Assessment of chronic postsurgical pain after knee replacement : a systematic review

Objective: Approximately 20% of patients experience chronic pain after total knee replacement (TKR), yet there is no consensus about how best to assess such pain. This systematic review aimed to identify measures used to characterise chronic pain after TKR. Methods: MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL databases were searched for research articles published in all languages from January 2002- November 2011. Articles were eligible for inclusion if they assessed knee pain at a minimum of 3-months after TKR, yielding a total of 1,164 articles. Data extracted included study design, country, timings of assessments, and outcome measures containing pain items. Outcome measures were compared with domains recommended by IMMPACT for inclusion in assessment of chronic pain related outcomes within clinical trials. Temporal trends were also explored. Results: The review found use of a wide variety of composite and single-item measures, with the American Knee Society Score most common. Many measures used in published studies do not capture the multi-dimensional nature of pain recommended by IMMPACT; of those commonly used, the WOMAC and Oxford Knee Score are most comprehensive. Geographical trends were evident, with nation-specific preferences for particular measures. A recent reduction in use of some clinically-administered tools was accompanied by increased use of patient-reported outcome measures. Conclusion: There was wide variation in methods of pain assessment alongside nation-specific preferences and changing temporal trends in pain assessment after TKR. Standardisation and improvements in assessment is needed to enhance the quality of research and facilitate the establishment of a core outcome set

A reference case for economic evaluations in osteoarthritis: An expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

Background: General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. Objectives: To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Methods: Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Results: Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumb-based disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the "standard optimal care" in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. Conclusions: The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness

Valutazione cinematica intraoperatoria con utilizzo del navigatore e postoperatoria con rsa dinamica nelle protesi totali di ginocchio

Restoring a correct implant kinematics and providing a good ligament balance and patellar tracking is mandatory to improve clinical and functional outcome after a Total Knee Replacement. Surgical navigation systems are a reliable and accurate tool to help the surgeon in achieving these goals. The aim of the present study was to use navigation system with an intra-operative surgical protocol to evaluate and determine an optimal implant kinematics during a Total Knee Replacement