Validation of a pre-anaesthetic screening questionnaire

Summary We developed a screening questionnaire to be used by nurses to decide which patients should see an anaesthetist for further evaluation before the day of surgery. Our objective was to measure the accuracy of responses to the questionnaire. Agreement between questionnaire responses and the anaesthetist's assessment was assessed. For questions with a prevalence of 5 to 95%, the Kappa coefficient was used; percentage agreement was used for all other questions. Criterion validity was excellent/good for all questions with a prevalence between 5 and 95%, except for the question ‘Do you have kidney disease?’ For questions with prevalence < 5%, all demonstrated adequate criterion validity except the questions ‘Has anyone in your family had a problem following an anaesthetic?’ and ‘If you have been put to sleep for an operation were there any anaesthetic problems?’ Therefore, it is reasonable for nurses to use this questionnaire to determine which patients an anaesthetist should see before the day of surgery.     

Genetic epidemiology of hip and knee osteoarthritis

Osteoarthritis (OA) is the most common cause of arthritis and represents an enormous healthcare burden in industrialized societies. Current therapeutic approaches for OA are limited and are insufficient to prevent the initiation and progression of the disease. Genetic studies of patients with OA can help to unravel the molecular mechanisms responsible for specific disease manifestations, including joint damage, nociception and chronic pain. Indeed, these studies have identified molecules, such as growth/differentiation factor 5, involved in signaling cascades that are important for the pathology of joint components. Genome-wide association studies have uncovered a likely role in OA for the genes encoding structural extracellular matrix components (such as DVWA) and molecules involved in prostaglandin metabolism (such as DQB1 and BTNL2). A ～300 kilobase region in chromosome 7q22 is also associated with OA susceptibility. Finally, the identification of individuals at a high risk of OA and of total joint arthroplasty failure might be facilitated by the use of combinations of genetic markers, allowing for the application of preventive and disease-management strategies.     

老年人髋关节置换术的麻醉处理

老年人股骨颈骨折临床上常见，由于许多患者同时并发多种疾病，加之髋关节置换术操作复杂，创伤大，出血多，且术中应用骨水泥时易出现心血管不良反应，故麻醉处理有其特殊性。自2001年1月-2003年6月我院共施行老年人髋关节置换术62例，根据患者的不同情况采取合理麻醉处理，麻醉效果满意，报告如下。     

Sex differences in osteoarthritis of the hip and knee

The prevalence, incidence, and severity of osteoarthritis are different in women than in men. Women are more likely than men to suffer from osteoarthritis,and women experience more severe arthritis in the knee. Genetics, anatomy,and prior knee injury are risk factors for developing osteoarthritis. Although the presentation of osteoarthritis does not differ between men and women,symptom severity does. Additionally, women are three times less likely than men to undergo hip or knee arthroplasty. Patient education, particularly for women, must be improved so that women with osteoarthritis who are candidates for hip and knee arthroplasty not only receive treatment but also receive it in a timely manner.     

Reliability of radiographic assessment in hip and knee osteoarthritis

OBJECTIVE: To evaluate the reproducibility of commonly used radiographic measures in hip and knee OA and to overcome certain limits of existing knowledge on their reliability from previous studies. DESIGN: Three readers evaluated 100 hip joints (50 pelvic X-rays) and 100 antero-posterior and lateral knee films of a hospital-based sample of patients with radiographic OA at two time points 3 months apart. They retrospectively estimated the presence and severity of joint specific individual radiographic features (osteophyte formation and joint space narrowing at different sites, cysts, subchondral sclerosis, bony deformity and chondrocalcinosis) and two different overall scores. Within and between observer reproducibility was calculated by intra-class correlation coefficient. RESULTS: At the hip joint excellent intra- as well as inter-observer reliability for superior joint space narrowing (JSN) and femoral head deformity could be demonstrated, while the assessment of medial JSN, osteophytes and acetabular sclerosis depends on the level of the investigator's experience. At the knee joint, femorotibial and patellofemoral osteophytes showed a high intra- and inter-observer reliability. Grading of JSN is highly reader dependent; rating of subchondral sclerosis and chondrocalcinosis does not seem to be reproducible enough. The overall scores showed an excellent reproducibility both at hip and knee joints. CONCLUSION: A reliable radiographic severity grading of hip and knee OA is possible with the application of global scores and individual features, if joint specific items are selected and readers are trained enough.     

Muscular changes in osteoarthritis of the hip and knee.

Muscular abnormalities in the patients with degenerative osteoarthritis were examined histologically and histochemically. Enzyme stainings for DPNH-tetrazolium reductase and myosin ATP-ase at pH 10.4 and 4.6 were performed on 26 vastus lateralis biopsies from the patients with osteoarthritis of the knee and 21 gluteus medius specimens from those with osteoarthritis of the hip. All specimens were obtained at surgery. The patients were all female with their ages ranging from 40 to 74 years. Control specimens were obtained from 16 fractured females with absence of arthritis. Type 2 fiber atrophy and internal derangement of fibers were found in both osteoarthritic and control muscles, but were more frequently seen in the vastus lateralis of the patients with osteoarthritis of the knee. Abnormal mosaic patterns of fiber types, such as fiber type grouping and grouped atrophy of type 2 fibers, were frequently found in the vastus lateralis of the patients with osteoarthritis of the knee (73.1%), and less frequently in that of controls (6.3%). However, abnormal mosaic patterns were not found in the gluteus medius obtained from either osteoarthritic patients or control subjects. Abnormal changes in mosaic pattern of fiber types in the vastus lateralis of osteoarthritis of the knee may suggest associated motor neuron dysfunction; the abnormality was not observed in the gluteus medius specimens of the patients with osteoarthritis of the hip, for which a different background in neurological factors may be involved.     

The KHOALA cohort of knee and hip osteoarthritis in France

ObjectivesThis study aimed to describe the prevalence of symptomatic knee and hip osteoarthritis (OA) and its course over time, as well as identify prognostic factors of OA course and determinants of costs and access to care in France in a patient cohort.MethodsSubjects aged 40 to 75 years, with uni- or bilateral symptomatic hip and/or knee OA (ACR criteria), Kellgren and Lawrence (KL) stage 2 or greater, were recruited from a French national prevalence survey for the multicenter KHOALA cohort study. Data collected at baseline included sociodemographic and clinical data; WOMAC, IKS and Harris scores for pain and function; MAQ score for physical activity; functional comorbidity index; GHQ28 score for psychological status; and SF-36 (generic) and OAKHQOL (specific) scores for quality of life. Blood and urine samples were collected.ResultsEight hundred and seventy-eight subjects were included, 222 with OA of the hip (mean age 61.2 ± 8.8 years), 607 knee (mean age 62.0 ± 8.5 years) and 49 both hip and knee (mean age 64.9 ± 7.9 years). Mean body mass index was 26.9 ± 4.5 for hip OA and 30.3 ± 6.3 for knee OA. Hip and knee OA patients had 1.99 and 2.06 comorbidities, on average, respectively. Disease severity on X-rays for KL stages 2, 3 and 4 for hip OA was 69.8, 26.1 and 4.1%, respectively, and for knee OA, 44.5, 30.3, and 25.2%. As compared with population norms, age- and sex-standardized SF-36 scores were greatly decreased for both knee and hip OA in all dimensions, particularly physical and emotional dimensions.PerspectivesPatients will be followed up annually, alternately by mail and clinical visit. This cohort of representative patients with knee and hip OA will be an opportunity for future collaborative research.     

The effects of hip muscle strengthening on knee load,pain, and function in people with knee osteoarthritis: a protocol for a randomised,single-blind controlled trial

Background  

Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis (OA). Strengthening the hip abductor and adductor muscles may influence joint loading and/or OA-related symptoms, but no study has evaluated these hypotheses directly. The aim of this randomised, single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA.     

Prevalence of symptomatic hip and knee osteoarthritis: a two-phase population-based survey

Objective

Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France.

Design

A two-phase population-based survey was conducted in six regions in 2007–2009. On initial phone contact using random-digit dialing, subjects 40–75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren–Lawrence grade ≥ 2). Multiple imputation for data missing not-at-random was used to account for refusals.

Results

Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7–5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6–14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively.

Conclusions

This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity.Study registration ID number 906297 at http://www.clinicaltrials.gov/.