Objective
To assess the relationship of hip and knee osteoarthritis (OA) to walking difficulty.
Methods
A population cohort ages ≤55 years recruited from 1996 to 1998 (n = 28,451) completed a ...standardized questionnaire assessing demographics, health conditions, joint symptoms, and functional limitations, including difficulty walking in the past 3 months. Survey data were linked to health administrative databases; self‐report and administrative data were used to identify health conditions. Hip/knee OA was defined as self‐reported swelling, pain, or stiffness in a hip or knee lasting ≥6 weeks in the past 3 months without an inflammatory arthritis diagnosis. Using multivariable logistic regression, we examined the determinants of walking difficulty and constructed a clinical nomogram.
Results
A total of 18,490 cohort participants were eligible (mean age 68 years, 60% women), and 25% reported difficulty walking. Difficulty walking was significantly and independently associated with older age, female sex, body mass index, and several health conditions. Of the conditions examined, the likelihood of walking difficulty was greatest with hip and knee OA and increased with the number of hip/knee joints affected. The predicted probability of difficulty walking for a 60‐year‐old middle‐income, normal‐weight woman was 5–10% with no health conditions, 10–20% with diabetes mellitus and cardiovascular (CV) disease, 40% with OA in 2 hips/knees, 60–70% with diabetes mellitus, CV disease, and OA in 2 hips/knees, and 80% with diabetes mellitus, CV disease, and OA in all hips/knees.
Conclusion
In a population cohort, symptomatic hip/knee OA was the strongest contributor to walking difficulty. Given the importance of walking to engagement in physical activity for chronic disease management, greater attention to OA is warranted.
Objective
Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about ...outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.
Methods
In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2‐year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).
Results
We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex–standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex–standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio HR 1.91, P = 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P = 0.03) relative to recipients with OA.
Conclusion
Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.
Although total joint replacement is an effective treatment for advanced arthritis, many whom might benefit are unwilling to consider this procedure. This review highlights advances in understanding ...of patients' perceptions of total joint replacement.
Research shows that patients' willingness to consider total joint replacement varies by sex, race/ethnicity, and socioeconomic status as a result of systematic differences in knowledge and beliefs about the procedure. Individuals with low socioeconomic status and minorities view the procedure less favorably than their wealthier, white counterparts, possibly partly explaining disparity in rates of use of the procedure among these groups. Among those undergoing total joint replacement, up to 30% experience a suboptimal outcome or are dissatisfied with results. Early work suggests that patients' expectations and self-efficacy are important potential predictors of postoperative outcome. Patient information needs regarding total joint replacement vary significantly and possibly systematically by sex and race/ethnicity. Available information materials may not address the concerns of many individuals contemplating the procedure, posing a potential barrier to surgery.
Targeted culturally sensitive knowledge dissemination strategies are needed to improve the knowledge and beliefs of people with hip/knee arthritis about total joint replacement.
Aims/hypothesis
This study examined the relationship between hip/knee osteoarthritis and incident diabetes. We hypothesised that hip/knee osteoarthritis would be independently related to an increased ...risk of incident diabetes and that this relationship would be due, at least in part, to walking difficulty. We also hypothesised a stronger relationship with incident diabetes for knee than hip osteoarthritis because of the higher prevalence in the former of obesity/the metabolic syndrome.
Methods
A population cohort aged ≥55 years recruited from 1996 to 1998 was followed through provincial health administrative data to 2014. Participants with baseline diabetes were excluded. Hip/knee osteoarthritis was defined as swelling, pain or stiffness in any joint lasting 6 weeks in the past 3 months and indication on a joint homunculus that a hip/knee was ‘troublesome’. Walking limitation was defined as self-reported difficulty standing or walking in the last 3 months (yes/no). Using Cox regressions, we examined the relationship of baseline hip/knee osteoarthritis with incident diabetes as defined from health administrative data, controlling for age, sex, BMI, income, prior hypertension, cardiovascular disease and primary care exposure. We tested whether the observed effect was mediated through walking limitation.
Results
In total, 16,362 participants were included: median age 68 years and 61% female. Of these, 1637 (10%) individuals met the criteria for hip osteoarthritis, 2431 (15%) for knee osteoarthritis and 3908 (24%) for walking limitation. Over a median follow-up of 13.5 years (interquartile range 7.3–17.8), 3539 individuals (22%) developed diabetes. Controlling for confounders, a significant relationship was observed between number of hip/knee joints with osteoarthritis and incident diabetes: HR for two vs no osteoarthritic hips 1.25 (95% CI 1.08, 1.44); HR for two vs no osteoarthritic knees 1.16 (95% CI 1.04, 1.29). From 37% to 46% of this relationship was explained by baseline walking limitation.
Conclusions/interpretation
In a large population cohort aged ≥55 years who were free of diabetes at baseline, and controlling for confounders, the presence and burden of hip/knee osteoarthritis was a significant independent predictor of incident diabetes. This association was partially explained by walking limitation. Increased attention to osteoarthritis and osteoarthritis-related functional limitations has the potential to reduce diabetes risk.
Objective
To evaluate patient predictors of good outcome following total joint arthroplasty (TJA).
Methods
A population cohort with hip/knee arthritis (osteoarthritis OA or inflammatory arthritis) ...ages ≥55 years was recruited between 1996 and 1998 (baseline) and assessed annually for demographics, troublesome joints, health status, and overall hip/knee arthritis severity using the Western Ontario and McMaster Universities OA Index (WOMAC). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as an improvement in WOMAC summary score greater than or equal to the minimal important difference (MID; 0.5 SD of the mean change). Logistic regression and Akaike's information criterion were used to determine the optimal number of predictors and the best model of that size. Log Poisson regression was used to determine the relative risk (RR) for a good outcome.
Results
Primary TJA was performed in 202 patients (mean age 71.0 years; 79.7% female; 82.7% with >1 troublesome hip/knee; 65.8% knee replacements). Mean improvement in WOMAC summary score was 10.2 points (SD 18.05; MID 9 points). Of these patients, 53.5% experienced a good outcome. Four predictors were optimal. The best 4‐variable model included pre‐TJA WOMAC, comorbidity, number of troublesome hips/knees, and arthritis type (C statistic 0.80). The probability of a good outcome was greater with worse (higher) pre‐TJA WOMAC summary scores (adjusted RR 1.32 per 10‐point increase; P < 0.0001), fewer troublesome hips/knees (adjusted RR 0.82 per joint; P = 0.002), OA (adjusted RR for rheumatoid arthritis versus OA 0.33; P = 0.009), and fewer comorbidities (adjusted RR per condition 0.88; P = 0.01).
Conclusion
In an OA cohort with a high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted.
Abstract
Background
Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the ...management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists’ perceptions and clinical behaviors related to early knee OA management.
Objective
The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population.
Design
We used a qualitative, descriptive research design.
Methods
Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis.
Results
Five main themes were constructed: (1) Physical therapists’ experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist “toolbox:” participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating “buy-in” to management: physical therapists used a range of strategies to gain “buy-in.”
Limitations
Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years.
Conclusions
Participants’ accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).
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