The Use of #MRI in Evaluating #Knee Pain in Patients Aged 40 Years and Older
http://mobile.journals.lww.com/jaaos/_layouts/15/oaks.journals.mobile/articleviewer.aspx?year=2016&issue=09000&article=00009
Discussion: Many prereferral MRIs do not contribute to clinical decision making. Weight-bearing radiographs can help identify those patients in whom MRI is unlikely to be helpful.
http://mobile.journals.lww.com/jaaos/_layouts/15/oaks.journals.mobile/articleviewer.aspx?year=2016&issue=09000&article=00009
Discussion: Many prereferral MRIs do not contribute to clinical decision making. Weight-bearing radiographs can help identify those patients in whom MRI is unlikely to be helpful.
LWW
The Use of MRI in Evaluating Knee Pain in Patients Aged 40 Y... : Journal of the American Academy of Orthopaedic Surgeons
Introduction: The use of MRI is increasing when evaluating patients with knee pain because it is highly sensitive for detecting intra-articular pathology. However, such changes can be associated with degenerative joint disease, which may be demonstrated with…
#Thromboprophylaxis after #Knee Arthroscopy and Lower-Leg Casting
http://www.nejm.org/doi/full/10.1056/NEJMoa1613303
The results of our trials showed that prophylaxis with low-molecular-weight heparin for the 8 days after knee arthroscopy or during the full period of immobilization due to casting was not effective for the prevention of symptomatic venous thromboembolism.
http://www.nejm.org/doi/full/10.1056/NEJMoa1613303
The results of our trials showed that prophylaxis with low-molecular-weight heparin for the 8 days after knee arthroscopy or during the full period of immobilization due to casting was not effective for the prevention of symptomatic venous thromboembolism.
The New England Journal of Medicine
Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting | NEJM
The use of thromboprophylaxis to prevent clinically apparent venous thromboembolism
after knee arthroscopy or casting of the lower leg is disputed. We compared the incidence
of symptomatic venous t...
after knee arthroscopy or casting of the lower leg is disputed. We compared the incidence
of symptomatic venous t...
Impact of total #knee replacement practice: cost effectiveness analysis of data from the #Osteoarthritis Initiative
http://www.bmj.com/content/356/bmj.j1131
Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use.
http://www.bmj.com/content/356/bmj.j1131
Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use.
The BMJ
Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative
Objectives To evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms.
Design…
Design…
!!
Repetitive #knee bending and #synovitis in people at risk and with knee osteoarthritis: Data from the FNIH Osteoarthritis Biomarkers Consortium
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23760
The prevalence of grade ≥1 Hoffa‐synovitis and effusion‐synovitis equaled 59% (n=353) and 62% (n=366), respectively. Adjusted for confounders, kneeling for ≥30 minutes during a single day was associated with grade ≥1 Hoffa‐synovitis prevalence (odds ratio (OR) (95% confidence interval (CI)): 1.65 (1.11, 2.47)). Participants engaging in this activity one day or less per week had greater odds for prevalent Hoffa‐synovitis, than those who did not perform the activity (OR (95% CI):1.88 (1.11, 3.18)). No other significant associations were found. Sensitivity analyses yielded similar findings.
Conclusions
In this selected sample with a preponderance of grade ≥1 Hoffa‐ and/or effusion‐synovitis on non‐contrast MRI, only prolonged kneeling associated with Hoffa‐synovitis prevalence. Replication in other samples is warranted.
Repetitive #knee bending and #synovitis in people at risk and with knee osteoarthritis: Data from the FNIH Osteoarthritis Biomarkers Consortium
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23760
The prevalence of grade ≥1 Hoffa‐synovitis and effusion‐synovitis equaled 59% (n=353) and 62% (n=366), respectively. Adjusted for confounders, kneeling for ≥30 minutes during a single day was associated with grade ≥1 Hoffa‐synovitis prevalence (odds ratio (OR) (95% confidence interval (CI)): 1.65 (1.11, 2.47)). Participants engaging in this activity one day or less per week had greater odds for prevalent Hoffa‐synovitis, than those who did not perform the activity (OR (95% CI):1.88 (1.11, 3.18)). No other significant associations were found. Sensitivity analyses yielded similar findings.
Conclusions
In this selected sample with a preponderance of grade ≥1 Hoffa‐ and/or effusion‐synovitis on non‐contrast MRI, only prolonged kneeling associated with Hoffa‐synovitis prevalence. Replication in other samples is warranted.
!!
Venous #thromboembolism prophylaxis strategies for people undergoing elective total #knee replacement: a systematic review and network meta-analysis
https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30155-3/fulltext
Risk of bias ranged from very low to high. Rivaroxaban ranked first for prevention of deep vein thrombosis (RR 0·12 [95% CrI 0·06–0·22]). Low molecular weight heparin (LMWH; standard prophylactic dose, 28–35 days) ranked first in the pulmonary embolism network (RR 0·02 [95% CrI 0·00–3·86]) and LMWH (low prophylactic dose, 10–14 days) ranked first in the major bleeding network (odds ratio 0·08 [95% CrI 0·00–1·76]), but the results for pulmonary embolism and major bleeding are highly uncertain.
Interpretation
Single prophylaxis strategies are more effective in prevention of deep vein thrombosis in the elective total knee replacement population than combination strategies, with rivaroxaban being the most effective. The results of the pulmonary embolism and major bleeding meta-analyses are uncertain and no clear conclusion can be made other than what is biologically plausible (eg, that no prophylaxis and mechanical prophylaxis strategies should have the lowest risk of major bleeding).
Venous #thromboembolism prophylaxis strategies for people undergoing elective total #knee replacement: a systematic review and network meta-analysis
https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30155-3/fulltext
Risk of bias ranged from very low to high. Rivaroxaban ranked first for prevention of deep vein thrombosis (RR 0·12 [95% CrI 0·06–0·22]). Low molecular weight heparin (LMWH; standard prophylactic dose, 28–35 days) ranked first in the pulmonary embolism network (RR 0·02 [95% CrI 0·00–3·86]) and LMWH (low prophylactic dose, 10–14 days) ranked first in the major bleeding network (odds ratio 0·08 [95% CrI 0·00–1·76]), but the results for pulmonary embolism and major bleeding are highly uncertain.
Interpretation
Single prophylaxis strategies are more effective in prevention of deep vein thrombosis in the elective total knee replacement population than combination strategies, with rivaroxaban being the most effective. The results of the pulmonary embolism and major bleeding meta-analyses are uncertain and no clear conclusion can be made other than what is biologically plausible (eg, that no prophylaxis and mechanical prophylaxis strategies should have the lowest risk of major bleeding).
Association of intermittent and constant #knee pain patterns with knee pain severity, radiographic knee #osteoarthritis duration and severity
https://2medical.news/2020/04/14/association-of-intermittent-and-constant-knee-pain-patterns-with-knee-pain-severity-radiographic-knee-osteoarthritis-duration-and-severity/
..Intermittent and Constant OA Pain (ICOAP) scores were characterized as 1) no intermittent or constant pain; 2) intermittent pain only; 3) constant pain only; and 4) a combination of constant and intermittent pain. Knee pain severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the Visual Analog Scale (VAS). Radiographic knee OA (ROA) severity was defined as Kellgren …
https://2medical.news/2020/04/14/association-of-intermittent-and-constant-knee-pain-patterns-with-knee-pain-severity-radiographic-knee-osteoarthritis-duration-and-severity/
..Intermittent and Constant OA Pain (ICOAP) scores were characterized as 1) no intermittent or constant pain; 2) intermittent pain only; 3) constant pain only; and 4) a combination of constant and intermittent pain. Knee pain severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the Visual Analog Scale (VAS). Radiographic knee OA (ROA) severity was defined as Kellgren …
The Association of Pain Sensitization and Conditioned Pain Modulation to Pain Patterns in #Knee #Osteoarthritis
https://2medical.news/2020/09/11/the-association-of-pain-sensitization-and-conditioned-pain-modulation-to-pain-patterns-in-knee-osteoarthritis/
To examine the cross‐sectional association of ascending pain mechanisms (APM), implicated in pain sensitization (PS), and descending pain modulation with pain patterns and unpredictability of pain The Multicenter Osteoarthritis (OA) Study is a longitudinal cohort of older adults with or at risk of knee OA. Peripheral and central APM were assessed using quantitative sensory tests (QST); pressure pain thresholds (PPTs) using a handheld pressure algometer …
https://2medical.news/2020/09/11/the-association-of-pain-sensitization-and-conditioned-pain-modulation-to-pain-patterns-in-knee-osteoarthritis/
To examine the cross‐sectional association of ascending pain mechanisms (APM), implicated in pain sensitization (PS), and descending pain modulation with pain patterns and unpredictability of pain The Multicenter Osteoarthritis (OA) Study is a longitudinal cohort of older adults with or at risk of knee OA. Peripheral and central APM were assessed using quantitative sensory tests (QST); pressure pain thresholds (PPTs) using a handheld pressure algometer …
Association between current medication use and progression of radiographic #knee #osteoarthritis: data from the Osteoarthritis Initiative
https://2medical.news/2021/02/02/association-between-current-medication-use-and-progression-of-radiographic-knee-osteoarthritis-data-from-the-osteoarthritis-initiative/
Use of specific medications may accelerate the progression of radiographic knee osteoarthritis (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI); an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (KL grade ≥2) and excluded those with a history of knee-related …
https://2medical.news/2021/02/02/association-between-current-medication-use-and-progression-of-radiographic-knee-osteoarthritis-data-from-the-osteoarthritis-initiative/
Use of specific medications may accelerate the progression of radiographic knee osteoarthritis (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI); an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (KL grade ≥2) and excluded those with a history of knee-related …
Effect of High-Intensity Strength #Training on #Knee Pain and Knee Joint Compressive Forces Among Adults With Knee #Osteoarthritis
https://2medical.news/2021/02/18/effect-of-high-intensity-strength-training-on-knee-pain-and-knee-joint-compressive-forces-among-adults-with-knee-osteoarthritis/
Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, …
https://2medical.news/2021/02/18/effect-of-high-intensity-strength-training-on-knee-pain-and-knee-joint-compressive-forces-among-adults-with-knee-osteoarthritis/
Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, …
The Value of Total #Knee Replacement in Patients With Knee #Osteoarthritis and a Body Mass Index of 40 kg/m2 or Greater A Cost-Effectiveness Analysis
https://2medical.news/2021/03/24/the-value-of-total-knee-replacement-in-patients-with-knee-osteoarthritis-and-a-body-mass-index-of-40-kg-m2-or-greater-a-cost-effectiveness-analysis/
Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population. Objective: To assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis. …
https://2medical.news/2021/03/24/the-value-of-total-knee-replacement-in-patients-with-knee-osteoarthritis-and-a-body-mass-index-of-40-kg-m2-or-greater-a-cost-effectiveness-analysis/
Total knee replacement (TKR) is an effective and cost-effective strategy for treating end-stage knee osteoarthritis. Greater risk for complications among TKR recipients with a body mass index (BMI) of 40 kg/m2 or greater has raised concerns about the value of TKR in this population. Objective: To assess the value of TKR in recipients with a BMI of 40 kg/m2 or greater using a cost-effectiveness analysis. …
#Dietary inflammatory index and MRI-detected #knee structural change and pain: a 10.7-year follow-up study
https://2medical.news/2024/02/12/dietary-inflammatory-index-and-mri-detected-knee-structural-change-and-pain-a-10-7-year-follow-up-study/
https://2medical.news/2024/02/12/dietary-inflammatory-index-and-mri-detected-knee-structural-change-and-pain-a-10-7-year-follow-up-study/
2Medical.News
#Dietary inflammatory index and MRI-detected #knee structural change and pain: a 10.7-year follow-up study
To determine whether the dietary inflammatory index (DII®) scores were associated with knee structural changes and pain over a 10.7-year follow-up.MethodsThis study utilised data from a prospective…