Management of osteoarthritis of the knee in younger patients

Khan, Moin; Adili, Anthony; Winemaker, Mitchell; Bhandari, Mohit

doi:10.1503/cmaj.170696

Cited by 47 publications

(40 citation statements)

References 68 publications

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“…A growing number of patients less than 60 years of age suffer from debilitating knee osteoarthritis (OA), due to the obesity epidemic and prolonged participation in high-impact sports and work activities. 6,32 Clinicians refer to these patients as falling into a “treatment gap,” 14,17 since knee arthroplasty (KA) at a young age is considered undesirable by patients as well as clinicians. 23 In the search for treatment alternatives to KA in young and active patients, use of high tibial osteotomy (HTO) has regained considerable interest in recent years.…”

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confidence: 99%

Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

et al. 2019

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Background: High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. Purpose: To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results: We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up ( P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). Conclusion: More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.

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Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

et al. 2019

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“…Management of Osteoarthritis in dealing with pain includes pharmacological and non-pharmacology with a focus on preventing disease and preventing the severity of the disease. Handling of non-pharmacological osteoarthritis can be in the form of weight regulation, lifestyle changes and physiotherapy actions with modalities and therapy for muscle strengthening exercises, one of which is bridging exercise [16,20,21,22]. Currently bridging exercise is more widely used to restore muscle around the lumbar vertebrae and pelvic column, especially stroke patients to train postural balance for stroke patients [23], while treating pain in OA patients is still rare.…”

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confidence: 99%

Effect of Bridging Exercise Interventions on Pain Reduction In the Elderly with Knee Osteoarthritis

Agustina

Lina²

2019

AJAS

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Introduction: Elderly people will experience physical and psychological declines, there will also be several kinds of degenerative diseases, one of which is osteoarthritis (OA) in the knee. Elderly people who suffer from knee OA generally experience muscle weakness, pain, and limited knee motion. This study aimed to analyze the effect of bridging exercise on reducing pain in elderly with knee OA. Methode: The study design was quasi experiment which consisted of the treatment and the control group. The research respondents were 34 elderlies at Eastern Jakarta Village and selected by purposive sampling. The bridging exercise intervention was given for 4 weeks, 2 times a week with a duration of 30 minutes. Data analysis included univariate and bivariate analysis using independent sample t-test and paired sample t-test. Results: The knee pain in treatment group before intervention was 8,29 and became 6,29 after intervention, whereas in control group was 7,58 and 7,53 respectively. The average difference in knee pain changed between groups was -1,76 with a p-value of 0.009. Conclusion: Bridging exercise could reduce pain in knee OA of elderly.Â The integrated development post could apply this exercise as additional exercise in their routine activity.

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“…In the article "Management of osteoarth ritis of the knee in younger patients," 1 Khan and colleagues cite a Cochrane review from 2014 2 to support the position that tibial osteotomy "improved pain and function, although available evidence was of limited quality" in disabling osteoarth ritis. The authors may have been wearing rosecoloured glasses when they read this exhaustive review.…”

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confidence: 99%

High tibial osteotomy technique for knee osteoarthritis

Preshaw¹

2018

CMAJ

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Management of osteoarthritis of the knee in younger patients

Cited by 47 publications

References 68 publications

Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

Effect of Bridging Exercise Interventions on Pain Reduction In the Elderly with Knee Osteoarthritis

High tibial osteotomy technique for knee osteoarthritis

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