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Wang Y, Shen Z, Xing X, Ge L, Pan F, Cai G. Association of physical activity trajectories over 8 years and risk of knee replacement: data from the osteoarthritis initiative. BMC Musculoskelet Disord 2024; 25:586. [PMID: 39061027 PMCID: PMC11282720 DOI: 10.1186/s12891-024-07710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND To identify physical activity (PA) trajectories in adults with or at risk of knee osteoarthritis and to evaluate the association of PA trajectories with incident knee replacement (KR). METHODS This study used data from the Osteoarthritis Initiative. The Physical Activity Scale for the Elderly and the KR were assessed annually from baseline to 9 years. Individuals were included if they did not undergo KR surgery at baseline and had data on PA at ≥ 1 visit before KR. Latent class growth mixture Modeling was used to identify the optimal trajectories of PA before KR. Log-binomial regression models were used to assess the association between PA trajectories and the risk of KR. Data analyses were conducted in all individuals and those with radiographic osteoarthritis (ROA) and significant knee pain (Western Ontario and McMaster Osteoarthritis Index pain score of ≥ 5 on a 0-20 scale) at baseline, respectively. RESULTS Of 4731 participants (mean age 61.1 years, 58.5% female), four distinct and slightly declined PA trajectories were identified. Compared to individuals with a "Low" PA trajectory, those with "Medium-low", "Medium-high", or "High" PA trajectories were not significantly associated with the risk of KR (risk ratios: 0.97-1.19, all p > 0.05). Similar PA trajectories and associations with the risk of KR were observed in the subgroups of individuals with radiographic osteoarthritis and those with significant knee pain at baseline, respectively. CONCLUSION In participants with or at risk of knee osteoarthritis, PA slightly declines over time and may play no role in the risk of KR.
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Affiliation(s)
- Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Xing Xing
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
- The Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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Zhu H, Zhou L, Wang Q, Cai Q, Yang F, Jin H, Chen Y, Song Y, Zhang C. Glucagon-like peptide-1 receptor agonists as a disease-modifying therapy for knee osteoarthritis mediated by weight loss: findings from the Shanghai Osteoarthritis Cohort. Ann Rheum Dis 2023; 82:1218-1226. [PMID: 37258065 PMCID: PMC10423473 DOI: 10.1136/ard-2023-223845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Obesity is a risk factor for knee osteoarthritis (KOA) development and progression. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are indicated for type 2 diabetes mellitus (T2DM) and obesity. However, whether KOA patients can benefit from GLP-1RA therapies has not been sufficiently investigated, especially in the long term. METHODS The Shanghai Osteoarthritis Cohort study is a prospective, observational, multicentre study of >40 000 adults with clinically diagnosed osteoarthritis aged >45 years in Shanghai. We identified all KOA participants with comorbid T2DM enrolled from 1 January 2011 to 1 January 2017. Primary outcome was incidence of knee surgery after enrolment. Secondary outcomes included pain-relieving medication use, number of intra-articular therapies, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and medial femorotibial joint cartilage thickness. To evaluate the effects of GLP-1RA, we performed before-and-after comparison and comparison with participants who had no GLP-1RA exposure. RESULTS For an intergroup comparison (non-GLP-1RA vs GLP-1RA), more weight loss (adjusted mean difference in weight change from baseline -7.29 kg (95% CI -8.07 to -6.50 kg), p<0.001) and lower incidence of knee surgery (93/1574 (5.9%) vs 4/233 (1.7%), adjusted p=0.014) were observed in the GLP-1RA group. Statistically significant differences in mean change from baseline for the WOMAC total and pain subscale scores were observed (adjusted mean difference in WOMAC total score -1.46 (95% CI -2.84 to -0.08), p=0.038; adjusted mean difference in WOMAC pain subscore -3.37 (95% CI -5.79 to -0.94), p=0.007). Cartilage-loss velocity of the medial femorotibial joint was significantly lower in the GLP-1RA group postadjustment for baseline characteristics (adjusted mean difference -0.02 mm (95% CI -0.03 to -0.002 mm), p=0.004). For the before-and-after comparison within the GLP-1RA group, we observed a significant decrease of symptom-relieving medication consumption and cartilage loss velocity of medial femorotibial joint (after-treatment vs before-treatment: -0.03±0.05 vs -0.05±0.07 mm/year, p<0.001). The association between GLP-1RA exposure and decreased incidence of knee surgery was mediated by weight reduction (mediation proportion: 32.1%), instead of glycaemic control (too small to calculate). CONCLUSION With sufficient treatment duration, GLP-1RA therapies might be disease-modifying for KOA patients with comorbid T2DM, possibly mediated by weight loss. Further investigation is needed to elucidate effects of GLP-1RA on disease process, joint structure and patient-reported outcomes of osteoarthritis.
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Affiliation(s)
- Hongyi Zhu
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
- Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Lenian Zhou
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
- Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Qiuke Wang
- General practice, Erasmus Medical Center, Rotterdam, Netherlands
| | - Qianying Cai
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
- Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Fan Yang
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Hanqiang Jin
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yiwei Chen
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yanyan Song
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
- Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
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Yu D, Huang X, Mamas MA, Wilkie R. Persistent high prevalence of modifiable cardiovascular risk factors among patients with osteoarthritis in the UK in 1992-2017. RMD Open 2023; 9:e003298. [PMID: 37648396 PMCID: PMC10471862 DOI: 10.1136/rmdopen-2023-003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To compare the annual and period prevalence of modifiable cardiovascular risk factors (MCVRFs) between populations with and without osteoarthritis (OA) in the UK over 25 years. METHODS 215 190 patients aged 35 years and over from the UK Clinical Practice Research Datalink GOLD database who were newly diagnosed OA between 1992 and 2017, as well as 1:1 age-matched, sex-matched, practice-matched and index year-matched non-OA individuals, were incorporated. MCVRFs including smoking, hypertension, type 2 diabetes, obesity and dyslipidaemia were defined by Read codes and clinical measurements. The annual and period prevalence and prevalence rate ratios (PRRs) of individual and clustering (≥1, ≥2 and ≥3) MCVRFs were estimated by Poisson regression with multiple imputations for missing values. RESULTS The annual prevalence of MCVRFs increased in the population with OA between 1992 and 2017 and was consistently higher in the population with OA compared with the population without OA between 2004 and 2017. Trends towards increased or stable annual PRRs for individuals and clustering of MCVRFs were observed. A 26-year period prevalence of single and clustering MCVRFs was significantly higher in individuals with OA compared with non-OA individuals. Period PRRs were higher in Southern England, women and increased with age for most MCVRFs except for obesity, which has the higher PRR in the youngest age group. CONCLUSIONS A consistently higher long-term prevalence of MCVRFs was observed in individuals with OA compared to those without OA. The higher prevalence of obesity in the youngest age group with OA highlights the need for public health strategies. Further research to understand MCVRF management in OA populations is necessary.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Xiaoyang Huang
- Shenzhen Ellen-Sven Precision Medicine Institute, Shenzhen, Guangdong, China
| | - Mamas A Mamas
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ross Wilkie
- School of Medicine, Keele University, Keele, Staffordshire, UK
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Jennison T, Ukoumunne OC, Lamb S, Sharpe I, Goldberg A. Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital. Foot Ankle Int 2023; 44:596-603. [PMID: 37345846 DOI: 10.1177/10711007231176512] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements. METHODS A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements. RESULTS The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure. CONCLUSION This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Toby Jennison
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sallie Lamb
- NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andy Goldberg
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, MSK Hub, White City Campus, London, UK
- The Wellington Hospital, St John's Wood, London, UK
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5
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Association of general and central obesity, and their changes with risk of knee osteoarthritis: a nationwide population-based cohort study. Sci Rep 2023; 13:3796. [PMID: 36882508 PMCID: PMC9992488 DOI: 10.1038/s41598-023-30727-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
In this study, we aimed to evaluate the association between general and central obesity, and their changes with risk of knee osteoarthritis (OA) using retrospective cohort data collected from the Korean National Health Insurance Service. We studied 1,139,463 people aged 50 and over who received a health examination in 2009. To evaluate the association between general and/or central obesity and knee OA risk, a Cox proportional hazard models were used. Additionally, we investigate knee OA risk according to the change in obesity status over 2 years for subjects who had undergone health examinations for 2 consecutive years. General obesity without central obesity (HR 1.281, 95% CI 1.270-1.292) and central obesity without general obesity (HR 1.167, 95% CI 1.150-1.184) were associated with increased knee OA risk than the comparison group. Individuals with both general with central obesity had the highest risk (HR 1.418, 95% CI 1.406-1.429). This association was more pronounced in women and younger age group. Remarkably, the remission of general or central obesity over two years was associated with decreased knee OA risk (HR 0.884; 95% CI 0.867-0.902; HR 0.900; 95% CI 0.884-0.916, respectively). The present study found that both general and central obesity were associated with increased risk of knee OA and the risk was highest when the two types of obesity were accompanied. Changes in obesity status have been confirmed to alter the risk of knee OA.
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Kostic AM, Leifer VP, Gong Y, Robinson MK, Collins JE, Neogi T, Messier SP, Hunter DJ, Selzer F, Suter LG, Katz JN, Losina E. Cost-Effectiveness of Surgical Weight-Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity. Arthritis Care Res (Hoboken) 2023; 75:491-500. [PMID: 35657632 PMCID: PMC9827536 DOI: 10.1002/acr.24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Class III obesity (body mass index [BMI] ≥40 kg/m2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m2 , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m2 . METHODS We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters. RESULTS The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m2 , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively. CONCLUSION RYGB offers good value among knee OA patients with BMI ≥40 kg/m2 , while LSG may provide good value among those with BMI between 35 and 41 kg/m2 .
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Affiliation(s)
- Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Yusi Gong
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Carle Illinois College of Medicine, Champaign, IL, USA
| | - Malcolm K. Robinson
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jamie E. Collins
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University of School of Medicine, Boston, MA, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, Australia
| | - Faith Selzer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa G. Suter
- Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA
- Section of Rheumatology, Veterans Affairs Medical Center, West Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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7
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Johns N, Noye N, Wall C, Martin G, Loch A. Efficacy of Adductor Canal Blocks in Total Knee Arthroplasty. J Knee Surg 2022; 35:1491-1494. [PMID: 33853151 DOI: 10.1055/s-0041-1726417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m2 and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS (p < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; p < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.
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Affiliation(s)
- Nicholas Johns
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Nicholas Noye
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Chris Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Glen Martin
- Department of Anaesthesia, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Department of Orthopaedics, St. Vincent's Private Hospital Toowoomba, Toowoomba, Queensland, Australia
| | - Alan Loch
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.,Department of Orthopaedics, St. Vincent's Private Hospital Toowoomba, Toowoomba, Queensland, Australia
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8
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Abbas Z, Hafeez S, Naseem A, Habib Y, Mumtaz H. Effect of body mass index on duration of total knee replacement surgery: A prospective cross sectional study. Ann Med Surg (Lond) 2022; 82:104637. [PMID: 36268351 PMCID: PMC9577639 DOI: 10.1016/j.amsu.2022.104637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Obesity and increased BMI has raised concerns throughout the globe. As obesity is often associated with many serious medical conditions. Obesity, older age and gender are major contributing factors for knee replacement surgeries. We aimed to compare the mean duration of surgery in obese and non-obese patients undergoing total knee replacement. Methods A Cross-sectional study is conducted at the orthopedic department at Shifa international hospital, Islamabad during June 2021–Dec 2021. Study is conducted to assess the effect of BMI on duration of total knee arthroplasty. Sample size was calculated to be 105 with 95% confidence limit. Data will be analyzed using SPSS version 22. Quantitative variables like age, BMI and duration of surgery were presented as mean and standard deviation. Qualitative variables like gender, laterality (unilateral/bilateral), and ASA were presented as frequency and percentage. Results There were more females undergoing the procedure than males. The predominant age group was found to be 56–65 years. On BMI classification scale, a far greater number of individuals were found to be obese constituting more than ⅗ of the study population and almost ⅕ of the patients were overweight. The Association of BMI Classification & Duration of Surgery has a significant p value of 0.00. Conclusion A linear and direct relation was observed between body mass index and duration of surgery. There may be other contributing factors and will need more data and research. The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations. High body mass index (BMI) is associated with increased rates of complications after total knee arthroplasty. Our study finds a strong association of Age, Gender & ASA Grade with BMI.
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Affiliation(s)
- Zamin Abbas
- Shifa International Hospital, Islamabad, Pakistan
| | | | - Ali Naseem
- Shifa International Hospital, Islamabad, Pakistan
| | - Yasir Habib
- Shifa International Hospital, Islamabad, Pakistan
| | - Hassan Mumtaz
- Health Services Academy, Islamabad, Pakistan
- Corresponding author.
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9
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Chen L, Zheng M, Chen Z, Peng Y, Jones C, Graves S, Chen P, Ruan R, Papadimitriou J, Carey-Smith R, Leys T, Mitchell C, Huang YG, Wood D, Bulsara M, Zheng MH. The burden of end-stage osteoarthritis in Australia: a population-based study on the incidence of total knee replacement attributable to overweight/obesity. Osteoarthritis Cartilage 2022; 30:1254-1262. [PMID: 34890810 DOI: 10.1016/j.joca.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. METHODS This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence. RESULTS The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged >75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category. CONCLUSIONS Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.
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Affiliation(s)
- L Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - M Zheng
- Institute for Health Research, Medical School, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Z Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Y Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - C Jones
- Department of Orthopaedic Surgery, Fiona Stanley Hospital Group, Perth, Western Australia, Australia
| | - S Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - P Chen
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - R Ruan
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - J Papadimitriou
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Pathwest Laboratories, Perth, Western Australia, Australia
| | - R Carey-Smith
- Department of Orthopaedic Surgery, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - T Leys
- Department of Orthopaedic Surgery, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - C Mitchell
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Y G Huang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - D Wood
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - M Bulsara
- Institute for Health Research, Medical School, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - M H Zheng
- Centre for Translational Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
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10
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11
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Pelletier JP, Dorais M, Paiement P, Raynauld JP, Martel-Pelletier J. Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221091359. [PMID: 35510169 PMCID: PMC9058358 DOI: 10.1177/1759720x221091359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this study was to investigate changes over time in osteoarthritis risk factors most closely associated with the occurrence of total knee arthroplasty (TKA). We hypothesize that the robustness of a longitudinal case–control study will provide new information on the association between changes in various clinical and structural parameters in different time frames before TKA. Methods: Cases (195; TKA after cohort entry) and controls (468) matched for age, gender, income, WOMAC pain, Kellgren–Lawrence grade and follow-up duration were from the Osteoarthritis Initiative cohort. Associations between changes in sociodemographic, clinical, imaging and osteoarthritis therapies with the occurrence of TKA were performed using conditional logistic regression analyses. Results: Worsening of WOMAC scores (cOR 1.02–1.20, p ⩽ 0.012), KOOS (1.02–1.04, p ⩽ 0.014), knee injuries sustained in the previous 30–40 years (women 2.70, p = 0.034) and valgus alignment (1.10, p = 0.052) were associated with the occurrence of TKA. Also associated with TKA was cartilage volume loss in the lateral (overall 1.76, p = 0.025; women 1.93, p = 0.047) and medial compartments (⩾10%, overall 1.54, p = 0.027; men 2.34, p = 0.008), occurrence of medial meniscal extrusion (overall 1.77, p = 0.046; men 2.86, p = 0.028), and increase in bone marrow lesions (BMLs) for women (1.09, p = 0.048). The association of risk factors with TKA was reinforced when both an increase in WOMAC pain and cartilage volume loss (1.85, p = 0.001) were combined. Pain medication usage, mainly narcotics and intra-articular steroid injections (IASI), was also associated with TKA, with no impact on changes in cartilage loss or structure. Conclusion: This study provides new information about gender differences in risk factors associated with the occurrence of TKA. Worsening of valgus alignment, cartilage volume loss in the lateral compartment, BMLs and older injuries are important risk factors in women, while medial compartment cartilage loss and meniscal extrusion are in men. The use of pain medication and IASI although associated was found not causal with TKA.
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Affiliation(s)
- Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412A, Montreal, QC H2X 0A9, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l’Île-Perrot, QC, Canada
| | | | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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12
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Wall CJ, de Steiger RN, Vertullo CJ, Stoney JD, Graves SE, Lorimer MF, Kondalsamy-Chennakesavan S. Obesity is associated with an increased risk of undergoing knee replacement in Australia. ANZ J Surg 2022; 92:1814-1819. [PMID: 35412005 PMCID: PMC9545084 DOI: 10.1111/ans.17689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
Background Obesity is associated with the development of knee osteoarthritis (OA). The aim of this study was to examine the incidence of obesity in patients undergoing knee replacement (KR) for OA in Australia compared to the incidence of obesity in the general population. Methods A cohort study was conducted, comparing data from the Australian Bureau of Statistics (ABS) 2017–2018 National Health Survey with data from the National Joint Replacement Registry. The distribution of patients who underwent KR from July 2017 to June 2018 by BMI category was compared to the distribution of the general population, in age and gender sub‐groups. Results During the study period, 35.6% of Australian adults were overweight and 31.3% were obese. Of the 56 217 patients who underwent primary KR for OA, 31.9% were overweight and 57.7% were obese. The relative risk of undergoing KR for OA increased with increasing BMI category. Class 1, 2 and 3 obese females aged 55–64 years were 4.7, 8.4 and 17.3 times more likely to undergo KR than their normal weight counterparts, respectively. Males in the same age and BMI categories were 3.4, 4.5 and 5.8 times more likely to undergo KR, respectively. Class 3 obese patients underwent KR 7 years younger, on average, than normal weight individuals. Conclusion Obesity is associated with an increased risk of undergoing KR, and at a younger age, particularly for females. There is an urgent need for a societal level approach to address the prevalence of obesity, to reduce the burden of obesity related KR.
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Affiliation(s)
- Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia.,School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Richard N de Steiger
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Christopher J Vertullo
- Knee Research Australia, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - James D Stoney
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Michelle F Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
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13
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Elcock KL, Carter TH, Yapp LZ, MacDonald DJ, Howie CR, Stoddart A, Berg G, Clement ND, Scott CEH. Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications. Bone Joint J 2022; 104-B:452-463. [PMID: 35360945 DOI: 10.1302/0301-620x.104b4.bjj-2021-0353.r3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m2 to examine whether this is supported. METHODS This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m2) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m2 in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient's lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. RESULTS All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m2: 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m2. In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m2 and £5,275 in patients with a BMI ≥ 40 kg/m2. CONCLUSION Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m2, suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452-463.
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Affiliation(s)
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Colin R Howie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Guy Berg
- Healthcare Improvement Scotland, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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14
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Seward MW, Chen AF. Obesity, preoperative weight loss, and telemedicine before total joint arthroplasty: a review. ARTHROPLASTY 2022; 4:2. [PMID: 35005434 PMCID: PMC8723914 DOI: 10.1186/s42836-021-00102-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/03/2021] [Indexed: 01/22/2023] Open
Abstract
The preoperative period prior to elective total joint arthroplasty (TJA) is a critical time for lifestyle interventions since a scheduled surgery may help motivate patients to lose weight. Weight loss may reduce complications associated with obesity following TJA and enable patients with severe obesity (body mass index [BMI] > 40 kg/m2) to become eligible for TJA, as many institutions use a 40 kg/m2 cut-off for offering surgery. A comprehensive review was conducted to (1) provide background on complications associated with obesity following TJA, (2) synthesize prior research on the success rate of patients losing weight after being denied TJA for severe obesity, (3) discuss bariatric surgery before TJA, and (4) propose mobile health telemedicine weight loss interventions as potential weight loss methods for patients preoperatively. It is well established that obesity increases complications associated with TJA. In total knee arthroplasty (TKA), obesity increases operative time, length of stay, and hospitalization costs as well as the risk of deep infection, revision, and component malpositioning. Obesity may have an even larger impact on complications associated with total hip arthroplasty (THA), including wound complications and deep infection. Obesity also increases the risk of hip dislocation, aseptic loosening, and venous thromboembolism after THA. Synthesis of the only two studies (n = 417), to our knowledge, that followed patients denied TJA for severe obesity demonstrated that only 7% successfully reduced their BMI below 40 kg/m2 via lifestyle modifications and ultimately underwent TJA. Unfortunately, bariatric surgery may only increase certain post-TKA complications including death, pneumonia, and implant failure, and there is limited research on preoperative weight loss via lifestyle modification. A review of short-term mobile health weight loss interventions that combined personalized counseling with self-monitoring via a smartphone app found about 5 kg of weight loss over 3-6 months. Patients with severe obesity have more weight to lose and may have additional motivation to do so before TJA, so weight loss results may differ by patient population. Research is needed to determine whether preoperative mobile health interventions can help patients become eligible for TJA and produce clinically significant weight loss sufficient to improve postoperative outcomes.
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Affiliation(s)
- Michael W Seward
- Mayo Clinic, Department of Orthopedic Surgery, 200 1st St SW, Rochester, MN 55905 USA
| | - Antonia F Chen
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, 75 Francis Street, Boston, MA 02115 USA
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15
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Xu H, Lin S, Huang H. Involvement of increased expression of chemokine C-C motif chemokine 22 (CCL22)/CC chemokine receptor 4 (CCR4) in the inflammatory injury and cartilage degradation of chondrocytes. Cytotechnology 2021; 73:715-726. [PMID: 34629747 DOI: 10.1007/s10616-021-00489-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
CCL22, which could induce chondrocyte apoptosis, was identified to be overexpressed in damaged cartilage. This study was conducted with the aim of investigating the effects of CCL22 interference on chondrocyte injury. The osteoarthritis model was established by stimulating chondrocytes with LPS. The expressions of CCL22, CCR4, matrix metallopeptidase (MMP) 3, MMP9, MMP13, (a disintegrin and metalloproteinase with thrombospondin-like motifs) ADAMTS-4, collagen II and inflammatory cytokines were measured using quantitative reverse transcription PCR (RT-qPCR) and western blot. Besides, immunoprecipitation (IP) was employed to verify the binding of CCL22 and CCR4. After CCR4 was overexpressed, cell viability was observed using Cell Counting Kit-8 (CCK-8). Additionally, cell apoptosis as well as its related proteins was detected by TUNEL and western blot, respectively. ng What's more, glycosaminoglycan (GAG) level was detected using GAG kits. CCL22 and CCR4 expression increased noticeably in LPS-stimulated ATDC5 chondrocytes. CCL22 inhibition could suppress the expression of CCR4 in LPS-induced ATDC5 cells. Likewise, CCL22 inhibition could revive the activation of LPS-induced ATDC5 cells by regulating CCR4. In addition, CCL22 knockdown alleviated inflammatory response and cell apoptosis through CCR4. Furthermore, the cartilage degradation of ADTC5 cells could be relieved by CCL22 silence via regulating CCR4. CCL22/CCR4 expression was increased in osteoarthritic cartilage injury and participated in the inflammation and cartilage degradation of chondrocytes.
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Affiliation(s)
- Haiqiao Xu
- Traumatic Orthopedics Department, Maoming People's Hospital, 101 Weimin Road, Maonan District, Maoming City, 525000 Guangdong Province China
| | - Shibang Lin
- Traumatic Orthopedics Department, Maoming People's Hospital, 101 Weimin Road, Maonan District, Maoming City, 525000 Guangdong Province China
| | - Haizhou Huang
- Traumatic Orthopedics Department, Maoming People's Hospital, 101 Weimin Road, Maonan District, Maoming City, 525000 Guangdong Province China
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16
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Huang X, Wilkie R, Mamas MA, Yu D. Prevalence of Cardiovascular Risk Factors in Osteoarthritis Patients Derived from Primary Care Records: A Systematic Review of Observational Studies. JOURNAL OF DIABETES AND CLINICAL RESEARCH 2021; 3. [PMID: 35784898 PMCID: PMC7612956 DOI: 10.33696/diabetes.3.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background People with osteoarthritis are at a high risk of cardiovascular disease (CVD). Detecting CVD risk factors in this high-risk population will help to improve CVD outcomes. Primary care electronic health records (EHRs) provide opportunities for the surveillance of CVD risk factors in the osteoarthritis population. This paper aimed to systematically review evidence of prevalence estimates of CVD risk factors in people with osteoarthritis derived from primary care EHRs. Methods Eight databases including MEDLINE were systematically searched till January 2019. Observational studies using primary care EHRs data to estimate the prevalence of six CVD risk factors in people with osteoarthritis were included. A narrative review was conducted to summarize study results. Results Six studies were identified. High heterogeneity between studies prevented the calculation of pooled estimates. One study reported the prevalence of smoking (12.5%); five reported hypertensions (range: 19.7%-55.5%); four reported obesities (range: 34.4%-51.6%); two reported dyslipidemias (6.0%, 13.3%); five reported diabetes (range: 5.2%-18.6%); and one reported chronic kidney disease (1.8%) in people with osteoarthritis. One study reported a higher prevalence of hypertension (Odds Ratio (OR) 1.25, 95% confidence interval (CI) 1.19-1.32), obesity (OR 2.44, 95%CI 2.33-2.55), dyslipidemia (OR 1.24, 95%CI 1.14-1.35) and diabetes (1.11, 95%CI 1.02-1.22) in the osteoarthritis population compared with the matched non-osteoarthritis population. Conclusions From studies identified in this review that had used primary care EHRs, prevalence estimates of CVD risk factors were higher in people with osteoarthritis compared with those without. These estimates may provide baseline frequency of CVD risk factors in osteoarthritis patients in primary care, although this is limited by the small number of studies and high heterogeneity. Further studies of frequency, using primary care EHRs, will help to answer whether this data source can be used for evaluating approaches to manage CVD risk factors in osteoarthritis patients.
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Affiliation(s)
- Xiaoyang Huang
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Ross Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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17
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Mahmoudian A, Lohmander LS, Mobasheri A, Englund M, Luyten FP. Early-stage symptomatic osteoarthritis of the knee - time for action. Nat Rev Rheumatol 2021; 17:621-632. [PMID: 34465902 DOI: 10.1038/s41584-021-00673-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.
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Affiliation(s)
- Armaghan Mahmoudian
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Frank P Luyten
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
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18
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Gonçalves TJM, Gonçalves SEAB, Nava N, Jorge VC, Okawa AM, Rocha VA, Forato LCH, Furuya VAO, Martins SS, Oksman D. Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes. JPEN J Parenter Enteral Nutr 2021; 45:1559-1566. [PMID: 33044001 PMCID: PMC8518379 DOI: 10.1002/jpen.2028] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C-reactive protein. RESULTS A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30-0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28-0.71; P < .001). CONCLUSION Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.
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Affiliation(s)
| | | | - Natássia Nava
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Valeria Conceição Jorge
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Andrea Massone Okawa
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Vanessa Azevedo Rocha
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | | | - Vicky Akemi Onizuca Furuya
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Sandra Salvador Martins
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Daniel Oksman
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
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Obesity Is Preferentially Associated With Patellofemoral Compartment Wear: A Magnetic Resonance Imaging Assessment. J Am Acad Orthop Surg 2021; 29:e722-e731. [PMID: 33273404 DOI: 10.5435/jaaos-d-20-00596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A well-known association exists between obesity and knee osteoarthritis (OA) for both incidence and progression of the disease. However, the cartilage wear patterns in OA associated with obesity are less well studied. METHODS The OA initiative, a prospective sample of 4,796 patients, was used for this study. After the application of inclusion and exclusion criteria, patients were stratified into increasing body mass index (BMI) cohorts (BMI < 25, 25 ≤ BMI < 30, 30 ≤ BMI < 40, and 40 ≤ BMI). Knee MRIs were assessed using the semiquantitative MRI Osteoarthritis Knee Score scores. Patellofemoral (PF), medial, and lateral compartment cartilage scores were compared among BMI cohorts, controlling for confounders using linear regression models. RESULTS In total, 2,006 patients were present in our cohort, 773 men (38.5%) and 1,233 women (61.5%); the mean age was 61.7 ± 8.9 years. Increasing BMI was independently associated with increasing grades of PF wear for both right and left knees in the lateral patella facet (right knee β: 0.208, 95% confidence interval [CI]: 0.128 to 0.288, P < 0.001, left knee β: 0.147, 95% CI: 0.056 to 0.237, P = 0.002), medial femoral trochlea (right knee β: 0.135, 95% CI: 0.065 to 0.204, P < 0.001, left knee β: 0.142, 95% CI: 0.063 to 0.221, P < 0.001), and lateral femoral trochlea (right knee β: 0.163, 95% CI: 0.093 to 0.232, P < 0.001, left knee β: 0.147, 95% CI: 0.067 to 0.226, P < 0.001). For the right knee, increasing BMI was associated with medial compartment wear in the posterior femoral area (β: 0.070, 95% CI: 0.015 to 0.126, P = 0.013) and lateral compartment wear in the central tibial area (β: 0.070, 95% CI: 0.002 to 0.138, P = 0.045). For the left knee, increasing BMI was associated with medial compartment wear in the central femoral area (β: 0.093, 95% CI: 0.016 to 0.171, P = 0.018). DISCUSSION Obesity is preferentially associated with increasing cartilage wear in the PF compartment in comparison to the tibiofemoral compartment. Physical therapy and exercise programs that promote weight loss should be modified to decrease forces on the PF joint.
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20
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Mesenchymal Stem Cells: Current Concepts in the Management of Inflammation in Osteoarthritis. Biomedicines 2021; 9:biomedicines9070785. [PMID: 34356849 PMCID: PMC8301311 DOI: 10.3390/biomedicines9070785] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) has traditionally been known as a “wear and tear” disease, which is mainly characterized by the degradation of articular cartilage and changes in the subchondral bone. Despite the fact that OA is often thought of as a degenerative disease, the catabolic products of the cartilage matrix often promote inflammation by activating immune cells. Current OA treatment focuses on symptomatic treatment, with a primary focus on pain management, which does not promote cartilage regeneration or attenuate joint inflammation. Since articular cartilage have no ability to regenerate, thus regeneration of the tissue is one of the key targets of modern treatments for OA. Cell-based therapies are among the new therapeutic strategies for OA. Mesenchymal stem cells (MSCs) have been extensively researched as potential therapeutic agents in cell-based therapy of OA due to their ability to differentiate into chondrocytes and their immunomodulatory properties that can facilitate cartilage repair and regeneration. In this review, we emphasized current knowledge and future perspectives on the use of MSCs by targeting their regeneration potential and immunomodulatory effects in the treatment of OA.
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21
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Lewis PL, Robertsson O, Graves SE, Paxton EW, Prentice HA, W-Dahl A. Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden. Acta Orthop 2021; 92:182-188. [PMID: 33263453 PMCID: PMC8159200 DOI: 10.1080/17453674.2020.1853340] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Studies describing time-related change in reasons for knee replacement revision have been limited to single regions or institutions, commonly analyze only 1st revisions, and may not reflect true caseloads or findings from other areas. We used revision procedure data from 3 arthroplasty registries to determine trends and differences in knee replacement revision diagnoses.Patients and methods - We obtained aggregated data for 78,151 revision knee replacement procedures recorded by the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) for the period 2003-2017. Equivalent diagnosis groups were created. We calculated the annual proportions of the most common reasons for revision.Results - Infection, loosening, and instability were among the 5 most common reasons for revision but magnitude and ranking varied between registries. Over time there were increases in proportions of revisions for infection and decreases in revisions for wear. There were inconsistent proportions and trends for the other reasons for revision. The incidence of revision for infection showed a uniform increase.Interpretation - Despite some differences in terminology, comparison of registry-recorded revision diagnoses is possible, but defining a single reason for revision is not always clear-cut. There were common increases in revision for infection and decreases in revision for wear, but variable changes in other categories. This may reflect regional practice differences and therefore generalizability of studies regarding reasons for revision is unwise.
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Affiliation(s)
- Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden,Correspondence:
| | - Otto Robertsson
- Swedish Knee Arthroplasty Register, Lund, Sweden;; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Stephan E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | | | | | - Annette W-Dahl
- Swedish Knee Arthroplasty Register, Lund, Sweden;; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
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22
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Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041630. [PMID: 33572081 PMCID: PMC7915738 DOI: 10.3390/ijerph18041630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient's quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted.
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Divino V, Ramasamy A, Anupindi VR, Eriksen KT, Olsen AH, DeKoven M, Meincke HH. Complication-specific direct medical costs by body mass index for 13 obesity-related complications: a retrospective database study. J Manag Care Spec Pharm 2020; 27:210-222. [PMID: 33307936 PMCID: PMC10394187 DOI: 10.18553/jmcp.2020.20272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Obesity, a multifactorial disease associated with many severe complications, affects more than 40% of adults in the United States. OBJECTIVE: To quantify the cost burden of 13 obesity-related complications (ORCs), overall and by body mass index (BMI) class. METHODS: Adult patients (aged ≥ 18 years) with ≥ 1 medical claim with an ICD-9/10 diagnosis code for the ORC of interest were identified using linked data from IQVIA's Ambulatory Electronic Medical Records and PharMetrics Plus. Thirteen ORCs were separately assessed (asthma, dyslipidemia, gastroesophageal reflux disease [GERD], heart failure with preserved ejection fraction [HFpEF], hypertension, musculoskeletal pain, obstructive sleep apnea [OSA], osteoarthritis [OA] of the knee, polycystic ovary syndrome [PCOS], prediabetes, psoriasis, type 2 diabetes mellitus [T2DM], and urinary incontinence); ORC cohorts were not mutually exclusive. For each ORC, the first claim identified for the ORC from January 2010-December 2016 was termed the index date. Patients had continuous enrollment in the 1-year pre-index (without a diagnosis code of the specific ORC under study) and the 1-year post-index, with ≥ 1 BMI value in the 6-months pre-index. Patients with underweight (BMI < 18.5 kg/m2) and those with cancer or pregnancy were excluded. Complication-specific costs were identified as claims with a diagnosis code for the ORC (primary position only for hospitalizations) or ORC-specific medications or procedures. Baseline demographic/clinical characteristics and complication-specific costs over the 1-year follow-up were assessed for each ORC cohort, overall and by BMI class (18.5-24.9; 25.0-29.9; 30.0-34.9; 35.0-39.9; ≥ 40 kg/m2). The association between total complication-specific costs and BMI class was assessed by generalized linear regression model for each ORC, adjusting for baseline characteristics. RESULTS: The total number of patients that comprised the ORC cohorts ranged from 1,275 (HFpEF) to 101,784 (musculoskeletal pain). Across ORC cohorts, 41.6% (musculoskeletal pain) to 73.5% (OSA) had obesity (BMI ≥ 30 kg/m2). For 4 ORC cohorts, more than one fifth of patients had class III obesity (BMI ≥ 40 kg/m2): T2DM, OSA, PCOS, and HFpEF. Baseline mean Charlson Comorbidity Index score increased with increasing BMI class for most ORC cohorts. The most costly ORCs overall based on mean total 1-year cost were: OA of the knee ($3,697 [range from normal weight (BMI: 18.5-24.9 kg/m2) to class III obesity: $2,453-$4,518]), HFpEF ($3,586 [range: $3,402-$4,685]), OSA ($2,768 [$2,442-$2,974]), and psoriasis ($2,711 [$2,131-$3,292]). The highest cost differences (≥20%) were observed among those with class III obesity versus those with normal weight for these aforementioned ORCs, as well as for GERD ($1,719 [$1,484-$1,893]) and asthma ($1,531 [$1,361-$1,780]). Following adjustment, most cost comparisons by BMI class were significantly higher versus those for normal weight for 6 ORCs. CONCLUSIONS: ORCs are important drivers of the economic burden of obesity, indicating an unmet need for the treatment of obesity. Appropriate weight management may reduce ORC-associated costs. DISCLOSURES: This study and its publication were supported by Novo Nordisk. Divino, Anupindi, and DeKoven are employed by IQVIA, which received funding from Novo Nordisk for this study. Ramasamy, Eriksen, Olsen, and Meincke are employed by and shareholders of Novo Nordisk. Material reported in this manuscript was presented in an abstract accepted by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2020, to be published in Value in Health. There was no presentation at ISPOR 2020.
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24
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Thuraisingam S, Dowsey M, Manski-Nankervis JA, Spelman T, Choong P, Gunn J, Chondros P. Developing prediction models for total knee replacement surgery in patients with osteoarthritis: Statistical analysis plan. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100126. [DOI: 10.1016/j.ocarto.2020.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
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Tran VN, Varfolomeev I, Hill G. Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search. Hosp Pharm 2020; 55:366-372. [PMID: 33245721 DOI: 10.1177/0018578719848732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of the study was to review the current literature for prophylactic enoxaparin dosing in obese orthopedic patients. Method: A literature search was undertaken using OVID Medline, OVID Embase, and Cochrane Central databases, accessed through hospital library websites. Key search terms (in UK and US spelling) included orthopaedics, low-molecular-weight heparin, enoxaparin, venous thromboembolism prophylaxis, weight, obese, morbid obesity. Possible related subheadings, such as bone, fractures, anticoagulants, overweight, body mass index, deep vein thrombosis, pulmonary embolism, were also included in the database search to optimize the search strategies. The search was restricted to human subjects and limited to articles published from 1998 to the present. Results: The search identified 429 potentially relevant articles. Once duplicates were removed, 345 were screened for inclusion in this review. Only 3 articles (a case-control study, an observational prospective study, and a case report) met both the inclusion and exclusion criteria. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias. Conclusion: The results of a multiple database search draw one to the conclusion that there is very limited evidence in the literature with regard to prophylactic enoxaparin dosing in obese orthopedic-specific patients. Orthopedic patients are among the highest risk of all surgical specialties for venous thromboembolism. There is strong evidence to support an increased prophylactic low-molecular-weight heparin doses in obese patients; thus, the authors recommend higher prophylactic enoxaparin dosing in obese orthopedic patients.
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Affiliation(s)
- Van N Tran
- Pharmacy Department, The Royal Melbourne Hospital, Victoria, Australia
| | - Ilya Varfolomeev
- Orthopaedic Department, The Royal Melbourne Hospital, Victoria, Australia
| | - Geoff Hill
- Health Sciences Library, The Royal Melbourne Hospital, Victoria, Australia
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26
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Arthritis and the role of endogenous glucocorticoids. Bone Res 2020; 8:33. [PMID: 32963891 PMCID: PMC7478967 DOI: 10.1038/s41413-020-00112-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis and osteoarthritis, the most common forms of arthritis, are chronic, painful, and disabling conditions. Although both diseases differ in etiology, they manifest in progressive joint destruction characterized by pathological changes in the articular cartilage, bone, and synovium. While the potent anti-inflammatory properties of therapeutic (i.e., exogenous) glucocorticoids have been heavily researched and are widely used in clinical practice, the role of endogenous glucocorticoids in arthritis susceptibility and disease progression remains poorly understood. Current evidence from mouse models suggests that local endogenous glucocorticoid signaling is upregulated by the pro-inflammatory microenvironment in rheumatoid arthritis and by aging-related mechanisms in osteoarthritis. Furthermore, these models indicate that endogenous glucocorticoid signaling in macrophages, mast cells, and chondrocytes has anti-inflammatory effects, while signaling in fibroblast-like synoviocytes, myocytes, osteoblasts, and osteocytes has pro-inflammatory actions in rheumatoid arthritis. Conversely, in osteoarthritis, endogenous glucocorticoid signaling in both osteoblasts and chondrocytes has destructive actions. Together these studies provide insights into the role of endogenous glucocorticoids in the pathogenesis of both inflammatory and degenerative joint disease.
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27
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Lewis PL, Graves SE, Robertsson O, Sundberg M, Paxton EW, Prentice HA, W-Dahl A. Increases in the rates of primary and revision knee replacement are reducing: a 15-year registry study across 3 continents. Acta Orthop 2020; 91:414-419. [PMID: 32285749 PMCID: PMC8023965 DOI: 10.1080/17453674.2020.1749380] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Rates of knee replacement (KR) are increasing worldwide. Based on population and practice changes, there are forecasts of a further exponential increase in primary knee replacement through to 2030, and a corresponding increase in revision knee replacement. We used registry data to document changes in KR over the past 15 years, comparing practice changes across Sweden, Australia, and the United States. This may improve accuracy of future predictions.Patients and methods - Aggregated data from the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) were used to compare surgical volume of primary and revision KR from 2003 to 2017. Incidence was calculated using population census statistics from Statistics Sweden and the Australian Bureau of Statistics, as well as the yearly active membership numbers from Kaiser Permanente. Further analysis of KR by age < 65 and ≥ 65 years was carried out.Results - All registries recorded an increase in primary and revision KR, with a greater increase seen in the KPJRR. The rate of increase slowed during the study period. In Sweden and Australia, there was a smaller increase in revision surgery compared with primary procedures. There was consistency in the mean age at surgery, with a steady small decrease in the proportion of women having primary KR. The incidence of KR in the younger age group remained low in all 3 registries, but the proportional increases were greater than those seen in the ≥ 65 years of age group.Interpretation - There has been a generalized deceleration in the rate of increase of primary and revision KR. While there are regional differences in KR incidence, and rates of change, the rate of increase does not seem to be as great as previously predicted.
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Affiliation(s)
- Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;; ,Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden,Correspondence:
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;;
| | - Otto Robertsson
- Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
| | - Martin Sundberg
- Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
| | | | | | - Annette W-Dahl
- Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Clinical Sciences Lund, Department of Orthopedics, Lund, Sweden
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28
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Trieu J, Dowsey MM, Schilling C, Spelman T, Choong PF. Population growth, ageing and obesity do not sufficiently explain the increased utilization of total knee replacement in Australia. ANZ J Surg 2020; 90:1283-1288. [PMID: 32671991 DOI: 10.1111/ans.16120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The utilization of total knee replacement (TKR) has increased significantly. The objective of this study was to assess the impact of changes in population demography (population growth, ageing and gender) and body mass indices (BMIs) on the additional volume of knee replacement surgery undertaken in Australia. METHODS Using national data, we compared estimates based on changes in population demography and BMIs to the reported increase in TKR between 2007 and 2017. The costs of additional surgery were estimated using the National Hospital Cost Data Collection. RESULTS An additional 25 814 TKRs were performed in 2017 compared to 2007. Contributions from population growth, ageing and changing BMIs were 27.1%, 10.4%, and 6.3%-15.3%, respectively. Other drivers contributed between 47.2% and 56.2%, representing 12 176-14 506 TKRs at a financial cost of A$320.9 million to A$382.3 million per year in 2017. CONCLUSION The volume of additional surgery being performed considerably exceeded estimates based on changing population demography and rising rates of obesity. The other drivers of additional TKR utilization will likely have significant implications for the health budget and warrant further investigation. This may involve an examination of the current indications for surgery and the cost-effectiveness of TKR in various settings, reviewing patient expectations and preferences, and assessing the impact of policies which relate to the funding and provision of TKR.
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Affiliation(s)
- Jason Trieu
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Chris Schilling
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F Choong
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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29
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Balogun SA, Graves SE, Lorimer M, Cicuttini F, Scott D, Jones G, Aitken D. Do Older Adults with Low Muscle Mass or Strength, in the Presence of Obesity, Have an Increased Risk of Joint Replacement Over 13 Years? Calcif Tissue Int 2020; 107:10-17. [PMID: 32347321 DOI: 10.1007/s00223-020-00698-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
This study aims to assess whether older adults with low muscle mass or strength, in the presence of obesity, have an increased risk of knee (TKR) and hip replacement (THR) over 13 years. 1082 community-dwelling older adults (51% women; mean age 62.9 ± 7.5 years) were studied at baseline and multiple time points over 13 years. The incidence of TKR and THR was determined by data linkage to National Joint Replacement Registry. Appendicular lean and fat mass were measured using DXA. Lower-limb muscle strength (LMS) was assessed by dynamometer. Low muscle mass and strength were defined as the lowest sex-specific tertiles for appendicular lean mass (adjusted for height and total body fat mass) and lower-limb strength, respectively. Obesity was defined as the highest sex-specific tertile for total body fat mass. Competing risk regression models were used to estimate the sub-distribution hazard ratio (SHR) for TKR and THR. Over 13 years of follow-up, 6.8% (n = 74/1082) of the participants had a TKR and 4.7% (n = 50/1066) had THR. Participants with the combination of obesity and low muscle strength (SHR 3.36, 95% CI 1.50, 7.53) but low muscle mass (SHR 1.11, 95% CI 0.52, 2.40) had a significantly increased risk of TKR, compared to individuals with neither obesity nor low muscle mass/strength. However, obesity with low muscle strength did not lead to a significantly greater risk of TKR compared to having low muscle strength or obesity alone. There was no evidence for an association between obesity with low muscle mass or strength and THR (all p > 0.05). This finding suggests that combining muscle and fat assessments to predict the future risk of TKR is no better than each condition on its own.
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Affiliation(s)
- Saliu A Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Scott
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science, Melbourne Medical School (Western Campus), The University of Melbourne, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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30
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Chen L, Yao F, Wang T, Li G, Chen P, Bulsara M, Zheng JJY, Landao-Bassonga E, Firth M, Vasantharao P, Huang Y, Lorimer M, Graves S, Gao J, Carey-Smith R, Papadimitriou J, Zhang C, Wood D, Jones C, Zheng M. Horizontal fissuring at the osteochondral interface: a novel and unique pathological feature in patients with obesity-related osteoarthritis. Ann Rheum Dis 2020; 79:811-818. [PMID: 32269059 PMCID: PMC7286031 DOI: 10.1136/annrheumdis-2020-216942] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023]
Abstract
Objectives Obesity is a well-recognised risk factor for osteoarthritis (OA). Our aim is to characterise body mass index (BMI)-associated pathological changes in the osteochondral unit and determine if obesity is the major causal antecedent of early joint replacement in patients with OA. Methods We analysed the correlation between BMI and the age at which patients undergo total knee replacement (TKR) in 41 023 patients from the Australian Orthopaedic Association National Joint Replacement Registry. We then investigated the effect of BMI on pathological changes of the tibia plateau of knee joint in a representative subset of the registry. Results 57.58% of patients in Australia who had TKR were obese. Patients with overweight, obese class I & II or obese class III received a TKR 1.89, 4.48 and 8.08 years earlier than patients with normal weight, respectively. Microscopic examination revealed that horizontal fissuring at the osteochondral interface was the major pathological feature of obesity-related OA. The frequency of horizontal fissure was strongly associated with increased BMI in the predominant compartment. An increase in one unit of BMI (1 kg/m2) increased the odds of horizontal fissures by 14.7%. 84.4% of the horizontal fissures were attributable to obesity. Reduced cartilage degradation and alteration of subchondral bone microstructure were also associated with increased BMI. Conclusions The key pathological feature in OA patients with obesity is horizontal fissuring at the osteochondral unit interface. Obesity is strongly associated with a younger age of first TKR, which may be a result of horizontal fissures.
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Affiliation(s)
- Lianzhi Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Felix Yao
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Tao Wang
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Guangyi Li
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peilin Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jessica Jun Yi Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Euphemie Landao-Bassonga
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Marty Firth
- Centre for Applied Statistics, Department of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Praveen Vasantharao
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yigang Huang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Junjie Gao
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Richard Carey-Smith
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - John Papadimitriou
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Pathwest Laboratories, Perth, Western Australia, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - David Wood
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher Jones
- Medical School, Curtin University, Perth, Western Australia, Australia .,Department of Orthopaedic Surgery, Fiona Stanley Hospital Group, Perth, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia .,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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Lifetime risk of knee and hip replacement following a GP diagnosis of osteoarthritis: a real-world cohort study. Osteoarthritis Cartilage 2019; 27:1627-1635. [PMID: 31220608 DOI: 10.1016/j.joca.2019.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to estimate lifetime risk of knee and hip replacement following a GP diagnosis of osteoarthritis and assess how this risk varies with patient characteristics. METHODS Routinely collected data from Catalonia, Spain, covering 2006 to 2015, were used. Study participants had a newly recorded GP diagnosis of knee or hip osteoarthritis. Parametric survival models were specified for risk of knee/hip replacement and death following diagnosis. Survival models were combined using a Markov model and lifetime risk estimated for the average patient profile. The effects of age at diagnosis, sex, comorbidities, socioeconomic status, body mass index (BMI), and smoking on risk were assessed. RESULTS 48,311 individuals diagnosed with knee osteoarthritis were included, of whom 2,561 underwent knee replacement. 15,105 individuals diagnosed with hip osteoarthritis were included, of whom 1,247 underwent hip replacement. The average participant's lifetime risk for knee replacement was 30% (95% CI: 25-36%) and for hip replacement was 14% (10-19%). Notable patient characteristics influencing lifetime risk were age at diagnosis for knee and hip replacement, sex for hip replacement, and BMI for knee replacement. BMI increasing from 25 to 35 was associated with lifetime risk of knee replacement increasing from 24% (20-28%) to 32% (26-37%) for otherwise average patients. CONCLUSION Knee and hip replacement are not inevitable after an osteoarthritis diagnosis, with average lifetime risks of less than a third and a sixth, respectively. Patient characteristics, most notably BMI, influence lifetime risks.
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Michel M, Bryère J, Maravic M, Marcelli C. Knee replacement incidence and social deprivation: results from a French ecological study. Joint Bone Spine 2019; 86:637-641. [DOI: 10.1016/j.jbspin.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022]
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Hawley S, Edwards CJ, Arden NK, Delmestri A, Cooper C, Judge A, Prieto-Alhambra D. Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: An analysis of UK electronic medical records. Semin Arthritis Rheum 2019; 50:237-244. [PMID: 31492436 DOI: 10.1016/j.semarthrit.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/08/2019] [Accepted: 08/22/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk. METHODS Incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score. RESULTS There were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00-6.78] and 8.57 [8.12-9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively. CONCLUSION We provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.
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Affiliation(s)
- Samuel Hawley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
| | - Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Unviersitat Autonoma de Barcelona and Insituto de Salud Carlos III, Barcelona, Spain
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The relationship of weight loss to structure modification in knee OA. Osteoarthritis Cartilage 2019; 27:845-847. [PMID: 30825610 DOI: 10.1016/j.joca.2019.02.794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 02/02/2023]
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Zhu Z, Aitken D, Cicuttini F, Jones G, Ding C. Ambulatory activity interacts with common risk factors for osteoarthritis to modify increases in MRI-detected osteophytes. Osteoarthritis Cartilage 2019; 27:650-658. [PMID: 30654117 DOI: 10.1016/j.joca.2018.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/10/2018] [Accepted: 12/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between objectively measured ambulatory activity (AA) and knee MRI-detected osteophytes (OPs), and to test whether this relationship was modified by common risk factors for OA including sex, obesity, disease severity and knee injury history. METHODS 408 community-dwelling adults aged 51-81 years were assessed at baseline and 2.7 years. T1-weighted fat-suppressed MRI was used to evaluate knee OPs at both time points. AA was assessed at baseline by pedometers and categorized as: less active (≤7499 steps per day), moderately active (7500-9999 steps per day) and highly active (≥10,000 steps per day). RESULTS Statistically significant interactions were detected between knee OA risk factors and AA on increases in MRI-detected OPs (all P < 0.05). In stratified analyses, being moderately active, compared to being less active, was protective against an increase in MRI-detected OPs (score change of ≥1) in females (relative risk (RR) = 0.42, 95%CI, 0.25-0.70, P < 0.01), those who were obese (RR = 0.50, 95%CI, 0.30-0.83, P < 0.01), those with radiographic OA (ROA) (RR = 0.68, 95%CI, 0.47-0.97, P = 0.02) and those with a history of knee injury (RR = 0.27, 95%CI, 0.08-0.88, P = 0.02) in almost every knee compartment, after adjustment for confounders. No statistically significant associations were found in males, non-obese, non-ROA or non-injury groups. CONCLUSIONS Being moderately active is protective against an increase in MRI-detected OPs in females, those with ROA, those who are obese and those with a history of knee injury. These findings suggest that being moderately active is beneficial for individuals who are at higher risk of knee OA.
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Affiliation(s)
- Z Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliate Hospital of Anhui Medical University, Hefei, China.
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The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 2019; 20:90. [PMID: 30797228 PMCID: PMC6387488 DOI: 10.1186/s12891-019-2411-9] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden. Methods De-identified TKR and THR data for 2003–2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003–2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1–5% of the overweight or obese population attained a normal body mass index. Results Based on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million. Conclusions If surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings. Electronic supplementary material The online version of this article (10.1186/s12891-019-2411-9) contains supplementary material, which is available to authorized users.
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Holden MA, Waterfield J, Whittle R, Bennell K, Quicke JG, Chesterton L, Mallen CD. How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed-methods study. Musculoskeletal Care 2019; 17:133-144. [PMID: 30663841 DOI: 10.1002/msc.1383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA. METHODS We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semi-structured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically. RESULTS There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness. CONCLUSIONS UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss. However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.
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Affiliation(s)
- Melanie Ann Holden
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Jackie Waterfield
- Division of Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Musselburgh, East Lothian, Scotland
| | - Rebecca Whittle
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan George Quicke
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Linda Chesterton
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Christian David Mallen
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
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Lamplot JD, Bansal A, Nguyen JT, Brophy RH. Risk of Subsequent Joint Arthroplasty in Contralateral or Different Joint After Index Shoulder, Hip, or Knee Arthroplasty: Association with Index Joint, Demographics, and Patient-Specific Factors. J Bone Joint Surg Am 2018; 100:1750-1756. [PMID: 30334885 PMCID: PMC6636793 DOI: 10.2106/jbjs.17.00948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The risk of subsequent joint replacement following an index joint replacement for osteoarthritis and the association of this risk with demographic and patient-specific factors are not well understood. The purpose of this study was to determine how demographic and other patient-specific factors are associated with the risk of subsequent joint replacement in the contralateral or a different joint following an index joint replacement for osteoarthritis. METHODS The Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) of New York was used to identify the first (primary) total hip arthroplasty (THA), total knee arthroplasty (TKA), or total shoulder arthroplasty (TSA) and the risk of subsequent joint replacement in the contralateral or a different joint over 5 to 8 years. The association of demographic and other patient-specific factors with subsequent joint replacement was assessed via multivariable Cox proportional hazards modeling. We also investigated the time between the index and subsequent joint replacement. RESULTS Of 85,616 patients, 20,223 (23.6%) underwent a subsequent replacement of the contralateral joint within 5 to 8 years (median, 343 days) after the index joint replacement. The strongest predictors were obesity (adjusted hazard ratio [HR] = 1.28; p < 0.001) and index TKA compared with THA (1.72; p < 0.001). A total of 3,197 patients (3.7%) underwent a subsequent replacement of a different joint within 5 to 8 years (median, 876 days) after the index joint replacement. The strongest predictors were obesity (adjusted HR = 1.41; p < 0.001) and index TSA compared with THA (adjusted HR = 2.52; p < 0.001). CONCLUSIONS There is a relatively high risk of subsequent replacement of the contralateral joint and a relatively low risk of subsequent replacement of a different joint within 5 to 8 years after an index THA, TKA, or TSA. Obesity was associated with a higher risk of subsequent replacement of the contralateral joint or a different joint. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph D. Lamplot
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anchal Bansal
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph T. Nguyen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri,E-mail address for R.H. Brophy:
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40
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Leech RD, Eyles J, Batt ME, Hunter DJ. Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review. Br J Sports Med 2018; 53:806-811. [PMID: 30030282 DOI: 10.1136/bjsports-2017-098051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.
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Affiliation(s)
- Richard D Leech
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Mark E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.,Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford) 2018; 57:iv61-iv74. [PMID: 29684218 PMCID: PMC5905611 DOI: 10.1093/rheumatology/key011] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 01/01/2023] Open
Abstract
As current treatment options in OA are very limited, OA patients would benefit greatly from some ability to self-manage their condition. Since diet may potentially affect OA, we reviewed the literature on the relationship between nutrition and OA risk or progression, aiming to provide guidance for clinicians. For overweight/obese patients, weight reduction, ideally incorporating exercise, is paramount. The association between metabolic syndrome, type-2 diabetes and OA risk or progression may partly explain the apparent benefit of dietary-lipid modification resulting from increased consumption of long-chain omega-3 fatty-acids from oily fish/fish oil supplements. A strong association between OA and raised serum cholesterol together with clinical effects in statin users suggests a potential benefit of reduction of cholesterol by dietary means. Patients should ensure that they meet the recommended intakes for micronutrients such as vitamin K, which has a role in bone/cartilage mineralization. Evidence for a role of vitamin D supplementation in OA is unconvincing.
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Affiliation(s)
- Sally Thomas
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Heather Browne
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Ali Mobasheri
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, Nottingham, UK.,Department of Regenerative Medicine, State Research Institute, Centre for Innovative Medicine, Santariskiu 5, 08661 Vilnius, Republic of Lithuania
| | - Margaret P Rayman
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
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Munugoda IP, Wills K, Cicuttini F, Graves SE, Lorimer M, Jones G, Callisaya ML, Aitken D. The association between ambulatory activity, body composition and hip or knee joint replacement due to osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2018; 26:671-679. [PMID: 29474994 DOI: 10.1016/j.joca.2018.02.895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between ambulatory activity (AA), body composition measures and hip or knee joint replacement (JR) due to osteoarthritis. DESIGN At baseline, 1082 community-dwelling older-adults aged 50-80 years were studied. AA was measured objectively using pedometer and body composition by dual-energy X-ray absorptiometry. The incidence of primary (first-time) JR was determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Log binomial regression with generalized estimating equations were used to estimate the risk of JR associated with baseline AA and body composition measures, adjusting for age, sex, X-ray disease severity, and pain. RESULTS Over 13 years of follow-up, 74 (6.8%) participants had a knee replacement (KR) and 50 (4.7%) a hip replacement (HR). AA was associated with a higher risk of KR (RR 1.09/1000 steps/day, 95% CI 1.01, 1.16) and a lower risk of HR (RR 0.90/1000 steps/day, 95% CI 0.81, 0.99). Body mass index (BMI) (RR 1.07/kg/m2, 95% CI 1.03, 1.12), total fat mass (RR 1.03/kg, 95% CI 1.01, 1.06), trunk fat mass (RR 1.05/kg, 95% CI 1.00, 1.09), and waist circumference (RR 1.02/cm, 95% CI 1.00, 1.04) were associated with a higher risk of KR. Body composition measures were not associated with HR. CONCLUSIONS An objective measure of AA was associated with a small increased risk of KR and a small reduced risk of HR. Worse body composition profiles were associated with KR, but not HR. Altogether this may suggest different causal pathways for each site with regard to habitual activity and obesity.
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Affiliation(s)
- I P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - K Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia.
| | - S E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.
| | - M Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - M L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Shelbaya A, Solem CT, Walker C, Wan Y, Johnson C, Cappelleri JC. The economic and clinical burden of early versus late initiation of celecoxib among patients with osteoarthritis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:213-222. [PMID: 29670383 PMCID: PMC5896655 DOI: 10.2147/ceor.s140208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the characteristics associated with early versus late initiation of celecoxib treatment after osteoarthritis (OA) diagnosis and whether economic and safety outcomes differ between patients with early versus late initiation of celecoxib. Methods Adults (≥18 years) with a confirmed OA diagnosis (International Classification of Diseases, 9th Edition, Clinical Modifications code: 715.XX), ≥12 months of continuous pre- and post-index enrollment, and ≥1 post-index claim for celecoxib were included from the MarketScan® Commercial Claims and Encounter Database (2009-2013). Index date was defined as initial OA diagnosis. Patients were categorized as initiating celecoxib early (within 6 months of index date) or late (≥6 months after index date). Logistic regressions were used to assess characteristics associated with early versus late celecoxib initiation. Key outcomes included health care resource utilization (HCRU) and costs post-index, and adverse event incidence post-celecoxib initiation. Unadjusted and adjusted comparisons (using generalized linear models with a gamma distribution for costs and Poisson distribution for event and resource utilization) were made between early and late celecoxib initiators. Results Of the 62,434 OA patients identified, 27,402 were early and 35,032 were late initiators. Post-index hospital admissions and length of stay did not differ statistically between early versus late initiators after controlling for pre-index event rates and covariates, but early patients had significantly fewer outpatient (incidence rate ratio [IRR]: 0.96; 95% confidence interval [CI]: 0.95, 0.97) and emergency room visits (IRR: 0.89; 95% CI: 0.84, 0.95). After adjustment for key covariates, early initiators (versus late initiators) had lower all-cause (US$12,909 versus US$13,781, P<0.001) and OA-related (US$4,988 versus US$5,178, P=0.015) costs per person-year. Early initiators had no statistically significant difference in the incidence of post-celecoxib cardiovascular (IRR: 0.92; 95% CI: 0.73, 1.14), gastrointestinal (IRR: 1.25; 95% CI: 0.81, 1.92), or renal (IRR: 1.19; 95% CI: 0.65, 2.18) events, controlling for pre-index event rates and covariates when compared to late initiators. Conclusion In this real-world cohort, patients initiated on celecoxib early (versus late) had significantly lower costs and HCRU; this may warrant consideration when making treatment decisions for OA patients.
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Affiliation(s)
- Ahmed Shelbaya
- Pfizer Inc., New York, NY.,Columbia School of Public Health, New York, NY
| | | | | | - Yin Wan
- Pharmerit International, Bethesda, MD, USA
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Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage 2018; 26:319-325. [PMID: 29229563 PMCID: PMC5835411 DOI: 10.1016/j.joca.2017.11.014] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
This review is based on a systematic review of the literature relevant to clinical topics in osteoarthritis (OA) performed for the time period February 22, 2016 to April 1, 2017. A PubMed search using the terms "osteoarthritis" and "treatment or epidemiology" returned over 800 papers, of which 57 are reviewed here, with inclusion primarily based on relevance to clinical OA. Epidemiologic studies in this time frame focused on the incidence and prevalence of OA, comorbidities and mortality in relation to OA (particularly obesity and cardiovascular disease), and multiple joint involvement. Papers on therapeutic approaches to OA considered: non-pharmacologic options, a number of topical, oral, and intra-articular therapies, as well as the cost-effectiveness of some OA treatments. There an enormous need to identify novel strategies to reduce the impact of this highly prevalent and debilitating condition.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7280, USA
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Weigl M, Wild H. European validation of The Comprehensive International Classification of Functioning, Disability and Health Core Set for Osteoarthritis from the perspective of patients with osteoarthritis of the knee or hip. Disabil Rehabil 2017; 40:3104-3112. [DOI: 10.1080/09638288.2017.1377295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Heike Wild
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
- Gesundheitszentrum Chiemgau, Traunstein, Germany
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Wu CL, McNeill J, Goon K, Little D, Kimmerling K, Huebner J, Kraus V, Guilak F. Conditional Macrophage Depletion Increases Inflammation and Does Not Inhibit the Development of Osteoarthritis in Obese Macrophage Fas-Induced Apoptosis-Transgenic Mice. Arthritis Rheumatol 2017; 69:1772-1783. [PMID: 28544542 PMCID: PMC5611814 DOI: 10.1002/art.40161] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/18/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether short-term, systemic depletion of macrophages can mitigate osteoarthritis (OA) following injury in the setting of obesity. METHODS CSF-1R-GFP+ macrophage Fas-induced apoptosis (MaFIA)-transgenic mice that allow conditional depletion of macrophages were placed on a high-fat diet and underwent surgery to induce knee OA. A small molecule (AP20187) was administrated to deplete macrophages in MaFIA mice. The effects of macrophage depletion on acute joint inflammation, OA severity, and arthritic bone changes were evaluated using histology and micro-computed tomography. Immunohistochemical analysis was performed to identify various immune cells. The levels of serum and synovial fluid cytokines were also measured. RESULTS Macrophage-depleted mice had significantly fewer M1 and M2 macrophages in the surgically operated joints relative to controls and exhibited decreased osteophyte formation immediately following depletion. Surprisingly, macrophage depletion did not attenuate the severity of OA in obese mice; instead, it induced systemic inflammation and led to a massive infiltration of CD3+ T cells and particularly neutrophils, but not B cells, into the injured joints. Macrophage-depleted mice also demonstrated a markedly increased number of proinflammatory cytokines including granulocyte colony-stimulating factor, interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor in both serum and joint synovial fluid, although the mice showed a trend toward decreased levels of insulin and leptin in serum after macrophage depletion. CONCLUSION Our findings indicate that macrophages are vital for modulating homeostasis of immune cells in the setting of obesity and suggest that more targeted approaches of depleting specific macrophage subtypes may be necessary to mitigate inflammation and OA in the setting of obesity.
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Affiliation(s)
- Chia-Lung Wu
- Department of Orthopaedic Surgery, Washington University, St. Louis MO, 63110
- Shriners Hospitals for Children – St. Louis, St. Louis MO, 63110
| | - Jenna McNeill
- Department of Orthopaedic Surgery, Washington University, St. Louis MO, 63110
- Shriners Hospitals for Children – St. Louis, St. Louis MO, 63110
| | - Kelsey Goon
- Department of Orthopaedic Surgery, Washington University, St. Louis MO, 63110
- Shriners Hospitals for Children – St. Louis, St. Louis MO, 63110
| | - Dianne Little
- Departments of Basic Medical Sciences and Biomedical Engineering, Purdue University, West Lafayette, IN, 47907
| | - Kelly Kimmerling
- Department of Orthopaedic Surgery, Washington University, St. Louis MO, 63110
- Shriners Hospitals for Children – St. Louis, St. Louis MO, 63110
| | - Janet Huebner
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham NC 27701
| | - Virginia Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham NC 27701
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham NC 27701
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University, St. Louis MO, 63110
- Shriners Hospitals for Children – St. Louis, St. Louis MO, 63110
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Sanders TL, Pareek A, Johnson NR, Carey JL, Maak TG, Stuart MJ, Krych AJ. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. Orthop J Sports Med 2017; 5:2325967117704644. [PMID: 28812032 PMCID: PMC5528941 DOI: 10.1177/2325967117704644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Osteochondritis dissecans (OCD) is a disorder of subchondral bone that commonly affects the knee. PURPOSE To (1) evaluate the rate of arthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated nonoperatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty. STUDY DESIGN Case series; Level of evidence, 4. METHODS Eighty-six patients (mean age, 21.4 years) with OCD lesions treated nonoperatively were identified between 1976 and 2014. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to arthritis was obtained from the medical record. Factors predictive of arthritis and arthroplasty (age, sex, body mass index [BMI], and lesion location) were examined. RESULTS At a mean ± SD follow-up of 12.6 ± 9.8 years from diagnosis, 13 patients (15%) were diagnosed with arthritis, corresponding to a cumulative incidence of 5.0% at 5 years, 10.0% at 10 years, 20.0% at 25 years, and 30.0% at 35 years. The cumulative incidence of arthroplasty was 1.0% at 5 years, 3.0% at 10 years, 8.0% at 25 years, and 8.0% at 35 years. BMI at diagnosis greater than 25 kg/m2 (hazard ratio [HR], 15.4; 95% CI, 1.9-124.5), patellar OCD lesions (HR, 15.0; 95% CI, 1.3-345.3), and diagnosis as an adult (HR, 21.7; 95% CI, 2.7-176.3) were factors associated with an increased risk of arthritis. CONCLUSION Arthritis after nonoperative treatment of OCD lesions is a challenging problem, with an estimated 30% cumulative incidence at 35 years after diagnosis. In contrast, the long-term rate of arthroplasty is low. BMI at diagnosis greater than 25 kg/m2 and patellar OCD lesions are predisposing factors for arthritis. Diagnosis of OCD as an adult was associated with a greater risk of arthritis.
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Affiliation(s)
- Thomas L Sanders
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nick R Johnson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - James L Carey
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Sanders TL, Pareek A, Obey MR, Johnson NR, Carey JL, Stuart MJ, Krych AJ. High Rate of Osteoarthritis After Osteochondritis Dissecans Fragment Excision Compared With Surgical Restoration at a Mean 16-Year Follow-up. Am J Sports Med 2017; 45:1799-1805. [PMID: 28419816 DOI: 10.1177/0363546517699846] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) is a disorder of subchondral bone that causes adverse effects on the overlying cartilage and commonly affects the knee. The incidence of OCD and its long-term effect on the knee joint are controversial. Hypothesis/Purpose: The purpose of this study was to (1) evaluate the rate of osteoarthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated operatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty. The investigators hypothesized that OCD lesions diagnosed after skeletal maturity and treatment with fragment excision would be predictive of a diagnosis of osteoarthritis. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The investigators identified 221 patients (mean ± SD age, 26.1 ± 13.6 years) with OCD lesions treated operatively between 1976 and 2010 and followed for 16.3 ± 11.4 years (mean ± SD) from diagnosis. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to osteoarthritis was obtained from the medical record. Surgical treatment was classified as fragment excision, fragment preservation (lesion drilling and/or fragment fixation), or chondral defect grafting (osteochondral allograft or autograft). Factors predictive of osteoarthritis and arthroplasty were examined. RESULTS There were 134 patients in the fragment excision group, 78 patients in the fragment preservation group, and 9 patients in the chondral defect grafting group. In the fragment excision group, the cumulative incidence of osteoarthritis was 12.0% at 5 years, 17.0% at 10 years, 26.0% at 15 years, 39.0% at 20 years, and 70% at 30 years. The cumulative incidence of arthroplasty was 2.0% at 5 years, 4.0% at 10 years, 4.0% at 15 years, 10.0% at 20 years, and 32.0% at 30 years. In the fragment preservation group, the cumulative incidence of osteoarthritis was 3.0% at 5 years, 7.0% at 10 years, 16.0% at 15 years, 25.0% at 20 years, and 51% at 30 years. The cumulative incidence of arthroplasty was 0.0% at 5 years, 0.0% at 10 years, 3.0% at 15 years, 6.0% at 20 years, and 11.0% at 30 years. No patients in the chondral defect grafting group developed osteoarthritis or underwent arthroplasty. Body mass index (BMI) greater than 25 kg/m2 (hazard ratio [HR] 3.3; 95% CI, 1.6-7.0), older age at diagnosis (HR 4.9; 95% CI, 1.8-17.3), and fragment excision (HR 2.3; 95% CI, 1.2-4.6) were predictive of osteoarthritis. CONCLUSION OCD patients treated with fragment excision have a high rate of osteoarthritis and knee arthroplasty at long-term follow-up. In contrast, patients treated with fragment preservation or chondral defect grafting have lower rates of osteoarthritis and arthroplasty. BMI greater than 25 kg/m2, older age at diagnosis, and fragment excision were predictive of osteoarthritis.
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Affiliation(s)
- Thomas L Sanders
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mitchel R Obey
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas R Johnson
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - James L Carey
- University of Pennsylvania Department of Orthopedic Surgery, Philadelphia, Pennsylvania, USA
| | - Michael J Stuart
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology 2017; 284:508-520. [PMID: 28463057 DOI: 10.1148/radiol.2017161005] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose To investigate the association of weight loss with progression of cartilage changes at magnetic resonance (MR) imaging over 48 months in overweight and obese participants compared with participants of stable weight. Materials and Methods The institutional review boards of the four participating centers approved this HIPAA-compliant study. Included were (a) 640 participants (mean age, 62.9 years ± 9.1 [standard deviation]; 398 women) who were overweight or obese (body mass index cutpoints of 25 and 30 kg/m2, respectively) from the Osteoarthritis Initiative, with risk factors for osteoarthritis or mild to moderate radiographic findings of osteoarthritis, categorized into groups with (a) weight loss of more than 10% (n = 82), (b) weight loss of 5%-10% (n = 238), or (c) stable weight (n = 320) over 48 months. Participants were frequency-matched for age, sex, baseline body mass index, and Kellgren-Lawrence score. Two radiologists assessed cartilage and meniscus defects on right knee 3-T MR images at baseline and 48 months by using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Progression of the subscores was compared between the weight loss groups by using multivariable logistic regression models. Results Over 48 months, adjusted mean increase of cartilage WORMS was significantly smaller in the 5%-10% weight loss group (1.6; 95% confidence interval [CI]: 1.3, 1.9; P = .002) and even smaller in the group with more than 10% weight loss (1.0; 95% CI: 0.6, 1.4; P = .001) when compared with the stable weight group (2.3; 95% CI: 2.0, 2.7). Moreover, percentage of weight change was significantly associated with increase in cartilage WORMS (β = 0.2; 95% CI: 0.02, 0.4; P = .007). Conclusion Participants who lost weight over 48 months showed significantly lower cartilage degeneration, as assessed with MR imaging; rates of progression were lower with greater weight loss. © RSNA, 2017.
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Affiliation(s)
- Alexandra S Gersing
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Benedikt J Schwaiger
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Michael C Nevitt
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Gabby B Joseph
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Nattagan Chanchek
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Julio B Guimaraes
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - John Mbapte Wamba
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Luca Facchetti
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Charles E McCulloch
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Thomas M Link
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
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Tilinca M, Pop TS, Bățagă T, Zazgyva A, Niculescu M. Obesity and Knee Arthroscopy – a Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Obesity is currently a global epidemic, often referred to as “globesity”, impacting the life of millions worldwide. A risk factor for many diseases, obesity can also be linked to developing intra-articular lesions of the knee, affecting the menisci, ligaments and cartilage. Furthermore, obesity has been shown to influence the outcome of surgical interventions, including those of the musculoskeletal system. Although many studies addressed the relationship of obesity and joint replacement, articles relating to arthroscopy and obesity, and knee arthroscopy in particular, are a bit scarcer. The majority of data suggest that an increase in BMI leads to a similar increase in the rates of intra- and postoperative complications, and most authors agree that a higher body mass index can influence both the procedure itself and its outcomes, including the subjective results reported by the patients. Still, some studies show different results, especially in patients that are overweight or with low-grade obesity, where the outcomes are comparable to those of the non-obese population. Thus, it can be concluded that obesity is an important patient characteristic that needs to be taken into consideration when planning, performing, and assessing the results of knee arthroscopy.
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Affiliation(s)
- Mariana Tilinca
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tudor Sorin Pop
- Department of Orthopedics and Traumatology I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tiberiu Bățagă
- Department of Orthopedics and Traumatology II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Ancuța Zazgyva
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Str. Gheorghe Marinescu nr. 38 540139, Romania
| | - Marius Niculescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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