WOMAC Domains Research Articles

Validation of the Chinese Western Ontario and McMaster Universities Osteoarthritis Index in Patients From Mainland China With Osteoarthritis of the Knee.

To establish the reliability, validity, and sensitivity to change of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among Chinese subjects with osteoarthritis (OA) of the knee, living in mainland China. A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted for validation of the electronic personal digital assistant version of the WOMAC Numerical Rating Scale (NRS) 3.1 Index in China. A total of 287 subjects with OA of the knee were randomized to receive either meloxicam (15 mg) or placebo. Psychometric properties of the WOMAC were evaluated by estimating the reliability, validity, and sensitivity to change. Equivalence of the electronic version was also compared with the paper version. Intraclass correlation coefficients for the WOMAC pain, stiffness, and physical function subscales were 0.81, 0.76, and 0.85, respectively, indicating good test-retest reliability. Similarly, internal consistency was strong (Cronbach's alpha for the 3 WOMAC subscales was 0.84, 0.86, and 0.96, respectively). Pearson's correlation coefficients for WOMAC pain and Short Form 36 health survey (SF-36) bodily pain, as well as WOMAC physical function and SF-36 physical functioning domains were >0.4, indicating convergent validity, whereas the coefficients for all 3 WOMAC domains with SF-36 mental health and mental health component scores were <0.4, indicating divergent validity. There was strong discriminant validity between healthy volunteers and OA patients. The effect sizes of change from baseline to week 12 in WOMAC subscale scores were large, demonstrating sensitivity to change. Equivalence between paper and electronic versions was very high. The culturally and linguistically validated Chinese version of the WOMAC NRS 3.1 for mainland China is psychometrically robust in its validity, reliability, and sensitivity to change for patients with OA of the knee.

Anterior Cruciate Ligament Repair Revisited. Preliminary Results of Primary Repair with Internal Brace Ligament Augmentation: A Case Series

Background: There is renewed interest in ACL repair following rupture with the development of new repair techniques. The aim of the audit was to assess outcomes and complications of ACL repair with Internal Brace Ligament Augmentation (IBLA) at minimum one year follow-up. Materials and methods: 68 consecutive patients who underwent Anterior Cruciate Ligament (ACL) repair with IBLA were followed for a minimum of one year following surgery. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster osteoarthritis index (WOMAC) scores were collected at set time points via an online outcomes system. Improvements in scores from baseline were recorded and effect sizes for the five KOOS and three WOMAC domains were calculated. Patients suffering from re-rupture or undergoing re-interventions were identified and Kaplan-Meier survivorship calculated. Results: Improvement was seen over the study period in all KOOS and WOMAC domains with the majority of improvement seen in the first three months. The results were comparable to the literature on ACL reconstruction. In the KOOS score, the greatest effect size at one year was seen in the Quality of Life (QoL) (2.82, 95% CI 2.25 to 3.39) and Sport domains (2.60, 95% CI 2.09 to 2.12). The lowest KOOS effect size was seen in the Activities of Daily Living (ADL) domain (1.1, 95% CI 0.68 to 1.51), with similar smaller improvements seen in the WOMAC domains. There were four re-interventions including one for re-rupture, and one each for surgery for arthrofibrosis, meniscal tear and chondral parthology. Conclusions: This audit provides early functional outcome and failure data that demonstrates the technique of ACL repair with IBLA is comparable with early results from ACL reconstruction, with the greatest improvements seen in return to sporting activity. Further randomised studies are required to directly compare repair against standard ACL reconstruction techniques.

Cemented ABG-II prosthesis: 5-year results.

ABG II - cemented anatomic stems share their geometry and instrumentation with the uncemented version and provide a promising concept. This study compares a consecutive series of cemented ABG IIs to a pool of all other implants used during the same observation period at the institution of the authors. This retrospective study is based on data from our regional hip arthroplasty register. The results of 141 cases with ABG II prosthesis were compared to those of 2,315 cases that were operated during the same period of time and reported in the regional arthroplasty registry. Survival was calculated using the Kaplan Meier method. The patients with cemented ABG II had a significantly worse preoperative WOMAC sum score and WOMAC domains, and similar ameliorated results as the control group at 1-year follow-up. The 5-year revision rate of the ABG II compares well to the 5-year revision rate of the controls in this study. Revision rate and health related, quality of life, of cases with cemented ABG prosthesis are similar to those of a register based control group.

Midterm Outcomes and Predictors of Clinical Success with the KineSpring Knee Implant System

The purpose of this study was to (1) evaluate joint pain and function in knee osteoarthritis (OA) patients treated with a joint-sparing, extracapsular implant and (2) identify patient characteristics that influenced clinical outcomes. This study included 99 patients with symptomatic medial knee OA refractory to conservative care who were treated with the KineSpring Knee Implant System and followed for a mean of 17 months (range, 1.5 to 48 months). All devices were successfully implanted and activated with no intraoperative complications. Statistically significant mean improvements of 56%, 50%, and 38% were observed for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Function, and Stiffness scales, respectively (all P < 0.001). Regardless of gender, age group, body mass index classification, or disease severity, all WOMAC domain scores significantly improved during the postoperative follow-up period. WOMAC clinical success rates were 77.8% for Pain, 77.8% for Function, and 68.7% for Stiffness. Neither gender, age group, body mass index classification, nor disease severity predicted clinical success in any WOMAC domain. In conclusion, the KineSpring System yields clinically meaningful improvements in joint pain and function in patients with medial knee OA. Additionally, unlike joint-altering procedures such as knee arthroplasty or high tibial osteotomy, patient characteristics had little association with postoperative clinical outcomes.

Outcome After Isolated Polyethylene Tibial Insert Exchange in Revision Total Knee Arthroplasty

We identified 45 knees in 42 patients who had an isolated tibial insert exchange for a failed primary knee arthroplasty with a minimum of 2 years of follow-up. The mean age at revision was 68 years, and the mean time to revision was 80 months. Thirty patients completed follow-up questionnaires (Oxford Knee Score, University Of California Activity Index score, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Short Form 12) with a mean follow-up of 58 months. Patients' current scores were compared with preoperative scores in 14 knees. Four patients (9%) were subsequently revised. Significant improvement was seen in the Oxford Knee Score, Short Form 12 physical component, and all WOMAC domains, but only 58% of patients had a clinically successful result by global WOMAC score. When patients are selected appropriately, an isolated liner exchange can significantly improve the function of the knee.

The Effect of Adding Whole-Body Vibration to Squat Training on the Functional Performance and Self-Report of Disease Status in Elderly Patients with Knee Osteoarthritis: A Randomized, Controlled Clinical Study

The study objectives were to evaluate the effects of adding whole-body vibration to squat training on functional performance and self-report of disease in elderly individuals with knee osteoarthritis (OA). This was a prospective, randomized trial in which selected variables were evaluated at three periods: 3 weeks prior to the training, immediately prior, and after the end of the training. Twenty-three (23) elderly subjects were evaluated using four functional performance tests: Berg Balance Scale (BBS), Timed Get Up and Go Test (TGUG), Chair Stand Test (CST), and 6-Minute Walk Test (6MWT), and a self-report of the status of disease (WOMAC). The intervention lasted for 12 weeks, 3 times per week. The participants were randomized into two groups: (1) squat training with whole-body vibration, and (2) squat training without vibration. Although there was no statistical difference in functional performance and self-report of disease status between the groups, performance in all the functional tests and in all the domains of WOMAC improved in the vibration group compared to their initial status. In the exercise group, performance improved only two tests (BBS and 6MWT), and there was a reduction in self-reported pain (WOMAC) compared to their initial status. Although the addition of whole-body vibration to squat training failed to result in a significant improvement in functional performance and self-reported status of knee osteoarthritis in the elderly, the intragroup results suggest that whole-body vibration may represent a feasible and effective way of improving the functionality and self-perception of disease status in older adults with knee OA.

Unicompartmental Versus Total Knee Arthroplasty Database Analysis: Is There a Winner?

TKA and unicompartmental knee arthroplasty (UKA) are both utilized to treat unicompartmental knee arthrosis. While some surgeons assume UKA provides better function than TKA, this assumption is based on greater final outcome scores rather than on change in scores and many patients with UKA have higher preoperative scores. We therefore asked whether TKA would demonstrate (1) better change in clinical outcome scores from preoperative to postoperative states and (2) better survivorship than UKA. We evaluated 4087 patients with 5606 TKAs and 179 patients with 279 UKAs performed between 1978 and 2009. Patients with TKA were older and heavier than patients with UKA (mean age, 68 versus 66 years; mean BMI, 32 versus 29). We compared preoperative, latest postoperative, and change in Knee Society Clinical Rating System (KSCRS), SF-12, and WOMAC scores. Minimum followup was 2 years (UKA: mean, 7 years; range, 2.0-23 years; TKA: mean, 6.5 years; range, 2.0-33 years). Preoperative outcome measure scores (WOMAC, SF-12, KSCRS) were higher in the UKA group. Patients with UKA had higher postoperative KSCRS and SF-12 mental scores. Changes in score for all WOMAC domains were similar between groups. Total KSCRS changes in score were similar between groups, although patients with TKA had higher knee scores (49 versus 43) but lower function scores than UKA (21 versus 26). Cumulative revision rate was higher for UKA than for TKA (13% versus 7%). Kaplan-Meier survivorship at 5 and 10 years was 95% and 90%, respectively, for UKA and 98% and 95%, respectively, for TKA. While patients with UKA had higher pre- and postoperative scores than patients with TKA, the changes in scores were similar in both groups and survival appeared higher in patients with TKA.

Use of a Disease-Specific Instrument in Economic Evaluations: Mapping WOMAC onto the EQ-5D Utility Index

Objective To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EuroQol 5 Dimension (EQ-5D) utility index in patients with knee osteoarthritis (OA). Methods A consecutive sample of patients ( n = 258) diagnosed with knee OA completed both the WOMAC and the EQ-5D. Regression models with the ordinary least squares (OLS) or the censored least absolute deviations as the estimator were used to establish the mapping function. The WOMAC was represented as explanatory variables in four ways: 1) total score; 2) domain scores (i.e., pain, stiffness, and physical function); 3) domain scores plus pair-wise interaction terms to account for possible nonlinearities; and 4) individual item scores. Goodness-of-fit criteria included the mean absolute error (the primary criterion) and the root mean squared error, and were obtained using an iterative random sampling procedure. Prediction precision was evaluated at individual patient level and at the group level. Results The model using the OLS estimator and the WOMAC domain scores as explanatory variables had the best fit and was chosen as the preferred mapping model. The prediction error at the individual level exceeded the maximal tolerance value (i.e., the minimally important difference of the EQ-5D) in about 16% of the patients. At the group level, the width of the 95% confidence interval of prediction errors varied from 0.0176 at a sample size of 400 to 0.0359 at a sample size of 100. Conclusions EQ-5D scores can be predicted using WOMAC domain scores with an acceptable precision at both individual and group levels in patients with mild to moderate knee OA.

Hylan G-F 20 Improves Hip Osteoarthritis: A Prospective, Randomized Study

We compared the efficacy and safety of intra-articular hylan G-F 20 with methylprednisolone acetate (MPA) for treating symptomatic Kellgren-Lawrence grade (KLG) 2 or 3 hip osteoarthritis in a prospective, randomized, multicenter, double-blind trial (N = 313). Two injections of hylan G-F 20 were administered 2 weeks apart (n = 150), or 1 injection of 40 mg MPA and 1 sham injection 2 weeks later (n = 155). The Western Ontario and McMaster Universities Arthritis Index (WOMAC) (total and subscale), clinician observations, and patient global assessments were collected at baseline and at weeks 4, 8, 12, 16, 20, and 26 (intent-to-treat population was analyzed; n = 305). Responder rates were assessed by WOMAC domain A, and criteria were established by the Outcome Measures in Rheumatology Clinical Trials–Osteoarthritis Research Society International (OMERACT-OARSI). At week 26, WOMAC A improved by 16.6 mm for hylan G-F 20 versus 13.6 mm for MPA. Response rates were higher with hylan G-F 20 versus MPA in patients with more advanced disease (KLG 3) and were similar between hylan G-F 20 and MPA in patients with less advanced disease (KLG 2). Adverse events were similar between groups and between patients with KLG 2 or 3. Hylan G-F 20 provided clinically meaningful improvements in pain and function, comparable with those of MPA, with good safety and tolerability. Thus, we conclude it is an appropriate option for treating hip osteoarthritis.

A Second Course of Hylan G-F 20 for the Treatment of Osteoarthritic Knee Pain – 12-Month Patient Follow-up

This prospective open-label study evaluated the efficacy and tolerability of a second course of hylan G-F 20 for the treatment of osteoarthritic knee pain over a 12-month period in patients who previously experienced a beneficial initial course of therapy. Men or women aged > or = 40 years with knee osteoarthritis received 3 weekly injections of hylan G-F 20. Consecutive patients requesting a second course of therapy were enrolled from October 2000 to January 2001. The mean time between the first and second courses of hylan G-F 20 was 19.6 months. All efficacy parameters significantly improved (P<.001) from baseline at weeks 1, 2, 4, 8, 12, 26, and 52. Improvements from baseline to weeks 26 and 52 for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index question A1, WOMAC domain C, and total WOMAC were 1.39+/-0.11 and 1.1+/-0.12, 18.50+/-1.43 and 13.69+/-1.54, and 26.77+/-1.97 and 19.8+/-2.13, respectively. Significant improvements from baseline were maintained for patient and physician VAS to week 26 (patient: 48.66+/-2.52; investigator: 51.51+/-2.34) and week 52 (patient: 46.10+/-2.73; investigator: 47.23+/-2.52). A second course of hylan G-F 20 therapy was generally well-tolerated; the types of local events observed in this study were not qualitatively different from those in the current product information and published literature. For continued relief of osteoarthritic knee pain, this study supports repeat use of hylan G-F 20 in patients who had a previous successful course of therapy.

Predictors of Health-related Quality-of-life Change after Total Hip Arthroplasty

Various parameters have been considered as possible predictors of health-related quality-of-life outcomes after THA in patients with hip osteoarthritis. We hypothesized the preintervention health status is the main and more homogeneous predictor of changes of the different aspects of health-related quality-of-life outcomes, mental health status has an important influence on results, whereas other sociodemographic or clinical factors had only a punctual influence. All patients who fulfilled the selection criteria completed the Medical Outcomes Study SF-36 and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 6 months after the intervention. Seven hundred eighty-eight patients completed the questionnaire before the intervention and 590 completed it (74.9%) at 6 months. The preintervention score in each SF-36 and WOMAC domain and the SF-36 mental health domain predicted changes after the intervention. Female gender, having comorbidities, contralateral hip osteoarthritis, or back pain predicted less improvement on some SF-36 domains. Older age, the presence of contralateral hip osteoarthritis, or back pain predicted less improvement on some of the WOMAC domains. Preintervention health status, measured by the WOMAC or SF-36, and mental health status uniformly predicted health-related quality-of-life changes, whereas some clinical parameters predicted some domains. SF-36 and WOMAC seem to be appropriate tools for predicting THA outcomes. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Change of quality of life due to exercise training in knee osteoarthritis: SF-36 and Womac

The aim of this study is to assess the effect of a 12 week multicomponent exercise training program on the quality of life in females with knee osteoarthritis. Thirty four subjects, aged 50-69 years, completed a 12 week multicomponent exercise training program. The SF-36 and WOMAC were applied at baseline, at mid-training, and post-training, and the responses of the exercise group (EG) and the control group (CG) were compared. The multicomponent training program resulted in significant group differences in all domains of SF-36 (p < 0.004), while there were no group difference in WOMAC domains (p > 0.004). In the EG between mid-training and baseline period vitality score increased; physical performance and general health scores increased between mid-training and post-training period; physical function, body pain, mental health, vitality, and general health scores increased between baseline and post-training period (p < 0.004). Between mid-training and baseline period of the WOMAC domains changed in the EG (p > 0.004), while all domains increased between mid-training and post-training and also between baseline and post-training (p < 0.004). Changes in quality of life after multicomponent training are affected by the different evaluation techniques.

General practitioners’ advice to use topical rather than oral ibuprofen resulted in equivalent effects on chronic knee pain

ED FROM Underwood M, Ashby D, Carnes D, et al. Topical or oral ibuprofen for chronic knee pain in older people. The TOIB study. Health Technol Assess 2008;12:1–176. Correspondence to:...

The John Insall Award: Gender-specific Total Knee Replacement: Prospectively Collected Clinical Outcomes

Gender-specific total knee replacement design is a recent and debated topic. We determined the survivorship and clinical outcomes of a large primary total knee arthroplasty cohort, specifically assessing any differences between gender groups. A consecutive cohort of 3817 patients with 5279 primary total knee replacements (3100 female, 2179 male) with a minimum of 2 years followup were evaluated. Preoperative, latest, and change in clinical outcome scores (WOMAC, SF-12, KSCRS) were compared. While men had higher raw scores preoperatively, women had greater improvement in all WOMAC domains including pain (29.87 versus 27.3), joint stiffness (26.78 versus 24.26), function (27.21 versus 23.09), and total scores (28.35 versus 25.09). There were no gender differences in improvements of the SF-12 physical scores. Men had greater improvement in Knee Society function (22.1 versus 18.63) and total scores (70.01 versus 65.42), but not the Knee Society knee score (47.83 versus 46.64). Revision rates were 10.2% for men and 8% for women. Women demonstrated greater implant survivorship, greater improvement in WOMAC scores, equal improvements in SF-12 scores, and less improvement in only the Knee Society function and total scores. The data refute the hypothesis of inferior clinical outcome for women following total knee arthroplasty when using standard components. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

PR_053: Functional Outcomes Improve With Hylan G-F 20 in Patients With Knee Osteoarthritis

Objective: To determine whether hylan G-F 20 (Synvisc) improves function when used to treat osteoarthritis (OA) knee pain. Design: Review of randomized, controlled, prospective clinical studies (with n>100 patients) that measured functional outcomes. Setting: Orthopedic clinics. Participants: Patients with knee OA. Interventions: Hylan G-F 20, intra-articular placebo, intra-articular corticosteroid, appropriate or conventional care, progressive knee exercises, and nonsteroidal anti-inflammatory drugs (NSAIDs). Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) domain C (physical function), 36-Item Short-Form Health Survey (SF-36) physical component, and extent of patient’s activity loss with difficult tasks, activity restriction, walking distance, and range of motion (ROM). Results: In 8 prospective, randomized, controlled trials (1675 total patients), hylan G-F 20 improved function in patients with knee OA. WOMAC domain C and SF-36 physical component were significantly better with hylan G-F 20 than appropriate care at 12 months (P<.000). WOMAC domain C was also significantly better with hylan G-F 20 than conventional treatment at 9 months (P=.000) or intra-articular triamcinolone hexacetonide at 12 and 26 weeks after treatment (P≤.001). In 1 study, WOMAC domain C was similar between hylan G-F 20, sodium hyaluronate, and placebo. In another study, however, the extent of the patient’s activity loss with difficult daily tasks was significantly better with hylan G-F 20 than with intra-articular saline from weeks 1 to 26 (P range, .004−.000). Finally, hylan G-F 20 improved similarly from baseline for WOMAC domain C compared with diclofenac, for walking distance and ROM versus progressive knee exercises, and in activity restriction compared with NSAIDs or hylan G-F 20+NSAIDs. Conclusions: Patients experience improvements in functional outcomes when given hylan G-F 20 for the treatment of OA knee pain.

Effect of patient characteristics on reported outcomes after total knee replacement

To evaluate the effect of pre-intervention factors in patient-reported outcomes at 6 months post-operatively following total knee replacement. A prospective observational study was carried out using two questionnaires sent to patients while they were on the waiting list for surgery: a generic questionnaire, the Medical Outcomes Study Short Form-36 (SF-36), and a specific questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Six months after intervention, patients again received the same questionnaires. The dependent variables were the scores of the three domains of the WOMAC and the eight domains of the SF-36. We recruited 640 patients. The mean age was 71 yrs and 73.6% of the patients were females. The multivariate analysis, in which the pre-intervention scores for each domain were added as covariates, showed that the most significant pre-intervention predictors were the baseline scores of each domain. Besides that, the social support, low back pain and the baseline score of the mental health domain (SF-36) were the pre-intervention predictors in the three WOMAC domains. With regard to the SF-36 domains the main predictors were the baseline mental health score, comorbidities, low back pain and social support. The main predictor of outcome at 6 months post-operatively in all eleven domains was the pre-intervention score of each domain. Presence of social support, absence of low back pain and higher baseline SF-36 mental health score were related to the improvement in the health-related quality of life post-operatively.

Health-Related Quality of Life and Appropriateness of Knee or Hip Joint Replacement

We studied the association between explicit appropriateness criteria for total hip joint replacement (THR) and total knee replacement (TKR) with changes in health-related quality of life of patients undergoing these procedures. Prospective observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR. Explicit appropriateness criteria using the RAND appropriateness method were applied. Patients completed 2 questionnaires that measured health-related quality of life, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), before the procedure and 6 months afterward. Patients who were considered appropriate candidates for these procedures had greater improvements than those who were considered inappropriate candidates in all 3 WOMAC domains (pain, functional limitation, and stiffness; THR: 43.0, 40.6, and 40.4 vs 14.7, 19.1, and 15.9; TKR: 34.9, 32.5, and 30.2 vs 23.2, 18.9, and 17.1; P<.001 for all comparisons). Patients who underwent THR and were judged to be appropriate candidates had greater improvements in the physical function, role-physical, bodily pain, and social function domains of the SF-36 than those judged to be inappropriate candidates (34.4, 35.1, 33.1, and 26.6 vs 19.6, 9.2, 5.7, and 7.0; P = .04, P = .03, P < .001, and P < .001, respectively). Appropriate candidates for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate candidates (19.9 vs 7.9; P = .004) but not in the other domains of functional status. These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality-of-life outcomes after THR and TKR surgery. Our results support the use of these criteria for clinical guidelines or evaluation purposes.

Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement

To study responsiveness and establish the minimal clinically important differences (MCID) and minimal detectable change (MDC) in patients undergoing total hip replacement (THR) using the Short Form 36 (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We conducted a prospective observational study in three public hospitals of all consecutive patients with a diagnosis of hip osteoarthritis (OA) on waiting lists to undergo THR. Patients completed the SF-36 and the WOMAC (subscales transformed to 0 to 100), which measured the health-related quality of life (HRQoL), before intervention and 6 months and 2 years later, and additional transitional questions, which measured the changes in the joint 6 months postoperatively. Improvements at 6 months after a THR were between 37 (stiffness) and 39 points (pain), depending on the WOMAC domain. The SF-36 domains also showed improvements: physical function (31.91), physical role (33.71), and bodily pain (29.77). From 6 months to 2 years, improvements ranged from 2 to 5 points, except for role physical (13.25). A ceiling effect was detected on some WOMAC domains as well as a floor effect on the SF-36. The MCID ranged from 25.91 (stiffness) to 29.26 (pain) on the WOMAC and from 10.78 (physical role) to 20.40 (physical function) on the SF-36. The MDC ranged from 21.38 (pain) to 27.98 (stiffness) on the WOMAC and from 18.99 (physical function) to 42.05 (social function) on the SF-36. These values indicate expected gains after THR. However, the MCID and MDC values must be viewed cautiously due to the uncertainty of these estimators and should not be considered as absolute thresholds.

The association of cartilage volume with knee pain

Objective: Whilst the characteristic pathologic feature of OA is the loss of hyaline cartilage, prior studies have demonstrated a poor relationship between severity of reported knee pain and degree of radiographic change. The aim of this study was to examine the association between knee symptoms and MRI cartilage volume. Design: A cross-sectional study was performed to assess the association between knee symptoms and MRI cartilage volume in an unselected, community based population. The subjects were 133 postmenopausal females. The subjects had a T2-weighted fat saturated sagittal gradient-echo MRI performed of their right knee. Femoral, tibial and patella cartilage volumes were measured using three-dimensional (3D) Slicer, a software that facilitates semi-automatic segmentation, generation of 3D surface models and quantitative analysis. Qualitative data relating to symptoms, stiffness, pain, physical dysfunction and the quality of life using the WOMAC were recorded. The statistical analyses conducted to determine measures of association between knee pain/symptoms and cartilage volume were correlation, multiple regression and inter-quartile regression. Results: Assessment of the association between patella cartilage volume and the WOMAC domains showed an inverse relationship between patella cartilage volume and pain, function and global score in a model including body mass index, physical activity and leg extensor power (all P=0.01). Inter-quartile regression comparing the lowest 25% with highest 25% patella cartilage volume demonstrated a stronger inverse relationship ( P=0.005). Conclusion: This study suggests that alterations in patella volume are associated with pain, function and global scores of the WOMAC. In participants with more knee pain, there was an association with severity of patella cartilage reduction. Other MRI cartilage volume features were not strongly associated with WOMAC sub-scores.

An open-label study of a second course of hylan G-F 20 for the treatment of pain associated with knee osteoarthritis

SUMMARYObjective: To evaluate the efficacy and tolerability of a second course of hylan G-F 20 for the treatment of osteoarthritic knee pain in patients who experienced a clinical benefit with an initial course of therapy.Research design and methods: In this prospective, open-label study, men or women (≥40 years of age) with knee osteoarthritis (OA) received three weekly injections of hylan G-F 20. Consecutive patients who requested a second course of hylan G-F 20 therapy due to OA knee pain subsequent to pain relief with a first course of therapy were enrolled between October 26, 2000 and January 18, 2001.Main outcome measures: Pain while walking on a flat surface (Western Ontario and McMaster's Universities Osteoarthritis Index, WOMAC, question A1), WOMAC domain C (physical functioning), full WOMAC, and patient and investigator overall visual analog scales (VAS). Efficacy variables were measured at baseline and at weeks 1,2,4,8,12 and 26. An analgesic washout was required before all efficacy evaluations.Results: Patients receiving at least one injection of hylan G-F 20 (n = 71) were predominantly Caucasian (84.5%) and female (64.8%), with a mean age of 65.5 years and mean weight of 200.1 pounds. The mean time between the first and second courses of hylan G-F 20 was 19.6 months (median 17.6 months). With hylan G-F 20, pain while walking on a flat surface was significantly lower (p < 0.001) than baseline at all time points up to week 26 (mean ± SEM: −1.40 ± 0.10 at week 26). Actual scores decreased from 2.4 ± 0.10 at baseline to 0.97 ± 0.11 at week 26. Scores for the WOMAC domain C, full WOMAC and patient and investigator overall VAS also significantly improved (p < 0.001) at all time points. A second course of hylan G-F 20 was generally well-tolerated, based on the low incidence of local adverse events (AEs) -only one patient (1.4%) experienced a severe event, the types of AEs, and the fact that no patients discontinued the study due to these AEs. The types of related AEs observed were not qualitatively different from those listed in the current product information and published literature.Conclusion: A second course of hylan G-F 20 therapy is an appropriate therapy for the treatment of OA knee pain in patients who had a previous favorable clinical response. For continued relief of osteoarthritis knee pain, this study supports repeat use of hylan G-F 20 in these patients.