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Decision algorithms for the re-treatment with viscosupplementation in patients suffering from knee osteoarthritis
Abstracts / Osteoarthritis and Cartilage 25 (2017) S76eS444
575 SPONTANEOUS PAIN IN A MONOARTICULAR OSTEOARTHRITIS MURINE MODEL: EFFECT OF GENDER AND CHRONICITY ON WEIGHT BEARING H.E. Krug y, N. Blanshan z, S.P. Frizelle z. y Univ. of Minnesota, Minneapolis, MN, USA; z VA Hlth. Care System, Minneapolis, MN, USA Purpose: To examine gender differences in spontaneous weight bearing pain behaviors in C57Bl6 mice with osteoarthritis (OA) in order to better define pain behaviors in this important model of arthritis pain. Methods: Male and female C57Bl6 mice were examined at twelve weeks of age. Chronic OA was produced by intra-articular (IA) injection of 10 IU Type IV Collagenase into the left knee. The contralateral, nonarthritic knee served as the non-painful control. Pain behavior was measured at four or six weeks post-collagenase injection. Spontaneous pain behaviors were measured by Automated Dynamic Weight Bearing (ADWB) (Bioseb, Vitrolles, France). Evoked pain response (EPR) was measured by calculating fights and vocalizations over a time period of 1 min with repeated firm palpation of the knees (tenderness). Analgesic therapies included 0.02IU onabotulinum toxin (BTX), 10 ml 0.01% capsaicin (CAP), or 10 ml 0.001% resiniferatoxin (RTX). Results: OA produced significantly increased evoked pain responses (p < 0.05) in both male (4.0) and female mice (6.31) after 4 weeks. However, 4 weeks after arthritis induction, neither male nor female mice demonstrated any significant alteration in weight bearing on the arthritic left hind limb. At 4 weeks, female arthritic mice spent a significantly greater percentage of time (61.07, p < 0.001) and a greater proportion of weight (21.81, p < 0.002) on the forelimbs than nonarthritic mice (36.99, 12.64, respectively). IA BTX in the arthritic joint corrected this offloading in female mice. Arthritic male mice at 4 weeks did not seem to offload the arthritic limb either to the normal contralateral hind limb or to the forelimbs, but after 6 weeks of arthritis, male mice demonstrated increased weight (15.82%) and time (45.22%) on forelimbs (p < 0.05) compared to 8.23% and 27.23% weight and time respectively. Both IA CAP and RTX normalized forepaw weight bearing in the arthritic male mice. Interestingly, evoked pain responses were not increased in male mice after 6 weeks of arthritis. Conclusions: These data demonstrate that collagenase induced arthritis pain is detectable in male and female C57Bl6 mice. Joint tenderness is increased in both sexes early in disease and demonstrates an analgesic response. Alterations in weight bearing were seen in both males and females with OA and normalized with IA analgesics, but weight bearing changes in males only appeared after arthritis was more chronic and evoked pain had resolved. Osteoarthritis pain in mice is subtle, does not greatly interfere with function, and is a challenge to measure. Chronicity and gender are important variables. In quadrupeds consideration of all possible alterations in weight bearing must be investigated in order to detect evidence of spontaneous pain. 576 WHAT EXACTLY IS A GOOD OUTCOME FOR TKR? AND WHAT PROPORTION OF PATIENTS EXPERIENCE ONE? A. Gao, D.J. Beard, A.J. price. Univ. of Oxford, Oxford, United Kingdom Purpose: In the field of total knee replacement (TKR) surgery, the importance of using patient reported outcome measures (PROMs) to assess surgical outcome has been widely accepted. However, a problem still remains - how much improvement is clinically significant? Researchers are therefore trying to identify important threshold values e the cut-off score separating a good outcome from a bad one. In previous studies, the reported proportion of “good outcomes” varied significantly: from as low as 53% to 79%. The aim of this study was to gain greater insight into the outcome of TKR by determining the proportion of patients experiencing a “good outcome” using four different wellrecognised criteria, and compare the results obtained via each method. Methods: This study used the freely available TKR-PROMs dataset (2012e2013, n ¼ 40,622), which was prospectively collected through the National Health Service. The main outcome measure is the 12-item Oxford Knee Score (OKS) e a validated instrument designed to assess the outcome of TKR. To assess pain and function separately, the 7-item OKS-pain component subscale (OKS-PCS) and 5-item OKS-function component subscale (OKS-FCS) were used. All data were analysed using
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R 3.3.0 programming language. Currently there are no universallyapproved criteria for defining “good outcome” following TKR. In this study we used four existing criteria: Difference between pre- and post-operative OKS (DOKS) must reach 1/2 standard deviation (SD) of the average baseline OKS for the total patient population. DOKS must reach minimal important change (MIC) - the average change in OKS associated with patients who feel “a little better” post-surgery. DOKS or 6-month post-op OKS must reach the patient acceptable symptom state (PASS) score, which separates the satisfied from the unsatisfied. The modified OMERACT-OARSI criteria, which categorises patients as “responders” and “non-responders” based on their relative and absolute change in pain and function. Results: For the 1/2 SD criterion, 88% of patients achieved the cut-off score for OKS-Summary, almost 90% achieved the cut-off for OKS-PCS, and 77% met the threshold for OKS-FCS. For MIC, the proportion of patients who met the threshold was 74%. When evaluated using the PASS scores, 71% met the threshold for DOKS, and 72% achieved the cut-off for 6-month post-operative score. Lastly, 83% patients met the modified OARSI criteria. Conclusions: This study used a large, prospectively collected dataset containing demographic and clinical information on over 40,000 TKR patients. The size and comprehensiveness of the data condones a high validity to our results. We have shown that the levels of improvement in terms of pain, function, global perceived improvement and satisfaction is high following TKR. Depending on the particular criterion used, the prevalence of good outcome range between 71% (PASS change score) and 90% (1/2 SD of OKS-PCS). Within each criterion, pain improves more significantly than function. Threshold values are useful in the sense that they assign qualitative meanings to quantitative scores, separating patients who truly feel better from those who do not. One drawback associated with using threshold values is that they are inherently binary, separating patients into “satisfied” versus “unsatisfied”, “good” versus “bad” outcome, expectation “fulfilled” versus “unfulfilled”. In reality, treatment outcomes often fall into multiple categories, as opposed to only two levels. 577 DECISION ALGORITHMS FOR THE RE-TREATMENT WITH VISCOSUPPLEMENTATION IN PATIENTS SUFFERING FROM KNEE OSTEOARTHRITIS Y. Henrotin y, P. Richette z, R. Raman x, T. Conrozier k, D. Baron ¶, J. Jerosch #, A. Migliore yy, J. Montfort zz, H. Bard xx, X. Chevalier kk. y CHU Sart-Tilman, Li ege, Belgium; z Hosp. Lariboisi ere, Paris, France; x Hull and East Yorkshire NHS trust Castle Hill Hosp., Cottingham, United Kingdom; k Nord Franche Comt e Hosp., Belfort, France; ¶ Ctr. de r eadaptation fonctionnelle de Lannion-Trestel, Tr evou- Tr eguignec, France; # Johanna-Etienne-Hosp., Neuss, Germany; yy Ospedale San Pietro zz Hosp. del Mar, Parc de Salut Mar, Fatebenefratelli, Rome, Italy; Barcelone, Spain; xx Hosp. Europeen Georges Pompidou, Paris, France; kk Henri Mondor Hosp., Creteil, France Purpose: Viscosupplementation is a symptomatic treatment of knee osteoarthritis. Although systematic reviews of its repeat use showed favourable benefit/risk ratio, no study was focused on the indication of re-treatment. Methods: A task force was created to look t issues regarding re-treatment with viscosupplementation in knee osteoarthritis. An attempt was made to reach consensus on several issues: 1) to define treatment “success” and “failure”. 2) to determine when to retreat patients successfully treated by a previous VS. 3) to determine how to re-treat patients in whom VS failed. 4) to define what to do in case of adverse reaction following previous VS. 5) to examine the interests of soluble biomarkers to manage re-treatment. After debate and review of literature the working group voted on 88 issues. Scoring and voting methods: For each statement, the experts had to score according to their degree of agreement, using an 4-point Likert scale (0e3), 0 meaning « I don’t agree », 1 “I tend to disagree”, 2 “I tend to agree” and 3 «I agree ». After discussion each item was finally classified into 2 categories: “Agree” or “Disagree”. The statement was adopted and was consequently included into the decision algorithm only if 8 experts or more voted either to “Agree“ or “Disagree”. At the end of the session, 2 “Decision Trees” regarding re-treatment with VS were built according to the results of the votes: one after failure and the second after success of a previous VS.
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Abstracts / Osteoarthritis and Cartilage 25 (2017) S76eS444
Results: In case of failure, the authors draw attention to the need of a rigorous clinical and radiological analysis, and the respect of EvidenceBased-Medicine. When VS was previously successful, re-treatment can be considered after recurrence or increase in pain. However, in subjects with high risk of disease progression, in young patients, and in professional sportsmen re-treatment could be considered systematically, because of the probability of HA to slow OA progression. Evidence on soluble biomarkers was not considered as enough strong to support their use as decision tools for patient re-treatment. VS.
Methods: Design: Systematic review and meta-analysis. Eligibility criteria for selecting studies: Longitudinal cohort studies were included in the review. To be included, studies needed to assess the association between obesity or physical activity participation assessed at baseline and clinical outcomes (i.e. pain, disability, and adverse events) following hip or knee arthroplasty. Data extraction: Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. Results: 63 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that non-obese participants tended to suffer less pain, less disability and report fewer postsurgical complications when compared to the obese participants. Limitations of this review: We have dichotomized follow-up duration into short-term or long-term follow-up. There was large heterogeneity in duration of follow-ups within each category. Only four studies assessed the impact of physical activity participation on surgical outcomes and given their methodological discrepancies, no pooled analysis was conducted. Conclusions: Pre-surgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. Systematic review registration: PROSPERO registration CRD42016032711. 579 ASSOCIATION BETWEEN DAIRY PRODUCE CONSUMPTION AND INCIDENCE OF TOTAL HIP ARTHROPLASTY FOR OSTEOARTHRITIS S. Hussain y, F. Cicuttini y, G. Giles y, S. Graves z, A. Wluka y, Y. Wang y. y Monash Univ., Melbourne, Australia; z South Australian Hlth.and Med. Res. Inst., Adelaide, Australia
Figure 1. Algorithm of recommendations for re-treatment with viscosupplementation of patients after failure of a previous viscosupplementation.
Figure 2. Algorithm of recommendations for re-treatment with viscosupplementation of patients improved by a previous viscosupplementation. Conclusions: The 2 Decision algorithms are intended to facilitate consideration of the therapeutic options, in patients with knee osteoarthritis previously treated with viscosupplementation. 578 CAN PHYSICAL ACTIVITY AND OBESITY PREDICT OUTCOMES OF ELECTIVE KNEE OR HIP SURGERY DUE TO OSTEOARTHRITIS? e A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES D. Pozzobon y, z, G.C. Machado y, x, P.H. Ferreira y, F.M. Blyth y, M.L. Ferreira y, x. y Univ. of Sydney, Sydney, Australia; z Inst. of Bone and Joint Res., Sydney, Australia; x The George Inst. for Global Hlth., Sydney, Australia Purpose: The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis searching the Medline, CINAHL, EMBASE, and Web of Science electronic databases.
Purpose: The aim of this prospective cohort study was to determine whether dairy produce consumption was associated with the incidence of total hip arthroplasty for osteoarthritis. Methods: 38,924 participants from the Melbourne Collaborative Cohort Study who had dairy produce consumption recorded in 1990e1994 were examined. The incidence of total hip arthroplasty for osteoarthritis during 2001e2013 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Results: Over an average of 11.8 years follow-up, 1,505 total hip arthroplasties for osteoarthritis were identified (524 in men; 981 in women). In men, a one-standard-deviation increase in dairy produce consumption was associated with a 21% increased incidence of total hip arthroplasty for osteoarthritis (HR 1.21, 95% CI 1.10e1.33), with a doseresponse relationship observed for quartiles of dairy produce consumption (P for trend ¼ 0.001). These results were independent of age, body mass index, country of birth, education, smoking status, vigorous physical activity, calcium supplementation, energy consumption, circulating 25-hydroxyvitamin D, hypertension and diabetes. No significant association was observed for women (HR 1.02, 95% CI 0.95e1.09). Conclusions: Increasing dairy produce consumption was associated with an increased risk of total hip arthroplasty for osteoarthritis in men. Understanding the mechanism will be important to optimize prevention of hip osteoarthritis, particularly for men. 580 CONSTRUCT VALIDITY AND INTER-OBSERVER RELIABILITY OF CLINICAL ASSESSMENT OF PASSIVE HIP RANGE OF MOTION TESTS IN PATIENTS WITH LONGSTANDING HIP/GROIN PAIN A. Pålsson y, I. Kostogiannis y, z, E. Ageberg y. y Dept. of Hlth.Sci., Lund Univ., Lund, Sweden; z Dept. of Clinical Sci., Lund, Lund Univ., Lund, Sweden Purpose: Longstanding hip/groin pain (LHGP) is a common problem in the young to middle-aged physically active population. These patients have functional limitations, reduced quality of life and are at high risk of early-onset osteoarthritis. Due to the likely multistructural origin of the pain, diagnostics is a challenge in this patient
575 SPONTANEOUS PAIN IN A MONOARTICULAR OSTEOARTHRITIS MURINE MODEL: EFFECT OF GENDER AND CHRONICITY ON WEIGHT BEARING H.E. Krug y, N. Blanshan z, S.P. Frizelle z. y Univ. of Minnesota, Minneapolis, MN, USA; z VA Hlth. Care System, Minneapolis, MN, USA Purpose: To examine gender differences in spontaneous weight bearing pain behaviors in C57Bl6 mice with osteoarthritis (OA) in order to better define pain behaviors in this important model of arthritis pain. Methods: Male and female C57Bl6 mice were examined at twelve weeks of age. Chronic OA was produced by intra-articular (IA) injection of 10 IU Type IV Collagenase into the left knee. The contralateral, nonarthritic knee served as the non-painful control. Pain behavior was measured at four or six weeks post-collagenase injection. Spontaneous pain behaviors were measured by Automated Dynamic Weight Bearing (ADWB) (Bioseb, Vitrolles, France). Evoked pain response (EPR) was measured by calculating fights and vocalizations over a time period of 1 min with repeated firm palpation of the knees (tenderness). Analgesic therapies included 0.02IU onabotulinum toxin (BTX), 10 ml 0.01% capsaicin (CAP), or 10 ml 0.001% resiniferatoxin (RTX). Results: OA produced significantly increased evoked pain responses (p < 0.05) in both male (4.0) and female mice (6.31) after 4 weeks. However, 4 weeks after arthritis induction, neither male nor female mice demonstrated any significant alteration in weight bearing on the arthritic left hind limb. At 4 weeks, female arthritic mice spent a significantly greater percentage of time (61.07, p < 0.001) and a greater proportion of weight (21.81, p < 0.002) on the forelimbs than nonarthritic mice (36.99, 12.64, respectively). IA BTX in the arthritic joint corrected this offloading in female mice. Arthritic male mice at 4 weeks did not seem to offload the arthritic limb either to the normal contralateral hind limb or to the forelimbs, but after 6 weeks of arthritis, male mice demonstrated increased weight (15.82%) and time (45.22%) on forelimbs (p < 0.05) compared to 8.23% and 27.23% weight and time respectively. Both IA CAP and RTX normalized forepaw weight bearing in the arthritic male mice. Interestingly, evoked pain responses were not increased in male mice after 6 weeks of arthritis. Conclusions: These data demonstrate that collagenase induced arthritis pain is detectable in male and female C57Bl6 mice. Joint tenderness is increased in both sexes early in disease and demonstrates an analgesic response. Alterations in weight bearing were seen in both males and females with OA and normalized with IA analgesics, but weight bearing changes in males only appeared after arthritis was more chronic and evoked pain had resolved. Osteoarthritis pain in mice is subtle, does not greatly interfere with function, and is a challenge to measure. Chronicity and gender are important variables. In quadrupeds consideration of all possible alterations in weight bearing must be investigated in order to detect evidence of spontaneous pain. 576 WHAT EXACTLY IS A GOOD OUTCOME FOR TKR? AND WHAT PROPORTION OF PATIENTS EXPERIENCE ONE? A. Gao, D.J. Beard, A.J. price. Univ. of Oxford, Oxford, United Kingdom Purpose: In the field of total knee replacement (TKR) surgery, the importance of using patient reported outcome measures (PROMs) to assess surgical outcome has been widely accepted. However, a problem still remains - how much improvement is clinically significant? Researchers are therefore trying to identify important threshold values e the cut-off score separating a good outcome from a bad one. In previous studies, the reported proportion of “good outcomes” varied significantly: from as low as 53% to 79%. The aim of this study was to gain greater insight into the outcome of TKR by determining the proportion of patients experiencing a “good outcome” using four different wellrecognised criteria, and compare the results obtained via each method. Methods: This study used the freely available TKR-PROMs dataset (2012e2013, n ¼ 40,622), which was prospectively collected through the National Health Service. The main outcome measure is the 12-item Oxford Knee Score (OKS) e a validated instrument designed to assess the outcome of TKR. To assess pain and function separately, the 7-item OKS-pain component subscale (OKS-PCS) and 5-item OKS-function component subscale (OKS-FCS) were used. All data were analysed using
S357
R 3.3.0 programming language. Currently there are no universallyapproved criteria for defining “good outcome” following TKR. In this study we used four existing criteria: Difference between pre- and post-operative OKS (DOKS) must reach 1/2 standard deviation (SD) of the average baseline OKS for the total patient population. DOKS must reach minimal important change (MIC) - the average change in OKS associated with patients who feel “a little better” post-surgery. DOKS or 6-month post-op OKS must reach the patient acceptable symptom state (PASS) score, which separates the satisfied from the unsatisfied. The modified OMERACT-OARSI criteria, which categorises patients as “responders” and “non-responders” based on their relative and absolute change in pain and function. Results: For the 1/2 SD criterion, 88% of patients achieved the cut-off score for OKS-Summary, almost 90% achieved the cut-off for OKS-PCS, and 77% met the threshold for OKS-FCS. For MIC, the proportion of patients who met the threshold was 74%. When evaluated using the PASS scores, 71% met the threshold for DOKS, and 72% achieved the cut-off for 6-month post-operative score. Lastly, 83% patients met the modified OARSI criteria. Conclusions: This study used a large, prospectively collected dataset containing demographic and clinical information on over 40,000 TKR patients. The size and comprehensiveness of the data condones a high validity to our results. We have shown that the levels of improvement in terms of pain, function, global perceived improvement and satisfaction is high following TKR. Depending on the particular criterion used, the prevalence of good outcome range between 71% (PASS change score) and 90% (1/2 SD of OKS-PCS). Within each criterion, pain improves more significantly than function. Threshold values are useful in the sense that they assign qualitative meanings to quantitative scores, separating patients who truly feel better from those who do not. One drawback associated with using threshold values is that they are inherently binary, separating patients into “satisfied” versus “unsatisfied”, “good” versus “bad” outcome, expectation “fulfilled” versus “unfulfilled”. In reality, treatment outcomes often fall into multiple categories, as opposed to only two levels. 577 DECISION ALGORITHMS FOR THE RE-TREATMENT WITH VISCOSUPPLEMENTATION IN PATIENTS SUFFERING FROM KNEE OSTEOARTHRITIS Y. Henrotin y, P. Richette z, R. Raman x, T. Conrozier k, D. Baron ¶, J. Jerosch #, A. Migliore yy, J. Montfort zz, H. Bard xx, X. Chevalier kk. y CHU Sart-Tilman, Li ege, Belgium; z Hosp. Lariboisi ere, Paris, France; x Hull and East Yorkshire NHS trust Castle Hill Hosp., Cottingham, United Kingdom; k Nord Franche Comt e Hosp., Belfort, France; ¶ Ctr. de r eadaptation fonctionnelle de Lannion-Trestel, Tr evou- Tr eguignec, France; # Johanna-Etienne-Hosp., Neuss, Germany; yy Ospedale San Pietro zz Hosp. del Mar, Parc de Salut Mar, Fatebenefratelli, Rome, Italy; Barcelone, Spain; xx Hosp. Europeen Georges Pompidou, Paris, France; kk Henri Mondor Hosp., Creteil, France Purpose: Viscosupplementation is a symptomatic treatment of knee osteoarthritis. Although systematic reviews of its repeat use showed favourable benefit/risk ratio, no study was focused on the indication of re-treatment. Methods: A task force was created to look t issues regarding re-treatment with viscosupplementation in knee osteoarthritis. An attempt was made to reach consensus on several issues: 1) to define treatment “success” and “failure”. 2) to determine when to retreat patients successfully treated by a previous VS. 3) to determine how to re-treat patients in whom VS failed. 4) to define what to do in case of adverse reaction following previous VS. 5) to examine the interests of soluble biomarkers to manage re-treatment. After debate and review of literature the working group voted on 88 issues. Scoring and voting methods: For each statement, the experts had to score according to their degree of agreement, using an 4-point Likert scale (0e3), 0 meaning « I don’t agree », 1 “I tend to disagree”, 2 “I tend to agree” and 3 «I agree ». After discussion each item was finally classified into 2 categories: “Agree” or “Disagree”. The statement was adopted and was consequently included into the decision algorithm only if 8 experts or more voted either to “Agree“ or “Disagree”. At the end of the session, 2 “Decision Trees” regarding re-treatment with VS were built according to the results of the votes: one after failure and the second after success of a previous VS.
S358
Abstracts / Osteoarthritis and Cartilage 25 (2017) S76eS444
Results: In case of failure, the authors draw attention to the need of a rigorous clinical and radiological analysis, and the respect of EvidenceBased-Medicine. When VS was previously successful, re-treatment can be considered after recurrence or increase in pain. However, in subjects with high risk of disease progression, in young patients, and in professional sportsmen re-treatment could be considered systematically, because of the probability of HA to slow OA progression. Evidence on soluble biomarkers was not considered as enough strong to support their use as decision tools for patient re-treatment. VS.
Methods: Design: Systematic review and meta-analysis. Eligibility criteria for selecting studies: Longitudinal cohort studies were included in the review. To be included, studies needed to assess the association between obesity or physical activity participation assessed at baseline and clinical outcomes (i.e. pain, disability, and adverse events) following hip or knee arthroplasty. Data extraction: Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. Results: 63 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that non-obese participants tended to suffer less pain, less disability and report fewer postsurgical complications when compared to the obese participants. Limitations of this review: We have dichotomized follow-up duration into short-term or long-term follow-up. There was large heterogeneity in duration of follow-ups within each category. Only four studies assessed the impact of physical activity participation on surgical outcomes and given their methodological discrepancies, no pooled analysis was conducted. Conclusions: Pre-surgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. Systematic review registration: PROSPERO registration CRD42016032711. 579 ASSOCIATION BETWEEN DAIRY PRODUCE CONSUMPTION AND INCIDENCE OF TOTAL HIP ARTHROPLASTY FOR OSTEOARTHRITIS S. Hussain y, F. Cicuttini y, G. Giles y, S. Graves z, A. Wluka y, Y. Wang y. y Monash Univ., Melbourne, Australia; z South Australian Hlth.and Med. Res. Inst., Adelaide, Australia
Figure 1. Algorithm of recommendations for re-treatment with viscosupplementation of patients after failure of a previous viscosupplementation.
Figure 2. Algorithm of recommendations for re-treatment with viscosupplementation of patients improved by a previous viscosupplementation. Conclusions: The 2 Decision algorithms are intended to facilitate consideration of the therapeutic options, in patients with knee osteoarthritis previously treated with viscosupplementation. 578 CAN PHYSICAL ACTIVITY AND OBESITY PREDICT OUTCOMES OF ELECTIVE KNEE OR HIP SURGERY DUE TO OSTEOARTHRITIS? e A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES D. Pozzobon y, z, G.C. Machado y, x, P.H. Ferreira y, F.M. Blyth y, M.L. Ferreira y, x. y Univ. of Sydney, Sydney, Australia; z Inst. of Bone and Joint Res., Sydney, Australia; x The George Inst. for Global Hlth., Sydney, Australia Purpose: The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis searching the Medline, CINAHL, EMBASE, and Web of Science electronic databases.
Purpose: The aim of this prospective cohort study was to determine whether dairy produce consumption was associated with the incidence of total hip arthroplasty for osteoarthritis. Methods: 38,924 participants from the Melbourne Collaborative Cohort Study who had dairy produce consumption recorded in 1990e1994 were examined. The incidence of total hip arthroplasty for osteoarthritis during 2001e2013 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Results: Over an average of 11.8 years follow-up, 1,505 total hip arthroplasties for osteoarthritis were identified (524 in men; 981 in women). In men, a one-standard-deviation increase in dairy produce consumption was associated with a 21% increased incidence of total hip arthroplasty for osteoarthritis (HR 1.21, 95% CI 1.10e1.33), with a doseresponse relationship observed for quartiles of dairy produce consumption (P for trend ¼ 0.001). These results were independent of age, body mass index, country of birth, education, smoking status, vigorous physical activity, calcium supplementation, energy consumption, circulating 25-hydroxyvitamin D, hypertension and diabetes. No significant association was observed for women (HR 1.02, 95% CI 0.95e1.09). Conclusions: Increasing dairy produce consumption was associated with an increased risk of total hip arthroplasty for osteoarthritis in men. Understanding the mechanism will be important to optimize prevention of hip osteoarthritis, particularly for men. 580 CONSTRUCT VALIDITY AND INTER-OBSERVER RELIABILITY OF CLINICAL ASSESSMENT OF PASSIVE HIP RANGE OF MOTION TESTS IN PATIENTS WITH LONGSTANDING HIP/GROIN PAIN A. Pålsson y, I. Kostogiannis y, z, E. Ageberg y. y Dept. of Hlth.Sci., Lund Univ., Lund, Sweden; z Dept. of Clinical Sci., Lund, Lund Univ., Lund, Sweden Purpose: Longstanding hip/groin pain (LHGP) is a common problem in the young to middle-aged physically active population. These patients have functional limitations, reduced quality of life and are at high risk of early-onset osteoarthritis. Due to the likely multistructural origin of the pain, diagnostics is a challenge in this patient