient advantages, potential researchers relying on big data would benefit from knowing about how these databases are coded, common errors they may encounter, and how to best use large data to address various research questions. In the first section of this paper, Dr. Nicholas A. Bedard addresses the four major pitfalls to avoid with diagnosis and procedure codes in administrative data. In the next section, Dr. Jeffrey N. Katz et al. focus on the strengths and limitations of administrative data, suggesting methods to mitigate these limitations. Lastly, Dr. Elena Losina et al. review the uses and misuses of large databases for cost-effectiveness research, detailing methods for careful economic evaluations. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.^1,2,3,4 jnkatz@bwh.harvard.edu, Zimmerman, Zoe E.^1,2, Mass, Hanna^1,2, Makhni, Melvin C.^2,3

المصدر: JAMA: Journal of the American Medical Association. 5/3/2022, Vol. 327 Issue 17, p1688-1699. 12p.

مصطلحات موضوعية: *TREATMENT of backaches, *SPINAL stenosis treatment, *LUMBAR vertebrae surgery, *GLUCOCORTICOIDS, *LUMBAR pain, *SPINAL fusion, *SPINAL stenosis, *SURGICAL decompression, *BACKACHE, *TREATMENT effectiveness, *SPONDYLOLISTHESIS, *DISEASE complications

مستخلص: Importance: Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis.Observations: The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age. The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI). Nonoperative treatment includes activity modification such as reducing periods of standing or walking, oral medications to diminish pain such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse. Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. For example, in a randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis, decompressive laminectomy improved symptoms more than nonoperative therapy (difference, 7.8 points; 95% CI, 0.8-14.9; minimum clinically important difference, 10-12.8) on the Oswestry Disability Index (score range, 0-100). Among persons with lumbar spinal stenosis and concomitant spondylolisthesis, lumbar fusion increased symptom resolution in 1 trial (difference, 5.7 points; 95% CI, 0.1 to 11.3) on the 36-Item Short Form Health Survey physical dimension score (range, 0-100), but 2 other trials showed either no important differences between the 2 therapies or noninferiority of lumbar decompression alone compared with lumbar decompression plus spinal fusion (MCID, 2-4.9 points). In a noninferiority trial, 71.4% treated with lumbar decompression alone vs 72.9% of those receiving decompression plus fusion achieved a 30% or more reduction in Oswestry Disability Index score, consistent with the prespecified noninferiority hypothesis. Fusion is associated with greater risk of complications such as blood loss, infection, longer hospital stays, and higher costs. Thus, the precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear.Conclusions and Relevance: Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candidates for decompressive surgery. [ABSTRACT FROM AUTHOR]

المؤلفون: Reyes, Angel M.^1,2 (AUTHOR) areyes7@mgh.harvard.edu, Katz, Jeffrey N.^1,2,3,4,5 (AUTHOR), Schoenfeld, Andrew J.⁵ (AUTHOR), Kang, James D.⁵ (AUTHOR), Losina, Elena^1,2,3,5,6 (AUTHOR), Chang, Yuchiao^2,7 (AUTHOR)

المصدر: Spine Journal. May2021, Vol. 21 Issue 5, p785-794. 10p.

مصطلحات موضوعية: *SPINAL fusion, *SAFETY, *PREOPERATIVE risk factors, *ETHNICITY, *ETHNIC groups, *SURGICAL complications

مستخلص: Background Context: Degenerative lumbar conditions are prevalent, disabling, and frequently managed with decompression and fusion. Black patients have lower spinal fusion rates than White patients.Purpose: Determine whether specific lumbar fusion procedure utilization differs by race/ethnicity and whether length of stay (LOS) or inpatient complications differ by race/ethnicity after accounting for procedure performed.Study Design: Large database retrospective cohort study PATIENT SAMPLE: Lumbar fusion recipients at least age 50 in the 2016 National Inpatient Sample with diagnoses of degenerative lumbar conditions.Outcome Measures: Type of fusion procedure used and inpatient safety measures including LOS, prolonged LOS, inpatient medical and surgical complications, mortality, and cost.Methods: We examined the association between race/ethnicity and the safety measures above. Covariates included several patient and hospital factors. We used multiple linear or logistic regression to determine the association between race and fusion type (PLF, P/TLIF, ALIF, PLF + P/TLIF, and PLF + ALIF [anterior-posterior fusion]) and to determine whether race was associated independently with inpatient safety measures, after adjustment for patient and hospital factors.Results: Fusion method use did not differ among racial/ethnic groups, except for somewhat lower anterior-posterior fusion utilization in Black patients compared to White patients (crude odds ratio [OR]: 0.81 [0.67-0.97]). Inpatient safety measures differed by race/ethnicity for rates of prolonged LOS (Blacks 18.1%, Hispanics 14.5%, and Whites 11.7%), medical complications (Blacks 9.9%, Hispanics 8.7%, and Whites 7.7%), and surgical complications (Blacks 5.2%, Hispanics 6.9%, and Whites 5.4%). Differences persisted after adjustment for procedure type as well as patient and hospital factors. Blacks and Hispanics had higher risk for prolonged LOS compared to Whites (adjusted OR Blacks 1.39 [95% confidence interval {CI} 1.22-1.59]; Hispanics 1.24 [95% CI 1.02-1.52]). Blacks had higher risk for inpatient medical complications compared to Whites (adjusted OR 1.24 [95% CI 1.05-1.48]), and Hispanics had higher risk for inpatient surgical complications compared to Whites (adjusted OR 1.34 [95% CI 1.06-1.68]).Conclusions: Fusion method use was generally similar between racial/ethnic groups. Inpatient safety measures, adjusted for procedure type, patient and hospital factors, were worse for Blacks and Hispanics. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.^1,2,3, Arant, Kaetlyn R.¹, Loeser, Richard F.⁴

المصدر: JAMA: Journal of the American Medical Association. 2/9/2021, Vol. 325 Issue 6, p568-578. 11p.

مصطلحات موضوعية: *HIP joint diseases diagnosis, *OSTEOARTHRITIS treatment, *OSTEOARTHRITIS diagnosis, *KNEE diseases, *HIP joint diseases, *DISEASE progression, *ADRENOCORTICAL hormones, *NONSTEROIDAL anti-inflammatory agents, *SELF-evaluation, *MAGNETIC resonance imaging, *ARTIFICIAL joints, *OSTEOARTHRITIS, *WEIGHT loss, *INTRA-articular injections, *EXERCISE, *MENTAL health surveys, *RESEARCH funding, *HEALTH self-care

مستخلص: 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. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.^1,2 jnkatz@bwh.harvard.edu

المصدر: JAMA: Journal of the American Medical Association. 11/23/2021, Vol. 326 Issue 20, p2012-2014. 3p.

مصطلحات موضوعية: *OSTEOARTHRITIS treatment, *TENDINOPATHY, *PLATELET-rich plasma

مستخلص: The author reflects on the effectiveness of platelet-rich plasma (PRP) therapy for the treatment of achilles tendinitis and osteoarthritis (OA). Also cited are the randomized clinical trials (RCT) on PRP therapy for treating knee and ankle OA and Achilles tendinopathy, and the growth factor contents of platelets like vascular endothelial growth factor and basic fibroblast growth factor.

المؤلفون: Lape, Emma C.¹ (AUTHOR), Katz, Jeffrey N.¹ (AUTHOR), Blucher, Justin A.¹ (AUTHOR), Chen, Angela T.¹ (AUTHOR), Silva, Genevieve S.¹ (AUTHOR), Schwab, Joseph H.² (AUTHOR), Balboni, Tracy A.³ (AUTHOR), Losina, Elena¹ (AUTHOR), Schoenfeld, Andrew J.¹ (AUTHOR) ajschoen@neomed.edu

المصدر: Spine Journal. Jun2020, Vol. 20 Issue 6, p905-914. 10p.

مصطلحات موضوعية: *ACADEMIC medical centers, *METASTASIS, *QUALITATIVE research, *SPINE diseases, *SEMI-structured interviews

مصطلحات جغرافية: BOSTON (Mass.)

مستخلص: Background: In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored.Purpose: We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases.Study Setting: Three tertiary academic medical centers.Patient Sample: We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA.Outcome Measures: We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions.Methods: We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached.Results: We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery.Conclusions: The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.^1,2,3 jnkatz@bwh.harvard.edu, Williams, Emma E.³

المصدر: Journal of Bone & Joint Surgery, American Volume. 2020 Supplement, Vol. 102, p15-20. 6p.

مصطلحات موضوعية: *ORTHOPEDICS, *PAIN management, *OPIOID analgesics

مصطلحات جغرافية: UNITED States

مستخلص: The United States is struggling with an epidemic of opioid use both within and outside of the medical field. Pain management is a critical focus for orthopaedic practice. Recent orthopaedic research literature has focused on international perspectives on opioid use, patterns of opioid use, chronic opioid use, preoperative opioid use, and educational interventions to reduce opioid prescribing. Studies at the intersection of opioid use and orthopaedics pose methodological challenges, including quantifying opioid use, confounding by indication, and interpreting the results of nonrandomized intervention studies given secular changes in practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Katz, Jeffrey N.¹ jnkatz@bwh.harvard.edu, Shrestha, Swastina¹, Losina, Elena¹, Jones, Morgan H.², Marx, Robert G.³, Mandl, Lisa A.³, Levy, Bruce A.⁴, MacFarlane, Lindsey A.¹, Spindler, Kurt P.², Silva, Genevieve S.¹, Collins, Jamie E.¹, Brophy, Robert, Cole, Brian J., Stuart, Michael J., Matava, Matthew J., Wright, Rick W., Safran‐Norton, Clare E.

المصدر: Arthritis & Rheumatology. Feb2020, Vol. 72 Issue 2, p273-281. 9p.

مصطلحات موضوعية: *ARTHROSCOPY, *CONFIDENCE intervals, *MATHEMATICAL models, *MENISCECTOMY, *MENISCUS injuries, *OSTEOARTHRITIS, *PAIN, *PHYSICAL therapy, *TOTAL knee replacement, *THEORY, *TREATMENT effectiveness, *DISEASE incidence, *PROPORTIONAL hazards models, *MIDDLE age

مستخلص: Objective: To determine the 5‐year outcome of treatment for meniscal tear in osteoarthritis. Methods: We examined 5‐year follow‐up data from the Meniscal Tear in Osteoarthritis Research trial (METEOR) of physical therapy versus arthroscopic partial meniscectomy. We performed primary intent‐to‐treat (ITT) and secondary as‐treated analyses. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale; total knee replacement (TKR) was a secondary outcome measure. We used piecewise linear mixed models to describe change in KOOS pain. We calculated 5‐year cumulative TKR incidence and used a Cox model to estimate hazard ratios (HRs) for TKR, with 95% confidence intervals (95% CIs). Results: Three hundred fifty‐one participants were randomized. In the ITT analysis, the KOOS pain scores were ~46 (scale of 0 [no pain] to 100 [most pain]) at baseline in both groups. Pain scores improved substantially in both groups over the first 3 months, continued to improve through the next 24 months (to ~18 in each group), and were stable at 24–60 months. Results of the as‐treated analyses of the KOOS pain score were similar. Twenty‐five participants (7.1% [95% CI 4.4–9.8%]) underwent TKR over 5 years. In the ITT model, the HR for TKR was 2.0 (95% CI 0.8–4.9) for subjects randomized to the arthroscopic partial meniscectomy group, compared to those randomized to the physical therapy group. In the as‐treated analysis, the HR for TKR was 4.9 (95% CI 1.1–20.9) for subjects ultimately treated with arthroscopic partial meniscectomy, compared to those treated nonoperatively. Conclusion: Pain improved considerably in both groups over 60 months. While ITT analysis revealed no statistically significant differences following TKR, greater frequency of TKR in those undergoing arthroscopic partial meniscectomy merits further study. [ABSTRACT FROM AUTHOR]