المؤلفون: Chen, Angela T., Bronsther, Corin I., Stanley, Elizabeth E., Paltiel, A. David, Sullivan, James K., Collins, Jamie E., Neogi, Tuhina, Katz, Jeffrey N., Losina, Elena

المصدر: Annals of Internal Medicine; 6/15/2021, Vol. 174 Issue 6, p747-757, 11p, 3 Charts, 1 Graph

مصطلحات موضوعية: TOTAL knee replacement, BODY mass index, PREOPERATIVE risk factors, CARDIOVASCULAR diseases, COST effectiveness, PAIN management, KNEE diseases, MORBID obesity, SURGICAL complications, OSTEOARTHRITIS, RESEARCH funding, QUALITY-adjusted life years, DISEASE complications

الشركة/الكيان: NATIONAL Institutes of Health (U.S.)

مستخلص: Background: Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population.Objective: To assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis.Design: Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of TKR in patients with a BMI of 40 kg/m2 or greater.Data Sources: Total knee replacement parameters from longitudinal studies and published literature, and costs from Medicare Physician Fee Schedules, the Healthcare Cost and Utilization Project, and published data.Target Population: Recipients of TKR with a BMI of 40 kg/m2 or greater in the United States.Time Horizon: Lifetime.Perspective: Health care sector.Intervention: Total knee replacement.Outcome Measures: Cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually.Results Of Base-case Analysis: Total knee replacement increased QALYs by 0.71 year and lifetime medical costs by $25 200 among patients aged 50 to 65 years with a BMI of 40 kg/m2 or greater, resulting in an ICER of $35 200. Total knee replacement in patients older than 65 years with a BMI of 40 kg/m2 or greater increased QALYs by 0.39 year and costs by $21 100, resulting in an ICER of $54 100.Results Of Sensitivity Analysis: In TKR recipients with a BMI of 40 kg/m2 or greater and diabetes and cardiovascular disease, ICERs were below $75 000 per QALY. Results were most sensitive to complication rates and preoperative pain levels. In the probabilistic sensitivity analysis, at a $55 000-per-QALY willingness-to-pay threshold, TKR had a 100% and 90% likelihood of being a cost-effective strategy for patients aged 50 to 65 years and patients older than 65 years, respectively.Limitation: Data are derived from several sources.Conclusion: From a cost-effectiveness perspective, TKR offers good value in patients with a BMI of 40 kg/m2 or greater, including those with multiple comorbidities.Primary Funding Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Internal Medicine is the property of American College of Physicians and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Farina, Evan M., Lowenstein, Natalie A., Yuchiao Chang, Arant, Kaetlyn R., Katz, Jeffrey N., Matzkin, Elizabeth G., Chang, Yuchiao

المصدر: Journal of Bone & Joint Surgery, American Volume; 3/3/2021, Vol. 103 Issue 5, p381-388, 8p

مصطلحات موضوعية: PATHOLOGY, SYMPTOMS, MENISCUS (Anatomy), DIAGNOSIS, KNEE injuries, REGRESSION analysis, CARTILAGE, MENISCUS surgery, OSTEOARTHRITIS diagnosis, KNEE diseases, ARTHROSCOPY, CARTILAGE diseases, OSTEOARTHRITIS, ARTICULAR cartilage, LONGITUDINAL method

مستخلص: Background: Traditionally defined "meniscal" and "mechanical" symptoms are thought to arise from meniscal tears. Yet meniscal tears and cartilage damage commonly coexist in symptomatic knees. To better characterize the primary driver of these symptoms, we investigated whether the presence of preoperative patient-reported knee symptoms (PRKS), including knee catching/locking, grinding/clicking/popping, and pain with pivoting, are associated with various intra-articular pathological conditions diagnosed at knee arthroscopy.Methods: We collected prospective data from 565 consecutive patients who underwent knee arthroscopy from 2012 to 2019 and had PRKS collected via the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The diagnosis of meniscal pathology and concomitant cartilage damage was confirmed and classified intraoperatively. We used multivariable regression models, adjusting for possible confounders, to examine the association of specific pathological conditions of the knee with the presence of preoperative PRKS.Results: Tricompartmental cartilage damage was strongly associated with significantly worse PRKS, with an increase of 0.33 point (95% confidence interval [CI] = 0.08 to 0.58; p = 0.01) on a 0 to 4-point scale. We did not observe an association between meniscal pathology and preoperative PRKS.Conclusions: Contrary to current dogma, this study demonstrates that traditionally defined "meniscal" and "mechanical" knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Bone & Joint Surgery, American Volume is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Guermazi, Ali, Jones, Morgan H., Spindler, Kurt P., Winter, Amelia R., Losina, Elena, Katz, Jeffrey N., Brophy, Robert H., Cole, Brian J., Levy, Bruce A., Mandl, Lisa A., Martin, Scott, Marx, Robert G., Matava, Mathew, Safran-Norton, Clare, Stuart, Michael, Wright, Rick

المصدر: American Journal of Sports Medicine; Mar2019, Vol. 47 Issue 3, p612-619, 8p

مصطلحات موضوعية: OSTEOARTHRITIS treatment, MENISCUS injuries, KNEE diseases, ARTHROSCOPY, LONGITUDINAL method, MAGNETIC resonance imaging, MENISCECTOMY, PHYSICAL therapy, REGRESSION analysis, BODY mass index, KNEE pain, DESCRIPTIVE statistics, THERAPEUTICS

مستخلص: Background: Arthroscopic partial meniscectomy (APM) is used to treat meniscal tears, although its efficacy is controversial. Purpose: This study used magnetic resonance imaging (MRI) to determine characteristics that lead to greater benefit from APM and physical therapy (PT) than from PT alone among patients with meniscal tear and knee osteoarthritis. Study Design: Cohort study; Level of evidence, 2. Methods: Using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, the authors first assessed whether the effect of treatment on pain scores at 6 months differed according to baseline MRI features (bone marrow lesions, cartilage and meniscal damage). Second, the authors summed MRI features associated with differential pain relief between APM and PT to create a "damage score," which included bone marrow lesion number and cartilage damage size with possible values of 0 (least damage), 1 (moderate), and 2 (greatest). The authors used linear models to determine whether the association between damage score and pain relief at 6 months differed for APM versus PT. Results: The study included 220 participants: 13%, had the least damage; 52%, moderate; and 34%, greatest. Although treatment type did not significantly modify the association of damage score and change in pain (P interaction = .13), those with the least damage and moderate damage had greater improvement with APM than with PT in Knee injury and Osteoarthritis Outcome Score pain subscale—by 15 and 7 points, respectively. Those with the greatest damage had a similar improvement with APM and PT. Conclusion: Among patients with osteoarthritis and meniscal tear, those with less intra-articular damage on MRI may have greater improvement in pain with APM and PT than with PT alone. However, these results should be interpreted cautiously owing to the limited sample size. [ABSTRACT FROM AUTHOR]

: Copyright of American Journal of Sports Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Jarraya, Mohamed, Guermazi, Ali, Mandl, Lisa A., Martin, Scott D., Wright, John, Losina, Elena, Katz, Jeffrey N., Brophy, Robert H., Levy, Bruce A., Marx, Robert G., Matava, Mathew, Safran‐Norton, Clare, Spindler, Kurt P., Stuart, Michael, Dahm, Diane L., Wright, Rick

المصدر: Arthritis & Rheumatology; Jan2019, Vol. 71 Issue 1, p73-81, 9p

مصطلحات موضوعية: CARTILAGE diseases, CONFIDENCE intervals, KNEE diseases, MAGNETIC resonance imaging, MENISCUS injuries, OSTEOARTHRITIS, PHYSICAL therapy, POISSON distribution, REGRESSION analysis, RELATIVE medical risk, SYNOVITIS, DISEASE progression, DISEASE complications, DISEASE risk factors, DIAGNOSIS, THERAPEUTICS

مستخلص: Objective: Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion‐synovitis and changes in effusion‐synovitis with changes in cartilage damage in a cohort with OA and meniscal tear. Methods: We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery versus physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion‐synovitis and cartilage damage on magnetic resonance imaging, and dichotomized effusion‐synovitis as none/small (minimal) and medium/large (extensive). We assessed the association of baseline effusion‐synovitis and changes in effusion‐synovitis with changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for patient demographic characteristics, treatment, and baseline cartilage damage. Results: We analyzed 221 participants. Over 18 months, effusion‐synovitis was persistently minimal in 45.3% and persistently extensive in 21.3% of the patients. The remaining 33.5% of the patients had minimal synovitis on one occasion and extensive synovitis on the other. In adjusted analyses, patients with extensive effusion‐synovitis at baseline had a relative risk (RR) of progression of cartilage damage depth of 1.7 (95% confidence interval [95% CI] 1.0–2.7). Compared to those with persistently minimal effusion‐synovitis, those with persistently extensive effusion‐synovitis had a significantly increased risk of progression of cartilage damage depth (RR 2.0 [95% CI 1.1–3.4]). Conclusion: Our findings indicate that the presence of extensive effusion‐synovitis is associated with subsequent progression of cartilage damage over 18 months. The persistence of extensive effusion‐synovitis over time is associated with the greatest risk of concurrent cartilage damage progression. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis & Rheumatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Collins, Jamie E., Donnell-Fink, Laurel A., Yang, Heidi Y., Usiskin, Ilana M., Lape, Emma C., Wright, John, Katz, Jeffrey N., Losina, Elena

المصدر: Journal of Bone & Joint Surgery, American Volume; 11/1/2017, Vol. 99 Issue 21, p1812-1818, 7p

مصطلحات موضوعية: BODY mass index, OSTEOARTHRITIS, ARTHROPLASTY, OVERWEIGHT persons, TOTAL knee replacement, OBESITY complications, CONVALESCENCE, KNEE diseases, OBESITY, PATIENT satisfaction, POSTOPERATIVE pain

مستخلص: Background: While obesity may be a risk factor for complications following total knee arthroplasty, data remain sparse on the impact of the degree of obesity on patient-reported outcomes following this procedure. Our objective was to determine the extent to which obesity level affects the trajectory of recovery as well as patient-reported pain, function, and satisfaction with surgery following total knee arthroplasty.Methods: We followed a cohort of patients who underwent total knee arthroplasty at 1 of 4 medical centers. Patients were ≥40 years of age with a primary diagnosis of osteoarthritis. We stratified patients into 5 groups according to the World Health Organization classification of body mass index (BMI). We assessed the association between BMI group and pain and function over the time intervals of 0 to 3, 3 to 6, and 6 to 24 months using a piecewise linear model. We also assessed the association between BMI group and patient-reported outcomes at 24 months. Multivariable models adjusted for age, sex, race, diabetes, musculoskeletal functional limitations index, pain medication use, and study site.Results: Of the 633 participants included in our analysis, 19% were normal weight (BMI of <25 kg/m), 32% were overweight (BMI of 25 to 29.9 kg/m), 27% were class-I obese (BMI of 30 to 34.9 kg/m), 12% were class-II obese (BMI of 35 to 39.9 kg/m), and 9% were class-III obese (BMI of ≥40 kg/m). Study participants with a higher BMI had worse preoperative WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and had greater improvement from baseline to 3 months. The mean change in pain and function from 3 to 6 and from 6 to 24 months was similar across all BMI groups. At 24 months, participants in all BMI groups had similar levels of pain, function, and satisfaction.Conclusions: Because of the differential trajectory of recovery in the first 3 months following total knee arthroplasty, the participants in the higher BMI groups were able to attain absolute pain and function scores similar to those in the nonobese and class-I obese groups. These data can help surgeons discuss expectations of pain relief and functional improvement with total knee arthroplasty candidates with higher BMI.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Bone & Joint Surgery, American Volume is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Winter, Amelia R., Collins, Jamie E., Katz, Jeffrey N.

المصدر: BMC Musculoskeletal Disorders; 10/4/2017, Vol. 18, p1-8, 8p, 1 Diagram, 1 Chart, 1 Graph

مصطلحات موضوعية: TOTAL knee replacement, OSTEOARTHRITIS, ARTHROSCOPY, JOINT surgery, SURGICAL complications, KNEE diseases, RISK assessment, ACQUISITION of data

مستخلص: Background: Arthroscopic surgery is a common treatment for knee osteoarthritis (OA), particularly for symptomatic meniscal tear. Many patients with knee OA who have arthroscopies go on to have total knee arthroplasty (TKA). Several individual studies have investigated the interval between knee arthroscopy and TKA. Our objective was to summarize published literature on the risk of TKA following knee arthroscopy, the duration between arthroscopy and TKA, and risk factors for TKA following knee arthroscopy.Methods: We searched PubMed, Embase, and Web of Science for English language manuscripts reporting TKA following arthroscopy for knee OA. We identified 511 manuscripts, of which 20 met the inclusion criteria and were used for analysis. We compared the cumulative incidence of TKA following arthroscopy in each study arm, stratifying by type of data source (registry vs. clinical), and whether the study was limited to older patients (≥ 50) or those with more severe radiographic OA. We estimated cumulative incidence of TKA following arthroscopy by dividing the number of TKAs among persons who underwent arthroscopy by the number of persons who underwent arthroscopy. Annual incidence was calculated by dividing cumulative incidence by the mean years of follow-up.Results: Overall, the annual incidence of TKA after arthroscopic surgery for OA was 2.62% (95% CI 1.73-3.51%). We calculated the annual incidence of TKA following arthroscopy in four separate groups defined by data source (registry vs. clinical cohort) and whether the sample was selected for disease progression (either age or OA severity). In unselected registry studies the annual TKA incidence was 1.99% (95% CI 1.03-2.96%), compared to 3.89% (95% CI 0.69-7.09%) in registry studies of older patients. In unselected clinical cohorts the annual incidence was 2.02% (95% CI 0.67-3.36%), while in clinical cohorts with more severe OA the annual incidence was 4.13% (95% CI 1.81-6.44%). The mean and median duration between arthroscopy and TKA (years) were 3.4 and 2.0 years.Conclusions: Clinicians and patients considering knee arthroscopy should discuss the likelihood of subsequent TKA as they weigh risks and benefits of surgery. Patients who are older or have more severe OA are at particularly high risk of TKA. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Musculoskeletal Disorders is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Losina, Elena, Michl, Griffin L., Smith, Karen C., Katz, Jeffrey N.

المصدر: Arthritis Care & Research; Aug2017, Vol. 69 Issue 8, p1164-1170, 7p

مصطلحات موضوعية: COMPARATIVE studies, INTERNET, KNEE diseases, RESEARCH methodology, MEDICAL cooperation, OSTEOARTHRITIS, PATIENT education, SENSORY perception, RESEARCH, RESEARCH funding, RISK assessment, EVALUATION research, RANDOMIZED controlled trials, TREATMENT effectiveness, EARLY medical intervention, PREVENTION

مستخلص: Objective: Young adults, in general, are not aware of their risk of knee osteoarthritis (OA). Understanding risk and risk factors is critical to knee OA prevention. We tested the efficacy of a personalized risk calculator on accuracy of knee OA risk perception and willingness to change behaviors associated with knee OA risk factors.Methods: We conducted a randomized controlled trial of 375 subjects recruited using Amazon Mechanical Turk. Subjects were randomized to either use a personalized risk calculator based on demographic and risk-factor information (intervention), or to view general OA risk information (control). At baseline and after the intervention, subjects estimated their 10-year and lifetime risk of knee OA and responded to contemplation ladders measuring willingness to change diet, exercise, or weight-control behaviors.Results: Subjects in both arms had an estimated 3.6% 10-year and 25.3% lifetime chance of developing symptomatic knee OA. Both arms greatly overestimated knee OA risk at baseline, estimating a 10-year risk of 26.1% and a lifetime risk of 47.8%. After the intervention, risk calculator subjects' perceived 10-year risk decreased by 12.9 percentage points to 12.5% and perceived lifetime risk decreased by 19.5 percentage points to 28.1%. Control subjects' perceived risks remained unchanged. Risk calculator subjects were more likely to move to an action stage on the exercise contemplation ladder (relative risk 2.1). There was no difference between the groups for diet or weight-control ladders.Conclusion: The risk calculator is a useful intervention for knee OA education and may motivate some exercise-related behavioral change. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Smith, Savannah R., Collins, Jamie E., Yang, Heidi, Katz, Jeffrey N., Losina, Elena, Bido, Jennifer

المصدر: Journal of Bone & Joint Surgery, American Volume; 5/17/2017, Vol. 99 Issue 10, p803-808, 6p

مصطلحات موضوعية: OPIOIDS, TOTAL knee replacement, COMORBIDITY, PAIN, OSTEOARTHRITIS, THERAPEUTIC use of narcotics, ANALGESICS, KNEE diseases, NARCOTICS, POSTOPERATIVE pain, PREOPERATIVE care, RESEARCH funding, PAIN measurement, JOINT pain, DIAGNOSIS

مستخلص: Background: There is growing concern about the use of opioids prior to total knee arthroplasty (TKA), and research has suggested that preoperative opioid use may lead to worse pain outcomes following surgery. We evaluated the pain relief achieved by TKA in patients who had and those who had not used opioids use before the procedure.Methods: We augmented data from a prospective cohort study of TKA outcomes with opioid-use data abstracted from medical records. We collected patient-reported outcomes and demographic data before and 6 months after TKA. We used the Pain Catastrophizing Scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to quantify the pain experiences of patients treated with TKA who had had a baseline score of ≥20 on the WOMAC pain scale (a 0 to 100-point scale, with 100 being the worst score), who provided follow-up data, and who had not had another surgical procedure within the 2 years prior to TKA. We built a propensity score for preoperative opioid use based on the Pain Catastrophizing Scale score, comorbidities, and baseline pain. We used a general linear model, adjusting for the propensity score and baseline pain, to compare the change in the WOMAC pain score 6 months after TKA between persons who had and those who had not used opioids before TKA.Results: The cohort included 156 patients with a mean age of 65.7 years (standard deviation [SD] = 8.2 years) and a mean body mass index (BMI) of 31.1 kg/m (SD = 6.1 kg/m); 62.2% were female. Preoperatively, 36 patients (23%) had had at least 1 opioid prescription. The mean baseline WOMAC pain score was 43.0 points (SD = 12.8) for the group that had not used opioids before TKA and 46.9 points (SD = 15.7) for those who had used opioids (p = 0.12). The mean preoperative Pain Catastrophizing Scale score was greater among opioid users (15.5 compared with 10.7 points among non-users, p = 0.006). Adjusted analyses showed that the opioid group had a mean 6-month reduction in the WOMAC pain score of 27.0 points (95% confidence interval [CI] = 22.7 to 31.3) compared with 33.6 points (95% CI = 31.4 to 35.9) in the non-opioid group (p = 0.008).Conclusions: Patients who used opioids prior to TKA obtained less pain relief from the operation. Clinicians should consider limiting pre-TKA opioid prescriptions to optimize the benefits of TKA.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Bone & Joint Surgery, American Volume is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Katz, Jeffrey N., Smith, Savannah R., Yang, Heidi Y., Martin, Scott D., Wright, John, Donnell-Fink, Laurel A., Losina, Elena

المصدر: Arthritis Care & Research; Apr2017, Vol. 69 Issue 4, p484-490, 7p

مصطلحات موضوعية: OSTEOARTHRITIS diagnosis, AGE distribution, COMPARATIVE studies, KNEE diseases, RESEARCH methodology, MEDICAL cooperation, MEDICAL history taking, MENISCUS (Anatomy), MULTIVARIATE analysis, OSTEOARTHRITIS, PHYSICAL diagnosis, RESEARCH, RESEARCH evaluation, RESEARCH funding, LOGISTIC regression analysis, EVALUATION research, PAIN measurement, PREDICTIVE tests, DISEASE prevalence, CROSS-sectional method, JOINT pain, ODDS ratio, DIAGNOSIS

مصطلحات جغرافية: MASSACHUSETTS

مستخلص: Objective: To evaluate the utility of clinical history, radiographic findings, and physical examination findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45 years, in whom concomitant osteoarthritis is prevalent.Methods: In a cross-sectional study of patients from 2 orthopedic surgeons' clinics, we assessed clinical history, physical examination findings, and radiographic findings in patients age >45 years with knee pain. The orthopedic surgeons rated their confidence that subjects' symptoms were due to meniscal tear; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT, and we used the regression results to construct an index of the likelihood of SMT.Results: In 174 participants, 6 findings were associated independently with the expert clinician having ≥70% confidence that symptoms were due to meniscal tear: localized pain, ability to fully bend the knee, pain duration <1 year, lack of varus alignment, lack of pes planus, and absence of joint space narrowing on radiographs. The index identified a low-risk group with 3% likelihood of SMT.Conclusion: While clinicians traditionally rely upon mechanical symptoms in this diagnostic setting, our findings did not support the conclusion that mechanical symptoms were associated with the expert's confidence that symptoms were due to meniscal tear. An index that includes history of localized pain, full flexion, duration <1 year, pes planus, varus alignment, and joint space narrowing can be used to stratify patients according to their risk of SMT, and it identifies a subgroup with very low risk. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)