Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery

OBJECTIVE: Little has been reported on changes in health status in patients with osteoarthritis (OA) while waiting for hip or knee replacement surgery. In this study we assessed (1) changes in self-reported pain, stiffness and physical function in patients with OA of the hip or knee, from the decision to undergo surgery to 14 days prior to surgery, and (2) the determinants of these changes. METHODS: Among 353 baseline respondents, 170 waited >30 days for surgery, completed the Western Ontario and McMaster Universities Arthritis Index (WOMAC) before surgery and were included in the analysis of changes; 120 with OA of the hip and 50 of the knee. We analyzed changes in WOMAC scores using the paired t test and determinants of the changes using multiple linear regression. RESULTS: Patients with OA of the hip did not change on any WOMAC scale before surgery. Knee patients deteriorated with time on the WOMAC stiffness and total scales, but not on the pain or physical function subscales. In both patient categories, higher baseline WOMAC scores were associated with smaller changes on all subscales and the total score, and female sex was associated with deterioration on the pain subscale. CONCLUSIONS: Patients with OA of the hip reported no change in pain, stiffness or physical function while waiting for joint replacement surgery, whereas patients with OA of the knee deteriorated on the stiffness and total scales of the WOMAC. This suggests a difference in patient selection, referral pattern or disease development between the patient categories.     

Cutpoints for mild,moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery

Background  

Cutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs.     

Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country

Background

Vitamin D plays an important role in bone mineralization, remodeling, and maintenance and therefore its deficiency may be implicated in the pathogenesis of osteoarthritis (OA). Vitamin D status was evaluated in patients with knee or hip OA scheduled for joint replacement. The impact of anthropometric parameters such as gender, age, and body mass index on vitamin D levels was also examined. The study was conducted in a Mediterranean country (Greece).

Materials and methods

We included 164 patients with knee or hip OA scheduled for joint replacement in this study. Serum levels of 25-hydroxyvitamin D (vitamin D) were measured in routine blood samples taken from the patients at their pre-admission visit, a week before the operation, using radioimmunoassay.

Results

The majority of patients were vitamin D deficient (81.7 %); 15.2 % of them were vitamin D insufficient (hypovitaminosis). Only 3 % of patients were vitamin D sufficient. There was a significantly positive association between vitamin D levels and male gender.

Conclusion

These findings indicate a large percentage of vitamin D deficient patients with knee or hip OA, which is unexpected considering the high annual insolation in northern Greece. Many other possible predisposing factors for OA should be taken into consideration. Whether treatment with vitamin D supplements may provide beneficial effects to these patients and the stage of disease in which this treatment should commence remains an issue for further scientific investigation.

Level of evidence

Level IV.     

Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls

OBJECTIVE: Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. METHOD: The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. RESULTS: The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (beta=-0.29 and beta=-0.25, respectively), whereas mental functioning was positively related (beta=0.30). CONCLUSION: The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity.     

Phase 1, placebo-controlled,dose escalation trial of chicory root extract in patients with osteoarthritis of the hip or knee

Background  

Extracts of chicory root have anti-inflammatory properties in vitro and in animal models of arthritis. The primary objective of this investigator-initiated, Phase 1, placebo-controlled, double blind, dose-escalating trial was to determine the safety and tolerability of a proprietary bioactive extract of chicory root in patients with osteoarthritis (OA). Secondary objectives were to assess effects on the signs and symptoms of this disorder.     

Comparison of daily, weekly or monthly pain assessments in hip and knee osteoarthritis. A 29-day prospective study

Objective

To compare the accuracy of daily and recalled pain measurements in hip and knee osteoarthritis (OA).

Methods

A prospective study investigating pain intensity over 29 days in patients with painful OA. Pain was assessed on days 1 and 29 during visits. Between these two visits, daily (worst, least, usual, mean, at rest and during daily life) and recalled pain intensities were randomly recorded by telephone interview with a numerical rating scale.

Results

We studied 129 patients, with a mean age of 67.7 ± 10.0 years, 27.1% males. Daily prospective assessments demonstrated that the strongest correlations were between ‘mean daily’ and ‘usual’ pain (r = 0.88) and between ‘mean daily’ and ‘worst’ pain (r = 0.86). Retrospective assessments demonstrated a strong correlation between recalled pain intensities and calculated mean of daily assessments over the seven and 28 days (0.78 and 0.67, respectively), but weakened by adjustment for pain intensity on the day of recalled pain assessment. Anxiety and depression scores did not affect pain recall for 7 and 28 days.

Conclusions

In hip and knee OA, prospective daily pain assessment can be performed either by assessing ‘usual pain’ or ‘worst pain’ of the day. When recalled over one and four weeks, recall pain intensity is well correlated with calculated mean of prospective daily pain assessments during the same period, but correlations are weaker as the length of period increases. Either for 1 and 4 weeks, retrospective assessments are influenced by current pain intensity at the end of the period.     

Adipokines correlate with pain in lower limb osteoarthritis: different associations in hip and knee

Purpose

Our aim was to investigate whether serum and synovial-fluid (SF) concentrations of interleukin-6 (IL-6), leptin, adiponectin, resistin or visfatin are associated with joint pain in hip and knee in end-stage osteoarthritis (OA).

Methods

A cross-sectional study assessing patients with hip and knee OA undergoing total joint arthroplasty between January and December 2010 was conducted at a large university hospital. Serum and SF cytokine and adipokine concentrations were determined in samples obtained on the day of surgery. The main outcome was pain severity measured pre-operatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) pain scores.

Results

A total of 206 patients were involved (112 with hip and 94 with knee OA). Median age was 72 years [interquartile range (IQR) 66–79], 59 % were women. All adipokine levels were significantly higher in the SF of hip joints than in that of knee joints, except for leptin, which tended to be higher in the knee. In both hip and knee OA, median serum concentrations of leptin, adiponectin, resistin and visfatin exceeded those in SF, whereas for IL-6, median concentrations were much higher in SF than in serum. In hip OA, worse pain was significantly associated with high SF concentrations of IL-6, visfatin and leptin; in knee OA, it was associated with high SF leptin and low SF adiponectin concentrations and a low adiponectin–leptin ratio.

Conclusion

Our findings support a connection between intra-articular concentrations of several adipokines and severity of preoperative OA pain. However, the specific adipokines differed by joints: in hip OA, pain was associated with IL-6 and visfatin and in knee OA with adiponectin; leptin played a role in both hip and knee OA.