We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish "Better Management of Patients with Osteoarthritis" registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear-avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara's test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25-0.57 and hip OA of 0.15-0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear-avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of -0.04 to 0.43 and hip OA of -0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear-avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.
Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in patients with PAO.
In the period 1999-2008, 93 patients (127 hips, median patient age 31, range 13-49 years) were operated on with PAO. Median follow-up was 7 (SD 2.1) years. Analyses of clinical and radiographic examinations, including WOMAC, were performed. Osteoarthritis was measured using Tönnis grade. Survival was assessed by the Kaplan-Meier method and predictors of conversion to THA were calculated using Cox regression analysis with THA as defined endpoint.
Centre-edge angle improved significantly with a mean of 8.7 (95% CI: 7.1; 10.3) preoperatively to a mean of 24.6 (95% CI: 22.6; 26.6) at follow-up. Likewise the acetabular roof obliquity angle improved significantly with a mean of 21.2 (95% CI: 19.7; 22.6) preoperatively to 8.7 (95% CI: 7.1; 10.4) at follow-up. Eleven out of 127 hips had conversion to THA. The 11.7 years cumulated hip joint survival rate was 85% (95% CI: 0.753; 0.945). Significant predictors of converting to THA were preoperative high grade of OA and postoperative high degree of acetabular roof obliquity angle. An improvement was found in Harris Hip Score pain score after receiving a PAO (p = 0.01).
Our results, with almost 12 years survival data, are comparable with the literature. PAO is considered as an effective treatment for young adults with painful hip dysplasia, especially when preoperative criteria for conversion to THA are highlighted.
Discriminant validity of the Western Ontario and McMaster Universities Osteoarthritis index physical functioning subscale in community samples with hip osteoarthritis.
Pua Y-H, Cowan SM, Wrigley TV, Bennell KL. Discriminant validity of the Western Ontario and McMaster Universities Osteoarthritis Index Physical Functioning Subscale in community samples with hip osteoarthritis.
To evaluate, in a community hip osteoarthritis (OA) sample, the discriminant validity of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning (PF) subscale to differentiate between self-report measures of pain and physical function.
Cross-sectional.
Human movement laboratory of a university.
Adults (N=100; 60 women, 40 men; age, 62.3+/-10.1y) with radiographically confirmed symptomatic hip OA.
Not applicable.
Six self-report measures of pain and physical function-WOMAC-PF and WOMAC-Pain subscales, Lower Extremity Functional Scale, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) bodily pain and PF subscales, and 4-item pain intensity measure-were obtained. Confirmatory factor analysis was applied to a correlated 2-factor measurement model that assumed discriminant validity: self-report measures of pain were conceptualized to load uniquely on 1 factor; self-report measures of physical function were conceptualized to load uniquely on the other factor.
Confirmatory factor analysis revealed that the initially proposed model did not achieve an acceptable fit to the data. Allowing a correlation between the error terms of the WOMAC-PF with those of the WOMAC-Pain and the SF-36 bodily pain subscales resulted in a viable model that provided adequate fit to the data (chi(2)=7.5, P=.28).
The findings suggest that the discriminant validity of the WOMAC-PF subscale from self-report pain measures cannot be confirmed in community-dwelling adults with hip OA.
Controversy exists regarding the outcome of THA after prior pelvic osteotomy.
We conducted a retrospective chart and radiographic review to obtain outcome measures for perioperative complications, acetabular and femoral component revisions, Harris hip score, and survivorship and compared these outcomes for patients presenting with developmental dysplasia of the hip treated surgically using THA with and without prior pelvic osteotomy.
We performed 103 primary THAs in 87 patients with osteoarthritis secondary to developmental dysplasia of the hip with a minimum 3-year followup. Previous pelvic osteotomy was performed in 52 hips (Salter, 40; Chiari, nine; Salter and Chiari, three), and 51 hips had no previous surgery (control group).
The pelvic osteotomy group did not have higher rates of femoral or acetabular intraoperative fracture or dislocation compared with the control group. The overall revision rate was 28.8% in the pelvic osteotomy group compared with 19.6% in the control group. The revision rate for aseptic loosening was 23.1% in the pelvic osteotomy group compared with 17.6% in the control group. Harris hip scores (range, 20-87) were not compromised, and overall survivorship rates 8 years postoperatively were not different at any time between the pelvic osteotomy (83.3%) and control (88.4%) groups.
Prior pelvic osteotomy did not lead to a higher perioperative complication rate, higher revision rate, compromised Harris hip score, or shortened survivorship in eventual THA in developmental dysplasia of the hip.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Waits for elective total hip arthroplasty for osteoarthritis are common in publicly funded health care systems, but they may lead to poorer postoperative outcomes and loss of health-related quality of life (HRQOL) through progressive pain and immobility during the wait. These issues have not been examined from the time of referral for surgery. Our primary objective was to test whether a longer wait was associated with poorer postoperative HRQOL.
Patients needing possible total hip arthroplasty for osteoarthritis were identified upon referral to a surgeon in London, Ont. Outcome measures, including the Western Ontario McMaster (WOMAC) Osteoarthritis Index and mobility in the 6-Minute Walk, were assessed at baseline and every 3-6 months thereafter until at least 3 months after the surgery.
Of 553 potentially eligible patients referred for surgical assessment, 123 were placed on a waiting list for total hip arthroplasty; 114 underwent the procedure, and 99 of them returned for postoperative assessment. No significant differences in HRQOL or mobility were seen postoperatively between patients with short waits and those with long waits (a priori definitions 6 months respectively). At referral, however, patients with short waits had poorer HRQOL and were less mobile than those with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, 0.001 for pain, 0.009 for stiffness and 0.008 for function; p = 0.006 for 6-Minute Walk results). Patients with short waits experienced larger gains in these measures from the time of referral until the postoperative assessment than did patients with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score,
Several quality-of-life studies in patients awaiting major joint replacement have focused on the outcomes of surgery. Interest in examining patients on the elective waiting list has increased since the beginning of 2000. We assessed health-related quality of life (HRQoL) in patients waiting for total hip (THR) or knee (TKR) replacement in three Finnish hospitals, and compared patients' HRQoL with that of population controls.
A total of 133 patients awaiting major joint replacement due to osteoarthritis (OA) of the hip or knee joint were prospectively followed from the time the patient was placed on the waiting list to hospital admission. A sample of controls matched by age, gender, housing and home municipality was drawn from the computerised population register. HRQoL was measured by the generic 15D instrument. Differences between patients and the population controls were tested by the independent samples t-test and between the measurement points by the paired samples t-test. A linear regression model was used to explain the variance in the 15D score at admission.
At baseline, 15D scores were significantly different between patients and the population controls. Compared with the population controls, patients were worse off on the dimensions of moving (P
Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.
Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.
The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.
Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.
