Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.
(25/1417)
OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities. (+info)
Controlled study of the prevalence of radiological osteoarthritis in clinically unrecognised juxta-articular Paget's disease.
(26/1417)
BACKGROUND: Paget's disease of bone is common and often undiagnosed in the population. The association of Paget's disease and osteoarthritis is well described but only in cases ascertained in secondary and tertiary care centres to which they have been referred largely because of pain. This study represents an attempt to confirm the association between Paget's disease and osteoarthritis in a population previously unknown to have Paget's disease. METHODS: Radiographs of people over 55 years that included the entire pelvis, sacrum, femoral heads and lumbar spine (mostly plain abdominal radiographs) were obtained from hospital records for the period 1993-95. Films were screened by a trained observer and the positive films were reviewed by a consultant radiologist who also examined a 1 in 10 sample of the negative films. A sub-sample of 153 confirmed positive cases were matched for age and sex using cases without Paget's disease and these pairs were assessed by two observers working in tandem. The hip joints were scored 0-5 using a modification of the original descriptive classification of Kellgren and Lawrence and minimum joint space of the hip was also measured. RESULTS: Not all cases were available for assessment. A total of 248 films were included (137 without Paget's, 89 with unilateral and 22 with bilateral disease). The mean age of the cases and controls was 78.4 years and 77.4 years respectively with 66/45 male/female cases and 78/59 male/female controls. One hundred and twenty nine affected hips were available for comparison with 352 unaffected hips. Median joint space narrowing for the affected hip was 3 mm (range, 0-5 mm) and for the unaffected hip 4 mm (range, 0-6 mm, Mann-Whitney U test, p=0.00001). Median Kellgren and Lawrence grade for both groups was 0, with no statistical difference between the groups (Mann-Whitney U test, p=0.74). In terms of severity of osteoarthritis, there were 19 instances of grades 2+ in the unaffected hips, and only five in the affected hips. CONCLUSIONS: Pagetic coxopathy is characterised by loss of joint space, which may represent a secondary chondropathy. Although joint failure may result from this secondary chondropathy progression may be dependent on non-Pagetic factors. It is also possible that the usual radiological features of osteoarthritis may be modified or obscured by the Paget's disease. (+info)
Perceptual variation in grading hand, hip and knee radiographs: observations based on an Australian twin registry study of osteoarthritis.
(27/1417)
OBJECTIVE: The radiographic diagnosis of osteoarthritis (OA) in the peripheral skeleton is dependent on the skilled examination of several morphological characteristics of the condition as visualised on plain radiographs. However, the process is perceptual and generally enhanced by comparison against photographic standards. This study assessed the intra-rater and inter-rater reliability of radiologists experienced in reporting hand, hip and knee films derived from a community-based sample when using the photographic atlas recently developed by Burnett et al. METHODS: This study was part of a multifaceted diagnostics protocol, evaluating methodological issues, in the conduct of genetic research in osteoarthritis. From a cohort of 118 twin pairs, registered with the Australian Twins Registry (ATR), standard clinical examinations were performed on 74 complete and 11 incomplete pairs of twins over age 50 years, followed by standard AP hand, AP pelvis and AP standing radiographs of the knees. The pairs were selected both to represent twin pairs who had previously self reported a diagnosis of OA, as well as those who had not. Radiologists read the films blind to the original self reported diagnosis and without reference to their pairing. The films were read by comparison against photographic standards and were scored according to specific features. All films were read independently by two consultant radiologists blind to one another's assessments, and selected films were thereafter assigned for rereading. Inter-rater and intra-rater agreement were different for different features, different anatomic areas, and, for the former, were different for the two radiologists. RESULTS: Inter-rater agreement was different for different anatomic areas, different radiographic features, and the two radiologists. Intra-rater agreement for the presence or absence of OA was as follows: actual observed agreement = 0.79 to 0.97 and 0.83 to 0.98; adjusted kappa statistic = 0.58 to 0.94 and 0.67 to 0.96; inter-rater agreement was as follows: actual observed agreement = 0. 77 to 0.97; adjusted kappa statistic = 0.54 to 0.94. Agreement was generally high in most of the principal target joints for OA: DIP, PIP, 1st CMC, hip and knee. CONCLUSIONS: Although assessor agreement was not perfect, it is concluded that for genetic epidemiology purposes, while duplicate assessments may be advantageous, it is possible for radiographs to be examined accurately by a single experienced assessor. However, for less experienced assessors independent examinations should be made by at least two assessors and either a consensus reached on disparate examinations or an algorithm developed to adjudicate any discrepancies. (+info)
Stem length and canal filling in uncemented custom-made total hip arthroplasty.
(28/1417)
We reviewed 60 custom-made femoral components of two different lengths : 125 mm (group A) and 100 mm (group B), in order to investigate the relationship between stem length and canal filling in uncemented custom-made total hip arthroplasty. There were no statistical differences between the two groups in age, gender, height, body weight, canal flare index, or bowing angle of the femur. Postoperatively there was no statistical difference between the two groups in the proximal canal filling, but significant difference in the distal canal filling (75.5% vs 85.8% on the anteroposterior view and 76.0% vs 82.5% in the lateral view, P<0.001). The distal canal filling inversely correlated with the ratio of the proximal portion and the distal portion of the stem curvature on the lateral view (lateral curve ratio of the stem, P=0.002). We conclude that superior filling at both the proximal and the distal levels can be obtained by using 100-mm custom made components with a small lateral curve ratio. (+info)
The incidence of enlarged chondrons in normal and osteoarthritic human cartilage and their relative matrix density.
(29/1417)
OBJECTIVE: To quantitate changes in the pericellular matrix in osteoarthritic (OA) articular cartilage. DESIGN: Chondrons were enzymatically isolated from normal and OA human cartilage. The cross-sectional area of the chondrons were measured. After immunolabeling for keratan sulfate, type VI collagen and type II collagen, the relative matrix density was determined for different size classes of chondrons with quantitative fluorescence microscopy. RESULTS: For individual chondrons, the average cross-sectional area (344+/-28 microm(2), mean+/-SE) for the normal specimens was significantly smaller than the average area (439+/-30 microm(2)) for the OA specimens. Using 496 microm(2) (mean+2 SD of the normal area) as the cut-off for enlarged chondrons, 33% of individual OA chondrons were enlarged compared to 16% for the normal. Chondrons under 300 microm(2) had a significantly higher density of keratan sulfate and type VI collagen than larger chondrons, while chondrons over 400 microm(2) had similar matrix densities. CONCLUSIONS: There is a higher incidence of enlarged chondrons in OA cartilage than in normal cartilage. The enlargement may initially be due to hydrodynamic swelling but further increases in size are due to increased matrix deposition. (+info)
Factors associated with hip joint rotation in former elite athletes.
(30/1417)
OBJECTIVES: To study factors associated with passive hip rotation range of motion (ROM) in former elite male athletes. METHODS: Athletes were interviewed about hip pain, disability, lifetime occupational loading, and athletic training. The passive hip rotation was measured with a Myrin inclinometer in 117 former elite male long distance runners, soccer players, weight lifters, and shooters aged 45-68 years. Magnetic resonance imaging was used to detect hip osteoarthritis. RESULTS: There were no differences in passive hip rotation ROM between the four athlete groups nor between diverging lifetime loading patterns associated with occupational or athletic activities. Among the subjects without hip osteoarthritis, hip pain, and hip disability according to a stepwise linear regression analysis, the only factor that was associated with the passive hip rotation ROM was body mass index (BMI), explaining about 21% of its variation. Subjects with high BMI had lower passive hip rotation ROM than those with low BMI. There was no right-left difference in the mean passive hip rotation ROM in subjects either with or without hip osteoarthritis as determined by magnetic resonance imaging. Nevertheless, hip rotation ROM was clearly reduced in a few hips with severe caput deformity. CONCLUSIONS: Long term loading appears to have no association with passive hip rotation ROM. On the other hand, the hip rotation value was lower in subjects with high BMI than in those with low BMI. A clear right-left difference in hip rotation was found only in those subjects who, according to our magnetic resonance imaging criteria, had severe hip osteoarthritis. These findings should be taken into account when hip rotation ROM is used in the clinical assessment of hip joints. (+info)
Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures.
(31/1417)
OBJECTIVE: To determine if acetabular dysplasia increases the risk of incident hip osteoarthritis (OA) among elderly white women. METHODS: Baseline and followup anteroposterior pelvic radiographs were obtained a mean of 8 years apart, and read for individual radiographic features (IRFs) of hip OA; summary grades (0-4) were then assigned based on the IRFs present. Acetabular dysplasia was defined by the results of measurements of the acetabular depth (<9 mm) or the center-edge angle (<30 degrees). Logistic regression analyses were performed to determine the association between acetabular dysplasia and incident hip OA, and all analyses were adjusted for age, current weight, body mass index, affected side, and investigational site. RESULTS: The odds ratios for the association of abnormal center-edge angle and acetabular dysplasia with incident hip OA were 3.3 (95% confidence interval 1.1-10.1) and 2.8 (95% confidence interval 1.0-7.9), respectively. CONCLUSION: Acetabular dysplasia, defined by a decrease in the center-edge angle, is associated with a modestly increased risk of incident hip OA in elderly white women. (+info)
Sonography for hip joint effusion in adults with hip pain.
(32/1417)
OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences. RESULTS: "Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION: This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs. (+info)