Pain

Background: Older adults often struggle to find footwear suitable for their clinical needs, thus affecting mobility, safety, and quality of life. Proper footwear is important due to fall risk, balance impairments, knee osteoarthritis (OA), hallux rigidus, plantar fasciitis, diabetic neuropathy, and limb length discrepancies (LLDs). Barriers such as inadequate clinical guidance and limited patient understanding persist. This paper provides updated, evidence-based recommendations for these challenges.

Methods: A topic review was conducted to evaluate shoe wear characteristics that address geriatric needs. Recommendations were synthesized from more than 45 years of clinical experience in physical therapy and categorized by clinical conditions. Evidence identified effective shoe features, including sole stiffness, tread patterns, heel elevation, and orthotic modifications to improve function, reduce pain, and reduce fall risk.

Results: Balance and fall risk: Shoes with wide soles, medium-firm materials, low heels, and high collars improved stability and reduced postural sway. Cupped, rigid insoles enhanced dynamic control, while treaded rubber outsoles minimized slipping. Knee OA: Flexible shoes with laterally wedged insoles and minimal heel lift reduced medial knee loads and pain. Supportive shoes and medially wedged insoles decreased lateral knee loads and pain. Hallux rigidus/bunions: Rocker-bottom shoes and stiffer soles accommodate deformities, improving function and comfort. Plantar fasciitis: Orthoses, supportive therapies, and stretching regimens were efficacious. Diabetic neuropathy: Rigid rocker soles and custom insoles reduced plantar pressure and ulcer recurrence. LLDs: Gradual shoe lift introduction alleviated low back pain. General recommendations: Properly fitted, comfortable shoes with moderately firm insoles, slip-resistant outsoles, and secure fastening mechanisms improve safety and function.

Conclusions: Footwear significantly impacts the mobility, safety, and well-being of older adults. Tailored recommendations enhance pain management, independence, and fall prevention. Providers should involve patients in decisions and counsel against the use of slippers or excessively elevated heels.

Keywords: fall prevention; older adults; orthoses; pain; shoes.

Author/s:

C Ray Cheever, Hyoungjun Sim, Mohamed Y. Ahmidouch, Jaewon Moon, Anissa Powell, Rayad B. Shams, Matthew Wang, Madison Hunter, Samantha Kodikara, Lindsay A. Wilson, Michael T. Gross

A Simplified Approach to Evaluate and Manage Shoulder Pain

Erin Blanchette — Mon, 24 Mar 2025 16:18:35 +0000

Date Added:

March 24, 2025

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

November 1, 2024

Issue:

Volume:

Pages:

1156-1166

URL:

A Simplified Approach to Evaluate and Manage Shoulder Pain

Type:

Best Local Practices

Format:

Article

DOI (1):

10.3122/jabfm.2024.240114R2

Keywords

PMID (1):

40118541

MeSH

Physical Examination / methods

A simplified algorithmic approach to the evaluation of shoulder pain. James W. Mold, MD, MPH

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With the lifetime prevalence of shoulder pain approaching 70%, accurate diagnosis and management remains essential. The shoulder is a complex joint with a vast range of motion making it susceptible to injury due to limited bony stabilization. This manuscript shares a simplified, novel approach to evaluating and managing atraumatic shoulder pain based on triaging symptoms on presence or loss of range of motion. In patients with loss of active and passive range of motion, the likely etiologies of pain include adhesive capsulitis or glenohumeral joint arthritis depending on imaging. In patients with preserved active and passive range of motion, implementing specific special testing can help pinpoint the diagnosis, and further guide appropriate management. Ultrasound plays an increasingly key role in diagnosing and managing shoulder pathology.

Author/s:

Kartik Sidhar, Hyung Jin Lim, Laurel Gutierrez

Diagnosis and management of patients with polyneuropathy

Aubrey Delammermore — Wed, 15 Feb 2023 06:00:00 +0000

Date Added:

February 15, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

February 13, 2023

Issue:

Volume:

195

Pages:

E227-E233

URL:

Diagnosis and management of patients with polyneuropathy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.220936

Keywords

PMID (1):

36781195

MeSH

Polyneuropathies* / diagnosis

Polyneuropathies* / therapy

Humans

diabetic neuropathies

Neurologic Examination

A general review of polyneuropathy syndromes noting red flags and a diagnostic algorithm. James W. Mold, MD, MPH

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Polyneuropathy is a common neurologic condition with an overall prevalence in the general population of about 1%–3%, increasing to roughly 7% among people older than 65 years. Polyneuropathy has many causes, and can present in many different ways; thus, it requires a logical clinical approach for evaluation, diagnosis and management. We review the approach to evaluating a patient with polyneuropathy by highlighting important aspects of the history and neurologic examination. We focus on the role of diagnostic investigations for distal symmetric polyneuropathy (DSP), the most common subtype, and an approach to the symptomatic treatment of painful diabetic polyneuropathy (PDN). We draw on practice based guidelines, meta-analyses and systematic reviews, where
possible, as they represent the highest levels of evidence (Box 1).

Author/s:

Mirian, A., Aljohani, Z., Grushka, D., Florendo-Cumbermack, A.

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Aubrey Delammermore — Sat, 07 Jan 2023 06:00:00 +0000

Date Added:

January 7, 2023

Journal/Publication:

Journal of Pain Research

Publisher:

DovePress

Publication Date:

December 6, 2022

Issue:

Pages:

3729-3832

URL:

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.2147/JPR.S386879

Keywords

evidence-based

interventional treatments

Low Back Pain

lumbar spinal disorders

Pain

PMID (1):

36510616

MeSH

Neurosurgery

anesthesiology

low back pain

Physical and Rehabilitation Medicine

Radiofrequency Ablation

A comprehensive evidence-based review of a variety of interventions for low back pain syndromes. James W. Mold, MD, MPH

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Introduction
Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety.

Objective
The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders.

Methods
The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented.

Results
After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain.

Conclusion
The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Keywords: back pain, intervention, clinical guideline, spinal cord stimulation, minimally invasive spine procedure, lumbar disorder, epidural steroid injection, radiofrequency ablation

Author/s:

Sayed, D., Grider, J., Strand, N., Hagedorn, J. M., Falowski, S., Lam, C. M., Francio, V. T., Beall, D. P., Tomycz, N. D., Davanzo, J. R., Aiyer, R., Lee, D. W., Kaila, H., Sheen, S., Malinowski, M. N., Verdolin, M., Vodapally, S., Carayannopoulos, A., Jain, S., Azeem, N., Tolba, R., Chien, G. C. C., Ghosh, P., Mazzola, A. J., Amirdelfan, K., Chakravarthy, K., Petersen, E., Schatman, M. E., Deer, T.

Review of systemic and syndromic complications of cannabis use: A review

Aubrey Delammermore — Mon, 19 Dec 2022 06:00:00 +0000

Date Added:

December 19, 2022

Journal/Publication:

Medicine

Publisher:

Wolters Kluwer Health

Publication Date:

December 9, 2022

Issue:

Volume:

101

Pages:

e32111

URL:

Review of systemic and syndromic complications of cannabis use: A review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/MD.0000000000032111

Keywords

complications of cannabis use

MeSH

A review of some of the complications of cannabis abuse. James W. Mold, MD, MPH

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Purpose of review: Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain – primary care, pain management, and neurology–will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders.

Recent Findings: Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use.

Summary: Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.

Author/s:

Shah, J., Fermo, O.

Non-steroidal anti-inflammatory drugs for acute low back pain

Devin Evans — Fri, 23 Apr 2021 05:00:00 +0000

Date Added:

April 23, 2021

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

April 16, 2021

Issue:

Volume:

URL:

Non-steroidal anti-inflammatory drugs for acute low back pain

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD013581

Keywords

back pain

Pain

Tylenol

PMID (1):

32297973

MeSH

low back pain

Anti-Inflammatory Agents, Non-Steroidal

Sciatica

Apparently NSAIDS aren’t much more effective than placebo or Tylenol for acute low back pain, but don’t discount the effectiveness of a good, safe placebo. James W. Mold, MD, MPH

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Background: Acute low back pain (LBP) is a common health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of LBP, particularly in people with acute LBP. In 2008, a Cochrane Review was published about the efficacy of NSAIDs for LBP (acute, chronic, and sciatica), identifying a small but significant effect in favour of NSAIDs compared to placebo for short-term pain reduction and global improvement in participants with acute LBP. This is an update of the previous review, focusing on acute LBP.

Objectives: To assess the effects of NSAIDs compared to placebo and other comparison treatments for acute LBP.

Search methods: We searched CENTRAL, MEDLINE, Embase, PubMed, and two trials registers for randomised controlled trials (RCT) to 7 January 2020. We also screened the reference lists from relevant reviews and included studies.

Selection criteria: We included RCTs that assessed the use of one or more types of NSAIDs compared to placebo (the main comparison) or alternative treatments for acute LBP in adults (≥ 18 years); conducted in both primary and secondary care settings. We assessed the effects of treatment on pain reduction, disability, global improvement, adverse events, and return to work.

Data collection and analysis: Two review authors independently selected trials to be included in this review, evaluated the risk of bias, and extracted the data. If appropriate, we performed a meta-analysis, using a random-effects model throughout, due to expected variability between studies. We assessed the quality of the evidence using the GRADE approach. We used standard methodological procedures recommended by Cochrane.

Main results: We included 32 trials, with a total of 5356 participants (age range 16 to 78 years). Follow-up ranged from one day to six months. Studies were conducted across the globe, the majority taking place in Europe and North-America. Africa and the Eastern Mediterranean region were not represented. We considered seven studies at low risk of bias. Performance and attrition were the most common biases. There was often a lack of information on randomisation procedures and allocation concealment (selection bias); studies were prone to selective reporting bias, since most studies did not register their trials. Almost half of the studies were industry-funded. There is moderate quality evidence that NSAIDs are slightly more effective in short-term (≤ 3 weeks) reduction of pain intensity (visual analogue scale (VAS), 0 to 100) than placebo (mean difference (MD) -7.29 (95% confidence interval (CI) -10.98 to -3.61; 4 RCTs, N = 815). There is high quality evidence that NSAIDs are slightly more effective for short-term improvement in disability (Roland Morris Disability Questionnaire (RMDQ), 0 to 24) than placebo (MD -2.02, 95% CI -2.89 to -1.15; 2 RCTs, N = 471). The magnitude of these effects is small and probably not clinically relevant. There is low quality evidence that NSAIDs are slightly more effective for short-term global improvement than placebo (risk ratio (RR) 1.40, 95% CI 1.12 to 1.75; 5 RCTs, N = 1201), but there was substantial heterogeneity (I² 52%) between studies. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events when using NSAIDs compared to placebo (RR 0.86, 95% CI 0.63 to 1.18; 6 RCTs, N = 1394). There is very low quality evidence of no clear difference between the proportion of participants who could return to work after seven days between those who used NSAIDs and those who used placebo (RR 1.48, 95% CI 0.98 to 2.23; 1 RCT, N = 266). There is low quality evidence of no clear difference in short-term reduction of pain intensity between those who took selective COX-2 inhibitor NSAIDs compared to non-selective NSAIDs (mean change from baseline -2.60, 95% CI -9.23 to 4.03; 2 RCTs, N = 437). There is moderate quality evidence of conflicting results for short-term disability improvement between groups (2 RCTs, N = 437). Low quality evidence from one trial (N = 333) reported no clear difference between groups in the proportion of participants experiencing global improvement. There is very low quality evidence of no clear difference in the proportion of participants experiencing adverse events between those who took COX-2 inhibitors and non-selective NSAIDs (RR 0.97, 95% CI 0.63 to 1.50; 2 RCTs, N = 444). No data were reported for return to work.

Authors' conclusions: This updated Cochrane Review included 32 trials to evaluate the efficacy of NSAIDs in people with acute LBP. The quality of the evidence ranged from high to very low, thus further research is (very) likely to have an important impact on our confidence in the estimates of effect, and may change the estimates. NSAIDs seemed slightly more effective than placebo for short-term pain reduction (moderate certainty), disability (high certainty), and global improvement (low certainty), but the magnitude of the effects is small and probably not clinically relevant. There was no clear difference in short-term pain reduction (low certainty) when comparing selective COX-2 inhibitors to non-selective NSAIDs. We found very low evidence of no clear difference in the proportion of participants experiencing adverse events in both the comparison of NSAIDs versus placebo and selective COX-2 inhibitors versus non-selective NSAIDs. We were unable to draw conclusions about adverse events and the safety of NSAIDs for longer-term use, since we only included RCTs with a primary focus on short-term use of NSAIDs and a short follow-up. These are not optimal for answering questions about longer-term or rare adverse events.

Author/s:

Van der Gaag, W.H., Roelofs, P.D., Enthoven, W.T., Van Tulder, M.W., Koes, B.W.

Management of Persistent Pain in the Older Patient A Clinical Review

Devin Evans — Fri, 02 Apr 2021 05:00:00 +0000

Date Added:

April 2, 2021

Journal/Publication:

Journal of the American Medical Association

Issue:

Volume:

312

Pages:

825-836

URL:

Management of Persistent Pain in the Older Patient A Clinical Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2014.9405

Keywords

PMID (1):

25157726

MeSH

A systematic review of published information on management of chronic pain in older patients. James W. Mold, MD, MPH

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Importance: Persistent pain is highly prevalent, costly, and frequently disabling in later life.

Objective: To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult.

Evidence acquisition: Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults.

Findings: Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended-emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician.

Conclusions and relevance: Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

Author/s:

Makris, Una E., Abrams, Robert C., Durland, Barry, Reid, M.C.

Rethinking mechanisms, diagnosis and management of endometriosis

Devin Evans — Fri, 26 Feb 2021 06:00:00 +0000

Date Added:

February 26, 2021

Journal/Publication:

Nature Reviews Endocrinology

Publication Date:

September 5, 2020

Issue:

Volume:

Pages:

666-682

URL:

Rethinking mechanisms, diagnosis and management of endometriosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1038/s41574-019-0245-z

Keywords

PMID (1):

31488888

MeSH

Our understanding of endometriosis has evolved substantially over the last decade. This is a fairly recent review of the current conceptualization of this multi-system inflammatory disease. James W. Mold, MD, MPH

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Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.

Author/s:

Chapton, Charles, Marcellin, Louis, Borghese, Bruno, Santulli, Pietro

Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain: A Randomized Clinical Trial

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Journal of the American Medical Association Internal Medicine

Publication Date:

February 22, 2021

URL:

Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2020.9049

Keywords

Telephone Cognitive Behavioral Therapy

PMID (1):

33616613

MeSH

aged

sleep initiation and maintenance disorders

Sleep Hygiene

osteoarthritis

Cognitive Behavioral Therapy

Telephone

Cognitive behavioral therapy is apparently the most effective way to help people sleep better, even if provided virtually. James W. Mold, MD, MPH

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Importance: Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and underserved populations lacking ready access to insomnia treatment.

Objective: To evaluate the effectiveness of telephone CBT-I vs education-only control (EOC) in older adults with moderate to severe osteoarthritis pain.

Design, setting, and participants: This is a randomized clinical trial of 327 participants 60 years and older who were recruited statewide through Kaiser Permanente Washington from September 2016 to December 2018. Participants were double screened 3 weeks apart for moderate to severe insomnia and osteoarthritis (OA) pain symptoms. Blinded assessments were conducted at baseline, after 2 months posttreatment, and at 12-month follow-up.

Interventions: Six 20- to 30-minute telephone sessions provided over 8 weeks. Participants submitted daily diaries and received group-specific educational materials. The CBT-I instruction included sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and homework. The EOC group received information about sleep and OA.

Main outcomes and measures: The primary outcome was score on the Insomnia Severity Index (ISI) at 2 months posttreatment and 12-month follow-up. Secondary outcomes included pain (score on the Brief Pain Inventory-short form), depression (score on the 8-item Patient Health Questionnaire), and fatigue (score on the Flinders Fatigue Scale).

Results: Of the 327 participants, the mean (SD) age was 70.2 (6.8) years, and 244 (74.6%) were women. In the 282 participants with follow-up ISI data, the total 2-month posttreatment ISI scores decreased 8.1 points in the CBT-I group and 4.8 points in the EOC group, an adjusted mean between-group difference of -3.5 points (95% CI, -4.4 to -2.6 points; P < .001). Results were sustained at 12-month follow-up (adjusted mean difference, -3.0 points; 95% CI, -4.1 to -2.0 points; P < .001). At 12-month follow-up, 67 of 119 (56.3%) participants receiving CBT-I remained in remission (ISI score, ≤7) compared with 33 of 128 (25.8%) participants receiving EOC. Fatigue was also significantly reduced in the CBT-I group compared with the EOC group at 2 months posttreatment (mean between-group difference, -2.0 points; 95% CI, -3.1 to -0.9 points; P = <.001) and 12-month follow-up (mean between-group difference, -1.8 points; 95% CI, -3.1 to -0.6 points; P = .003). Posttreatment significant differences were observed for pain, but these differences were not sustained at 12-month follow-up.

Conclusions and relevance: In this randomized clinical trial, telephone CBT-I was effective in improving sleep, fatigue, and, to a lesser degree, pain among older adults with comorbid insomnia and OA pain in a large statewide health plan. Results support provision of telephone CBT-I as an accessible, individualized, effective, and scalable insomnia treatment.

Author/s:

McCurry, Susan M., Zhu, Weiwei, Von Korff, Michael, Wellman, Robert, Morin, Charles M., Thakral, Manu, Yeung, Kai, Vitiello, Michael V.

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