Browsing by Subject "knee"
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Item Effects of Osteopathic Manipulative Treatment on Osteoarthritis(2000-08-01) Pham, Chau N.Osteoarthritis (OA) is the most prevalent form of arthritis in the United States. Of those 65 to 74 years old, 18 per 100 women and 8 out of 100 men will experience OA of the knee. (Towheed and Hochberg, 1997) The Center for Disease Control and Prevention (CDC) reported a high prevalence for disability for person [greater than] 65 years. Arthritis or rheumatism accounts for 7.2 million (17.1%) people ranking above back problems and heart disease. (CDC, 1994) The Framingham epidemiologic study of knee osteoarthritis estimated a 27% prevalence for those 44% of those [greater than] 80 years. Nelson, Naimark, Anderson, Kazis, Castell & Meenan, 1987) This study uses the principles of Osteopathy to treat OA for the elderly as osteopathic manipulative treatment (OMT) specifically addresses the symptoms and signs of OA. The typical symptom of OA is pain stiffness “in and around a joint accompanied by limitation of function.” (Klippel, 1997) Pain from OA may originate from “periostitis at sites of bony remodeling; subchondral microfractures; irritation of sensory nerve endings in the synovium from osteophytes; periarticular muscle spasm; bony angina due to decreased blood flow and/or elevated intraosseous pressure; and synovial inflammation accompanied by release of prostaglandins, leukotrienes, and other cytokine.” (Klippel, 1997) Other symptoms include morning stiffness, gel phenomenon, buckling/instability. The signs of OA are bony enlargements, limitation of range of motion, crepitus, tenderness on pressure, pain, join effusion, malalignment and/or joint deformity. (Hazzard, 1999) Most often, pain and limitation of movement from OA cause signficiant changes in lifestyle for the older adult; functional independence is adversely affected. Decreased functional independence that affects the quality of life makes this the most debilitating illness in the 65 and older population. Studies have shown that patients with osteoarthritis of the hip and knee have comparable number of days with restricted activity as patients rheumatoid arthritis. (Towheed, 1997; Holman & Lorig, 1997). Treatment goals for managing osteoarthritic patients is to control pain subsequently minimizing functional limitation and disability. (Hazzard, 1999) To treat the above dysfunction, current treatments for OA include pharmacologic agents such as NSAIDs, analgesics, intra-articular steroid injections, topical analgesics; glucosamine sulfate and hyaluronic acid; nonpharmacologic measures include weight reduction, therapeutic ultrasound, acupuncture, transcutaneous electrical nerve simulation (TENS), physical therapy, pulsed electrical stimulation, orthotics, hydrotherapy, self management courses, and support groups. (Womheim, 1996; Zizic, 1995; Creamer, 1997; & McNoll, 199*) The primary objective of pharmacologic treatments is to decrease pain resulting in an increased functional capacity and improved quality of life. There are side effects and limitations to pharmacologic regimens. For example, the usage of NSAIDs in the treatment of the elderly can result in gastrointestinal bleeding. (McNoll, 1998) Non-pharmacologic treatments are viable alternatives in treating osteoarthritis; osteopathic manipulative treatment is such an alternative. A primary osteopathic principle dictates that structure and function are reciprocally inter-related. Any change from the “normal” is called somatic dysfunction. Specifically, somatic dysfunction is the altered or impaired function of related components of the somatic (body framework) system-skeletal, arthrodial, and myofascial structures and related vascular, lymphatic, and neural elements. (Greenman, 1989) OMT is used to return the body to its normal state by increasing symmetry and motion thereby improving body balance and reducing inflammation and pain by increasing fluid flow. When considering the physiological causes for OA of the knee coupled with the side effects from pharmacological treatment, health care providers must consider alternative treatments. The principles of osteopathy provide a logical spring board to meet that challenge. This present study provides a preliminary understanding of the efficacy of OMT for OA of the knee.Item Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit(1997-06-01) Brittain, Paul D.; Licciardone, John C.Brittain, Paul D., Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit Master of Public Health (Biomedical Sciences), June, 1997, 75 pp., 12 tables, bibliography, 16 titles. The primary purpose of this study was to determine the efficacy of osteopathic manipulative treatment (OMT) in improving clinical outcomes in patients who had undergone a surgical procedure for either a hip fracture or osteoarthritis affecting the hip or knee. OMT treatment subjects were recruited from an inpatient rehabilitation unit housed with an osteopathic hospital. OMT subjects received a standard course of OMT throughout their stay in the rehabilitation unit. Clinical outcomes were assessed principally through the administration of the Functional Independence Measure (FIM), a standard disability measure, to study subjects on admission to and discharge from the rehabilitation unit. Mean FIM score charges were compared between the OMT and a control group of similar patients. Receipt of OMT was associated with shorter length-of-stay, higher total FIM score change, and greater improvement on FIM locomotion items. These findings suggest that OMT is a beneficial therapy for this population of patients.Item EVALUATION OF INTRAOPERATIVE LIGAMENT INJURY DURING TOTAL KNEE ARTHROPLASTY INVOLVING RESIDENT TRAINING(2014-03) Joseph, Ryan; Wagner, Russell; Webb, BrianThe purpose of this study is to evaluate if the operative experience level of residents affects the incidence of ligament injuries in patients who have received a total knee arthroplasty. Purpose (a): The focus of this study was to evaluate intraoperative errors in the performance of total knee arthroplasties (TKAs) and compare the error rate of when a junior resident versus a senior resident served as the primary surgeon. Methods (b): A restrospective analysis was performed on all of the TKAs performed by either a junior or senior resident, directly supervised by Russell Wagner, MD, over a four year period of time. This study identified 346 cases, 143 of which were performed by a junior resident and 203 of which were performed by a senior resident. Incidence of injury was also evaluated to determine if intraoperative errors occur as frequently throughout a given rotation or if the occurrences decreased as the rotation progressed. In addition to this, differences between rotations taking place at the beginning of the year and rotations occuring at the end of the year was also investigated. Finally, the last factor analyzed was whether there was a correlation between a patient’s BMI and a ligament injury. Results (c): Of the 346 total knee arthroplasties performed from January 1, 2008 to December 31, 2012, there was an incidence of ligament injury in 7.5% of the cases. The occurrence of injury in which junior residents performed the surgery was 6.3%, compared to 8.3% when senior residents performed the surgery. There were no significant differences between junior or senior residents performing the surgery with regards to intraoperative ligament or tendon injury (p=. 58). The most common ligament injured was the medial collateral in 11 (3%); other ligament injuries included the posterior cruciate ligament in 10 (3%), the patellar tendon in 3 (1%), the popliteus tendon in 2 (.5%), and the lateral collateral ligament and iliotibial band in 1 (.3%). There was no relationship between ligament/tendon damage and in which month of the rotation the surgery was performed. There was also no correlation between rotations during the beginning versus the end of the year. 1 ligament/tendon injury occurred in 89 patients (1%) with a BMI of 30 or less while 25 ligament/tendon injuries occurred in 257 patients (10%) with a BMI of more than 30. This difference was statistically significant (p=.034). Conclusions (d): This analysis suggests that supervised junior residents may safely play a more active role when performing total knee arthroplasty since their involvement is not associated with increased intraoperative ligament or tendon injury. This information may assist attending orthopaedic surgeons and resident training programs in determining the role of junior residents during surgery.Item Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study(2020-09-16) Zeng, Chao; Bennell, Kim; Yang, Zidan; Nguyen, Uyen-Sa D. T.; Lu, Na; Wei, Jie; Lei, Guanghua; Zhang, YuqingOBJECTIVES: Osteoarthritis is a leading cause of immobility and joint replacement, two strong risk factors for venous thromboembolism (VTE). We aimed to examine the relation of knee, hip and hand osteoarthritis to the risk of VTE and investigate joint replacement as a potential mediator. METHODS: We conducted three cohort studies using data from The Health Improvement Network. Up to five individuals without osteoarthritis were matched to each case of incident knee (n=20 696), hip (n=10 411) or hand (n=6329) osteoarthritis by age, sex, entry time and body mass index. We examined the relation of osteoarthritis to VTE (pulmonary embolism and deep vein thrombosis) using a multivariable Cox proportional hazard model. RESULTS: VTE developed in 327 individuals with knee osteoarthritis and 951 individuals without osteoarthritis (2.7 vs 2.0 per 1000 person-years), with multivariable-adjusted HR being 1.38 (95% CI 1.23 to 1.56). The indirect effect (HR) of knee osteoarthritis on VTE through knee replacement was 1.07 (95% CI 1.01 to 1.15), explaining 24.8% of its total effect on VTE. Risk of VTE was higher in hip osteoarthritis than non-osteoarthritis (3.3 vs 1.8 per 1000 person-years; multivariable-adjusted HR=1.83, 95% CI 1.56 to 2.13). The indirect effect through hip replacement yielded an HR of 1.14 (95% CI 1.04 to 1.25), explaining 28.1% of the total effect. No statistically significant difference in VTE risk was observed between hand osteoarthritis and non-osteoarthritis (1.5 vs 1.6 per 1000 person-years; multivariable-adjusted HR=0.88, 95% CI 0.67 to 1.16). CONCLUSION: Our large population-based cohort study provides the first evidence that knee or hip osteoarthritis, but not hand osteoarthritis, was associated with an increased risk of VTE, and such an association was partially mediated through knee or hip replacement.