Arthritis is the most common chronic condition affecting patients over the age of 70. The prevalence of osteoarthritis increases with age, and with an aging population, the effect of this disease will represent an ever-increasing burden on health care. The knee is the most common joint affected in osteoarthritis, with up to 41% of limb arthritis being located in the knee, compared to 30% in hands and 19% in hips. We review the current concepts with regard to the disease process and risk factors for developing hip and knee osteoarthritis. We then explore the nonsurgical management of osteoarthritis as well as the operative management of hip and knee arthritis. We discuss the indications for surgical treatment of hip and knee arthritis, looking in particular at the controversies affecting young and obese patients in both hip and knee replacements. Patient and implant related outcomes along with survivorships are addressed as well as the experiences and controversies described in national joint registries.

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Psychological and substance use disorders are highly prevalent in persons living with chronic liver disease (CLD). This review will summarize the mechanisms through which comorbid psychiatric and substance use disorders impact CLD-related outcomes. Furthermore, this review will summarize evidence supporting the treatment of comorbid psychiatric and substance use disorders to improve CLDrelated outcomes. PsYCHOlOGiCal DisOrDers/DisTress anD ClDIt has been established that psychological disorders and distress are related to a range of poor outcomes, including more severe liver symptoms, more advanced liver histological abnormalities, higher liver disease-related mortality, and poor compliance with medical treatment.Even in the modern era of hepatitis C (HCV) treatment, psychological disorders and distress reduce the odds of treatment success. 1 Depression and anxiety are the most prevalent psychological disorders that impact patients with liver disease, with anxiety impacting 25% to 45% of CLD patient populations and depression impacting 29% to 72%. 2 The rates of depression vary across liver diagnosis; patients with nonalcoholic fatty liver disease (NAFLD) and HCV diagnosis demonstrate increased rates of depression, and patients with hepatitis B report a similar rate of depression to the general population. 3 Most of these studies were single center or cross-sectional. 2 We should also note a lack of consensus on the definitions of "depression" and "anxiety" used in studies. For example, scales such as the hospital anxiety and depression scale and patient health questionnaire-9 measure anxiety and depressive symptoms, while instruments such as the structured Abbreviations: ADHD, attention deficit hyperactivity disorder; ADL, activities of daily living; ALD, alcoholic liver disease; CLD, chronic liver disease; GAD, generalized anxiety disorder; HCV, hepatitis C; HRQOL, health-related quality of life; IL, interleukin; MDD, major depressive disorder; miRNA, microRNA; NAFLD, nonalcoholic fatty liver disease; OH, alcohol; PNPLA3, patatin-like phospholipase domain-containing protein 3; PTSD, posttraumatic stress disorder; TNFα, tumor necrosis factorα.

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