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Posts Tagged ‘Osteoarthritis research society international’

This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

knee arthrodesis

knee arthrodesis

Recommendation XXV

In patients with knee osteoarthritis joint fusion can be considered when joint replacement has failed.  This is a salvage procedure.

Joint fusion or knee arthrodesis is usually indicated when a total knee replacement becomes infected and is not reconstructable.  Outcome evidence is based primarily on uncontrolled cohort studies.  Patients can expect a stable knee, relatively pain free knee following joint fusion but will experience problems with function.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 69%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

knee surgery

arthroscopic knee surgery

Recommendation XXIV

Arthroscopic debridement and lavage for knee osteoarthritis is controversial.

3 out of 3 treatment guidelines recommend arthroscopic debridement and lavage as a treatment option for knee OA but some studies have demonstrated symptomatic pain relief can be attributed to a placebo effect.  Controversy regarding the efficacy and indications for this treatment option continues.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 60%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

tibial osteotomy

tibial osteotomy

Recommendation XXIII

Patients with significant symptoms from unicompartmental knee osteoarthritis may benefit from a high tibial osteotomy.

Ten out of ten existing guidelines recommend osteotomy as a treatment option.  High tibial osteotomies came into fashion during the 1960’s.  19 uncontrolled cohort studies examined 2406 osteotomies.  Good or excellent outcomes were achieved in 75% of the patients.  The overall failure rate at 10 years was 25%.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 75%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162

 



This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Unicompartmental Knee Surgery

Unicompartmental Knee Surgery

Recommendation XXII

Unicompartmental knee replacement is effective for patients with unicompartmental OA.

33% of the patients with knee osteoarthritis only have the disease in one compartment of their knee.  Nine studies and one randomized controlled trial were examined for this recommendation.  Knee pain and function were similar following unicompartmental knee replacement when compared to total knee replacement.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 76%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Knee Replacement Surgery

Knee Replacement Surgery

Recommendation XXI

Patients with hip and knee osteoarthritis who are not experiencing an imporvement in function and pain relief from a combination of pharmacological and non-phamracological treatment should consider joint replacement surgery.

Total knee replacement surgery is recommended in14 out of 14 existing guidelines for the treatment of osteoarthritis.  Replacement surgeries are effective and cost-effective treatments for patients with significant symptoms.  All studies reported improvements in pain and physical function.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 96%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Opioid

Opioid

Recommendation XX

The use of weak opioids and narcotic analgesics can be considered for the treatment of refractory pain in patients with hip or knee OA, where other pharmacological agents have been ineffective, or contraindicated.

9 out of 9 existing treatment guidelines recommend the use of opioid analgesics for the management of hip and knee osteoarthritis.  Weak opioids were shown to have a moderate effect on pain relief in 18 randomized controlled trials involving 3244 patients.

There have been no long term trials on using opioids in treating patients with knee osteoarthritis.  Addiction is the primary reason for this, and addiction is a major concern when taking narcotics and or opioids.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 82%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

glucosamine and chondrotin

Recommendation XIX

In patients with symptomatic knee OA glucosamine sulphate and chondrotin sulphate may have structure-modifying effects.

Two randomized controlled trials involving 414 patients reported evidence that 1500mg of glucosamine sulphate taken on a daily basis may have structure-modifying effects in patients with knee OA.  This means cartilage may be rebuilt.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 41%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.




This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

glucosamine and chondroitin

Recommendation XVIII

Glucosamine and Chondroitin sulphate may be effective in providing symptomatic pain relief in patients with knee osteoarthritis.

Analysis of eight randomized controlled trials involving 755 patients reported moderate pain reduction.  However with so many products on the market with varying purity levels of glucosamine and chondroitin there is significant controversy as to the efficacy of this treatment option for knee osteoarthritis.

No adverse effects are reported from long-term use of glucosamine and chondroitin.  However if no response is apparent within 6 months treatment should be discontinued.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 63%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Hyaluronate Injection

Intra-articular injections of hyaluronate may be useful in patients with hip and knee osteoarthritis.

Hyaluronate is characterized by delayed onset, but it works longer for symptomatic pain relief when compared to injections of corticosteroids.  Injections of hyaluronate in the knee supplement existing synovial fluid with gel-like substances.

A comprehensive industry-sponsored review of 40 placebo-controlled trials involving viscosupplementation found improvements in pain.  No major safety issues were detected but adverse events such as transient pain at the injection site were reported.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 64%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

corticosteroid

Recommendation XVI

Intra-articular injections with corticosteroids should be considered to treat hip and knee osteoarthritis  when patients have moderate to severe pain and they are not responding to oral pain relievers and/or anti-inflmmatory agents.

Corticosteroid injections have been used to treat knee osteoarthritis for over 50 years.  It was recommended in 11 out of 13 existing guidelines.  The efficacy of intra-articular injections is well documented as a treatment for knee osteoarthritis.  Patients with knee OA were studied in 28 controlled trials and rarely were negative side effects reported.

Most experts do not recommend more than 4 corticosteroid injections per year.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 78%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.