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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-eight cases (31 joints) with osteoarthritis of the knee associated with varus deformity were operated on by modified Koshino high tibial osteotomy. After operation 19 knee joints were followed up for more than one year (average 34.1 months). Eighteen knee joints had a satisfactory result, especially excellent are the pain relief and increment of walking ability. The operative procedures and surgical indication were described. The main factors affecting the curative effect of high tibial osteotomy on osteoarthritis of the knee, the advantages and disadvantages of this method were discussed.
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PMID:[High tibial osteotomy for osteoarthritis of the knee with varus deformity]. 803 70

The chance of a person with osteoarthritis of the knee receiving a knee replacement is highly variable. To understand better the reasons for this variation, all practicing orthopaedists in Indiana were surveyed about their management of severe knee osteoarthritis and their perception of tricompartmental knee replacement as a therapeutic option. Their perceptions of indications and outcomes of knee replacement were compared with the self reported annual number of patients for whom they performed (or referred to other surgeons for) tricompartmental knee replacements. A completed survey was returned by 220 (79%) of the 280 orthopaedists surveyed; analyses were limited to the 188 respondents who had cared for at least one patient with osteoarthritis of the knee in the prior 2 weeks (mean = 13). These surgeons reported performing (or referring patients for) a mean of 31 knee replacements in the prior year (SD 45, median 21, range 0-480 knee replacements). There was strong agreement (> 95%) among respondents for seven (21%) of 33 surgical indications and contraindications, and more general agreement (> 60%) for 21 (64%). In the five factors (15%) for which there was disagreement, there was no consistent relationship between opinions and self reported knee replacement performance rate. Surgeons reporting more knee replacements had significantly higher estimates of pain relief and functional improvement following surgery, and lower estimates of prosthesis infection and failure rates. When all responses were considered together, four decision factors correlated independently with the performance of more knee replacements, but these four factors explained only 24% of the variation in self reported knee replacement performance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Tricompartmental knee replacement. A comparison of orthopaedic surgeons' self reported performance rates with surgical indications, contraindications, and expected outcomes. Knee Replacement Patient Outcomes Research Team. 805 Feb 31

A double-blind, placebo (PBO)-controlled trial was carried out on 155 adult outpatients with painful (Huskisson's analogical scale > 40 mm) monolbilateral femorotibial and/or femoropatellar osteoarthritis of the knee, radiologically confirmed. Patients were randomly given either diclofenac hydroxyethylpyrrolidine plasters (DHEP, 78 patients), containing 180 mg of active drug each, or matched PBO (77 ptns). Plasters were applied b.i.d. (at 8 a.m. and 8 p.m.) on the affected joint, for 15 days. No NSAID treatment was allowed during the trial, while paracetamol was admitted from the 4th day on and its daily intake carefully recorded. Huskisson's test and Lequesne's index were assessed at days 0, 4, 7 and 15. Patients were asked to fill in a daily cared with Huskisson's scale and subjective evaluations. Differences in favour of DHEP were observed from the first assessment (4th d.) on Huskisson's scale and Lequesne's index (p < 0.001). According to the patients' subjective evaluation, pain decreased as soon as the first day in both groups, with significant differences in favour of DHEP (p < 0.005). Even the number of night awakenings recorded by the patient was significantly in favour of DHEP (p < 0.005). It is worth noting that these results were obtained in spite of a significant reduction of paracetamol intake in DHEP patients in comparison with PBO patients (p < 0.01). Tolerability was judged good or excellent in the majority of cases: only minor side effects occurred in five patients (4 PBO, 1 DHEP) and the interruption of treatment was required for only one of the PBOs. This study shows that DHEP plaster significantly differs from matched PBO in the improvement of pain and patient's condition in painful knee osteoarthritis.
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PMID:DHEP plasters as a topical treatment of knee osteoarthritis--a double-blind placebo-controlled study. 811

Two nontraumatizing and reproducible tools for quantitative gait analysis as part of the objective evaluation of nonsteroidal antiinflammatory drugs are reported. The Bessou gait analyzer is a simple mechanical device which measures spatiotemporal and kinematic parameters (stride length; duration of stride, weight-bearing, and forward swing; speed and peak speed of swing; and overall speed of walking). The ELITE system is a considerably more complex instrument for analyzing three-dimensional motions through high-speed shape recognition. Computerized data management allows not only to determine the spatiotemporal parameters listed above but also to study displacements of selected landmarks in several planes and to derive joint angles and angular speeds. Coupling of the ELITE system to a force platform and to telemetric transmission surface electromyography substantially expands the range of data provided. The mechanical gait analyzer was used to evaluate the effects of naproxen in 11 patients with osteoarthritis of the knee; another similar study in 13 patients with osteoarthritis of the hip is ongoing. Gait was recorded before and after daily administration of naproxen for seven days. After treatment, walking speed was significantly increased as a result of increased stride length and decreased stride duration. Durations of monopodal and bipodal weight-bearing decreased concomitantly with the increase in speed, whereas duration of forward swing remained unchanged. These data demonstrating improved kinematic gait parameters show that naproxen is effective in reducing the adverse mechanical effects of pain. This study also demonstrates the usefulness of gait analysis for evaluating drugs.
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PMID:[New methods of analysis of gait in the evaluation of the action of anti-inflammatory drugs. Apropos of naproxen]. 816 3

The arthroscope, currently used in OA mostly as a tool to deliver surgical therapy, can play an important diagnostic role in patients with knee pain for whom OA is part of the differential diagnosis. Concepts that may seem foreign to clinicians who take care of patients with knee OA (that is, of arthroscopy as a purely diagnostic tool and of knee OA as a clinical situation for which a differential diagnosis might be rendered) are supported by an appreciation for the heterogeneity of conditions of which OA is a part as well as an awareness of the pathoanatomic complexity of symptomatic knee OA as revealed by recent MRI and arthroscopy studies. Inspection of the perplexing OA knee with one of the newly available needle arthroscopes in an ambulatory office setting may be preferable to referral for conventional operating room--based arthroscopy, as this new technique adequately delineates intra-articular anatomical abnormalities (for which surgical therapy is not always indicated) and provides saline lavage to the joint (considered by many as a major factor in the improvement of symptoms reported by many patients with knee OA after arthroscopy). At present arthroscopy can serve to aid differential diagnostic efforts in five clinical situations involving knee OA: painful swollen knee with normal radiographs and noninflammatory fluid, clinical and radiographic OA with pain out of proportion to radiographic findings and refractory to conventional medical therapy, chronic stable (radiographic) OA with profound worsening of symptoms, OA with predominate "mechanical" symptoms, and OA with unexpected synovial fluid characteristics. Future use of needle arthroscopy in knee OA could serve to define the intraarticular correlates of pain in OA, to identify specific subgroups of knee OA upon which prospective randomized testing of arthroscopic surgical interventions could be conducted, and to quantitatively assess the effects of new treatment modalities on articular cartilage and other intraarticular structures.
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PMID:The role of arthroscopy in the differential diagnosis of osteoarthritis of the knee. 821 May 81

The authors discuss the use of lateral heel wedges in the treatment of medial osteoarthritis of the knee in 121 knees in 85 patients. Follow-up was an average of 12 months after the insertion of the wedge. Patients' roentgenograms were graded according to the Ahlback classification, and various improvements were noted. Overall, 38% of patients improved to a Hospital for Special Surgery pain score of 25 or 30, which corresponds to an excellent result from total knee arthroplasty. Fifty percent of patients improved to a pain score of 20 or higher, which corresponds to a good result from total knee arthroplasty. The patients with milder osteoarthritis received greater pain relief. However, even patients with complete loss of joint space and bony erosion showed some improvement. It appears that the use of lateral wedges has a place in the conservative treatment of medial osteoarthritis.
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PMID:Use of lateral heel and sole wedges in the treatment of medial osteoarthritis of the knee. 826 30

Osteoarthritides of the hip and knee represent two of the most important causes of pain and physical disability in the community. Recent studies have helped delineate the different patterns, rates of progression, and determinants of outcome in these two conditions. For example, patellofemoral and tibiofemoral osteoarthritis of the knee appear to have different associations and consequences; psychosocial factors and muscle strength seem to be the key determinants of pain and disability. These insights have contributed to a parallel development in new treatment strategies for established hip and knee osteoarthritis, including increased psychosocial support, educational and fitness programs, and different drugs and physical interventions. Therapeutic regimens geared to the specific needs of patients with lower limb osteoarthritis are emerging. They should replace the inappropriate application of treatments designed for inflammatory arthropathies to patients with osteoarthritis.
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PMID:Management of osteoarthritis of the hip and knee joints. 835 45

In a single-blind, randomized clinical trial, both the efficacy and safety of hyaluronic acid (HA) were compared with that of mucopolysaccharide polysulfuric acid ester (MPA) in patients with osteoarthritis of the knee joint. Both agents were administered intra-articularly over six weeks. Patients received either seven injections of HA or 13 injections of MPA. Joint function, range of motion, severity of pain, the general condition of the bony structure and soft tissue of the joint area, and the global clinical efficacy and safety of the medication were assessed. The mean improvement in the modified total Larson rating score was 22% (SD = 28) after HA treatment and 7% (SD = 17) after treatment with MPA (analysis of variance: p = 0.02). This change was mainly caused by a reduction of pain. The onset of pain relief was more rapid in the HA group. The therapeutic effect increased in both treatment groups during the follow-up period. During this interval, lasting six months after the start of treatment, a further reduction of pain and an improvement of knee joint function could be observed. At the end of the study, 25 out of 33 (76%) patients in the HA group and 11 out of 24 (46%) patients in the MPA group were symptom-free or markedly improved (Chi-square test: p = 0.02). Both agents were tolerated very well.
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PMID:Intra-articular treatment with hyaluronic acid in osteoarthritis of the knee joint: a controlled clinical trial versus mucopolysaccharide polysulfuric acid ester. 840 80

Walking is an ideal physical activity for patients with osteoarthritis because it can help to improve functional status without exacerbating pain or necessitating an increase in the use of medication. Although patient education programs designed to encourage walking have become increasingly important in the management of this condition, there is no single synthesis or other published source of theory and intervention strategies to guide the practitioner in the development of such programs. This paper describes a hospital-based patient education program designed to enhance the functional capacity of who have osteoarthritis of the knee by encouraging the adoption and maintenance of walking. The paper describes the goals, objectives, process, and impact of the program; the principal theoretical model utilized in the design of the program; and how concepts and intervention strategies from the literatures on patient compliance and patient education, exercise compliance, behavioral psychology, and relapse prevention have been operationalized and integrated in a walking program that we have evaluated for safety and efficacy.
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PMID:A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies. 844 26

One thousand and three women aged 45-64 from the Chingford general population survey were studied cross sectionally to find the effect of quantity and distribution of body fat on the prevalence of radiologically confirmed osteoarthritis (OA) in the knee, carpometacarpal (CMC), distal interphalangeal (DIP), and proximal interphalangeal (PIP) joints. Obesity was classified as the upper tertile of body mass index (BMI kg/m2); the boundaries of the middle tertile were 23.4 and 26.4 kg/m2. The age adjusted odds ratio (OR) [and 95% confidence interval (CI)] of radiographic OA at the knee comparing the high and low tertile of BMI was 6.17 (3.26-11.71) and for bilateral knee radiographic OA was 17.99 (6.25-51.73). Comparing the middle and low tertile of BMI, the odds ratio for radiographic OA knee was 2.86 (1.44-5.68). For other joints the association between BMI and radiographic OA was less strong; the OR at CMC was 1.71 (1.05-2.78), at DIP was 1.52 (0.90-2.57), and at PIP was 1.23 (0.52-2.91). For all joints except PIP these OR increased if the diagnostic criteria included knee pain for at least a month, clinically evident swelling at the DIP or PIP, and pain or tenderness at the CMC. Recalled weight at age 20 years, or recalled maximum weight improved prediction of radiographic OA from current BMI, but measurement of fat distribution from circumference of waist, hip and thigh did not. Our results confirm that excess body weight is a powerful predictor of OA of the knee in middle aged women, and a modest predictor of DIP and CMC OA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. 847 72


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