Hip Osteoarthritis Research Articles

EFEITOS DA TERAPIA MANUAL NA OSTEOARTRITE DE QUADRIL E JOELHO:REVISÃO INTEGRATIVA.1

Osteoarthritis commonly affects the hips and knees, causing joint pain, stiffness and reduced range of motion, which results in fatigue, depressed mood and functional limitations, including difficulty walking. Manual therapy as a special physiotherapeutic technique is also recommended in knee OA. The general objective of the study was to investigate the effects of manual therapy on improving the symptoms of people with knee and hip osteoarthritis. As for the methodology, it was an Integrative Literature Review with a search from 2019 to 2024 in the PEDRO, SCIELO, LILACS and MEDLINE databases. 53 studies were found in the aforementioned databases, however, after the selection only 5 articles were included, the results of the analyzed studies indicated that different intervention techniques have been used, such as mobilization with movement, Mulligan techniques, Thermal Therapy Focal and Maitland Mobilization, to reduce pain and improve the physical function of those affected. These studies have important clinical implications, suggesting that physical therapists and other healthcare professionals should consider incorporating these techniques into their treatment protocols for knee osteoarthritis.

Decreased volume of rectus femoris and iliocapsularis in patients with femoroacetabular impingement syndrome after primary hip arthroscopy

Purpose(1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes.MethodsData between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs.ResultsA total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P < .05). Both G-med/min and G-max presented decreased volume at postoperative 6 months (all with P < .05). G-med/min presented decreased volume (P = .001) at postoperative 12 months. Changes in RF at postoperative 3 months and 12 months were positively related to improvement of iHOT-12 (Beta = 0.371, P = .012 and Beta = 0.330, P = .026, respectively). Changes in IC at postoperative 6-month was positively related to improvement of mHHS (Beta = 0.367, P = .027) and iHOT-12 (Beta = 0.315, P = .044).ConclusionDuring the initial first year following arthroscopic treatment for FAIS, decreased volume of the RF and gluteal muscles was observed. Early changes in volume of RF and IC were positively correlated to the improvement of minimum 2-year PROs.Level of evidenceLevel IV; case series.

Alterations in Small Non-coding MicroRNAs (miRNAs) and the Potential Role in the Development of Aseptic Loosening After Total Hip Replacement: Study Protocol for an Observational, Cross-Sectional Study.

Total hip arthroplasty (THA) is one of the most successful and effective surgeries for the treatment of hip osteoarthritis, with good rates in terms of survival, pain relief, and patient functional recovery. Aseptic loosening (AL) accompanied by periprosthetic osteolysis (PPOL) is the most frequent late complication, accounting for almost 50% of all revision surgeries. The primary purpose of this observational, cross-sectional study is to identify alterations in small, non-coding RNAs, miRNAs, that could be involved in the pathogenesis of AL and PPOL following THA. Sixty-three patients will be included in this study and will be divided into three groups (21 in each group): Group A (control group), including patients undergoing primary THA due to degenerative hip osteoarthritis, Group B including patients without clinical and radiological evidence of PPOL/AL following primary THA, and Group C including patients with clinical and radiological evidence of PPOL and AL undergoing revision surgery following primary THA. Blood samples will be collected from all patients. Peripheral blood samples from Group A and C patients will be collected prior to surgery while synovial membrane samples will also be collected intraoperatively. Synovial membrane samples will not be collected from Group B patients since they are not candidates for any surgical intervention. The relative expression of miRNAs let-7i-5p, let-7e-5p, miR-15a-5p, miR-30a-3p, and miR-130a-3p, will be measured using real-time quantitative PCR (qRT-PCR) at baseline from all patients. The primary goal is to identify the expression of inflammation-related miRNAs that could play a role in the pathophysiology of AL and highlight the differences among patients with confirmed AL, patients with degenerative hip disease, and patients with no signs of AL following THA. The secondary goal is to use these miRNAs as biomarkers to estimate the possibility for a patient to develop AL after total hip replacement, and also as possible treatment targets. Our study has been registered with an International Standard Randomized Controlled Trial Number ID: ISRCTN25839413.

Intraarticular hip corticosteroid injections offer no meaningful benefit in delaying time to total hip arthroplasty in patients with hip osteoarthritis

IntroductionSymptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention.MethodsA cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared.Results357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p < 0.001). Of 117 patients in the CSI-noTHA group at mean 25 months follow-up, only 43 (12% of all injection patients) had not had THA because they found injections effective. The remaining 74 (63%) of CSI-noTHA patients have been deemed medically unfit for surgery or are currently scheduled for THA.Discussion/ConclusionThe results of this study suggest the utilization of intra-articular CSI as conservative treatment in an arthroplasty clinic does not prolong time to THA for a clinically important duration. The use of CSI should be reserved for diagnostic purposes and/or short-term pain relief in poor surgical candidates.Level of evidenceIII.

Spatiotemporal gait characteristics post-total hip arthroplasty and its impact on locomotive syndrome: a before-after comparative study in hip osteoarthritis patients.

Understanding the gait pattern of patients eligible for total hip arthroplasty (THA) due to hip osteoarthritis (OA) offers valuable information for improving locomotive syndrome (LS). This study aims to measure the gait patterns of THA-eligible patients using an optical motion capture system and to analyze these patterns using principal component analysis (PCA). Additionally, this study examines the relationship between THA-induced gait patterns and LS. This before-after study included 237 patients who underwent unilateral primary THA due to hip OA. The primary outcome measures were spatiotemporal gait parameters. Secondary outcome measures included three LS risk tests: a stand-up test, a two-step test, a 25-question Geriatric Locomotive Function Scale (GLFS-25), and total clinical decision limits stages. PCA was performed using 16 spatiotemporal gait parameters collected before and three months after THA. Principal components (PC) were selected to achieve a cumulative contribution rate of 90% (0.9) or higher. Each summarized PC was compared using a paired t-test before and three months after THA. Furthermore, multiple regression analysis was conducted to determine how changes in each PC between before and three months after THA related to changes in the four LS evaluation items. PCA identified three principal components (PC1, PC2, PC3) that accounted for a cumulative contribution rate of 0.910 using 16 spatiotemporal gait parameters. When comparing before and three months after THA for all three PCs, significant differences were observed in each PC (p<0.001), with overall walking ability and stance phase being higher three months after THA than before THA, while the asymmetry of support time was lower three months after THA. The results of multiple regression analysis revealed that PC1, PC2, and PC3 were the most influential factors in total clinical decision limits stage. For each LS risk test, the factors related to the stand-up test were identified as PC1, PC2, and PC3, while the factors related to the two-step test were identified as PC1 and PC2. The factors related to the GLFS-25 were also identified as PC1 and PC2. The most important findings of this study indicate that the three PCs represent over 90% of the 16 spatiotemporal gait parameters, which are associated with total clinical decision limits stage and LS risk tests. The present results suggest that PC1 represents overall walking ability, PC2 represents the stance phase, and PC3 represents asymmetry of support time. Gait pattern characteristics, such as overall walking ability, stance phase, and asymmetry of support time, were clearly defined by these PCs. Regarding the relationship between PC and LS, all three PCs are related to total clinical decision limits stage. In addition, PC1 and PC2 related to all three LS risk tests, and PC3 related only to the stand-up test.

Efficacy and Safety of Platelet-Rich Plasma (PRP) Intra-articular Injections in Hip Osteoarthritis: A Systematic Review of Randomized Clinical Trials.

Hip osteoarthritis (OA) is a prevalent condition causing significant pain and disability. Platelet-rich plasma (PRP) intra-articular injections have emerged as a potential therapeutic option, but their efficacy is still debatable and their safety profile remains under-explored compared to standard treatments. This systematic review aims to evaluate the efficacy and safety of PRP injections in patients with hip OA by analyzing data from randomized clinical trials (RCTs). A comprehensive literature search was conducted in PubMed, Scopus, and the Virtual Health Library (VHL) until October 31, 2022, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were RCTs assessing PRP injections for hip OA and reporting adverse events. Data extraction and methodological quality assessment were performed using the Cochrane Risk of Bias Tool (RoB 2 tool).Out of 188 identified studies, five met the inclusion criteria. The studies varied in sample size (43-111 patients) and PRP preparation methods (closed vs. open systems). All studies demonstrated significant pain reduction and functional improvement with PRP. No major adverse events were reported, indicating a favorable safety profile. Minor side effects were transient and resolved without further intervention. Methodological quality ranged from low to high risk of bias. In conclusion, PRP injections appear to be a safe and effective treatment option for managing hip OA, with favorable outcomes compared to hyaluronic acid. Further research is necessary to standardize PRP protocols and assess long-term safety and efficacy.

Assessing the measurement properties of PROMIS Computer Adaptive Tests, short forms and legacy patient reported outcome measures in patients undergoing total hip arthroplasty.

The commonly used ('legacy') PROMs evaluating outcomes of total hip arthroplasty (THA), have several limitations regarding their measurement properties and interpretation of scores. One innovation in PROMs is the use of Computerized Adaptive Testing (CAT). The Patient-Reported Outcomes Measurement Information System (PROMIS®) is a validated system of CATs. The aim of this study was to assess the measurement properties of PROMIS and legacy instruments in patients undergoing THA. Patients in this multicenter study filled out a questionnaire twice, including Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) and v1.1 Pain Interference (PROMIS-PI) CATs and short forms, PROMIS v1.0 Pain Intensity, and legacy PROMs (Hip disability and Osteoarthritis Outcome Score (HOOS), HOOS-Physical function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), and two numeric rating scales measuring pain). The reliability, measurement precision (Standard Error of Measurement (SEM)), smallest detectable change (SDC), and burden of PROMIS instruments were presented head-to-head to legacy PROMs. Furthermore, construct validity was assessed. 208 patients were included. All instruments had a sufficient test-retest reliability (range ICC: 0.83-0.96). The SEM of PROMIS CATs and short forms ranged from 1.8 to 2.2 T-score points, the SEM of legacy instruments 2.6-11.1. The SDC of PROMIS instruments ranged from 2.1 to 7.3 T-score points, the SDC of legacy instruments 7.2-30.9. The construct validity of PROMIS CAT and short forms were found sufficient, except for the PROMIS-PI short form. The burden of PROMIS CATs was smaller than PROMIS short forms (range 4.8-5.2 versus 8-20 items, respectively). The burden of legacy instruments measuring physical functioning ranged from 5 to 40 items. The PROMIS-PF is less burdensome, with high measurement precision, and almost no minimal or maximal scores, and an equal reliability compared to legacy instruments measuring physical functioning in patients undergoing THA. The PROMIS Pain Intensity 1a is comparable to the legacy pain instruments in terms of burden, reliability and SDC. Measuring the construct Pain Interference may not have additional value in this population because of its high correlation with instruments measuring physical functioning. The SDC values presented in this study can be used for individual patient monitoring.

Clinical and Radiographic Outcomes With Minimum 2-Year Follow-up and Sub-Analysis of Navigation vs Non-Navigation for Hip Resurfacing.

The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes. Data were retrospectively analyzed for patients who received hip resurfacing between 2010 and 2021. Eligible patients had postoperative radiographs and completed a minimum 2-year follow-up questionnaire for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Forgotten Joint Score (FJS), visual analog scale (VAS) score, satisfaction, and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Hips were propensity matched in a 1:1 ratio based on the use of navigation, age, and body mass index. The percentage of hips that met the minimal clinically important difference (MCID) for mHHS and VAS score was noted. Component placement analysis was conducted based on the safe zones defined by Lewinnek and Callanan and the Relative Acetabular Inclination Limit. Seventy-six hips were matched, 38 per group. No differences were observed in patient-reported outcomes or the percentage of hips reaching MCID between the groups. The navigation group was 28.8 and 6.8 times more likely to be within the Callanan and Lewinnek safe zones, respectively. Based on the Relative Acetabular Inclination Limit, the navigation group was 3.1 and 6.4 times more likely to be within the 95% and 99% CI safe zones, respectively. Comparable improvements in patient-reported outcomes were observed in the two groups during a minimum 2-year follow-up. Navigation-assisted surgery enhances the accuracy of acetabular component positioning, with a higher likelihood of cup placement within the safe zones. [Orthopedics. 202x;4x(x):xx-xx.].

The Influence of Pelvic Tilt and Femoral Torsion on Hip Biomechanics: Implications for Clinical Assessment and Treatment

Background: Hip biomechanics are crucial in understanding movement disorders and joint pathologies. Pelvic tilt and femoral torsion are key factors influencing hip function and stability. This review aims to elucidate their effects on acetabular orientation, hip range of motion (ROM), and associated compensatory mechanisms. Methods: A comprehensive search of databases, including PubMed, Scopus, and Pedro, was conducted. Studies were selected based on Population, Concept, and Context (PCC) criteria, focusing on those examining the relationship between pelvic tilt, femoral torsion, and hip biomechanics. Eight studies were included, utilizing methodologies such as CT imaging, musculoskeletal modeling, and gait analysis, covering populations ranging from asymptomatic adults to elderly women with pelvic retroversion. Results: The review identified significant effects of pelvic retroversion on acetabular anteversion and hip extension. Some studies found no correlation between pelvic index (PI) and acetabular orientation, while others reported a linear increase in acetabular anteversion with pelvic retroversion. Subjects with pelvic retroversion showed greater hip extension. Additionally, femoral anteversion was linked to increased internal rotation and altered hip joint contact forces during gait, with changes in hip ROM and force distribution. No relationship was found between femoral and acetabular anteversion in patients with hip osteoarthritis. Conclusions: Pelvic tilt and femoral torsion significantly affect hip biomechanics, influencing acetabular orientation, ROM, and compensatory mechanisms. Future studies should include symptomatic populations to explore these relationships further. These findings emphasize the critical need for individualized clinical assessments and further research on symptomatic populations to enhance our understanding of pelvic tilt and femoral torsion’s impact on hip biomechanics.

Gait compensations, pain, and functional performance during the six minute walk test in individuals with unilateral hip osteoarthritis

BackgroundIndividuals with unilateral hip osteoarthritis walk with kinematic and spatiotemporal compensations compared to healthy individuals. Our purpose was to determine associations between gait, pain, and functional performance during the six-minute walk test. MethodsTrunk and hip kinematics and spatiotemporal gait outcomes were recorded from individuals with unilateral hip osteoarthritis using inertial sensors (Xsens Technologies). Pain was collected prior to and at the end of the six-minute walk test. Paired t-tests were conducted to evaluate gait between limbs and between the first and final minutes of walking. Correlations were conducted between gait, pain, and six-minute walk test performance. FindingsNineteen participants (8 females, age: 63 ± 5 yrs., BMI: 29.0 ± 4.5 kg/m2) completed the study. Between-limb differences in hip flexion, hip extension, and trunk forward flexion peak angles were observed during the six-minute walk test (P < .05). Participants demonstrated an increase in trunk forward flexion of the osteoarthritis side (t = −2.34, P = .031) and a bilateral decrease in stride length (osteoarthritis limb: t = 2.98, P = .008, non- osteoarthritis limb: t = 3.17, P = .006) from the first to the final minute of walking. Greater pain was associated with greater osteoarthritis limb hip extension (first minute: r = −0.506, P = .027, final minute: r = −0.53, P = .020) and greater hip abduction (r = 0.46, P = .046) during the final minute of walking. InterpretationsGait compensations increase throughout the six-minute walk test, and pain associates with hip kinematics during the six-minute walk test. Wearable technology may allow for more accurate clinical movement assessments.

Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures.

The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain. This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients. Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values. This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.

Loss of body weight is dose-dependently associated with reductions in symptoms of hip osteoarthritis.

While weight loss is recommended for managing hip osteoarthritis (OA), most evidence comes from knee OA studies, limiting its applicability to hip OA. This study addresses this gap by examining the effects of weight loss on hip OA symptoms. A retrospective audit of routinely collected healthcare data from participants enrolled in the Osteoarthritis Healthy Weight for Life (OAHWFL) program, designed for individuals with knee or hip OA. In total, 1714 adults with hip OA were selected from the OAHWFL program; 1408 completed the initial 18-week weight loss phase, while 306 did not complete it. After 18 weeks, participants transitioned to an indefinite weight maintenance phase. Percentage change in body weight from baseline at 18 weeks. Changes in the five subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS) (Pain, Activity Limitations in Daily Living, Stiffness and Range of Motion, Sports and Recreation Function, and Hip-related Quality of Life) from baseline to 18 weeks. Linear regression, adjusted for sex and baseline values of age, weight, and respective HOOS scores, assessed the relationship between percentage weight change (analyzed as both a continuous variable and in categories: ≤2.5%, >2.5-5.0%, >5.0-7.5%, >7.5-10%, and >10% of baseline weight) and changes in all five HOOS subscales. At baseline, participants had a mean age of 65.14 years, 70% were female, and 78% were individuals with obesity (Body Mass Index ≥30 kg/m2). A statistically significant dose-response relationship was observed between weight loss and improvements in all HOOS subscales, with the greatest improvement in the Hip-related Quality of Life subscale (14.42 points, 31.14%) for >10% weight loss. Our findings suggest that weight loss is associated with reduced symptoms of hip OA, supporting weight loss as an effective treatment strategy for hip OA.

Exercise as medicine in hip osteoarthritis: an investigation of exercise type, muscle power and predictive factors (PhD Academy Award)

Exercise as medicine in hip osteoarthritis: an investigation of exercise type, muscle power and predictive factors (PhD Academy Award)

Perioperative Analgesic Interventions for Reduction of Persistent Postsurgical Pain After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-analysis.

High pain levels immediately after surgery have been associated with persistent postsurgical pain. Still, it is uncertain if analgesic treatment of immediate postsurgical pain prevents the development of persistent postsurgical pain. We searched MEDLINE, CENTRAL, and Embase up to September 12, 2023, for randomized controlled trials investigating perioperative analgesic interventions and with reported pain levels 3 to 24 months after total hip or knee arthroplasty in patients with osteoarthritis. The primary outcome was pain score 3 to 24 months after surgery, assessed at rest and during movement separately. Two authors independently screened, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. We conducted meta-analyses and tested their robustness with trial sequential analyses and worst-best and best-worst case analyses. We included 49 trials with 68 intervention arms. All but 4 trials were at high risk of bias for the primary outcome. Moreover, the included trials were heterogeneous in terms of exclusion criteria, baseline pain severity, and which cointerventions the participants were offered. For pain at rest, no interventions demonstrated a statistically significant difference between intervention and control. For pain during movement, perioperative treatment with duloxetine (7 trials with 641 participants) reduced pain scores at 3 to 24 months after surgery (mean difference -4.9 mm [95% confidence interval {CI}, -6.5 to -3.4] on the 0-100 visual analog scale) compared to placebo. This difference was lower than our predefined threshold for clinical importance of 10 mm. We found no perioperative analgesic interventions that reduced pain 3 to 24 months after total hip or knee arthroplasty for osteoarthritis. The literature on perioperative analgesia focused little on potential long-term effects. We encourage the assessment of long-term pain outcomes.

The Presentation, Clinical Diagnosis, Risk Factors, and Management of Rapidly Progressive Hip Osteoarthritis: A Narrative Literature Review.

Rapidly progressive hip osteoarthritis (RPOH) is a rare and severe form of osteoarthritis (OA), marked by the rapid degeneration and destruction of the femoral head, often within months. Despite its unclear etiology, several factors such as subchondral fractures and immune responses have been proposed as possible contributors. This narrative review aims to synthesize current knowledge on the pathogenesis, risk factors, clinical presentation, imaging features, and grading systems of RPOH. Predominantly affecting elderly females, RPOH presents distinctive challenges in both diagnosis and management due to its abrupt onset and severity. Known risk factors include advanced age, female gender, obesity, intra-articular corticosteroids use, and long-term hemodialysis. Clinically, RPOH is characterized by severe pain during active weight-bearing movements, despite patients presenting a normal range of motion during passive examination in the early stages. While several classification systems exist, there is no universal standard, complicating differential diagnosis and clinical approaches. This review emphasizes the necessity for early diagnostic methods utilizing specific biomarkers, rapid differential diagnosis, and targeted, personalized interventions based on individual risk factors.

Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic, randomized, controlled trial (The DRAW1 trial)

ImportanceComparative effectiveness trials have not shown superiority of one type of physical rehabilitation over another following total hip (THA) and knee (TKA) arthroplasty. We therefore ask the fundamental effectiveness question: Does physical rehabilitation “work” better than no physical rehabilitation? ObjectiveTo compare the effectiveness of a 6-week program of physical rehabilitation (home-based telerehabilitation, or home-based rehabilitation) to no physical rehabilitation following THA and TKA. Design3-arm,randomized, controlled, superiority trial with blinded outcome assessments. 377 patients (210 THA/167 TKA) were screened for eligibility before the targeted sample size of 168 patients was reached. Outcome measures were assessed at baseline, at the end of intervention (6 weeks), and 3 and 12 months postoperatively. The primary outcome was the Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee injury and Osteoarthritis Outcome Score (KOOS)-subscale: function in daily living. Secondary outcomes included: HOOS/KOOS-subscales: pain, symptoms, and quality of life, patient global assessment, analgesics, walking aids, 30-s chair stand test, 4 ​× ​10 ​m fast-paced walk test, exercise adherence, and satisfaction. ResultsComparing physical rehabilitation (home-based telerehabilitation, and home-based rehabilitation) to no physical rehabilitation, the mean group-differences for the primary outcome were 3.3 (95%CI: −1.9 to 8.6; p ​= ​0.10) points at 6 weeks, and 1.9 (95%CI: −3.7 to 7.6; p ​= ​0.25) and 2.6 (95%CI: −4.4 to 9.6; p ​= ​0.23) points at the 3- and 12-months follow-ups, respectively. ConclusionPhysical rehabilitation was not superior to the no physical rehabilitation comparator following THA or TKA in terms of self-reported function or any of the secondary outcomes. Trial registrationNCT03750448 (November 23, 2018), URL: https://clinicaltrials.gov/ct2/show/NCT03750448.

Genetic association of gut microbiota with osteoarthritis: a multivariable Mendelian randomization study considering medication use.

Background. The interplay among human gut microbiota (GM) composition, osteoarthritis (OA) and OA-related medication use has been extensively discussed. However, to date, there has been no exploration of the genetic correlation among these three factors.Hypothesis/Gap. The potential causal link between GM and OA), and whether medications influence this relationship, remains unclear.Methods. We utilized bidirectional Mendelian randomization (MR) to explore the genetic associations between GM and OA. We leveraged genome-wide association study (GWAS) summary statistics from the MiBioGen and GO consortia, which provided data on GM taxa and OA cases, respectively. We identified outlier single-nucleotide polymorphisms using radial-MR and assessed causal associations using inverse variance weighting (IVW), weighted median and MR-Egger methods. Robust outcomes, consistent across these methods, were reported. We addressed potential biases through tests for horizontal pleiotropy and heterogeneity, supplemented by the Mendelian randomization pleiotropy residual sum and outlier method. Multivariable MR techniques were applied to adjust for OA medication use using UK Biobank data.Results. IVW estimates revealed a significant increase in hip OA risk for Gordonibacter and Eubacterium (brachy group) [odds ratio (OR): 1.09, 95% confidence interval (CI): 1.04-1.15, P=7.82E-04; OR: 1.09, 95% CI: 1.03-1.16, P=4.67E-03, respectively]. Conversely, Senegalimassilia, Slackia and Streptococcus exhibited protective effects (OR: 0.88, P=2.14E-02; OR: 0.88, P=3.33E-02; 0.91, P=4.29E-02). Sutterella increased the risk of knee OA (OR=1.15, 95% CI: 1.07-1.25, P=4.06E-04), while Haemophilus decreased it (OR=0.94, 95% CI: 0.88-1.00, P=4.26E-02). No significant heterogeneity or horizontal pleiotropy was observed in the results. Even after accounting for the potential confounding effect of medication, the results remained consistent. No reverse causation was detected.Conclusions. Our MR study reveals gut microbiome links to OA risk. Associations hold after adjusting for medication, indicating a potential causal connection between GM and OA.

Patient-Level Value Analysis in Total Hip Arthroplasty: Optimizing the Value of Care Delivery

Background: Value is defined as the ratio of patient outcomes to the cost of care. One method to assess value is through patient-level value analysis (PLVA). To our knowledge, this tool has not previously been implemented in the setting of total hip arthroplasty (THA). The purposes of this study were to perform PLVA for a 1-year episode of care among patients undergoing primary THA and to identify characteristics that affect value in a metropolitan health-care system. Methods: The patient-reported outcome (PRO) measure database of the institution was queried for all primary THAs from 2018 to 2019. The PRO measure that was utilized was the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Cost was evaluated with use of time-driven activity-based costing (TDABC) for a 1-year episode of care (consisting of the day of surgery, inpatient stay, discharge facility, postoperative appointments, and physical therapy). The primary outcome was the 1-year value quotient, or the ratio of the 1-year change in HOOS-JR to the cost of the episode of care (VHOOS). The value quotient was compared among all included patients and evaluated for variables that may affect the overall value of the episode of care. Results: In total, 480 patients were included in the analysis. The mean improvement in the HOOS-JR was +34.9 ± 16.1 (95% confidence interval [CI]: 33.5, 36.3). The mean cost was $13,835 ± $3,471 (95% CI: $13,524, $14,146). The largest contributor to cost was implants (39.0%), followed by post-recovery care (i.e., inpatient stay and specialized nursing facilities; 24.1%). Change in the HOOS-JR was poorly correlated with the cost of care (r = −0.06; p = 0.19). THAs performed at an ambulatory surgery center (ASC) with discharge to home demonstrated higher value (VHOOS = 0.42) than THAs performed at a hospital with discharge to a rehabilitation facility (VHOOS = 0.15; analysis of variance F-test, p &lt; 0.01). Conclusions: Our study found that PROs did not correlate with costs in the setting of primary THA. Implants were the largest cost driver. Surgical setting (an ASC versus a hospital) and discharge destination influenced value as well. PLVA is a value measurement tool that can be utilized to optimize components of the care delivery pathway. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Challenges of Hip and Knee Arthroplasty in Patients With Osteopetrosis.

Osteopetrosis is a rare metabolic bone disease, characterized by dysfunction of osteoclasts, resulting in increased bone density and brittleness leading to pathological fractures and bone deformities. Hip and knee osteoarthritis (OA) are common long-term complications in patients with osteopetrosis. Joint arthroplasty surgery remains an effective and recommended treatment for these patients with an end-stage OA because it provides favorable outcomes. However, in osteopetrosis, joint arthroplasty surgery carries an increased risk of complications, and specific preoperative and perioperative considerations are required to deal with the technical challenges related to the disease. The aim of this article was to review some of the key aspects of osteopetrosis, provide technical recommendations, and answer clinically relevant questions related to hip and knee arthroplasty surgery.

Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis

ObjectiveThis study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors...