Surgical management of osteoarthritis.
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ABSTRACT:
SUBMITTER: Katz JN
PROVIDER: S-EPMC2942971 | biostudies-literature | 2010 Sep
REPOSITORIES: biostudies-literature
Publications
Surgical management of osteoarthritis.
Katz Jeffrey N JN Earp Brandon E BE Gomoll Andreas H AH
Arthritis care & research 20100901 9
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Project description:ObjectiveThis study is an economic evaluation of total knee replacement (TKR) in comparison with non-surgical management in India.MethodsCost-utility analysis and budget impact analysis (BIA) were conducted on individuals aged ≥ 50 years with osteoarthritis of the knee (OA knee) Kellgren-Lawrence grades 2 and 3 using a provider's perspective. Three scenarios were considered, varying the age at which TKR is administered while assuming a 20-year lifespan for the implant. A Markov model was used to determine incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was conducted incorporating implant costs and other input parameters.ResultsNet quality-adjusted life-years (QALYs) gained per OA knee treated with TKR were superior when performed at the age of 50, regardless of OA severity and across all scenarios. The lowest ICER was 36,107 Indian National Rupees (INR) (USD 482.9)/QALY gained, observed at 50 years, while the highest was INR 61,363 (USD 820.72)/QALY gained at 70 years for grade-2 severity. Sensitivity analysis revealed that the ICER was most sensitive to the cost of non-surgical management, health utility values gained in an improved state, and the cost of TKR across scenarios. For the BIA in Scenario 1, with 40% coverage for TKR, costs reach INR 5013 crores (cr) (USD 670,477,060) in 2023 and INR 8444 cr (USD 1,024,628,736) in 2028 (1% of government budgets). In Scenario 2 (full coverage), costs are INR 12,532 cr (USD 1,520,683,008) (2.7%) in 2023, declining to 2.4% in 2028. In Scenario 3, covering 40% under the National Health Mission (NHM), costs vary from 17% in 2023 to 25% in 2028.ConclusionThis study concludes that TKR is a cost-effective treatment option compared with non-surgical management for OA knee in India, irrespective of age, implant types, and severity.
| S-EPMC11865410 | biostudies-literature
Project description:UNLABELLED: Isolated patellofemoral osteoarthritis in the healthy middle-aged population is a challenging problem. Fifty-one knees in 50 patients with isolated patellofemoral osteoarthritis were treated by partial lateral facetectomy, lateral release, and medialization of the tibial tubercle. The minimum followup was 7 months (mean, 20.2 months; range, 7-32 months). Preoperative radiographs showed Ahlbäck Grades III and IV lateral patellofemoral joint space narrowing. The mean age of the patients was 60.1 years (range, 46-81 years). The subjective outcome was based on the WOMAC and the McCarroll score. Posteroanterior flexion weightbearing views, lateral views, and 45 degrees axial views were taken. According to the WOMAC score, the scores improved considerably by 2.34 points with respect to pain and by 1.63 points with respect to function. The Insall-Salvati index decreased considerably but still remained in the physiologic range. The majority of these patients experienced improvement in their patellofemoral symptoms. However, the clinical outcome was not better in comparison to other surgical procedures. After the short followup, we would not recommend combined lateral facetectomy, lateral release, and medialization of the tibial tubercle until longer results are available. LEVEL OF EVIDENCE: Level IV Therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2505141 | biostudies-other
Project description:BackgroundIsolated patellofemoral (PF) osteoarthritis (OA) affects 9% of persons older than 40 years. Nonoperative treatment should be exhausted fully before surgical treatment.Questions/purposesThe purpose of this article is to review the literature after 2008 with the aim of answering the following question: Which of the following surgical procedures has the highest survival rate and the lowest revision rate in advanced isolated PF OA: patellofemoral arthroplasty (PFA), total knee arthroplasty (TKA) or lateral facetectomy.MethodsThe search engine was MedLine. The keywords used were: PF OA and PFA. Three hundred and fifty-three articles were found between 2008 and 25 July 2013. Of those, only 23 were selected and reviewed because they were strictly focused on the topic and the question of this article.ResultsThe types of studies reported so far have a low level of evidence (levels III and IV). Most of them are prospective case series (level IV). Some are systematic reviews of level III studies. Reported survival rate of lateral facetectomy is 85% at 5 years, 67% at 10 years and 47% at 20 years. Reported failure rate of lateral facetectomy is 26% at 10 years and 16% at 12 years. The reported average time of reoperation is 8 years and 37% of such procedures fail. Survival rate of PFA has been reported to be 87.5% on average (range, 60-100%). The revision rate of PFA is 20%. Recent improvements in PFA design have resulted in improvements in short-and medium-term results, similar to those of TKA.ConclusionsThere is still no gold standard for the surgical treatment of isolated PF OA. However, PFA or TKA appear to be the most recommendable treatment in cases that do not respond to conservative treatment.
| S-EPMC3903957 | biostudies-literature
Project description:BackgroundThe primary aim of this systematic review was to investigate the individual/combined effectiveness of nonpharmacological interventions in individuals with persistent acromioclavicular joint osteoarthritis. The secondary aims were to investigate the comparative effectiveness of nonpharmacological versus surgical interventions, and to identify the criteria used for defining failure of conservative interventions in individuals who require surgery for persistent acromioclavicular joint osteoarthritis.MethodMajor electronic databases were searched from inception until October 2018. Studies involving adults aged 16 years and older, diagnosed clinically and radiologically with isolated acromioclavicular joint osteoarthritis for at least three months or more were included. Studies must explicitly state the type and duration of conservative interventions. Methodological risk of bias was assessed using the Modified Downs and Black checklist.ResultsTen surgical intervention studies were included for final synthesis. No studies investigated the effectiveness of nonpharmacological interventions or compared them with surgical interventions. Common nonpharmacological interventions trialed from the 10 included studies were activity modification (n = 8) and physiotherapy (n = 4). Four to six months was the most often reported timeframe defining failure of conservative management (range 3-12 months).ConclusionsCurrently, there is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis.
| S-EPMC7094063 | biostudies-literature
Project description:This prospective study aimed to investigate salivary proteome changes in periodontitis patients in response to treatment. Ten systemically healthy, non-smokers with stage III, grade C periodontitis (32-43yrs, F:M:5:5) underwent non-surgical periodontal treatment. Saliva (n=30) was collected pre- (T0), and one (T1) and six (T6) month post-treatment. Whole-mouth plaque (PI) and gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) were measured. The saliva proteome was investigated by label-free quantitative proteomics. Normalized protein intensities were measured and protein changes modeled over time (linear model) with significant protein regulation considered at false discovery rate (FDR)<0.05. Treatment significantly reduced PI, GI, BOP, percentages of sites with PD≥5mm and PD≥5mm+BOP (T1vsT0 and T6vsT0), PD and CAL (T6vsT0). Overall, 1713 proteins (5927 peptides) were identified. Following analysis, considering proteins quantified by ≥2 peptides, resulted in 878 distinct proteins. At T1, 80 (T1vsT0:60↑:20↓), and at T6, 118 human proteins (T6vsT0:67↑:51↓) were regulated. Top-regulated disease categories were shared between T1vsT0 and T6vsT0, with highest activity patterns for ‘cellular movement’. The post-treatment proteome (T6vsT1) remained stable. Periodontal treatment reduced clinical disease parameters and these changes were reflected in the salivary proteome.
2024-06-10 | PXD043901 | Pride
Project description:BackgroundThe aim of this study was to examine the racial and ethnic representation in studies included in the 2015 American Academy of Orthopaedic Surgeons Surgical Management of the Knee Evidence-Based Clinical Practice Guideline relative to their representation of the United States (US).MethodsThe demographic characteristics reported in articles included in the 2015 American Academy of Orthopaedic Surgeons Surgical Management of the Knee Evidence-Based Clinical Practice Guideline were analyzed. The primary outcome of interest was the representation quotient, which is the ratio of the proportion of a racial/ethnic group in the guideline studies relative to their proportion in the US. There were 211 studies included, of which 15 (7%) reported race. There were 35 studies based in the US and 7 of the US-based studies reported race.ResultsNo US-based studies reported race and ethnicity separately, no studies reported American Indian/Alaska Native participants and no US-based studies reported Asian participants. The representation quotient of US-based studies was 0.66 for Black participants, 0.33 for Hispanic participants, and 1.30 for White participants, which indicates a relative over-representation of White participants compared to national proportions.ConclusionThis study illustrated that the evidence base for the surgical management of knee osteoarthritis has been constructed from studies which fail to consider race and ethnicity. Of those US-based studies which do report race or ethnicity, study cohorts do not reflect the US population. These results illustrate a disparity in clinical orthopedic surgical evidence and highlight the need for improved research recruitment strategies.
| S-EPMC11210326 | biostudies-literature
Project description:IntroductionTo conduct a literature review exploring the humanistic burden, costs, and guideline recommendations for non-surgical management of moderate-severe pain in knee osteoarthritis (KOA).MethodsPublished studies (2018-25 April 2023) assessing the burden of moderate-severe pain in KOA were identified by searching Medline, Embase, EconLit, and Cochrane database, supplemented with grey literature hand searches and reference list snowballing. Treatment guidelines were also identified for key countries.ResultsThis review included 106 publications and 37 treatment guidelines. Patients with moderate-severe pain were found to experience a low quality of life (QoL) and an impaired ability to perform daily tasks. The economic burden of KOA was substantial, including cost of medical visits, non-operative treatment (physical therapy and hyaluronic acid [HA] being key drivers) and productivity losses. Non-steroidal anti-inflammatory drugs (NSAIDs) were among the most frequently used pharmacological treatments, with intra-articular (IA) injections used to varying degrees. Opioid use was also frequently reported. Guidelines universally recommended NSAIDs, albeit with limited dose and duration for oral NSAIDs. IA-corticosteroids were conditionally/moderately recommended for short-term use by most guidelines, while IA-HA and opioids were rarely recommended. Guidelines are not specific to patients with moderate-severe pain and do not distinguish between different KOA phenotypes.ConclusionsKOA with moderate-severe pain is associated with substantial humanistic and economic burden. Real-world data suggest that some treatments are regularly used at high cost regardless of the lack of evidence-based recommendations. There remains a need for new treatment options that successfully relieve pain, improve QoL and delay the need for surgery. Graphical abstract available for this article.
| S-EPMC11557795 | biostudies-literature
Project description:Osteoarthritis of the knee is a common disease that causes significant disability. Most patients can be managed conservatively in the outpatient setting. A small minority require surgery. The cornerstones of treatment are weight loss, exercise and analgesia. Walking aids, medial patellar taping, acupuncture and transcutaneous electrical nerve stimulation are useful management adjuncts. Current evidence does not support routine prescription of glucosamine and chondroitin supplements. Early consultation with an orthopaedic surgeon should be made when conservative measures fail.
| S-EPMC5651502 | biostudies-literature
Project description: Not available
| S-EPMC4162780 | biostudies-literature
Project description:Surgical interventions for knee osteoarthritis (OA) have markedly different procedure attributes and may have dramatic differences in patient desirability. A total of 323 patients with knee OA were included in a dual response, choice-based conjoint analysis to identify the relative preference of 9 different procedure attributes. A model was also developed to simulate how patients might respond if presented with the real-world knee OA procedures, based on conservative assumptions regarding their attributes. The "amount of cutting and removal of the existing bone" required for a procedure had the highest preference score, indicating that these patients considered it the most important attribute. More specifically, a procedure that requires the least amount of bone cutting or removal would be expected to be the most preferred surgical alternative. The model also suggested that patients who are younger and report the highest pain levels and greatest functional limitations would be more likely to opt for surgical intervention.
| S-EPMC5613842 | biostudies-literature