Time spent in primary care for hip osteoarthritis patients once the diagnosis is set: a prospective observational study

Background: Previous research on time to referral to orthopaedic surgery has predominantly used hip complaints as starting point instead of the moment the diagnosis of osteoarthritis (OA) of the hip is established, therefore little is known about the length of time a patient diagnosed with hip OA stays under the care of a general practitioner (GP). No knowledge on factors of influence on this time period is available either. Aim of this study was thus to determine the time an incident hip OA patient stays in the care of a GP until referral to an orthopaedic department. Influencing factors were also analyzed. Methods: A prospective observational study was conducted based on data over a 10-year period from a general practice-based registration network (17 GPs, > 30,000 patients registered yearly). Patients with the diagnosis of hip OA were included. A survival analysis was used to determine time until referral to an orthopaedic department, and to determine factors of influence on this time. Results: Of 391 patients diagnosed with hip OA, 121 (31%) were referred; average survival time until referral was 82.0 months (95% CI 76.6-87.5). Less contact with the GP for hip complaints before the diagnosis of hip OA was established resulted in a decreased time to referral. Conclusions: The results of this study show that patients with hip OA were under the care of a general practitioner, and thus in primary care, for a considerable amount of time once the diagnosis of hip OA was established

The Influence of Overweight/Obesity on Patient-Perceived Physical Functioning and Health-Related Quality of Life After Primary Total Hip Arthroplasty

# The Author(s) 2011. This article is published with open access at Springerlink.com Background Overweight/obesity in patients after total hip arthroplasty (THA) is a growing problem and is associated with postoperative complications and a negative effect on functional outcome. The objective of this study is to determine to what extent overweight/obesity is associated with physical functioning and health-related quality of life 1 year after primary THA

The effects of exercise and weight loss in overweight patients with hip osteoarthritis: design of a prospective cohort study

BACKGROUND: Hip osteoarthritis (OA) is recognised as a substantial source of disability, with pain and loss of function as principal symptoms. An aging society and a growing number of overweight people, which is considered a risk factor for OA, contribute to the growing number of cases of hip OA. In knee OA patients, exercise as a single treatment is proven to be very effective towards counteracting pain and physical functionality, but the combination of weight loss and exercise is demonstrated to be even more effective. Exercise as a treatment for hip OA patients is also effective, however evidence is lacking for the combination of weight loss and exercise. Consequently, the aim of this study is to get a first impression of the potential effectiveness of exercise and weight loss in overweight patients suffering from hip OA. METHODS/DESIGN: This is a prospective cohort study. Patients aged 25 or older, overweight (BMI > 25) or obese (BMI > 30), with clinical and radiographic evidence of OA of the hip and able to attend exercise sessions will be included. The intervention is an 8-month exercise and weight-loss lifestyle program. Main goal is to increase aerobic capacity, lose weight and stimulate a low-calorie and active lifestyle. Primary outcome is self-reported physical functioning. Secondary outcomes include pain, stiffness, health-related quality of life and habitual activity level. Weight loss in kilograms and percentage of fat-free mass will also be measured. DISCUSSION: The results of this study will give a first impression of potential effectiveness of exercise and weight loss as a combination program for patients with OA of the hip. Once this program is proven to be effective it may lead to postponing the moment of total hip replacement. TRIAL REGISTRATION NUMBER: NTR1053

Patients with hip osteoarthritis : body weight and life style before and after arthroplasty

Patiënten met overgewicht die last hebben van slijtage van het heupgewricht (artrose) zijn gebaat bij behandeling die is gericht op beweging en afvallen. Ondanks dat internationale richtlijnen dit aanbevelen, krijgt slechts 10% van de patiënten deze behandeling voorgeschreven door de huisarts. UMCG-onderzoeker Nienke Paans heeft laten zien dat een gecombineerd beweeg- en afvalprogramma vóór de heupoperatie het lichamelijk functioneren van artrosepatiënten met overgewicht verbetert en pijnklachten vermindert. Paans pleit ook voor meer aandacht voor bewegen en afvallen nadat een heupprothese is geplaatst. Op 20 juni promoveert zij op de resultaten van haar onderzoek aan de Rijksuniversiteit Groningen. Patiënten met slijtage van het heupgewricht (artrose) zijn gemiddeld 7 jaar onder behandeling van hun huisarts voordat zij operatief een kunstheup krijgen. Paans stelde dit vast met behulp van de gegevens van 30.000 patiënten uit een medisch registratie netwerk van huisartsen over een periode van 10 jaar, van 1998-2008. Vicieuze cirkel Patiënten die last hebben van heupartrose lopen het risico in een vicieuze cirkel terecht te komen. “Als het lopen pijn doet vanwege de artrose, gaan mensen beweging vermijden en blijven ze in de stoel zitten. Dan bestaat de kans dat hun gewicht toeneemt. Door dit gebrek aan bewegen, met daarbij de extra belasting van het gewicht op het heupgewricht, zullen de klachten toenemen,” licht Paans toe. Bewegen en afvallen Bij artrosepatiënten met overgewicht onderzocht Paans de effecten van een programma voor bewegen en afvallen voordat zij een kunstheup krijgen. Deelname aan het programma resulteerde in een verbetering van het zelfgerapporteerde lichamelijk functioneren. Daarnaast werd een verbetering gezien in het loopvermogen. Ook vielen de patiënten af. Ten opzichte van de start van het programma waren de deelnemers na 8 maanden gemiddeld 5,6 kg lichter en was hun lichaamsvet met 3,3% afgenomen. “Het gecombineerde programma voor bewegen en afvallen betekent dat je patiënten met heupartrose meer te bieden hebt dan alleen pijnbestrijding,” legt Paans uit. “Bovendien kan het leiden tot uitstel van de heupoperatie, wat gunstig is omdat een kunstheup maar 10-15 jaar meegaat.” Na de operatie Artsen en andere behandelaars veronderstellen dat patiënten met overgewicht na plaatsing van de heupprothese weer gaan bewegen, omdat dit weer mogelijk is. Daardoor zouden ze weer kunnen afvallen. Paans stelde vast dat dit niet het geval is. “Het is belangrijk dat patiënten gaan bewegen en afvallen, omdat overgewicht het succes van de operatie beïnvloedt. Teveel lichaamsgewicht kan leiden tot vroegtijdige loslating van de prothese en dat is niet wat je wilt,” vertelt Paans. Richtlijn Paans concludeert dat Nederlandse huisartsen beter ondersteund zouden moeten worden in hun medisch beleid bij heupartrose in de periode voorafgaand aan het plaatsen van een kunstheup. De ontwikkeling van een richtlijn voor huisartsen is daartoe belangrijk. Bewegen en afvallen voor en na de operatie zouden daarin een belangrijke plaats moeten krijgen, aldus Paans Obese patients suffering from osteoarthritis to the hip joint are helped by treatment concentrating on exercise and losing weight. Despite the recommendations of international guidelines, in only 10% of the cases this treatment is prescribed by the GP. UMCG researcher Nienke Paans has shown that a combined exercise and weight loss program before hip replacement can improve the physical functioning of obese patients with hip osteoarthritis and reduce pain. Paans also recommends more attention to exercise and losing weight after hip replacement. The date for completing her PhD qualification concerning her research in Medical Science has been set for 20 June 2012. Patients suffering from osteoarthritis of the hip joint are treated by their GPs for about 7 years before they get an artificial hip. Paans established this by using data from 30,000 patients in a medical registration network of GPs over a period of 10 years, 1998-2008. Vicious circle Patients with osteoarthritis of the hip are at risk to end up in a vicious circle. ‘If walking hurts due to osteoarthritis, people tend to reduce the amount of exercise they take and remain in their chairs. That increases the chance of gaining weight. This lack of exercise, and extra pressure on the hip joint due to the extra weight, will increase the symptoms’, explains Paans. Exercise and losing weight Paans analysed the effects of a combination program of exercise and weight loss in obese patients with hip osteoarthritis before they got a new hip. Participation in the program resulted in an improvement in the self-reported physical functioning. In addition, there was an improvement in the ability to walk, and the patients lost weight. After 8 months the participants were on average 5.6 kg lighter and their body fat had declined by 3.3 %, compared with the start of the program. ‘The combined program of exercise and weight loss means that we have more to offer to patients with osteoarthritis of the hip than just pain control’, explains Paans. ‘In addition, it can postpone hip replacement, which is beneficial because artificial hips have a lifespan of 10-15 years.’ After hip replacement Doctors and other specialists assume that obese patients will start to be physically active again after a hip operation, simply because they are once again able to. That could also lead to losing weight. Paans has established that this does not happen. ‘It is important that patients get physical active again and subsequently lose weight because obesity can affect the success of the operation. High body weight can lead to premature detachment of the prosthesis and that’s not what you want’, explains Paans. Guidelines Paans concludes that Dutch GPs should be more supported in their medical policy regarding osteoarthritis of the hip in the period preceding the hip operation. To this end the development of guidelines for GPs is important. Exercise and losing weight before and after the operation should be given an important place in these guidelines, according to Paans.

Effect of Exercise and Weight Loss in People Who Have Hip Osteoarthritis and Are Overweight or Obese:A Prospective Cohort Study

<p>Background. Osteoarthritis (OA) is the most common joint disorder in the world and is recognized as a substantial source of disability. For people with OA of the knee, exercise in combination with weight loss is a proven, effective, conservative treatment option, yet evidence is lacking for people with hip OA.</p><p>Objective. The aim of this study was to obtain preliminary evidence of the effect of a program of exercise in combination with weight loss on physical function in people who have hip OA and are overweight or obese.</p><p>Design. This investigation was a prospective cohort study.</p><p>Methods. Thirty-five people who were 25 years or older, had clinical and radiological evidence of hip OA, and were overweight or obese (body mass index of >25 kg/m(2)) were included. They participated in an 8-month program of exercise in combination with weight loss. A body mass index of 40 kg/m(2) was used as the upper limit. The primary outcome was self-reported physical function, as measured with a subscale of the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcome measures included pain and walking tests as quantitative measures of function.</p><p>Results. Participation in the combination program resulted in a 32.6% improvement in self-reported physical function after 8 months, a finding that could be considered clinically relevant. Significant improvements also were seen in pain and on walking tests.</p><p>Limitations. The lack of a control group was a limitation of this study.</p><p>Conclusions. This appears to be the first study investigating the effect of exercise and weight loss as a combination treatment in people with hip OA. The results provide preliminary evidence that this combination treatment is effective in people with hip OA.</p>