Symptoms Of Hip Osteoarthritis Research Articles

The GLA:D® Canada program for knee and hip osteoarthritis: A comprehensive profile of program participants from 2017 to 2022.

The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA.

Effects of adding aerobic physical activity to strengthening exercise on hip osteoarthritis symptoms: protocol for the PHOENIX randomised controlled trial

BackgroundHip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Most evidence is based on muscle-strengthening exercise, but aerobic physical activity has potential to enhance clinical benefits. The primary aim of this study is to test the hypothesis that adding aerobic physical activity to a muscle strengthening exercise leads to significantly greater reduction in hip pain and improvements in physical function, compared to a lower-limb muscle strengthening exercise program alone at 3 months.MethodsThis is a superiority, 2-group, parallel randomised controlled trial including 196 people with symptomatic hip OA from the community. Following baseline assessment, participants are randomly allocated to receive either i) aerobic physical activity and muscle strengthening exercise or; ii) muscle strengthening exercise only. Participants in both groups receive 9 consultations with a physiotherapist over 3 months. Both groups receive a progressive muscle strengthening exercise program in addition to advice about OA management. The aerobic physical activity plan includes a prescription of moderate intensity aerobic physical activity with a goal of attaining 150 min per week. Primary outcomes are self-reported hip pain assessed on an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at 3 months. Secondary outcomes include other measures of self-reported pain (assessed at 0, 3, 9 months), self-reported physical function (assessed at 0, 3, 9 months), performance-based physical function (assessed at 0, 3 months), joint stiffness (assessed at 0, 3, 9 months), quality of life (assessed at 0, 3, 9 months), muscle strength (assessed at 0, 3 months), and cardiorespiratory fitness (assessed at 0, 3 months). Other measures include adverse events, co-interventions, and adherence. Measures of body composition, serum inflammatory biomarkers, quantitative sensory measures, anxiety, depression, fear of movement and self-efficacy are included to explore causal mechanisms.DiscussionFindings will assist to provide an evidence-based recommendation regarding the additional effect of aerobic physical activity to lower-limb muscle strengthening on hip OA pain and physical function.Trial registrationAustralian New Zealand Clinical Trials Registry reference: ACTRN 12619001297112. Registered 20th September 2019.

Single and Composite Endpoints of Within-Patient Improvement in Symptoms: Pooled Tanezumab Data in Patients with Osteoarthritis.

IntroductionCombining measures of key core domains (especially pain and function) into a composite endpoint that requires each patient to meet a threshold of improvement for each domain provides information on multiple aspects of osteoarthritis within individual patients. This pooled analysis of two phase 3 studies (NCT02697773, NCT02709486) explored single and composite endpoints for assessing within-patient improvement in knee or hip osteoarthritis symptoms following subcutaneous administration of tanezumab or placebo.MethodsEndpoints at week 16 included proportions of responders (≥ 30% improvement) in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function, WOMAC Pain/Function composite, and weekly average pain; and patient acceptable symptom state (PASS) composite responders, minimal clinically important improvement (MCII) composite responders, Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders, and sustained weekly average pain responders.ResultsPooled population comprised 1545 patients. Of patients who had a ≥ 30% improvement in WOMAC Pain and/or WOMAC Physical Function, 88.5% were WOMAC Pain/Function composite responders, 7.0% were WOMAC Pain (but not Function) responders, and 4.4% were WOMAC Function (but not Pain) responders. Of weekly average pain responders, 43.1% were PASS composite responders. Odds ratios (tanezumab 2.5 mg and 5 mg groups, respectively, vs placebo) were 1.75 and 1.86 (WOMAC Pain/Function composite responders), 1.41 and 1.65 (weekly average pain responders), 1.60 and 1.73 (PASS composite responders), 1.52 and 1.68 (MCII composite responders), 1.75 and 1.88 (OMERACT-OARSI responders), and 1.85 and 1.48 (sustained weekly average pain responders). Subgroup analyses suggested a greater magnitude of effect for patients with a knee index joint compared with hip on some endpoints.ConclusionResponders on single pain endpoints were in many cases also responders on function or composite endpoints. Separation of tanezumab from placebo was similar and consistent across single and composite endpoints.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00372-2.

Efficacy and safety of avocado-soybean unsaponifiables for the treatment of hip and knee osteoarthritis: A systematic review and meta-analysis of randomized placebo-controlled trials.

We performed a systematic review and meta-analysis from randomized controlled trials to examine the efficacy and safety of avocado-soybean unsaponifiables (ASU) in patients with hip or knee osteoarthritis (OA). Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials. Original studies were randomized placebo-controlled trials evaluating the effect of orally administered ASU on knee or hip OA symptoms using the Lequesne index, visual analog scale (VAS) and/or joint space width (JSW). Meta-analysis was conducted using a random-effects model and generic inverse variance method. Heterogeneity was tested using the I2 statistic index. Avocado-soybean unsaponifiables therapy had a significant reduction on pain by VAS assessment (weighted mean difference [WMD]: -9.64mm, 95% CI: -17.43, -1.84; P=.02; I2 =92%). A subanalysis according to the type of OA showed that ASU significantly decreased both VAS and Lequesne index in knee OA (WMD: -17.36, 95% CI: -25.91, -8.82; P<.0001; I2 =87% and WMD: -2.33, 95% CI: -2.88, -1.78; P<.00001; I2 =18%, respectively) but not in hip OA. Finally, ASU supplementation showed no significant differences for adverse events compared to placebo (relative risk: 1.02, 95% CI: 0.83, 1.25; P=.88; I2 =0%). Results of this meta-analysis suggest a beneficial effect of ASU treatment in symptomatic knee OA but not in hip OA. Additionally, adverse events were similar in patients receiving ASU therapy or placebo.

Comparison of the history and physical examination for hip osteoarthritis and lumbar spinal stenosis

BACKGROUNDLeg pain associated with walking is sometimes incorrectly attributed to hip osteoarthritis (OA) or lumbar spinal stenosis (LSS). PURPOSEThis study compared physicians' values of signs and symptoms for diagnosing and differentiating hip OA and LSS to their clinical utility. STUDY DESIGN/SETTINGMusculoskeletal physicians were surveyed with online questionnaires. Patients were recruited from hip and spine specialty practices. PATIENT SAMPLESeventy-seven hip OA and 79 LSS patients. OUTCOME MEASURESSigns and symptoms of hip OA and LSS. METHODSFifty-one of 66 invited musculoskeletal physicians completed online surveys about the values of 83 signs and symptoms for diagnosing hip OA and LSS. Of these, the most valued 32 symptoms and 13 physical examination items were applied to patients with symptomatic hip OA or LSS. Positive likelihood ratios (+LR) were calculated for each items' ability to differentiate hip OA from LSS, with a +LR>2 set as indicating usefulness for favoring either diagnosis. Positive LRs were compared with surveyed physicians' values for each test. RESULTSAll symptoms were reported by some patients with each diagnosis. Only 11 of 32 physician-valued symptoms were useful for discriminating hip OA from LSS. Eight symptoms favored hip OA over LSS: groin pain (+LR=4.9); knee pain (+LR=2.2); pain that decreased with continued walking (+LR=3.9); pain that occurs immediately with walking (+LR=2.4); pain that occurs immediately with standing (+LR=2.1); pain getting in/out of a car (+LR=3.3); pain with dressing the symptomatic leg (+LR=3.1); and difficulty reaching the foot of the symptomatic leg while dressing (+LR=2.3). Three symptoms favored LSS over hip OA: pain below the knee (+LR=2.3); leg tingling and/or numbness (+LR=2.7); and some pain in both legs (+LR=2.5). Notable symptoms that did not discriminate hip OA from LSS included: pain is less while pushing a shopping cart (+LR=1.0); back pain (+LR=1.1); weakness and/or heaviness of leg (+LR=1.1); buttocks pain (+LR=1.2); poor balance or unsteadiness (+LR=1.2); pain that increased with weight-bearing on the painful leg (+LR=1.3), and step to gait on stairs (+LR=1.7). Consistent with physicians' expectations, 7 of 13 physical examination items strongly favored hip OA over LSS: limited weight-bearing on painful leg when standing (+LR=10); observed limp (+LR=9); and painful and restricted range-of-motion with any of five hip maneuvers (+LR range 21–99). Four of five tested neurological deficits (+LR range 3–8) favored the diagnosis of LSS over hip OA. CONCLUSIONSThere is substantial crossover of symptoms between hip OA and LSS, with some physician-valued symptoms useful for differentiating these disorders whereas others were not. Physicians recognize the value of the examination of gait, the hip, and lower extremity neurological function for differentiating hip OA from LSS. These tests should be routinely performed on all patients for which either diagnosis is considered. Awareness of these findings might reduce diagnostic errors.

MP06: Use of ultrasound and x-ray to predict improvement in hip osteoarthritis symptoms following intra-articular steroid injection

Introduction: Intra-articular steroid injection (IASI) is commonly used in the emergency department for management of osteoarthritis (OA) symptoms. Hip IASI carries risks, such as avascular necrosis, and there is currently no reliable way to predict long-term response of a patient’s OA to IASI. Ultrasound (US) conveniently assesses for active arthropathy by detecting effusion-synovitis, and x-ray (XR) is useful for visualizing bone-related changes. We investigated the extent that a response to hip IASI could be predicted from baseline OA patient clinical and physical features alongside US and XR imaging features. Methods: 97 consenting patients with symptomatic hip OA presenting for hip IASI were evaluated at baseline (XR and US) and again 8-weeks after IASI (US only). Self-reported pain (WOMAC), hip range of motion (ROM) were measured at baseline and follow up. On US images we quantified joint effusion and synovial thickening, i.e., “effusion-synovitis”, by the bone-capsule distance (BCD) at the apex of the femoral head from outer femoral cortex to outer synovium. On XR, we measured minimum joint space width (cm) and Kellgren-Lawrence (K-L) Grade for osteophytes and sclerotic changes. Results: In our 97 patients (43 female) aged 28-87 years (mean 59+/-13 years, K-L grades averaged 2.5+/-1.5, and US BCD averaged 5.9+/-2.0 mm. We performed multiple linear regression using age, sex, BMI, ROM of hip flexion, US BCD, radiographic joint space width and K-L grade against the dependent variable, change in WOMAC pain subscore (R=0.587, P=0.002). We compared the response predicted by this model to the actual change in WOMAC pain. At a threshold value of -20% for minimal clinically important difference, 35/97 patients were responders, and a 2x2 table gave 67% overall model predictive accuracy, 61% sensitivity, and 71% specificity. Likelihood ratio for a positive response (LR+) was 2.13. Conclusion: Combining radiographic information on structural damage, US information on active arthropathy, and demographics correctly predicted about two-thirds of the patients that would benefit from IASI after 8 weeks. A patient with hip OA that met our model criteria was more than twice as likely to respond to IASI. With further model refinement, effective, personalized evidence-based management of symptomatic hip OA is possible using XR and hip US, which could both be performed during an ER visit.

Walking speed affects instrumental activities of daily living in patients with hip osteoarthritis.

The symptoms of hip osteoarthritis (OA) influence instrumental activities of daily living (IADL). Evidence form previous studies suggest that body functions and walking speed are important etiological factors for IADL. However, no studies have investigated which factors that have the greatest influence on IADL. The aims of this study were (1) to analyze factors related to IADL in patients with hip OA, including 10 m walking speed (10 mWS), and (2) to establish cut-off values for factors that predict maintenance of IADL. Forty-eight patients participated in this study. IADL was treated as dependent variable. Range of motion (ROM), muscle strength of the hips and knees, and 10 mWS were measured as independent variables. Other potential confounding factors were also measured. Data were analyzed using hierarchical multiple regression and Receiver Operating Characteristic curve analysis. The hip flexion ROM on the affected side and 10 mWS were selected as significant variables in this study. The cut-off values obtained were 92.5 degrees for the hip flexion ROM on the affected side and 42.3 m/min for 10 mWS. The suggested target associated with maintaining IADL in patients with hip OA is the cut-off value of 42.3 m/min for 10 mWS found in this study.

Efficacy, safety, and effects on blood pressure of naproxcinod 750 mg twice daily compared with placebo and naproxen 500 mg twice daily in patients with osteoarthritis of the hip: A randomized, double‐blind, parallel‐group, multicenter study

To test the superiority of naproxcinod compared with placebo in relieving the signs and symptoms of hip osteoarthritis and to assess the safety of naproxcinod and its effects on blood pressure. In a 13-week, randomized, double-blind, parallel-group, multicenter study, 810 patients were randomized to receive either naproxcinod 750 mg twice daily, placebo, or naproxen 500 mg twice daily (2:2:1). Primary efficacy analyses compared naproxcinod and placebo using an analysis of covariance for 3 co-primary end points (the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain and function subscales and patient's overall rating of disease status). Safety assessments included adverse events and in-office blood pressure measurements. The least squares mean changes from baseline were significantly greater with naproxcinod than with placebo (P < 0.0001) and were similar to those with naproxen at week 13 for the WOMAC pain score (-25.81, -17.97, and -24.31 mm, respectively), the WOMAC function score (-22.24, -13.45, and -21.67 mm, respectively), and patient's rating of disease status (0.86, 0.51, and 0.82, respectively). Changes from baseline in systolic blood pressure were similar in the naproxcinod and placebo groups at weeks 2, 6, and 13 (differences between groups of 0.25, -0.45, and -0.11 mm Hg, respectively). Changes in the naproxen group were greater than those in the placebo group (differences of 3.11, 3.03, and 2.00 mm Hg, respectively). Systolic blood pressure increases ≥10 mm Hg from baseline to week 13 occurred in 13.3%, 15.0%, and 20.3% of patients receiving naproxcinod, placebo, and naproxen, respectively. Naproxcinod and naproxen had similar adverse event and general safety profiles. The efficacy of naproxcinod for treating the signs and symptoms of hip osteoarthritis was statistically superior to that of placebo and similar to that of naproxen. Naproxcinod was well tolerated, with effects on systolic blood pressure similar to those of placebo.

Endoscopic Treatment of Calcinosis Circumscripta of the Hip Joint: A Report of 2 Cases of Arthroscopic Removal of a Calcific Deposition Between the Labrum and Capsule

We present 2 cases of arthroscopic removal of a calcific deposition in the form of calcinosis circumscripta between the labrum and capsule of the hip joint. Case 1 was a 42-year-old woman who presented with complaints of a 2-year history of right hip pain. Radiographs showed a calcific deposition in the area of the acetabular roof. Arthroscopy showed a calcific deposition between the labrum and capsule in the form of calcinosis circumscripta. At the 4-month follow up, she was symptom free with painless full range of motion. Case 2 was a 48-year-old slim woman who presented with complaints of right hip pain over the last 6 months. Preoperative radiographs showed a hip with a calcific deposition lateral to the pronounced acetabular roof. At the 4-month follow up after removal, she was also symptom free. To our knowledge, these are the first patients with calcinosis circumscripta treated by hip arthroscopy. We recommend the endoscopic approach, which is effective and minimally invasive, for treatment of calcinosis circumscripta and other calcifications in the hip joint. Especially in young patients, with a high activity level and without any symptoms of hip osteoarthritis, hip arthroscopy is the ideal treatment.