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Рубрика: Остеоартрит коленного сустава

Новый сисобзор! Orhurhu 2019

Откуда инфа? См. запрос PubMed!

@article{Orhurhu2019,
 title = {Systematic {Review} of {Radiofrequency} {Ablation} for {Management} of {Knee} {Pain}},
 volume = {23},
  issn = {1534-3081},
 doi = {10.1007/s11916-019-0792-y},
  abstract = {PURPOSE OF REVIEW: Chronic pain of the lower extremity remains challenging to manage. Radiofrequency ablation procedure applies heat to nerve fibers with the goal of mitigating chronic pain conditions of the knee. However, the clinical efficacy has not yet been adequately established. The goal of this review paper is to report the use of radiofrequency ablations in the treatment of osteoarthritis of the knee.
RECENT FINDINGS: PubMed and the Cochrane Controlled Trials Register were searched (final search 28 February 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," and "pain" in the English literature. Bibliographies of the published papers were screened for relevance to lower extremity radiofrequency ablation therapies. The quality of selected publications was assessed using the Cochrane risk of bias instrument. Of the 923 papers screened, 317 were further investigated for relevance. Our final search methodology yielded 19 studies that investigated the use of radiofrequency ablation at the knee. Of these 19 studies, there were four randomized control trials, two non-randomized control trials, three prospective studies, two retrospective studies, one case-control study, one technical report, and seven case reports. In summary, the data available suggests radiofrequency ablation as a promising and efficacious with all 19 studies revealing significant short- and long-term pain reductions in patients with knee pain.},
  language = {eng},
   number = {8},
   journal = {Current Pain and Headache Reports},
  author = {Orhurhu, Vwaire and Urits, Ivan and Grandhi, Ravi and Abd-Elsayed, Alaa},
 month = jul,
    year = {2019},
  pmid = {31286282},
  keywords = {Knee pain, Neurolysis, Pain therapy, RFA, Radiofrequency ablation, Radiofrequency therapy},
 pages = {55}
}

Новый сисобзор! Price 2019

Откуда инфа? См. запрос PubMed!

@article{Price2019,
    title = {The {Arthroplasty} {Candidacy} {Help} {Engine} tool to select candidates for hip and knee replacement surgery: development and economic modelling},
    volume = {23},
    issn = {2046-4924},
    shorttitle = {The {Arthroplasty} {Candidacy} {Help} {Engine} tool to select candidates for hip and knee replacement surgery},
    doi = {10.3310/hta23320},
    abstract = {BACKGROUND: There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS.
OBJECTIVES/RESEARCH QUESTIONS: Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery?
METHODS: A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process.
RESULTS: From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75\% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of {\textless} £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores.
LIMITATIONS: The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery.
CONCLUSION: The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility.
FUTURE WORK: Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions.
FUNDING: The National Institute for Health Research Health Technology Assessment programme.},
    language = {eng},
    number = {32},
    journal = {Health Technology Assessment (Winchester, England)},
    author = {Price, Andrew and Smith, James and Dakin, Helen and Kang, Sujin and Eibich, Peter and Cook, Jonathan and Gray, Alastair and Harris, Kristina and Middleton, Robert and Gibbons, Elizabeth and Benedetto, Elena and Smith, Stephanie and Dawson, Jill and Fitzpatrick, Raymond and Sayers, Adrian and Miller, Laura and Marques, Elsa and Gooberman-Hill, Rachael and Blom, Ashley and Judge, Andrew and Arden, Nigel and Murray, David and Glyn-Jones, Sion and Barker, Karen and Carr, Andrew and Beard, David},
    month = jun,
    year = {2019},
    pmid = {31287051},
    keywords = {ARTHROPLASTY, COST–UTILITY ANALYSIS, HIP, KNEE, OSTEOARTHRITIS, OUTCOME, REFERRAL, SYSTEMATIC REVIEW, THRESHOLD},
    pages = {1--216}
}