Knee osteoarthritis

Objective To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Design, Setting, and Participants The RETREAT study was a 2-group superiority randomized clinical trial enrolling participants who met clinical criteria for knee osteoarthritis in Australian communities from August 2023 and November 2024.

Interventions Participants in the control group received access to a purpose-built website containing information about osteoarthritis and exercise benefits. Participants in the intervention group received the My Joint Tai Chi intervention comprising access to the same website plus tai chi information, a 12-week unsupervised video-based Yang-style tai chi program, and encouragement to use an app to facilitate program adherence.

Main Outcomes and Measures Changes in knee pain during walking (Numeric Rating Scale; range 0-10 with higher scores indicating greater pain) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68 with higher scores indicating greater dysfunction) during 12 weeks. Secondary outcomes included another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, fear of movement, self-efficacy, balance confidence, positive activated affect, sleep quality, global improvement, and oral medication use.

Results Of 2106 patients screened, 178 met inclusion criteria and were randomized, 89 (mean [SD] age, 61.0 [8.7] years; 66 female [74%] and 23 [26%] male participants) to the control group and 89 (mean [SD] age, 62.1 [7.3] years; 59 [66%] female and 30 male [34%] participants) to the tai chi intervention. Of the total, 170 (96%) completed both of the primary outcomes at 12 weeks. The tai chi group reported greater improvements in knee pain (control, −1.3; tai chi, −2.7; mean difference, −1.4 [95% CI, −2.1 to −0.7] units; P < .001) and function (control, −6.9; tai chi, −12.0; mean difference, −5.6 [95% CI, −9.0 to −2.3] units; P < .001) compared to the control group. More participants in the tai chi than in the control group achieved a minimal clinically important difference in pain (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007). Between-group differences for most secondary outcomes favored tai chi, including another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, global improvement, pain self-efficacy, and balance confidence. No associated serious adverse events were reported.

Conclusions and Relevance This randomized clinical trial found that this unsupervised multimodal online tai chi intervention improved knee pain and function compared with the control at 12 weeks. This free-to-access web-based intervention offers an effective, safe, accessible, and scalable option for guideline-recommended osteoarthritis exercise.

Author/s:

Shiyi Julia Zhu, Rana S. Hinman, Rachel K. Nelligan

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 11 Nov 2025 14:30:40 +0000

Date Added:

November 11, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

Pain Medicine

Tai Chi

Knee osteoarthritis

PMID (1):

41143827

MeSH

This free online Tai Chi program (https://myjoint-taichi.org/) appears to be effective for reducing pain in patients with OA of the knees. James W. Mold, MD, MPH

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Importance: Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective: To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Design, setting, and participants: The RETREAT study was a 2-group superiority randomized clinical trial enrolling participants who met clinical criteria for knee osteoarthritis in Australian communities from August 2023 and November 2024.

Interventions: Participants in the control group received access to a purpose-built website containing information about osteoarthritis and exercise benefits. Participants in the intervention group received the My Joint Tai Chi intervention comprising access to the same website plus tai chi information, a 12-week unsupervised video-based Yang-style tai chi program, and encouragement to use an app to facilitate program adherence.

Main outcomes and measures: Changes in knee pain during walking (Numeric Rating Scale; range 0-10 with higher scores indicating greater pain) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68 with higher scores indicating greater dysfunction) during 12 weeks. Secondary outcomes included another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, fear of movement, self-efficacy, balance confidence, positive activated affect, sleep quality, global improvement, and oral medication use.

Results: Of 2106 patients screened, 178 met inclusion criteria and were randomized, 89 (mean [SD] age, 61.0 [8.7] years; 66 female [74%] and 23 [26%] male participants) to the control group and 89 (mean [SD] age, 62.1 [7.3] years; 59 [66%] female and 30 male [34%] participants) to the tai chi intervention. Of the total, 170 (96%) completed both of the primary outcomes at 12 weeks. The tai chi group reported greater improvements in knee pain (control, -1.3; tai chi, -2.7; mean difference, -1.4 [95% CI, -2.1 to -0.7] units; P < .001) and function (control, -6.9; tai chi, -12.0; mean difference, -5.6 [95% CI, -9.0 to -2.3] units; P < .001) compared to the control group. More participants in the tai chi than in the control group achieved a minimal clinically important difference in pain (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007). Between-group differences for most secondary outcomes favored tai chi, including another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, global improvement, pain self-efficacy, and balance confidence. No associated serious adverse events were reported.

Conclusions and relevance: This randomized clinical trial found that this unsupervised multimodal online tai chi intervention improved knee pain and function compared with the control at 12 weeks. This free-to-access web-based intervention offers an effective, safe, accessible, and scalable option for guideline-recommended osteoarthritis exercise.

Author/s:

Shiyi Julia Zhu, Rana S. Hinman, Rachel K. Nelligan

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 28 Oct 2025 15:08:17 +0000

Date Added:

October 28, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

Knee osteoarthritis

kinesiophobia

Tai Chi

PMID (1):

41143827

MeSH

Minimal Clinically Important Difference

Use of a freely available online Tai Chi coaching app improved function and pain in individuals with osteoarthritis of the knees. James Mold, MD, MPH

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Importance: Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective: To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Author/s:

Shiyi Julia Zhu, Rana S Hinman, Rachel K Nelligan, Peixuan Li, Anurika P De Silva, Jenny Harrison, Alexander J Kimp, Kim L Bennell

Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis

Megan George — Tue, 28 Oct 2025 15:03:10 +0000

Date Added:

October 28, 2025

Journal/Publication:

BMJ

Publication Date:

October 15, 2025

URL:

Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1136/bmj-2025-085242

Keywords

exercise

exercise therapy

Knee osteoarthritis

PMID (1):

41093618

MeSH

Exercise Therapy* / adverse effects

Exercise Therapy* / methods

Network Meta-Analysis as Topic

osteoarthritis

Knee* / physiopathology

Knee* / rehabilitation

Knee* / therapy

Randomized Controlled Trials as Topic

quality of life

Humans

A summary and comparison of various modes of exercise on pain and function in patients with osteoarthritis of the knees. James W. Mold, MD, MPH

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Objective: To assess the efficacy and safety of various exercise modalities as therapeutic interventions for managing knee osteoarthritis.

Design: Systematic review with network meta-analysis.

Data sources: PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, AMED, PEDro, Scopus, ClinicalTrials.gov, ICTRP, and ClinicalTrialsRegister.eu from database inception to August 2024.

Eligibility criteria for selecting studies: Randomised controlled trials comparing different exercise modalities, including aerobic exercise, flexibility exercise, mind-body exercise, neuromotor exercise, strengthening exercise, mixed exercise, and control group for patients with knee osteoarthritis.

Main outcome measures: Primary outcomes included pain, function, gait performance, and quality of life, assessed at short term (four weeks), mid-term (12 weeks), and long term (24 weeks) follow-up. When exact time points were unavailable, data from adjacent time windows were used.

Results: 217 randomised controlled trials involving 15 684 participants were included. Moderate certainty evidence showed that, compared with the control group, aerobic exercise probably results in large improvements in pain at short term (standardised mean difference -1.10, 95% confidence interval -1.68 to -0.52) and mid-term follow-up (-1.19, -1.59 to -0.79), function at mid-term (1.78, 1.05 to 2.51), gait performance at mid-term (0.85, 0.55 to 1.14), and quality of life at short term (1.53, 0.47 to 2.59). Mind-body exercise probably results in a large increase in function at short term follow-up (0.88, 0.03 to 1.73; moderate certainty), while neuromotor exercise probably results in a large increase in gait performance at short term follow-up (1.04, 0.51 to 1.57; moderate certainty). Strengthening (0.86, 0.53 to 1.18) and mixed exercise (1.07, 0.68 to 1.46) probably result in a large increase in function at mid-term follow-up, all with moderate certainty evidence. Regarding long term follow-up, flexibility exercise may result in a large reduction in pain (-0.99, -1.63 to -0.36; low certainty); aerobic exercise may result in a large increase in function (0.87, 0.02 to 1.72, low certainty); and mixed exercise may increase function (0.56, 0.26 to 0.86; low certainty) and probably increases gait performance (0.57, 0.21 to 0.92, moderate certainty). Overall, aerobic exercise consistently showed the highest probability of being the best treatment, as reflected by surface under the cumulative ranking curve values (mean 0.72) across outcomes. The safety outcome was reported in a small proportion of studies (40 studies, 18%), and no clear differences were observed between exercise interventions and control.

Conclusions: In patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.

Systematic review registration: PROSPERO CRD42023469762.

Author/s:

Lei Yan, Dijun Li, Dan Xing, Zijuan Fan, Guangyuan Du, Jingwei Jiu, Xiaoke Li, Janne Estill, Qi Wang, Ahmed Atef Belal, Chen Tian, Jiao Jiao Li, Songyan Li, Haifeng Liu, Xuanbo Liu, Yijia Ren, Yiqi Yang, Jinxiu Chen, Yihe Hu, Long Ge, Bin Wang

Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial

Alex Haga — Thu, 29 May 2025 13:14:00 +0000

Date Added:

May 29, 2025

Journal/Publication:

JAMA

Publication Date:

April 24, 2025

Issue:

Volume:

333

Pages:

1804-1812

URL:

Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2025.3471

Keywords

PMID (1):

40274279

MeSH

Hypoglycemic Agents* / therapeutic use

Metformin* / therapeutic use

Obesity* / complications

osteoarthritis

Knee* / complications

Metformin 2000mg per day appears to reduce the pain of osteoarthritis of the knees in people who are overweight or obese. James W. Mold, MD, MPH

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Importance: Preclinical and preliminary human evidence suggests that metformin, a first-line treatment for type 2 diabetes, reduces inflammation, preserves cartilage, and improves knee pain in knee osteoarthritis.

Objective: To evaluate the effects of metformin on knee pain at 6 months in participants with symptomatic knee osteoarthritis and overweight or obesity.

Design, setting, and participants: Community-based randomized, parallel-group, double-blind, placebo-controlled clinical trial that used telemedicine to recruit and follow up participants remotely. Individuals with knee pain for 6 months or longer, a pain score greater than 40 mm on a 100-mm visual analog scale (VAS), and body mass index of 25 or higher were recruited from the community through local and social media advertisements in Victoria, Australia, between June 16, 2021, and August 1, 2023. Final follow-up occurred on February 8, 2024.

Interventions: Participants were randomly assigned to receive either oral metformin, 2000 mg/d (n = 54), or identical placebo (n = 53) for 6 months.

Main outcomes and measures: The primary outcome was change in knee pain, measured using a 100-mm VAS (score range, 0-100; 100 = worst; minimum clinically important difference = 15) at 6 months.

Results: Of 225 participants assessed for eligibility, 107 (48%) were randomized (mean age, 58.8 [SD, 9.5] years; 68% female) and assigned to receive metformin or placebo. Eighty-eight participants (82%) completed the trial. At 6 months, the mean change in VAS pain was -31.3 mm in the metformin group and -18.9 mm in the placebo group (between-group difference, -11.4 mm; 95% CI, -20.1 to -2.6 mm; P = .01), corresponding to an effect size (standardized mean difference) of 0.43 (95% CI, 0.02-0.83). The most common adverse events were diarrhea (8 [15%] in the metformin group and 4 [8%] in the placebo group) and abdominal discomfort (7 [13%] in the metformin group and 5 [9%] in the placebo group).

Conclusions and relevance: These results support use of metformin for treatment of symptomatic knee osteoarthritis in people with overweight or obesity. Because of the modest sample size, confirmation in a larger clinical trial is warranted.

Author/s:

Feng Pan, Yuanyuan Wang, Yuan Z Lim, Donna M Urquhart

Evaluation and Treatment of Knee Pain: A Review

Erin Blanchette — Mon, 06 Nov 2023 17:54:15 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 24, 2023

Issue:

Volume:

330

Pages:

1568–1580

URL:

Evaluation and Treatment of Knee Pain: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.19675

Keywords

Arthralgia

Knee Joint

Knee pain

Magnetic Resonance Imaging

Knee osteoarthritis

osteoarthritis

Patellofemoral Pain Syndrome

Tibial Meniscus Injuries

meniscal tear

PMID (1):

37874571

MeSH

Arthralgia* / diagnosis

Knee Joint*

Magnetic Resonance Imaging / methods

osteoarthritis

Knee / diagnosis

Tibial Meniscus Injuries / complications

A review of the diagnosis and management of patients with knee pain. James W. Mold, MD, MPH

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Importance: Approximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain.

Observations: Knee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching).

Conclusions and Relevance: Knee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.

Author/s:

Win Min Oo, Changhai Ding, Adam G. Culvenor, David J. Hunter

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial

Saige Blanchard — Wed, 13 Jul 2022 05:00:00 +0000

Date Added:

July 13, 2022

Journal/Publication:

JAMA Network Open

Publisher:

JAMA Network Open

Publication Date:

July 8, 2022

Issue:

Volume:

URL:

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2022.20394

Keywords

physical therapy

Arthroscopic Partial Meniscectomy

clinical trial

Knee osteoarthritis

Degenerative Meniscal Tear

PMID (1):

35802374

MeSH

Meniscectomy

osteoarthritis, knee

follow-up studies

Intention to Treat Analysis

Netherlands

Physical Therapy Modalities

PT appears to as effective as surgery for partial meniscus tears in the knee. James W. Mold, MD, MPH

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Importance: There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears.

Objectives: To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear.

Design, setting, and participants: A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020.

Interventions: Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.

Main outcomes and measures: The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups.

Results: Of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. The crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P < .001 for noninferiority). The 95% CI did not exceed the noninferiority threshold of 11 points. Comparable rates of progression of radiographic-demonstrated knee osteoarthritis were noted between both treatments.

Conclusions and relevance: In this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear.

Author/s:

Noordyun, J. C. A., Van de Graaf, V. A., Willigenburg, N. W., Scholten-Peeters, G. G. M., Kret, E. J., Van Dijk, R. A., Buchbinder, R., Hawker, G. A., Coppieters, M. W., Poolman, R. W., ESCAPE Research Group

Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis: A Secondary Analysis From a Randomized Clinical Trial

Saige Blanchard — Mon, 31 Jan 2022 06:00:00 +0000

Date Added:

January 31, 2022

Journal/Publication:

JAMA Network Open

Publisher:

JAMA Network Open

Publication Date:

January 4, 2022

Issue:

Volume:

URL:

Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis: A Secondary Analysis From a Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2021.42709

Keywords

physical therapy

Knee osteoarthritis

Randomized Clinical Trial

Glucocorticoid Injection

PMID (1):

35072722

MeSH

Humans

Cost-Benefit Analysis

glucocorticoids

osteoarthritis, knee

quality-adjusted life years

Physical therapy provides greater long term benefits for patients with knee osteoarthritis than corticosteroid injection. James W. Mold, MD, MPH

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Importance: Physical therapy and glucocorticoid injections are initial treatment options for knee osteoarthritis, but available data indicate that most patients receive one or the other, suggesting they may be competing interventions. The initial cost difference for treatment can be substantial, with physical therapy often being more expensive at the outset, and cost-effectiveness analysis can aid patients and clinicians in making decisions.

Objective: To investigate the incremental cost-effectiveness between physical therapy and intra-articular glucocorticoid injection as initial treatment strategies for knee osteoarthritis.

Design, setting, and participants: This economic evaluation is a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017. Health economists were blinded to study outcomes and treatment allocation. A randomized sample of patients seen in primary care and physical therapy clinics with a radiographically confirmed diagnosis of knee osteoarthritis were evaluated from the clinical trial with 96.2% follow-up at 1 year.

Interventions: Physical therapy or glucocorticoid injection.

Main outcomes and measures: The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained.

Results: A total of 156 participants (mean [SD] age, 56.1 [8.7] years; 81 [51.9%] male) were randomized 1:1 and followed up for 1 year. Mean (SD) 1-year knee-related medical costs were $2113 ($4224) in the glucocorticoid injection group and $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000.

Conclusions and relevance: A course of physical therapy was cost-effective compared with a course of glucocorticoid injections for patients with knee osteoarthritis. These results suggest that, although the initial cost of delivering physical therapy may be higher than an initial course of glucocorticoid injections, 1-year total knee-related costs are equivalent, and greater improvement in QALYs may justify the initial higher costs.

Author/s:

Rhon, D. I., Kim, M., Asche, C. V., Allison, S. C., Allen, C. S., Deyle, G. D.

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Journal/Publication:

The Canadian Medical Association Journal

Publication Date:

February 1, 2021

Issue:

Volume:

193

Pages:

158-166

URL:

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1503/cmaj.200934

Keywords

PMID (1):

33526542

MeSH

This study documents to beneficial effects of high tibial osteotomy for medial compartment osteoarthritis of the knee. James W. Mold, MD, MPH

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BACKGROUND: An important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it.

METHODS: We prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery.

RESULTS: Among 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%–7%) at 5 years and 21% (95% CI 17%–26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12–3.45), pain (adjusted HR 0.85, 95% CI 0.75–0.96)], female sex (adjusted HR 1.67, 95% CI 1.08–2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17–1.93) and BMI (adjusted HR 1.31 per 5 kng/m2, 95% CI 1.12–1.53).

Author/s:

Primeau, Codie A., Birmingham, Trevor B., Leitch, Kristyn M., Willits, Kevin R., Litchfield, Robert B., Fowler, Peter J., Marsh, Jacquelyn D., Chesworth, Bert M., Dixon, Stephanie N., Bryant, Dianne M., Giffin, J. Robert

Stepped Exercise Program for Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

BMC Musculoskeletal Disorder

Publication Date:

May 28, 2019

Issue:

254

Volume:

URL:

Stepped Exercise Program for Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1186/s12891-019-2627-8

Keywords

PMID (1):

31138256

MeSH

Physical Therapy Modalities

Patient-Centered Care

exercise therapy

An interesting type of stepped intervention that could be applied to other health conditions as well. James W. Mold, MD, MPH

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Background: Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions.

Methods / design: Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA.

Discussion: STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA.

Author/s:

Allen, Kelli D., Bongiorni, Dennis, Caves, Kevin, Coffman, Cynthia J., Floegel, Theresa A., Greysen, Heather M., Hall, Katherine S., Heiderscheit, Bryan, Hoenig, Helen M., Huffman, Kim M., Morey, Miriam D., Ramasunder, Shalini, Severson, Herbert, Smith, Battista, Van Houtven, Courtney, Woolson, Sandra