scholarly journals Frailty Questionnaire Is Not a Strong Prognostic Factor for Functional Outcomes in Hip or Knee Arthroplasty Patients

2019 ◽  
Vol 10 ◽  
pp. 215145931880816
Author(s):  
Jennifer M. T. A. Meessen ◽  
Marta Fiocco ◽  
Claudia S. Leichtenberg ◽  
Thea P. M. Vliet Vlieland ◽  
P. Eline Slagboom ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Change Score ◽  
Baseline Score ◽  
Change Scores ◽  
Knee Oa ◽  
Frail Patients ◽  
Outcome Score ◽  
Univariate Model ◽  
End Stage

Introduction: Up to 33% and 25% of patients with end-stage hip and knee osteoarthritis (OA) are considered frail by the Groningen Frailty Indicator (GFI). This study aims to assess whether frail patients have lower functional gains after arthroplasty and to assess GFI as a tool to discriminate between good and adverse change score. Materials and Methods: Patients with end-stage hip/knee OA scheduled for arthroplasty were recruited from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study. Functional outcome was measured as change score on the Hip Osteoarthritis Outcome Score/Knee Osteoarthritis Outcome Score (HOOS/KOOS), by subtracting preoperative score from 1-year postsurgery score and then dichotomized based on a cutoff of 20 points. For each HOOS/KOOS subscale, 3 models were estimated: GFI univariate (model 1), GFI and baseline score (model 2), and baseline score univariate (model 3). A receiver operating characteristic analysis was performed to assess the discriminative ability of each model. Results: Eight hundred five patients with end-stage hip OA (31.4% frail) and 640 patients with end-stage knee OA (25.4% frail) were included. Frail patients were older, had a higher body mass index, had more comorbidities, and lived more often alone. Persons considered frail by GFI had significant lower baseline score; however, except for “function in sports and recreation” and “quality of life,” change scores were similar in frail and nonfrail persons. The discriminatory value of GFI was negligible for all HOOS/KOOS subscales. Baseline score, however, was adequate to discriminate between total knee arthroplasty patients with more or less than twice the minimally clinically important difference on KOOS symptoms subscale (area under the curve = 0.802). Discussion/Conclusion: Although frail patients with OA have lower functioning scores at baseline, the change scores on HOOS/KOOS subscales are similar for both frail and nonfrail patients. Exploring other heath assessements may improve patient-specific outcome prediction.

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review

2019 ◽  
Vol 32 (11) ◽  
pp. 1046-1057 ◽  
Author(s):  
Kavin Sundaram ◽  
Juan S. Vargas-Hernández ◽  
Tomas Roca Sanchez ◽  
Nestor Moreno Moreu ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Bone Substitute ◽  
Knee Oa ◽  
Patient Reported ◽  
Intraosseous Injection ◽  
Bone Substitute Materials ◽  
Substitute Materials

AbstractKnee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic reviews. English and Spanish retrospective and prospective studies assessing the results of subchondral intraosseous injection of bone substitute materials and/or biologicals in human patients with knee OA, with a minimum of 6 months of follow-up were collected. A total of 1,081 potential articles were identified through our search. Six studies were included with a total of 163 patients. The mean follow-up was 18 months (range: 6–24 months). Patient reported outcomes measures (PROMs), complications, and conversion to total knee arthroplasty (TKA) were collected. All six studies showed PROMs improvement relative to baseline. Overall, the five studies reporting visual-analog scale (VAS) pain outcomes improved from a baseline mean score of 6.68 to 2.74. Also, knee injury and osteoarthritis score (KOOS), Tegner-Lysholm, and/or international knee documentation committee (IKDC) scores rose compared with baseline scores in all studies. Overall, 2.5% (4/163) of patients had a complication attributed to study-related treatment. Most patients (81%, 86/106) remained TKA-free at a 1-year follow-up. Subchondral intraosseous injections of bone substitute materials and platelet-rich plasma (PRP) suggest (1) improved PROMs of pain and functional status, (2) low complication rate, and (3) relatively low rates of conversion to TKA. However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.

Patterns of cartilage loss and anterior cruciate ligament status in end-stage osteoarthritis of the knee

2020 ◽  
Vol 102-B (6) ◽  
pp. 716-726 ◽  
Author(s):  
Chloe E. H. Scott ◽  
George Holland ◽  
Oliver Krahelski ◽  
Iain R. Murray ◽  
John F. Keating ◽  
...  
Keyword(s):  
Bone Loss ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Cartilage Loss ◽  
Full Thickness ◽  
Knee Oa ◽  
Tibial Bone ◽  
Anterior Cruciate ◽  
End Stage ◽  
Bicompartmental Arthroplasty

Aims This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status. Methods A cross-sectional analysis of 300 consecutive patients (mean age 69 years (SD 9.5, 44 to 91), mean body mass index (BMI) 30.6 (SD 5.5, 20 to 53), 178 female (59.3%)) undergoing total knee arthroplasty (TKA) for Kellgren-Lawrence grade ≥ 3 knee OA was conducted. The point of maximal tibial bone loss on preoperative lateral radiographs was determined as a percentage of the tibial diameter. At surgery, Lachman’s test and ACL status were recorded. The presence of full-thickness cartilage loss within 16 articular surface regions (two patella, eight femoral, six tibial) was recorded. Results According to articular cartilage loss and ACL status, 195/293 (67%) were suitable for PKA or CPKA: medial unicompartmental knee arthroplasty (UKA) 97/293 (33%); lateral UKA 25 (9%); medial bicompartmental arthroplasty 31 (11%); lateral bicompartmental arthroplasty 12 (4%); bicondylar-UKA 23 (8%); and patellofemoral arthroplasty (PFA) seven (2%). The ACL was intact in 166 (55%), frayed in 82 (27%), disrupted in 12 (4%), and absent in 33 (11%). Lachman testing was specific (97%) but poorly sensitive (38%) for disrupted/absent ACLs. The point of maximal tibial bone loss showed good interclass correlation (ICC 0.797, 0.73 to 0.85 95% confidence interval (CI); p < 0.001) and was more posterior when the ACL was absent. Maximum tibial bone loss occurring at > 55% of the anterior to posterior distance predicted ACL absence with 93% sensitivity and 91% specificity (area under the curve 0.97 (0.94 to 0.99 95% CI; p < 0.001). Conclusion ACL status can be reliably determined from a lateral radiograph using the location of maximal tibial bone loss. According to regions of cartilage loss and ACL status, two-thirds of patients with end-stage knee OA could potentially be treated with PKA or CPKA. Cite this article: Bone Joint J 2020;102-B(6):716–726.

scholarly journals AB0879 DOES BODY WEIGHT INFLUENCE THE KNEE INJURY AND OSTEOARTHRITIS OUTCOME SCORE IN PERSONS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1745.2-1745
Author(s):  
A. Ben Tekaya ◽  
L. Rouached ◽  
A. Slimi ◽  
J. Galalou ◽  
E. Bahlouli ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Impairment ◽  
Knee Injury ◽  
Short Form ◽  
Normal Weight ◽  
Knee Oa ◽  
Outcome Score ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Grade Iii

Background:Overweight is a major risk factor for the development and progression of knee osteoarthritis (OA). Weight loss for patients with knee OA has been associated with improvement in self-reported pain and function and is recommended by EULAR as part of the therapeutic management.Objectives:The aim of the study was to evaluate the relation between overweight and functional impairment in adults with knee OA.Methods:It was a prospective study conducted in a rheumatologic department over a 4 months period. Patients with symptomatic knee OA based on the ACR criteria, were included. A screening of body mass index (BMI) was carried out for all patients. It was categorized following the WHO classification into: normal (<25 kg/m2), overweight (25 to <30), obese (up to 30).Pain level was evaluated using the Visual Analogue Scale (VAS). Function was assessed by the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). The patients’ knee radiographies were graded according to Kellgren Lawrence criteria (KL). The patients were allocated in two groups; as grade I-II KL (Group 1) and grade III-IV KL (Group 2).Results:We included 143 patients with a mean age of 65.17± 10.7 years and 88.1% of women. Patients were from low socio-economic class in 30.8% of cases. Mean disease duration of the KOA was 5.4 years [3months-20 years] and mean BMI was 31.8±5.6kg/m2. Patients were with normal weight in 16.1%, overweight in 19.6% and obese in 64.3%.Knee OA was bilateral in 85.3% and other OA sites were associated in 37.8% of patients. Mean VAS pain of knee OA was 6.6±1.5 and KOOS-PS was 48.8±16.5/100. Concerning the radiographic damage; we found grade I-II (KL) in 22.6% and grade III-IV (KL) in 77.4%.High BMI (BMI≥25 kg/m2was not significantly associated with worse KOOS score (p=0.9), more pain (p=0.5) or an increasing severity of radiological knee osteoarthritis (p=0.14). Moreover, the level BMI was not associated with the presence of other OA sites (p=0.9) or a bilateral KOA (p=0.07).Conclusion:These data, from a subset of participants with symptomatic radiographic knee OA, demonstrate no correlation between obesity and pain, functional impairment and radiographic severity.Acknowledgments:noneDisclosure of Interests:None declared

Early Economic Analysis of Robotic-Assisted Unicondylar Knee Arthroplasty May Be Cost Effective in Patients with End-Stage Osteoarthritis

2020 ◽  
Author(s):  
David Yeroushalmi ◽  
James Feng ◽  
Leo Nherera ◽  
Paul Trueman ◽  
Ran Schwarzkopf
Keyword(s):  
Cost Effectiveness ◽  
Markov Model ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Cost Effective ◽  
The United States ◽  
Unicondylar Knee Arthroplasty ◽  
Robotic Assisted ◽  
Single Compartment ◽  
End Stage

AbstractUnicondylar knee arthroplasty (UKA), as an alternative to total knee arthroplasty (TKA), has been shown to be an effective option for patients with single-compartment end-stage knee osteoarthritis. Implant survival is contingent upon proper alignment, which has been improved with the advent of robotic-assisted surgery (r-UKA), but whether this outweighs the increased cost of the robotic-assist device has not been analyzed in the literature. The purpose of this study was to investigate the mid-term cost-effectiveness of r-UKA compared with UKA with traditional instrumentation (t-UKA) in the United States. A cost-effectiveness analysis using a four-state Markov model was performed using data from the 2018 National Joint Registry of England and Wales and a retrospective multicenter, cohort study on a cohort of 65-year-old patients having undergone r-UKA. The main outcome was cost per revision avoided and sensitivity analyses were conducted to evaluate the impact of using different model assumptions on the results. The Markov model illustrated that the benefit derived from r-UKA versus t-UKA was beneficial from a payer's perspective. The estimated incremental cost-effectiveness ratio (ICER) was $14,737 per revision avoided in a facility seeing 100 patients a year. Case volume was shown to be the primary variable affecting cost-effectiveness, with the value of r-UKA directly increasing with higher case volumes. Cost-effectiveness analyses demonstrated that the use of r-UKA is an effective alternative to t-UKA in patients with single-compartment knee osteoarthritis. While this study could benefit from longer follow-up clinical studies to illustrate the benefits of r-UKAs beyond the current 2 years time horizon, r-UKAs remained cost-effective, even after investigating several different assumptions.

THE POTENTIAL UTILISATION OF PARTIAL KNEE ARTHROPLASTY AND ASSESSMENT OF ACL STATUS IN END STAGE KNEE OSTEOARTHRITIS

The Knee ◽  
2020 ◽  
Vol 27 ◽  
pp. S2
Author(s):  
O. Keenan ◽  
G. Holland ◽  
O. Krahelski ◽  
I. Murray ◽  
J. Keating ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Partial Knee Arthroplasty ◽  
End Stage

scholarly journals Reduction of Falls and Factors Affecting Falls a Year After Total Knee Arthroplasty in Elderly Patients with Severe Knee Osteoarthritis

2016 ◽  
Vol 10 (1) ◽  
pp. 522-531 ◽  
Author(s):  
T. Tsonga ◽  
M. Michalopoulou ◽  
S. Kapetanakis ◽  
E. Giovannopoulou ◽  
P. Malliou ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Elderly Patients ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Prospective Longitudinal Study ◽  
Factors Affecting ◽  
Knee Oa ◽  
Total Knee ◽  
Prospective Longitudinal

Background:Total Knee Arthroplasty (TKA)1is a common surgical treatment for severe knee Osteoarthritis (OA)2, which generally improves pain, physical function, quality of life and possibly fall risk. Fall risk increases for older adults with severe knee OA; however it has not been studied extensively whether this parameter is improved after TKA.Objective:To investigate: a) the history and frequency of falls, including mechanism or causes of falls, injuries sustained from falls reported, activity during falling and location of falls and, b) the factors affecting falls, a year after TKA in elderly patients with severe knee OA.Patients and Method:An observational prospective longitudinal study of 68 patients (11 males and 57 females) was conducted. The frequency of falls was recorded every month after knee replacement for a year period. A year after the TKA patients completed self-administered questionnaires (SF-36, Womac, FOF, ABC, PASE) and were assessed in physical performance tests (TUG and BBS).Results:There was significant improvement in falls frequency (p<0.001), differentiation of falling status to the benefit of non fallers (p<0.001) and risk of serious injuries (p<0.001). The factors that affected falling status was history of falls (p<0.0005), fear of falls (p<0.017) and advanced age, marginally (p<0.097).Conclusion:TKA generally improved a lot of aspects in patients’ life. One of these was the reduction of fall risk, which always co-exists in this population and can cause devastating problems threatening the benefits of the procedure.

scholarly journals Tibial Condyle Valgus Osteotomy for Ipsilateral Knee Osteoarthritis after Hip Arthrodesis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Daisuke Fukuhara ◽  
Hiroaki Inoue ◽  
Shuji Nakagawa ◽  
Yuji Arai ◽  
Kenji Takahashi
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Mechanical Load ◽  
Weight Bearing ◽  
Valgus Osteotomy ◽  
Hip Arthrodesis ◽  
Knee Oa ◽  
Early Loosening ◽  
Tibial Condyle ◽  
End Stage

We report a case of tibial condylar valgus osteotomy (TCVO) for ipsilateral knee osteoarthritis (OA) after hip arthrodesis. A 58-year-old woman developed right purulent hip arthritis at one month of age and underwent right hip fusion at 16 years old. She visited our department at the age of 57 because her right knee joint pain worsened. The range of motion for her right knee was 80° and -5° of flexion and extension, respectively, and she experienced medial weight-bearing pain. A plain X-ray image showed that the right knee joint had end-stage knee OA with a bone defect inside the tibia, and the tibial plateau shape was the pagoda type. There was a marked instability in her right knee with a valgus of 9° and varus of 7° on stress photography. She underwent TCVO on her right knee and was allowed full load four weeks after surgery. Computed tomography imaging showed bone union nine months after surgery. Two years after the operation, there was no correction loss, and she could walk independently without pain. In general, total knee arthroplasty (TKA) is indicated for end-stage knee OA; however, there are problems, such as early loosening due to the increased mechanical load on the knee after hip OA. In this case, since a good course was obtained, TCVO is considered a treatment option for terminal knee OA after hip arthrodesis.

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