Lower Limb Osteoarthritis Research Articles

Effectiveness of Exercise Therapy and its Variations in Lower Limb Osteoarthritis: A Literature Review

ABSTRACT Osteoarthritis is an irreversible, progressive, degenerative joint disorder of multifactorial etiology that commonly affects weight-bearing joints and leads to pain, loss of movement and functional limitation. Exercise therapy has been shown to be beneficial in osteoarthritis, in terms of decreased pain, improved motion and improved functional outcomes. This review aims to look at some of the common as well as newer modalities of exercise therapy for osteoarthritis (OA), such as strength, training, stretching, agility training, aquatic exercises, Tai Chi and combinations of these modalities. How to cite this article Dhillon HS, Sharma M, Sharma S. Effectiveness of Exercise Therapy and its Variations in Lower Limb Osteoarthritis: A Literature Review. J Postgrad Med Edu Res 2014;48(4):190-196.

Wear patterns in anteromedial osteoarthritis of the knee evaluated with CT-arthrography

To analyze the value of CT-arthrography imaging in the diagnosis of knee osteoarthritis and to facilitate the selection of partial versus total knee replacement. A retrospective study of 100 patients that had either medial unicompartmental knee replacement (UKR) (N=50) or total knee replacement (TKR) (N=50). One observer measured lower limb mechanical alignment and osteoarthritis patterns of the knee in each compartment with radiographs, CT-arthrography and full leg standing radiographs. All patients had Kellgren-Lawrence grade IV osteoarthritis of the medial femorotibial joint with a mean (SD) varus alignment of the lower limb (172° (3.5°) HKA-angle). Zone mechanical axis distribution showed strong correlation with HKA-axis. Arthritis patterns were different for patients selected for UKR or TKR. UKR patients had anteromedial osteoarthritis and wear of the medial facet of the patella in contrast to TKR patients who had medial osteoarthritis associated with diffuse or lateral patellofemoral wear and wear of the central or posterior zones of the lateral compartment. Medial facet wear of the patella is related to more important varus alignment of the lower limb (Kennedy zone 0 and 1). CT-arthrography imaging can show lesions that are not visible on plain or stress radiographs because of central or posterior localization with surrounding intact cartilage. Patients who develop tri-compartmental osteoarthritis despite varus alignment have probably other risk factors than their mechanical alignment and should be considered candidates for TKR.

Review: Strength training, with or without flexibility and aerobic training, reduces pain in lower limb osteoarthritis

Source Citation Uthman OA, van der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013...

GPs don’t offer exercise options to patients with osteoarthritis

I was a bit taken aback by your article suggesting that exercise is an effective treatment for lower limb osteoarthritis (Clinical Digest October 23).

Exercise is an effective treatment for lower limb osteoarthritis.

Osteoarthritis is the most common form of arthritis and one of the leading causes of pain and disability worldwide. The economic burden of treatment costs and lost productivity is substantial, with the total cost to the UK estimated at 1 per cent of gross national product.

Is it all about a pain in the back?

Multisite musculoskeletal pain is common among people suffering from low back pain. Although the mechanisms behind co-occurrence of multiple somatic symptoms and musculoskeletal pain are still unknown, patients with co-morbidities and co-occurring musculoskeletal symptoms tend to have worse functional status, a poorer prognosis and respond less favourably to treatment. Evidence also suggests that the more pain sites a patient reports, the more reduced their physical and mental function will be regardless of location of pain. At the same time, evidence suggests that strategies for diagnosis and treatment of low back pain and other musculoskeletal disorders such as neck pain and lower limb osteoarthritis are very similar. In this chapter, we discuss the prevalence, consequences, and implications of commonalities between low back pain, pain in other sites and co-occurring pain. In addition, we propose a conceptual framework for a common stepwise approach to the diagnosis and management of back and musculoskeletal pain.

Weight-bearing asymmetries during Sit-To-Stand in patients with mild-to-moderate hip osteoarthritis

The Sit-To-Stand (STS) transition is a mechanically demanding task that may pose particular challenges for individuals with lower limb osteoarthritis (OA). Biomechanical features of STS have been investigated in patients with OA, but not in patients with early stage hip OA. The purpose of this study was to explore inter-limb weight-bearing asymmetries (WBA) and selected kinematic and kinetic variables during STS in patients with mild-to-moderate hip OA compared with healthy controls. Twenty-one hip OA patients and 23 controls were included in the study. Sagittal and frontal plane kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. There were no distinctive biomechanical alterations in sagittal or frontal plane kinematics or kinetics, movement time, or time to reach peak ground reaction force (GRF) in hip OA patients compared with controls. However, the hip OA patients revealed a distinct pattern of WBA compared with the controls, in unloading their involved limb by 18.4% at peak GRF. These findings indicate that patients with early stage hip OA are not yet forced into a stereotypical movement strategy for STS; however, the observed pattern of WBA requires clinical attention.

Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

Objective To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in...

Is the “EWGSOP Sarcopenia Algorythm” feasible for all older patients? A sub-analysis among older patients with lower limb osteoarthritis

Is the “EWGSOP Sarcopenia Algorythm” feasible for all older patients? A sub-analysis among older patients with lower limb osteoarthritis

SAT0313 No Sweat – No Gain? Persons with Lower Limb Osteoarthritis Report Less Intensity and Duration of Physical Activity Compared to their Healthy Peers - Data from the Must Cohort

BackgroundPhysical activity (PA) for persons with lower limb osteoarthritis (OA) may result in reduced pain, increased function and overall health benefits. Despite this, recent research from US has revealed that...

SAT0594-HPR Lower Self-Reported Quality of Care for Persons with Hand Osteoarthritis Compared to Lower Limb Osteoarthritis.

BackgroundPrevious research has revealed low adherence with published recommendations for osteoarthritis (OA) care. Little is known about the quality of OA care in Norway and whether OA joint location is...

Corrigendum to “Impact of comorbidities on measuring indirect utility by the Medical Outcomes Study Short Form 6D in lower-limb osteoarthritis” [Best Pract & Res Clin Rheumatol 26 (2012) 627–635

Corrigendum to “Impact of comorbidities on measuring indirect utility by the Medical Outcomes Study Short Form 6D in lower-limb osteoarthritis” [Best Pract & Res Clin Rheumatol 26 (2012) 627–635] Kossar Hosseini , Cecile Gaujoux-Viala , Joel Coste , Jacques Pouchot , Bruno Fautrel , Anne-Christine Rat , Francis Guillemin a,* Universite de Lorraine, Paris Descartes University, APEMAC, EA 4360, F-54 000, France b Paris 6 – Pierre et Marie Curie University, Department of Rheumatology, Pitie-Salpetriere Hospital, Paris, France

Balance and falls risk in women with lower limb osteoarthritis or rheumatoid arthritis

Background/purposeLower limb arthritis is a risk factor for falls, although few studies have used comprehensive balance assessment to determine the degree to which this contributes to falls risk. This study evaluated the falls risk and balance impairment of women with lower limb osteoarthritis (OA) or rheumatoid arthritis (RA). MethodsA cross-sectional comparative study was conducted of women living in the general community.Seventeen women with lower limb OA [mean age: 66.9 years, standard deviation (SD) = 9.8 years], 17 with lower limb RA (mean age: 66.3 years, SD = 9.4 years), and 17 age-matched healthy (no lower limb arthritis) women (mean age: 66.3 years, SD = 10.1 years) were recruited.All participants underwent a comprehensive balance and mobility assessment, including clinical balance measures (Step Test, Functional Reach), self-generated (Neurocom Balance Master long plate), and externally generated (Chattecx Balance System) force platform measures. Falls risk was assessed using the Falls Risk for Older People – Community version (FROP-Com). ResultsSixty-five percent of the OA and 65% of the RA women reported one or more falls in the preceding 12 months, and both groups had significantly higher falls risk (FROP-Com) than the matched sample (p < 0.001). Both OA and RA participants had significantly impaired balance and mobility, lower activity level, and lower falls efficacy after adjustment for multiple comparisons, compared to the matched sample. Although women with RA performed worse on the majority of measures than the OA women, the difference was only significant for the Maximum Excursion measure of the Limits of Stability test. ConclusionsWomen with lower limb OA or RA have mild to moderate falls risk and balance impairments in comparison to age-matched older women. Further research is needed to evaluate whether exercise programs targeting balance performance, and other interventions to address their multiple falls risk factors, can improve balance and reduce falls in these clinical groups.

PMS59 Impact of Comorbidities on Measuring Indirect Utility by the Medical Outcomes Study Short Form 6D in Lower-Limb Osteoarthritis

PMS59 Impact of Comorbidities on Measuring Indirect Utility by the Medical Outcomes Study Short Form 6D in Lower-Limb Osteoarthritis

Impact of co-morbidities on measuring indirect utility by the Medical Outcomes Study Short Form 6D in lower-limb osteoarthritis

Co-morbidities can influence generic measurement of health indirect utility. We investigated their impact to assess indirect utility with the Medical Outcomes Study Short Form 6D (SF-6D) in patients with osteoarthritis (OA). In patients with hip and knee OA from the Knee and Hip Osteo-Arthritis Long-term Assessment (KHOALA) study, co-morbidities were assessed by the Functional Co-morbidity Index. Multivariate linear regressions were used to determine predictors of utility score. For the 878 patients included, the mean (standard deviation (SD)) utility score for 808 patients was 0.66 (11; range 0.32-1.00) and mean number of co-morbidities 2.05 (1.58). Number of co-morbidities (beta = -0.30; p = 0.002), psychiatric disease (beta = -0.043; p < 0.0001) and degenerative disc disease (beta = -0.014; p = 0.018) were predictors of low utility score. The WOMAC functional score had a higher significant effect (beta = -0.003; p < 0.0001) and explained a higher percentage of the model variance. Compared to greater negative effect of functional severity of OA, co-morbidities have a negative but relatively marginal impact on indirect utility score. This suggests that, clinically, considering the functional severity of OA remains a first priority.

Calcaneal spurs: Examining etiology using prehistoric skeletal remains to understand present day heel pain

BackgroundCalcanei are the most common sites for bony spurs. Although calcaneal enthesophytes have been extensively researched, many unknowns remain. Whether biological factors, such as age, weight and genetics, play a greater role in calcaneal spur etiology than activity is still unknown. ObjectivesThe current study examines 121 adults from a prehistoric hunter-gatherer population to aid in understanding bony spur etiology. MethodsCalcaneal spurs are scored as present or absent on the dorsal or plantar side; they are analyzed in regards to their relationships with age, sex, osteoarthritis, cortical index, femoral head breadth and muscle markers. ResultsDorsal and plantar spurs frequencies increase with age (chi-squares=16.90, 7.268, Ps<0.05, respectively). Dorsal spurs were more frequent than plantar spurs (chi-square=38.000; P<0.0001). There is a positive relationship with calcaneal spurs and upper limb and lower limb osteoarthritis (chi-squares=5.587, 7.640, Ps<0.05, respectively). ConclusionsThe data presented support that dorsal spurs are in part the result of activities, but plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight.

Aerobic Activity in Prevention and Symptom Control of Osteoarthritis

AbstractAlmost 27 million adults in the United States experience some form of osteoarthritis (OA). An epidemic of arthritis-associated disability is expected in the United States during the next 2 decades, largely fueled by the aging population and the tremendous growth in the prevalence of knee OA. Regular physical activity (PA), particularly strengthening and aerobic activity, can reduce pain and improve function and health status among patients with knee and hip OA. The focus of this review is on the impact of aerobic activity on the progression and symptom control of OA. In general, both strengthening and aerobic exercise are associated with improvements in pain, perceived physical function, and performance measures for persons with lower limb OA, although comparisons of strengthening versus aerobic exercise on these outcomes are unusual. Structural disease progression in persons with established OA has been directly evaluated by a limited number of PA clinical trials for persons with knee OA, but these protocols focused on strength training exclusively. In healthy subjects, it appears that overall PA is beneficial, rather than detrimental, to knee joint health. Possibly the most important reason for engaging in PA is to prevent obesity, which independently has been associated with many serious chronic diseases, including the incidence and progression of OA. More research is needed to determine the optimal types and dosing of aerobic conditioning.

Reliability and validity of the physical activity scale for the elderly (PASE) in patients with hip osteoarthritis

Purpose: Physical activity (PA) is beneficial in reducing pain and improving function in lower limb osteoarthritis (OA), and is recommended as a first line treatment. Self-administered questionnaires are frequently used to assess level and intensity of PA, but knowledge on reliability and validity of these PA questionnaires are limited, in particular for patients with OA. The purpose of this study was to evaluate the reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip OA.

Radiographic features, better than clinical features, represent actual joint degeneration and inflammation: considerations for total knee replacement surgery

Radiographic features, better than clinical features, represent actual joint degeneration and inflammation: considerations for total knee replacement surgery

Reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip osteoarthritis

BackgroundPhysical activity (PA) is beneficial in reducing pain and improving function in lower limb osteoarthritis (OA), and is recommended as a first line treatment. Self-administered questionnaires are used to assess PA, but knowledge about reliability and validity of these PA questionnaires are limited, in particular for patients with OA. The purpose of this study was to evaluate the reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip OA.MethodsForty patients with hip OA (20 men and 20 women, mean age 61.3 ± 10 years) were included. For test-retest reliability PASE was administered twice with a mean time between tests of 9 ± 4 days. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for the total score and for the particular items assessing different PA intensity levels. In addition a Bland-Altman analysis for the total PASE score was performed. Construct validity was evaluated by comparing the PASE results with the Actigraph GT1M accelerometer and the International Physical Activity Questionnaire (IPAQ), using the Spearman rank correlation coefficient.ResultsICC for the total PASE score was 0.78, with relatively large error of measurement; SEM = 31 and MDC = 87. ICC for the intensity items was 0.20 for moderate PA intensity, 0.46 for light PA intensity and to 0.68 for vigorous PA intensity. The Spearman rank correlation coefficient between the Actigraph GT1M total counts per minute and the total PASE score was 0.30 (p = 0.089), and ranging from 0.20-0.38 for the different PA intensity categories. The Spearman rank correlation between IPAQ and PASE was 0.61 (p = 0.001) for the total scores.ConclusionsIn patients with hip OA the test-retest reliability of the total PASE score was moderate, with acceptable ICC, but with large measurement errors. The construct validity of the PASE was poor when compared to the Actigraph GT1M accelerometer. Test-retest reliability and construct validity revealed that the PASE was unable to assess PA intensity levels. PASE is not recommended as a valid tool to examine PA level for patients with hip OA.