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]

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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: Jin Qin, Trudeau, Matthew, Buchholz, Bryan, Katz, Jeffrey N., Xu Xu, Dennerlein, Jack T.

المصدر: Journal of Applied Biomechanics; Apr2014, Vol. 30 Issue 2, p338-342, 5p, 1 Diagram, 3 Charts, 1 Graph

مصطلحات موضوعية: ELBOW physiology, SHOULDER joint, WRIST physiology, METACARPOPHALANGEAL joint, KEYBOARDS (Electronics), KINEMATICS, LONGITUDINAL method, RESEARCH funding, MOTION capture (Human mechanics), DATA analysis software, PHYSIOLOGY

مستخلص: Upper extremity kinematics during keyboard use is associated with musculoskeletal health among computer users; however, specific kinematics patterns are unclear. This study aimed to determine the dynamic roles of the shoulder, elbow, wrist and metacarpophalangeal (MCP) joints during a number entry task. Six subjects typed in phone numbers using their right index finger on a stand-alone numeric keypad. The contribution of each joint of the upper extremity to the fingertip movement during the task was calculated from the joint angle trajectory and the Jacobian matrix of a nine-degree-of-freedom kinematic representation of the finger, hand, forearm and upper arm. The results indicated that in the vertical direction where the greatest fingertip movement occurred, the MCP, wrist, elbow (including forearm) and shoulder joint contributed 10.2%, 55.6%, 27.7% and 6.5%, respectively, to the downward motion of the index finger averaged across subjects. The results demonstrated that the wrist and elbow contribute the most to the fingertip vertical movement, indicating that they play a major role in the keying motion and have a dynamic load beyond maintaining posture. [ABSTRACT FROM AUTHOR]

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المؤلفون: Paik, Julie M., Rosen, Harold N., Katz, Jeffrey N., Rosner, Bernard A., Rimm, Eric B., Gordon, Catherine M., Curhan, Gary C.

المصدر: Obesity (19307381); Sep2019, Vol. 27 Issue 9, p1513-1519, 7p

مصطلحات موضوعية: WAIST circumference, LEAN body mass, OLDER women, MUSCLE mass, SPINAL injuries, RESEARCH funding, BODY mass index, BONE fractures, LONGITUDINAL method

مستخلص: Objective: The study aimed to investigate the association between BMI, waist circumference, and vertebral fracture (VF) risk in women.Methods: This prospective study was conducted in 54,934 Nurses' Health Study participants. BMI was assessed biennially, and waist circumference was assessed in the year 2000. Self-reports of VF were confirmed by record review. BMI reflects lean body mass, and waist circumference reflects abdominal adiposity when included in the same regression model.Results: This study included 536 VF cases (2002 to 2014). Compared with women with BMI of 21.0 to 24.9 kg/m2 , the multivariable-adjusted relative risk (RR) of VF for women with BMI ≥ 32.0 was 0.84 (95% CI: 0.61-1.14; Ptrend  = 0.08). After further adjustment for waist circumference, the multivariable-adjusted RR of VF for women with BMI ≥ 32.0 was 0.70 (95% CI: 0.49-0.98; Ptrend  = 0.003). Compared with women with waist circumference < 71.0 cm, the multivariable-adjusted RR of VF for women with waist circumference ≥ 108.0 cm was 1.76 (95% CI: 1.06-2.92; Ptrend  = 0.01), and after further adjustment for BMI, the multivariable-adjusted RR of VF was 2.49 (95% CI: 1.44-4.33; Ptrend  < 0.001).Conclusions: Greater lean body mass was independently associated with lower VF risk. Larger waist circumference was independently associated with higher VF risk. These findings suggest that fat distribution is an important predictor of VF and that avoiding central adiposity, as well as maintaining muscle mass, may potentially confer reduced risk of VF in older women. [ABSTRACT FROM AUTHOR]

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المؤلفون: Alves, Kristin^1,2 kalves@partners.org, Katz, Jeffrey N.², Sabatini, Coleen S.³

المصدر: Journal of Bone & Joint Surgery, American Volume. 2/20/2019, Vol. 101 Issue 4, p361-368. 8p.

مصطلحات موضوعية: *FIBROSIS, *CATHETER ablation, *NATURAL history, *OPERATIVE surgery, *META-analysis, *BUTTOCKS, *CONTRACTURE (Pathology), *RESEARCH funding, *SURGICAL complications, *TREATMENT effectiveness, *SKELETAL muscle

مستخلص: Background: The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.Methods: We searched PubMed, Embase, and Cochrane literature databases, from database inception to December 15, 2016. We used the following search terms including variants: "contracture," "fibrosis," "injections," "injections, adverse reactions,' "gluteal," and "hip." All titles and abstracts of potentially relevant studies were scanned to determine whether the subject matter was potentially related to GF, using predefined inclusion and exclusion criteria. If the abstract had subject matter involving GF, the paper was selected for review if full text was available. Only papers including ≥10 subjects who underwent surgical treatment were included in the systematic analysis. Data abstracted included the number of patients, patient age and sex, the type of surgical treatment, the method of outcome measurement, and outcomes and complications.Results: The literature search yielded 2,512 titles. Of these, 82 had a focus on GF, with 50 papers meeting the inclusion criteria. Of the 50 papers reviewed, 18 addressed surgical outcomes. The surgical techniques in these papers included open, minimally invasive, and arthroscopic release and radiofrequency ablation. Of 3,733 operatively treated patients in 6 reports who were evaluated on the basis of the criteria of Liu et al., 83% were found to have excellent results. Few papers focused on the incidence, prevalence, and natural history of GF, precluding quantitative synthesis of the evidence in these domains.Conclusions: This study provided a systematic review of surgical outcomes and a summary of what has been reported on the prevalence, diagnosis, prognosis, and pathogenesis of GF. Although GF has been reported throughout the world, it requires further study to determine the exact etiology, pathogenesis, and appropriate treatment. Surgical outcomes appear satisfactory.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

المؤلفون: Teeple, Erin, Collins, Jamie E., Shrestha, Swastina, Dennerlein, Jack T., Losina, Elena, Katz, Jeffrey N.

المصدر: Work; 2017, Vol. 58 Issue 2, p173-184, 12p, 1 Diagram, 2 Charts, 3 Graphs

مصطلحات موضوعية: INDUSTRIAL safety, INFORMATION storage & retrieval systems, MEDICAL databases, MEDICAL information storage & retrieval systems, MEDICAL personnel, MEDLINE, META-analysis, ONLINE information services, REGRESSION analysis, RESEARCH funding, SAFETY, SYSTEMATIC reviews, EVIDENCE-based medicine, PROFESSIONAL practice, TRANSPORTATION of patients, EVALUATION of human services programs

مستخلص: BACKGROUND: Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization (SPHM) programs. OBJECTIVE: We performed a systematic meta-analysis of SPHM program evaluations. METHODS: Systematic literature review identified published SPHM program evaluations. Injury Rate Ratios (IRR), pre-to post-intervention, were used to estimate intervention effects and to examine the influence of patient care level, program components, and follow-up time using meta-regression. RESULTS: 27 articles reported evaluations from 44 sites. Combined effect estimate for all SPHM programs was 0.44 (95% CI 0.36, 0.54), reflecting substantial injury reductions after program implementation. While specific program components were not associated with greater effectiveness, longer follow-up duration was associated with greater injury rate reduction (p = 0.01) and intervention effects varied by level of care (p = 0.01), with the greatest effect in intensive care unit interventions (IRR 0.14; 95% CI 0.07, 0.30). CONCLUSIONS: SPHM programs appear to be highly effective in reducing injuries. More research is needed to identify the most effective interventions for different patient care levels. [ABSTRACT FROM AUTHOR]

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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]

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المؤلفون: Barbhaiya, Medha, Yan Dong, Sparks, Jeffrey A., Losina, Elena, Costenbader, Karen H., Katz, Jeffrey N., Dong, Yan

المصدر: BMC Musculoskeletal Disorders; 6/19/2017, Vol. 18, p1-6, 6p, 3 Charts

مصطلحات موضوعية: OSTEONECROSIS, OSTEORADIOGRAPHY, MAGNETIC resonance imaging, EPIDEMIOLOGY, ALGORITHMS, ARM, COMPARATIVE studies, LEG, RESEARCH methodology, MEDICAL cooperation, NOSOLOGY, RESEARCH, RESEARCH funding, EVALUATION research

مستخلص: Background: Studies of the epidemiology and outcomes of avascular necrosis (AVN) require accurate case-finding methods. The aim of this study was to evaluate performance characteristics of a claims-based algorithm designed to identify AVN cases in administrative data.Methods: Using a centralized patient registry from a US academic medical center, we identified all adults aged ≥18 years who underwent magnetic resonance imaging (MRI) of an upper/lower extremity joint during the 1.5 year study period. A radiologist report confirming AVN on MRI served as the gold standard. We examined the sensitivity, specificity, positive predictive value (PPV) and positive likelihood ratio (LR+) of four algorithms (A-D) using International Classification of Diseases, 9th edition (ICD-9) codes for AVN. The algorithms ranged from least stringent (Algorithm A, requiring ≥1 ICD-9 code for AVN [733.4X]) to most stringent (Algorithm D, requiring ≥3 ICD-9 codes, each at least 30 days apart).Results: Among 8200 patients who underwent MRI, 83 (1.0% [95% CI 0.78-1.22]) had AVN by gold standard. Algorithm A yielded the highest sensitivity (81.9%, 95% CI 72.0-89.5), with PPV of 66.0% (95% CI 56.0-75.1). The PPV of algorithm D increased to 82.2% (95% CI 67.9-92.0), although sensitivity decreased to 44.6% (95% CI 33.7-55.9). All four algorithms had specificities >99%.Conclusion: An algorithm that uses a single billing code to screen for AVN among those who had MRI has the highest sensitivity and is best suited for studies in which further medical record review confirming AVN is feasible. Algorithms using multiple billing codes are recommended for use in administrative databases when further AVN validation is not feasible. [ABSTRACT FROM AUTHOR]

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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]

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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]

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