Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

Abstract Background Arthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA. Methods Functional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use. Results Forty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p 2 = 0.403). Conclusions Younger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.</p

Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto Effect of pulsed ultrasound and continuous ultrasound linked to exercise in patients with knee osteoarthritis: pilot study

A osteoartrite (OA) é uma doença crônica associada à morbidade significante. O objetivo deste estudo foi comparar o exercício isolado ao ultrassom pulsado (USP) e contínuo (USC) associados a exercício na redução da dor, melhora da amplitude de movimento (ADM), força muscular (FM), qualidade de vida (QV) e funcionalidade de pacientes com OA de joelhos. Trinta indivíduos, 50 a 75 anos, OA grau 2-4, foram randomizados: Grupo USC (USC + exercícios), Grupo USP (USP + exercícios) e Grupo EXE (exercícios). Os grupos foram avaliados antes e após o tratamento. A intervenção foi realizada três vezes por semana durante oito semanas: nas quatro primeiras foi aplicado USC ou USP e, nas demais foram realizados os exercícios. O Grupo EXE realizou exercícios durante oito semanas. Para análises intragrupos, utilizou-se o teste de Wilcoxon e, intergrupos, o teste de Kruskall-Walis. Na comparação intragrupos, o Grupo USC apresentou melhora significativa (p<0,05) nas variáveis da Western Ontario and McMaster Universities Osteoarthritis (WOMAC) dor, função e escore total; o Grupo USP na dor repouso, ADM, FM e nas variáveis da WOMAC dor, função e escore total; já, o Grupo EXE na mobilidade e ADM. Na comparação intergrupos, o Grupo USC apresentou melhora significativa (p<0,05) quando comparado aos demais grupos na dor repouso, ADM, escores função e total da WOMAC e o Grupo EXE na dor da WOMAC. A associação do USC a exercícios foi mais efetiva na melhora da dor, ADM, função e QV em pacientes com OA de joelho.<br>Osteoarthritis (OA) is a chronic disease associated with significant morbidity. The aim of this study was to compare the isolated exercises with association of pulsed (PUS) and continuous (CUS) ultrasound with exercise in reducing pain, improving range of motion (ROM), muscle strength (MS), quality of life (QL) and functionality of patients with knee OA. Thirty individuals, 50 to 75 years old, 2-4 OA grade, were randomized: Group CUS (CUS + exercise), Group PUS (PUS + exercise) and EXE group (exercises). The groups were evaluated before and after treatment. The intervention was performed three times a week for eight weeks: in the first four weeks, it was applied CUS or PUS, and in other weeks, exercises were carried out. The EXE group performed exercises for eight weeks. For intra-group analysis, the Wilcoxon test was used and inter-group analysis, the Kruskall-Walis test was used. Within the groups, the USC group showed significant improvement (p<0.05) in variables of Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain, function and total score; the Group USP in pain-rest, ROM, MS, variables of WOMAC pain, function and total score; and EXE Group in mobility and ROM. In intergroup comparison, the USC group showed significant improvement (p<0.05) when compared to other groups in pain-rest, ROM, variables of WOMAC function and total score and EXE group in WOMAC-pain. The association of USC and exercise was more effective in reducing pain, ROM, function and QL in patients with knee OA