Elderly Osteoarthritis Patients Research Articles

The interplay of body composition, pain intensity, and psychological status in Egyptian patients with knee osteoarthritis

BackgroundThere is a clear relationship between poor mental health, obesity, and osteoarthritis (OA). Individuals who experience symptoms of anxiety and depression are more likely to report higher levels of pain and disability in OA. In addition, higher body mass index (BMI) levels can contribute to additional pain and disability in individuals with OA. We aimed to explore the interplay of Body composition, pain intensity, and psychological status in Egyptian patients with knee OA.ResultsThis cross-sectional study included 60 patients with Knee OA diagnosed clinically according to the American College of Rheumatology (ACR) criteria. Body composition measurement was performed with an InBody analyzer. Pain was assessed by the pain visual analog scale (VAS), disability was measured with Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and depressed mood and/or anxiety was measured by the Hospital Anxiety and Depression Scale (HADS). Body mass index (BMI), total body fat (TBF) %, fat mass (FM), and fat mass index (FMI) were positively correlated with pain and disability in patients with knee OA. TBF% was positively correlated with depression and anxiety.ConclusionsThis study has shed light on the association between mental disorders, body composition measurements, knee pain, and disability. Interventions to treat osteoarthritis in elderly patients should focus on treating mood changes such as anxiety and depression, psychological support, and controlling body mass with proper diet and exercise programs.

Evaluation of risk factors for surgical site infections in osteoarthritis patients undergoing total knee arthroplasty.

This research sought to delineate risk factors associated with surgical site infections (SSIs) post-total knee arthroplasty (post-TKA) in elderly osteoarthritis patients, aiming to enhance post-surgical outcomes. A retrospective examination was conducted on a cohort of 650 elderly patients who underwent unilateral TKA between January 2018 and August 2022. Data procurement was from the hospital's Electronic Health Record, and a comprehensive statistical evaluation was performed using IBM SPSS Statistics version 24.0. Both univariate and multivariate techniques assessed a spectrum of risk determinants such as age, body mass index (BMI), coexisting medical conditions and surgical variables. The univariate examination spotlighted age, BMI, diabetes prevalence, chronic corticosteroid consumption and American Society of Anesthesiologists (ASA) physical status classification as notable predictors of SSIs. The multivariate logistic regression pinpointed age, BMI, history of smoking and diabetes diagnosis as salient risk attributors for post-TKA infections. Concurrently, parameters like ASA classification, surgical duration and intraoperative haemorrhage further enriched the risk landscape. Geriatric patients undergoing TKA for knee osteoarthritis manifest a tangible infection susceptibility post-surgery. Precision interventions concentrating on amendable risk components, including meticulous preoperative evaluations and strategic postoperative care, are imperative to attenuate SSI incidence, thereby amplifying surgical efficacy and optimizing patient recuperation trajectories.

Accelerometer-derived physical activity analysis of elderly osteoarthritis patients

BackgroundBecause disability in Osteoarthritis (OA) may change physical activity (PA), which might affect the disease progression, it is important to measure a patient's daily PA to study the relationship between a patient's PA and disease progression. ObjectiveThe objective of the present study was to investigate the relationship between PA and patients with OA and people without OA using data from the Korea National Health and Nutrition Examination Survey (KNHANES). MethodsDemographic study was conducted to obtain data of comorbidities of participants. PA was compared between the group with OA (OA group) and the group without OA (non-OA group). In addition, PAs of OA patients with comorbidities and those without comorbidities were compared. The cut-off of moderate to vigorous physical activity (MVPA) was obtained through a receiver operating characteristic (ROC) curve. ResultsIn the demographic study, there were significantly more educated participants in the OA group (p < .001). Actigraph data showed a significant decrease in MVPA (p < .001) but a significant increase in light activity (p = .002) in the OA group. In addition, the OA group showed significantly lower light PA but significantly higher MVPA in ≥10 min bout length. OA patients with comorbidities showed higher MVPA than OA patients without comorbidities (p = .044). The cut-off point of MVPA was 7.071 min/day when ROC curve was conducted. ConclusionsThe present study suggests that patients with OA and low activity need a certain level of physical activity and a cut-off point for MVPA is presented which accounts for comorbidities in OA patients.

GuiLu-ErXian Glue extract promotes mesenchymal stem cells (MSC)-Induced chondrogenesis via exosomes release and delays aging in the MSC senescence process

Ethnopharmacological relevanceThe treatment of osteoarthritis (OA) patients is a challenging problem. Mesenchymal stem cells (MSCs) are multipotent cells and play key roles in regenerative medicine for cartilage degeneration. GuiLu-ErXian Glue (GLEXG) is an herbal remedy widely used in traditional Chinese medicine to treat joint pain and disability in elderly OA patients. However, the mechanisms of how GLEXG affects MSCs-induced chondrogensis remains to be elucidated. Aim of the studyThe aim of this study was to investigate the effects of GLEXG on MSC-derived chondrogenesis, both in vitro and in vivo and its potential mechanisms. MethodsUsing human MSC (hMSCs) as in vitro model, the effects of HPLC-profiled GLEXG water extract on chondrogenic differentiation were investigated by 3D spheroid cultures under chondrogenesis-inducing medium (CIM) condition. The chondrogenesis process was evaluated by measuring the sphere sizes, chondrogenesis-related genes expression by reverse transcription real-time PCR that targeted type II/X collagens, SOX9, aggrecan, and protein expression by immunostaining. Anti-TGF-β1 neutralization antibody was used for mechanistic study. Mono-iodoacetate (MIA) induced OA joint was used to evaluate the effects of GLEXG on in vivo model. MSCs-derived exosomes were purified for proteomics study and senescence process was evaluated by cumulative population doublings and senescence-associated β-Galactosidase staining. ResultsThe results showed that GLEXG enhanced hMSCs chondrogenesis and upregulated RNA expression of type II/X collagen, SOX9 and aggrecan at 0.1 μg/mL, 0.3 μg/mL in vitro. In vivo, GLEXG at the dose of 0.3 μg intraarticular (i.a.) injection rescued the MIA-induced cartilage defect. Proteomics and ingenuity pathway analysis obtained from MSCs-released exosomes suggested that senescence pathway was less activated in GLEXG group than in vehicle group. Besides, GLEXG was able to increase cumulative population doubling and delayed hMSCs senescence process after four passages in cultures. Conclusionwe conclude that GLEXG promotes in vitro MSC-induced chondrogenesis possibly via exosomes release and delays aging in the MSC senescence process and that treatment with GLEXG (0.3 μg, i.a.) rescued cartilage defects in rat OA knee model.

Geriatric syndromes and nutrition status of elderly osteoarthritis patients

This study describes numerous characteristics of comorbidities and geriatric syndromes in elderly osteoarthritis patients at the National Geriatrics Hospital. A cross-sectional study on 184 knee osteoarthritis (OA) patients aged ≥ 60 years old treated at the National Geriatrics Hospital. The mean age of the patients was 73.12 ± 8.62 years, male patients accounted for 83.7%. Most participants (85.9%) had experienced 2 sides of knee OA, more than half of these participants (63.6%) were experiencing moderate pain. There were 73 patients with reduced mobility accounting for 39.7%. The dependency ratio of functional activities on the ADL scale was 32.6%, and on the IADL scale it was 35.9%. The number of participants using less than 5 drugs was 45.7%. More than half of the survey participants used polypharmacy accounting for 54.3%. There was a significant association between nutritional status and reduced physical function (ADLs and IADLs), impaired cognitive function, depression status and sleep disorder. Geriatric syndromes and risk of malnutrition are common in older OA patients, and assessment for them should be done routinely in these patients to early detect impaired physical activities, impaired cognitions, depression problems, sleep disturbances and progressive symptoms of knee osteoarthritis.

Intra-Articular Laser Therapy May Be a Feasible Option in Treating Knee Osteoarthritis in Elderly Patients.

Knee osteoarthritis (OA) is a common problem in elderly patients. They are often troubled with altered knee function, such as pain and weakness. However, not all these patients are able to receive autologous platelet-rich plasma (PRP) injections as they may be taking antiplatelet or anticoagulant medications. Their physical condition may not allow them to receive total knee replacement surgery as well. Long-term oral intake of nonsteroidal anti-inflammatory drugs may be detrimental to the gastrointestinal tract. As a result, it is crucial to discover new treatment options that can alleviate painful knee symptoms in elderly knee OA patients. In this study, 19 elderly patients diagnosed with moderate degree of knee OA as well as suprapatellar bursitis were recruited. They received low-level laser therapy (LLLT) to their affected knees. Under ultrasound guidance, flexible fiber optic wire was inserted intra-articularly into the knee joint. Red laser followed by infrared irradiation was performed once every 2 weeks for a total of 3 times. The Lequesne index for knee OA and the volume of suprapatellar synovial fluid (SF) were measured. SF proteomic analyses were also performed up to a period of 6 months. The results revealed that after 3 LLLT, the Lequesne index significantly decreased, signifying improvement in the knee joint functional status. The volume of suprapatellar SF and SF proteins associated with inflammation also decreased significantly in the SF. These findings lasted up to a period of at least 3 months. Therefore, LLLT may be considered as a feasible option in treating elderly patients with knee OA who are not suitable for surgical interventions or intra-articular PRP injections.

Paper 90: Histopathology of Rotator Cuff Tendons in Elderly Patients with Glenohumeral Arthritis without Cuff Tears

Paper 90: Histopathology of Rotator Cuff Tendons in Elderly Patients with Glenohumeral Arthritis without Cuff Tears

Optimization of lyophilized hyperacute serum as a regenerative therapeutic in osteoarthritis

Purpose: Blood-derived products are known to be involved in musculoskeletal regeneration by promoting cell proliferation and modulating inflammation. By altering the cell-hostile microenvironment we are pursuing to stop or even reverse the degenerative process in the joints of osteoarthritic patients. Hyperacute serum is a blood-derived product that retains the regenerative potential of platelet rich plasma (PRP) overcoming its variability disadvantages. Hyperacute serum obtained by squeezing a fibrin clot and its composition has been compared to PRP, showing that it better resembles cellular and molecular concentrations of in vitro and in vivo samples. To expand the potential therapeutic use, a new formulation method as lyophilized powder was established. This freeze-dried format will enable allogenic therapy with a highly regenerative, standardized and stable blood product. In contrast to freshly isolated hyperacute serum, which allows for autologous therapy, where the donors and the patients are the same individuals, most of the time elderly OA patients; the allogenic serum is a nutrient-enriched version as it is obtained from young healthy donors. Moreover, it is manufactured by pooling multiple donor´s serum, which solves the problem of donor variability. Hyperacute serum in lyophilized format can be stored for longer periods of time, therefore, administration to patients is facilitated. Two different manufacturing processes lead to the development of two different versions of lyophilized hyperacute serum. Our aim is to test the regenerative capacities of the two new lyophilized hyperacute sera in the context of osteoarthritis (OA) alone and in combination with hyaluronic acid (HA). Methods: Two-dimensional (2D) cultures of primary chondrocytes were kept in culture under different supplementation conditions, including three versions of hyperacute serum (one freshly isolated and two lyophilized), PRP, FCS and combinations of hyperacute serum+HA. These 2D cultures were analyzed with the XTT viability assay. 3D chondrogenic spheroids from primary-isolated chondrocytes were developed and kept in culture for 1 week within the listed culture conditions. In addition to XTT viability analysis , collagen type II and aggrecan production and secretion within the extracellular matrix, confocal microscopy together with immunofluorescence were applied. Results: XTT assays (sample size=5) of the 2D cultures were performed at the following time points: day 3, day 5 and day 7. When comparing the different formats of hyperacute serum at day 3, we have observed that 10% lyophilized extra-filtered hyperacute serum promotes cell viability in a comparable level to 10% FCS (1,87 and 1,57 a.u. respectively, ns). Moreover, increasing the concentration of this hyperacute serum to 20% leads to 2,27 a.u.; however, this increase did not reach the level of statistical significance. In previous publications, it was shown that freshly isolated hyperacute serum had a high performance in promoting cell viability as well as in affecting gene expression of genes that play a role in osteoarthritis, by holding back inflammation (TNFα, Il-1β, Il-1ra), promoting tissue regeneration (COL1A, osteonectin) and preventing bone degradation (RANKL). However, lyophilized extra-filtered hyperacute serum did not present the same strong effect. We hypothesize that due to the further filtration process, nutrients including growth factors were removed, which had a clear impact in promoting cell viability. Nevertheless, filtered lyophilized hyperacute serum still showed a comparable effect as FCS, known to be a gold standand in cellular supplementation. Due to the loss of nutrient supply, a non-filtered lyophilized hyperacute serum with a different manufacturing process was produced. Same experiments were repeated demonstrating that non-filtered lyophilized hyperacute serum shows a significant promotion of cell viability (2,93 a.u., P=0,0313), similarly to freshly isolated hyperacute serum or PRP (3,26 a.u. and 3,15 a.u., respectively; ns.). When testing the effect of HA alone (2,19 a.u., ns) or in combination with extra-filtered or non-filtered lyophilized hyperacute sera, it showed no significant differences in cell viability due to a possible added effect on such hypercute sera (1,83 a.u. and 3,39 a.u., respectively; ns.). Further gene expression analysis need to be performed in order to better understand the mechanisms involved in each of the conditions. XTT data from days 5 and 7 of culture supported the findings concerning HA and the significant difference between the two lyophilized versions of hyperacute sera; however, it revealed higher cell viability when cultures were supplemented with 10% PRP and 10% freshly isolated hyperacute serum. Confocal microscopy of 3D chondrogenic pellets has shown that production and secretion of collagen type II and aggrecan, two main structural proteins of the cartilage, increased in 3D chondrogenic spheroids supplemented with the different formulations of hyperacute sera as well as FCS. Conclusions: Non-filtered lyophilized hyperacute serum maintains the supplementation capacity in 2D and 3D chondrogenic cultures, as shown in the past by the freshly isolated format. The implementation of hyaluronic acid to such blood-derived products does not show, for now, any added effect. Non-filtered lyophilized hyperacute serum is a stable and standardized blood product with regenerative potential in the context of OA.

Revision rate of THA in patients younger than 40\xa0years depends on primary diagnosis \u2013 a retrospective analysis with a minimum follow-up of 10\xa0years

BackgroundTreating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses.MethodsWe included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years.ResultsThe mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005).ConclusionTHA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).

Predictive value of adipose to muscle area ratio based on MRI at knee joint for postoperative functional outcomes in elderly osteoarthritis patients following total knee arthroplasty

BackgroundThe current research used a new index—adipose to muscle area ratio (AMR)—to measure fatness compared with body mass index (BMI) in elderly osteoarthritis (OA) patients following total knee arthroplasty. Our study aimed to test the relationship between the two indexes (AMR and BMI) and to examine whether AMR was a predictive factor of patient-reported outcome measures (PROMS) for elderly OA patients following total knee arthroplasty (TKA).MethodsThe retrospective data of 78 OA patients (older than 60 years) following TKA was included in our study. Clinical features of patients included age, BMI, sex, AMR, side of the implant, time of follow-up, complications, the Knee Society Score (KSS score), and the Hospital for Special Surgery knee score (HSS score). The area of adipose tissue and muscle tissue was measured on the cross section (supra-patella, midline of the patella, joint line of the knee) of the knee magnetic resonance imaging (MRI). AMR was calculated as the average of adipose to muscle area ratio at the three levels. The Pearson correlation analysis, simple linear regression, and multiple linear regression were used to study the relationship between BMI, AMR, and PROMS (KSS total-post score and HSS-post score) in the study.ResultsOf all patients, the mean (± standard deviations (SD)) of age was 67.78 ± 4.91 years. For BMI and AMR, the mean (± SD) were 26.90 ± 2.11 and 2.36 ± 0.69, respectively. In Pearson correlation analysis, BMI had a good correlation with AMR (r = 0.56, p = 0.000), and AMR (r = − 0.37, p = 0.001, HSS-post score; r = − 0.43, p = 0.000, KSS total-post score) had better correlations with PROMS postoperatively compared with BMI (r = − 0.27, p = 0.019, HSS-post score; r = − 0.33, p = 0.003, KSS total-post score). In multivariate linear regression analysis, AMR was negatively correlated with KSS total-post score as well as HSS-post score, while BMI was not. As for patients with complications, AMR values were between the 3rd quartile and 4th quartile of the AMR value in the entire study cohort.ConclusionsIn this study, the new obesity evaluation indicator—AMR, which was well related with BMI, was found to be a predictor of PROMS (KSS total-post score and HSS-post score) in elderly OA patients following TKA.

Feasibility of image-based augmented reality guidance of total shoulder arthroplasty using microsoft HoloLens 1

ABSTRACT Total Shoulder Arthroplasty (TSA) is a shoulder replacement procedure to treat severe rotator cuff deficiency, primarily caused by osteoarthritis in elderly patients. One of the critical factors in reducing postoperative complications is accurate drilling of a centring hole on the glenoid surface at a precise position and orientation. While the drilling path is planned pre-operatively on 3D diagnostic images, the absence of visual guidance during surgery can lead to low reproducibility. In this paper, we present the design and feasibility analysis of a marker-less image-based registration pipeline using the Microsoft HoloLens 1 and its built-in sensors to guide glenoid drilling during TSA. Our solution intra-operatively registers the pre-operative 3D scan to the exposed glenoid surface both with and without occlusion. Our results provide a breakdown of the sources contributing to registration error. In addition to the commonly discussed errors (SLAM-based head tracking, partial overlap etc.), we find that the poor performance of the depth sensing camera becomes a major source of error. We further find that partial overlap between the source and target remains a large concern for registration in high occlusion scenarios. This work begins to characterise the depth sensor error and suggests future work towards image-based augmented reality guidance.

Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly-A Subgroup Analysis of Routine Clinical Practice Data.

Background Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p ≤ 0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p ≤ 0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.

Effects of Single-Task Versus Dual-Task Training on Balance Performance in Elderly Patients With Knee Osteoarthritis.

This study aims to compare the effects of single-task and dual-task training on balance performance in elderly patients with knee osteoarthritis (OA). Fifty elderly osteoarthritic patients with balance impairment (16 males, 34 females; mean age 72.9±5.5 years; range 65 to 84 years) were included in this study. Patients were randomly assigned to single-task balance training (group 1) or dual-task balance training (group 2) groups. Balance activities were given to both groups for three times a week for four weeks. Patients in group 2 also performed cognitive tasks simultaneously with these exercises. Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer static and dynamic scores, timed up and go (TUG) test and walking speed (WS) for single and dual tasks, number of stopping and activities-specific balance confidence (ABC) scale at baseline and at the end of four weeks. At the end of the therapy, there were statistically significant improvements in BBS, KAT 2000 static and dynamic scores, TUG test and WS for single and dual tasks, number of stopping and ABC scale in both groups (p<0.05). But there was no statistical difference in any parameter between the groups (p>0.05). Both single- and dual-task trainings are effective in improving balance performance under single- and dual-task conditions in elderly patients with knee OA. Dual-task training is not superior to single-task training for balance improvement in elderly osteoarthritic patients.

Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly: Improvements in Daily Functioning and Quality of Life

Background: Chronic osteoarthritis (OA) pain leads to severe impairments in physical functioning and quality of life. Patients & methods: Data of patients with severe chronic knee and/or hip OA pain were extracted from the database of a prospective, noninterventional trial to assess the benefits of tapentadol prolonged release (PR) in elderly patients (>65years of age; n=1162) compared with younger patients (≤65years of age; n=498). Results: Tapentadol PR treatment (up to 3months) significantly reduced pain intensity and pain-related restrictions on daily functioning and significantly improved physical and mental quality of life in both patient groups. The incidence of adverse drug reactions was low. Conclusion: Tapentadol PR is a useful strong analgesic to improve pain intensity, physical functioning and quality of life in elderly OA patients.

Is the Association of Platelet Rich Plasma and Hyaluronic Acid Useful for Severe Knee Arthrosis?

Background: Evaluate the effectiveness of intra-articular injections of platelet rich plasma associated with hyaluronic acid, in severe knee osteoarthritis in elderly patients. By comparing the results of mild and moderate osteoarthritis group (younger) with the severe osteoarthritis group (older). Methods: The treatment was based on a technique which consisted of a superolateral knee injection of 2 mL of xylocaine (1% without constrictor vessel) followed by an injection of 2 mL of hyaluronic acid and an injection of 4 mL of platelet rich plasma. All injections were guided by ultrasound and given in the same site. Comparative analysis of pre and post treatment was performed. Results: No significant difference were obtained between the groups (p value > 0.05), showing that despite having a different Kellgren and Lawrence classification, the two groups showed a similar improvement result. Conclusion: The association of platelet rich plasma and hyaluronic acid in the treatment of knee arthrosis is useful for the improvement of the WOMAC total score, as well as of its subscores (pain, function, and stiffness). Similar results were obtained for patients with severe arthrosis and those with mild and moderate arthrosis.

Quality of Care for Knee and Hip Osteoarthritis in Elderly Patients

Quality of Care for Knee and Hip Osteoarthritis in Elderly Patients

Gastrointestinal risk of non-steroidal anti-inflammatory drugs and gastroprotective agents used in the treatment of osteoarthritis in elderly patients: A nationwide retrospective cohort study .

Osteoarthritis is highly prevalent in older adults and often treated with nonsteroidal anti-inflammatory drugs (NSAIDs). COX-2-selective NSAIDs have been shown to offer better gastrointestinal (GI) safety benefits than non-selective NSAIDs (ns-NSAIDs). However, most COX-2-selective NSAIDs have not been comprehensively evaluated for use in combination with gastroprotective agents (GPAs). This study compared the risk of adverse GI events in patients treated with COX-2-selective NSAIDs and ns-NSAIDs alone, or in combination with GPAs. We utilized National Health Insurance Claim Data collected from 2012 to 2015. Newly diagnosed patients with osteoarthritis (60 years or older) were included in this study. The study population was divided into two groups: 1) COX-2-selective NSAID treatment and 2) ns-NSAIDs treatment. Patients were followed-up for up to 6 months to determine whether GI events occurred. The Cox proportional hazards model was used to identify differences in risk. Subgroup analyses were conducted for monotherapies and combination treatments with GPAs. The number of subjects prescribed COX-2-selective NSAID and ns-NSAIDs were 20,868 (5.6%) and 353,494 (94.4%), respectively. After adjustment for confounding factors, COX-2-selective NSAID were safer than ns-NSAIDs (adjusted hazard ratio (aHR) = 0.80, 95% confidence interval (CI): 0.77-0.82). Use of GPAs with COX-2-selective NSAID was associated with a lower risk of GI events than use of ns-NSAIDs (aHR = 0.92, 95% CI: 0.87-0.97). Use of COX-2-selective NSAID was associated with a lower risk of GI adverse events than use of ns-NSAIDs as a monotherapy. Furthermore, COX-2-selective NSAID were safer than ns-NSAIDs in combination with GPAs. .

Serum Phosphorylated Neurofilament Heavy Subunit-H, a Potential Predictive Biomarker for Postoperative Cognitive Dysfunction in Elderly Subjects Undergoing Hip Joint Arthroplasty

BackgroundPostoperative cognitive dysfunction (POCD), which refers to a cognitive impairment subsequent to surgical procedures, is a common complication in the elderly subjects. This study aimed to investigate potential risk factors for POCD in elderly subjects undergoing hip joint arthroplasty. MethodsConsecutive elderly osteoarthritis patients who were scheduled to undergo hip arthroplasty under epidural anesthesia were enrolled into this single-center, prospective observational study. Serum phosphorylated neurofilament heavy subunit-H (pNF-H) was measured by the enzyme-linked immunosorbent assay method. A level of >70.5 pg/mL was accepted as pNF-H positivity. Neuropsychological assessment at baseline (1 day before the surgery) and postoperative day 7 was conducted. POCD was defined according to the calculated Z scores. Risk factors for POCD were evaluated by univariate and multivariate logistic regression analyses. ResultsIn final, 287 patients were enrolled, and 55 had suffered POCD within postoperative 7 days with an incidence of 19.2%. The final multiple logistic regression analysis revealed a higher pNF-H positivity was the only independent risk factor for POCD (odds ratio: 2.03, 95% confidence interval: 1.21-3.29, P = .012). ConclusionsOur results revealed an increased preoperative serum pNF-H expression was an independent risk factor for POCD development in elderly subjects undergoing hip joint arthroplasty, suggesting the close association between anatomical damage in central nervous system and POCD.

Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data.

ObjectiveOsteoarthritis (OA) is highly prevalent throughout the world, especially in the elderly population, and is strongly associated with patients’ frailty. However, little is known about the prevalence and treatment of OA in elderly patients in routine clinical care in Germany.Materials and methodsAs a part of Linking Patient-Reported Outcomes with CLAIms Data for Health Services Research in Rheumatology (PROCLAIR), a cross-sectional study using claims data from a large Germany statutory health insurance (BARMER) was conducted. We included people aged 60 years or older and assessed the prevalence of OA of the hip or knee, defined as having outpatient diagnoses (ICD: M16 or M17) in at least two quarters of 2014. The use of conservative treatment, including analgesics and physical therapy, and total joint replacement was studied. Analyses were stratified by age, sex, comorbidities, and level of care dependency defined by social law.ResultsA total of 595,754 patients (mean age: 74.9 years; 69.8% female) were diagnosed with OA (21.8%), with the highest prevalence in those between 80 and 89 years (31.0%) and in females compared to males (23.9% vs 18.3%). Prevalence decreased with increasing level of care dependency from 30.5% in patients with a low level (0/1) to 18.7% in the highest level of care dependency. A total of 63.4% of the patients with OA received analgesics, with higher use with increasing age. Physical therapy was prescribed to 43.1% of the patients, but use decreased with age. In all, 5.3% of the patients received total joint replacement in 2014.ConclusionThe lower frequency of coded OA with increasing level of care dependency may reflect underdiagnosis, and patients with many other medical problems seem to be at risk for inadequate recognition and treatment of their OA.

EFFECT OF FLAMINGO EXERCISES ON BALANCE IN PATIENTS WITH BALANCE IMPAIRMENT DUE TO SENILE OSTEOARTHRITIS

To investigate the effect of flamingo exercise with or without KAT 2000 device on the balance problems due to senile OA. Ninety elderly osteoarthritic patients with balance impairment. Participants were randomly assigned into three groups; Kinesthetic ability trainer (KAT 2000) training group (Group 1) (n = 30), Flamingo training group (Group 2) (n = 30), Combined training group (Group 3) (n = 30) group. 45 minutes individualized training sessions as three times a week for 4 weeks were given to all participants. Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer (KAT 2000) static and dynamic scores, timed up and go test (TUGT), walking speed (WS), Activities Specific Balance Confidence (ABC) Scale and Functional Reach Test (FRT) at the baseline and at the end of 4 weeks. At the end of the therapy, there were statistically significant improvements in KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale in all groups (p < 0.05). At the end of the therapy there were statistically significant differences in Group 3 for KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale than the other groups (p < 0.05). But there were no statistical difference in BBS and FRT score between the groups (p > 0.05). Both flamingo and KAT2000 exercises device have positive effects on the balance problems due to senile OA. Combined with the KAT2000 device, the effects of flamingo exercises on balance disorder in senile osteoarthritis patients are more pronounced.