Are All Unloader Braces Created Equal?: Recommendations for Evidence-Based Implementation of Unloader Braces for Patients with Unicompartmental Knee OA

2021 ◽  
Author(s):  
Kylee Rucinski ◽  
Jonathan Williams ◽  
Cory R. Crecelius ◽  
Lindsey Redington ◽  
Trent M. Guess ◽  
...  
Keyword(s):  
Mechanical Axis ◽  
Weight Bearing ◽  
Cost Effective ◽  
Current Evidence ◽  
Evidence Based ◽  
Joint Loading ◽  
Knee Oa ◽  
Unicompartmental Knee ◽  
Cost Effective Treatment ◽  
Reaction Forces

AbstractUnicompartmental knee osteoarthritis (UKOA) is a complex issue that is estimated to affect roughly 28% of patients with knee OA, and can result in severe cartilage degeneration, meniscus deficiency, and concomitant varus or valgus malalignment. This malalignment results in abnormally high joint reaction forces in the affected compartment, which can elicit pain, cause dysfunction, and exacerbate joint degradation. For more than two decades, the use of knee unloader braces has been advocated as a cost-effective option for symptomatic management of UKOA.During bipedal ambulation with a normal lower extremity mechanical axis, ground reaction forces create a knee adduction moment (KAM) such that the medial compartment of the knee experiences approximately 60% of joint loading and the lateral compartment experiences approximately 40% of joint loading. UKOA disrupts the mechanical axis, altering KAM and joint loading and causing pain, dysfunction, and disease progression. In theory, knee unloader braces were designed to mitigate the symptoms of UKOA by normalizing KAM via shifts in the lever arms about the knee. However, studies vary, and suggest that push-mechanism knee unloaders do not consistently provide significant biomechanical benefits for medial or lateral UKOA. Current evidence suggests that pull-mechanism unloaders may be more effective, though contrasting data have also been reported, such that further validation is necessary. The purpose of our study was to synthesize current best evidence for use of knee unloader braces for management of UKOA to suggest evidence-based best practices as well as gaps in knowledge to target for future studies. Unloader bracing for patients with UKOA appears to be a cost-effective treatment option for patients with medial UKOA who have insurance coverage. Pull-mechanism unloader bracing should be considered in conjunction with other nonoperative management therapies for those who are willing to adhere to consistent brace use for weight-bearing activities.

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

2019 ◽  
Author(s):  
Yuichi Kuroda ◽  
Koji Takayama ◽  
Kazunari Ishida ◽  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Component ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Postoperative Outcome ◽  
Diagnostic Study ◽  
Hindfoot Alignment ◽  
Unicompartmental Knee ◽  
The Mean

AbstractSince a hindfoot alignment is not included in the conventional mechanical axis (hip–ankle [HA] line), a mechanical axis including the calcaneus (hip–calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip–knee–ankle (HKA) and hip–knee–calcaneus (HKC) angles were compared in the same patient. Regarding tibial inclination, the conventional tibial component–ankle (TCA) angle was compared with reference to the HC line (tibial component–calcaneus [TCC] angle). The mean postoperative HKA and HKC angles were 2.8 ± 2.7 and 2.0 ± 2.5 degree, respectively. The mean postoperative TCA and TCC angles were 87.7 ± 2.1 and 88.5 ± 2.1 degree, respectively. There were significant differences between the two groups in both lower limb alignment and tibial component angle. The present study indicated that the HKC and the TCC angles significantly decreased the varus alignment by approximately 1 degree compared with the HKA and TCA angles. Neutral in the HA line corresponds to valgus in reference to the HC line, which may result in overcorrection. Surgeons should consider evaluating the HC line in place of the HA line, which may affect preoperative planning and postoperative outcome during UKA. This is a Level II, diagnostic study.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen
Keyword(s):  
Elderly Population ◽  
Cost Effective ◽  
The Elderly ◽  
Bisphosphonate Therapy ◽  
Evidence Based ◽  
First Line ◽  
Treatment Of Osteoporosis ◽  
Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

scholarly journals Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Peizhao Wang ◽  
Xiao Wang ◽  
Xiaotao Shi ◽  
Honglue Tan
Keyword(s):  
Lower Limb ◽  
Preoperative Planning ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Medial Knee ◽  
Knee Oa ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Objective. The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods. Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results. The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02 % to a postoperative value of 56.19 ± 0.10 % from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08 % at the final follow-up ( P < 0.01 ). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values ( P > 0.05 ). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63 ° to a postoperative week-one valgus of 2.37 ± 0.28 ° , and it had a valgus of 2.48 ± 0.39 ° at the final follow-up ( P < 0.01 ). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26 ° ( P > 0.05 ). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53 ° and 90.33 ± 1.52 ° , respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72 ° and the intraoperative setting value of 90.25 ± 1.67 ° ( P > 0.05 ). All corrected values were within the acceptable range of preoperative planning. Conclusion. Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.

Estimation of In-Vivo Quadriceps Forces of the Knee: A Combined In-Vivo Patellofemoral Joint Kinematics Measurement and Finite Element Prediction

2011 ◽  
Author(s):  
Koichi Kobayashi ◽  
Guoan Li
Keyword(s):  
Knee Joint ◽  
Load Transfer ◽  
Weight Bearing ◽  
Knee Oa ◽  
Moment Arms ◽  
Joint Reaction Forces ◽  
Joint Contact ◽  
Reaction Forces ◽  
Knee Pathology

The load transfer mechanics across the patellofemoral (PF) joint during weight-bearing conditions is important for treatment of the knee pathology, such as knee OA, ACL deficiency as well as TKA. Many studies have characterized the PF joint reaction forces using equilibriums of the quadriceps and ground reaction forces at the knee joint [1,2,3]. However, this simplification does not consider other muscle function as well as 3D knee joint contact location when calculate moment arms of the involved forces.

scholarly journals Osteoid Osteoma Treated with Radiofrequency Ablation

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Murat Çakar ◽  
Cem Zeki Esenyel ◽  
Metin Seyran ◽  
Ali Çağrı Tekin ◽  
Müjdat Adaş ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Osteoid Osteoma ◽  
Weight Bearing ◽  
Proximal Phalanx ◽  
Distal Tibia ◽  
Cost Effective ◽  
X Rays ◽  
Ct Guided ◽  
Cost Effective Treatment ◽  
Difficult Area

Purpose.Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation.Materials and Methods.Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes.Results.All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process.Conclusion.CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery.

Monoclonal antibodies in immunotherapy

2019 ◽  
Vol 1 (1) ◽  
pp. 26-31
Author(s):  
Roy Jefferis
Keyword(s):  
Monoclonal Antibodies ◽  
Cost Effective ◽  
Mechanisms Of Action ◽  
Cellular Immunotherapy ◽  
Human Antibody ◽  
Evidence Based ◽  
Patient Stratification ◽  
Drug Conjugates ◽  
Cost Effective Treatment ◽  
Antibody Drug

The bench-to-bedside ideal is being realised for both humoral and cellular immunotherapy. Monoclonal antibodies (mAbs) are established in the clinic, but continuous development has resulted in progression from mouse/human chimeric to humanised, ‘fully’ human, antibody–drug conjugates, biosimilars and biobetter therapeutics. The objective has been to minimise their potential for immunogenicity and to elucidate and exploit their multiple mechanisms of action (MoA). However, exploitation of these advances within the NHS is limited due their high cost. Consequently, the National Institute for Health and Care Excellence (NICE) offers evidence-based recommendations for the availability of approved mAbs, and other ‘speciality drugs’ within the NHS; alternative avenues for funding may be available while the efficacy of such drug is being fully evaluated. More cost-effective treatment is being achieved through patient stratification following genome sequencing and identification of polymorphisms that predispose people to disease susceptibilities and their responses to particular drugs or combinations of therapeutics.

scholarly journals Functional bracing is a safe and cost effective treatment for isolated Weber B fracture

2020 ◽  
Author(s):  
Ahmed Abdelaal ◽  
Sherif Elnikety
Keyword(s):  
Weight Bearing ◽  
Cost Effective ◽  
Ankle Fractures ◽  
National Guidelines ◽  
Early Weight Bearing ◽  
Cost Effective Treatment ◽  
Significant Difference ◽  
Score Method ◽  
Functional Outcome Measures ◽  
The Stability

Abstract BackgroundDespite the current recommendations that stable Weber B ankle fractures can be treated with functional bracing and weightbearing as tolerated, some reluctance exists among trauma surgeons to follow these recommendations. We report on our institution’s experience in managing these injuries and compare it to the national guidelines.Patients and MethodsConsecutive patients with isolated Weber B fractures referred to the local outpatient clinic over the period of six months were included in the study. Radiographs and clinic letters were examined, the patients were interviewed via telephone to obtain outcome scores (Olerud and Molandar score). Method of immobilisation, weightbearing status, radiological fracture union, clinical outcomes and complications were all assessed and analysed.ResultsOne hundred and twenty-three patients with isolated Weber B fractures were identified. This cohort of patients did not show clinical or radiographic evidence of instability, they were deemed stable and were initially treated non-operatively. Minimum follow-up period was six months. Sixty-two patients were treated in plaster and were non-weight bearing on the affected limb, while 61 were treated with functional bracing in a boot and were allowed early weight bearing. Three patients showed displacement requiring surgical fixation. All fractures progressed to union and patients were discharged irrespective of the method of immobilisation or weightbearing status during treatment. There was no statistically significant difference in the functional outcome measures between the two groups. The protocol of functional bracing and weightbearing was associated with fewer outpatient clinics and a reduced number of radiographs obtained in the clinic and fewer complications. ConclusionIsolated trans-syndesmotic Weber B ankle fractures, that are clinically and radiologically stable, can be safely treated with functional bracing in a boot and weightbearing as tolerated. Weightbearing radiographs are reliable in confirming the stability of such fractures.

scholarly journals A Diagnostic Approach to Hemochromatosis

2006 ◽  
Vol 20 (8) ◽  
pp. 535-540 ◽  
Author(s):  
Anthony S Tavill ◽  
Paul C Adams
Keyword(s):  
Genetic Testing ◽  
Large Scale ◽  
Diagnostic Algorithm ◽  
Cost Effective ◽  
Diagnostic Approach ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Expression ◽  
Extensive Experience ◽  
Scale Population

In the present clinical review, a diagnostic approach to hemochromatosis is discussed from the perspective of two clinicians with extensive experience in this area. The introduction of genetic testing and large-scale population screening studies have broadened our understanding of the clinical expression of disease and the utility of biochemical iron tests for the detection of disease and for the assessment of disease severity. Liver biopsy has become more of a prognostic test than a diagnostic test. The authors offer a stepwise, diagnostic algorithm based on current evidence-based data, that they regard as most cost-effective. An early diagnosis can lead to phlebotomy therapy to prevent the development of cirrhosis.

scholarly journals Kidney Exchange Program Reporting Standards: Evidence-Based Consensus From Europe

2021 ◽  
Vol 9 ◽  
Author(s):  
Bart Smeulders ◽  
Michal A. Mankowski ◽  
Joris van de Klundert
Keyword(s):  
Performance Measures ◽  
Cost Effective ◽  
Evidence Base ◽  
Evidence Based ◽  
Reporting Standard ◽  
Exchange Programs ◽  
Kidney Exchange ◽  
Exchange Program ◽  
Cost Effective Treatment ◽  
National Programs

Background: Kidney Exchange Programs can play an important role to increase access to the life saving and most cost-effective treatment for End Stage Renal Disease. The rise of national KEPs in Europe brings a need for standardized performance reporting to facilitate the development of an international evidence base on program practices.Methods: We systematically searched and reviewed the literature to extract kidney exchange program performance measures. Reported measures were initially categorized as structure, process, and outcome measures. Expert feedback was used to redefine categories and extend the set of measures to be considered. Using the Delphi method and a panel of 10 experts, the resulting measures were subsequently classified as mandatory (Base set), optional (Extended set), or deleted.Results: Out of the initial 1,668 articles identified by systematic literature search, 21 European publications on kidney exchange programs were included to collect performance measures, accompanied by three national program reports. The final measurement categories were Context, Population, Enrollment, Matching, Transplantation, and Outcomes. The set of performance measures resulting from the literature review was modified and classified as mandatory or optional. The resulting Base set and Extended set form the kidney exchange program reporting standard.Conclusions: The evidence-based and consensus-based kidney exchange program reporting standard can harmonize practical and scientific reporting on kidney exchange programs, thus facilitating the advancement of national programs. In addition, the kidney exchange program reporting standard can promote and align cross-national programs.

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