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- Dell'Isola, Andrea, et al.
(författare)
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Road to Total Knee Replacement: Utilization of Knee Surgeries Up to Ten Years Before Total Knee Replacement in England and Sweden
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 75:5, s. 1104-1112
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the prevalence and timing of knee surgery (including meniscal, ligamentous, synovial, and osteotomy) in the 10 years prior to primary total knee replacement (TKR) between England and Sweden.METHODS: This was a population-based, case-control study within England and southern Sweden using electronic health care databases. Patients underwent primary TKR between 2015 and 2019. Risk-set sampling showed that general population controls matched 1:1 by age, sex, and practice/municipality. The annual prevalence and prevalence ratio of having at least 1 recorded surgery in each of the 10 years preceding TKR was estimated using Poisson regressions.RESULTS: We included 6,308 and 47,010 TKR cases in Sweden and England, respectively. Meniscal surgeries were the most frequent procedure prior to TKR in both countries; prevalence was higher in England across all time points. The prevalence of meniscal surgery increased in both countries in the years approaching TKR, reaching 33.2 (95% confidence interval [95% CI] 31.6-34.9) per 1,000 persons in England, and 9.83 (95% CI 7.66-12.61) in Sweden. In England, we observed a decrease from 2014 to 2018 in the utilization of this procedure in the 4 years preceding a TKR. The prevalence of all analyzed surgeries was consistently lower in controls.CONCLUSION: There are comparable trends in the use of knee surgery in the years preceding TKR across England and Sweden. Of note, meniscal surgeries remain common, even within the year prior to TKR, highlighting that these patients may experience low-value care. Careful consideration of knee surgery in those with late-stage disease is required.
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| 2. |
- Dell'Isola, Andrea, et al.
(författare)
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Use of non-surgical treatments on the journey to knee replacement in patients with knee osteoarthritis : A 10-year population-based case-control study
- 2023
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Ingår i: RMD Open. - 2056-5933. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Aim To investigate temporal trends in primary care visits, physiotherapy visits, dispensed non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in knee osteoarthritis (OA) patients who have and have not undergone knee replacement. Methods We analysed 5665 OA patients from the Skåne Healthcare Register, Sweden, who underwent knee replacement between 2015 and 2019. Controls were OA patients without knee replacement, matched 1:1 by sex, age, time and healthcare level of initial OA diagnosis, and assigned a pseudo-index date corresponding to their case's knee replacement date. Annual prevalence and prevalence ratio of primary care and physiotherapy visits, dispensed NSAIDs and opioids (all for any cause) in the 10 years before knee replacement were estimated using Poisson regression. Results The annual prevalence of all-cause primary care visits, physiotherapy visits and opioid use was similar between cases and controls until 3 years before the index date when it started to increase among the cases. The year before the index date, the prevalence ratio (cases vs controls) for physiotherapy use was 1.8 (95% CI 1.7, 1.8), while for opioid use 1.6 (1.5, 1.7). NSAID use was consistently higher among cases, even 10 years before the index date when the prevalence ratio versus controls was 1.3 (1.2, 1.3), increasing to 1.8 (1.7, 1.9) in the year preceding the index date. Conclusions Management of OA patients who have and have not undergone knee replacement appears largely similar except for higher use of NSAIDs in knee replacement cases. Symptomatic treatments start to increase a few years before the surgery in knee replacement cases.
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| 4. |
- Snoeker, Barbara, et al.
(författare)
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Risk of knee osteoarthritis after different types of knee injuries in young adults : A population-based cohort study
- 2020
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Ingår i: British journal of sports medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 54:12, s. 725-730
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To estimate the risk of clinically diagnosed knee osteoarthritis (OA) after different types of knee injuries in young adults. Methods In a longitudinal cohort study based on population-based healthcare data from Skåne, Sweden, we included all persons aged 25-34 years in 1998-2007 (n=149 288) with and without diagnoses of knee injuries according to International Classification of Diseases (ICD)-10. We estimated the HR of future diagnosed knee OA in injured and uninjured persons using Cox regression, adjusted for potential confounders. We also explored the impact of type of injury (contusion, fracture, dislocation, meniscal tear, cartilage tear/other injury, collateral ligament tear, cruciate ligament tear and injury to multiple structures) on diagnosed knee OA risk. Results We identified 5247 persons (mean (SD) age 29.4 (2.9) years, 67% men) with a knee injury and 142 825 persons (mean (SD) age 30.2 (3.0) years, 45% men) without. We found an adjusted HR of 5.7 (95% CI 5.0 to 6.6) for diagnosed knee OA in injured compared with uninjured persons during the first 11 years of follow-up and 3.4 (95% CI 2.9 to 4.0) during the following 8 years. The corresponding risk difference (RD) after 19 years of follow-up was 8.1% (95% CI 6.7% to 9.4%). Cruciate ligament injury, meniscal tear and fracture of the tibia plateau/patella were associated with greatest increase in risk (RD of 19.6% (95% CI 13.2% to 25.9%), 10.5% (95% CI 6.4% to 14.7%) and 6.6% (95% CI 1.1% to 12.2%), respectively). Conclusion In young adults, knee injury increases the risk of future diagnosed knee OA about sixfold with highest risks found after cruciate ligament injury, meniscal tear and intra-articular fracture.
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| 5. |
- Yu, Dahai, et al.
(författare)
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Population trends in the incidence and initial management of osteoarthritis : age-period-cohort analysis of the Clinical Practice Research Datalink, 1992-2013
- 2017
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 56:11, s. 1902-1917
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data.Methods: Using the Clinical Practice Research Datalink we identified new cases of diagnosed OA and clinical OA (including OA-relevant peripheral joint pain in those aged over 45 years) using established code lists. For both definitions we estimated annual incidence density using exact person-time, and undertook descriptive analysis and age-period-cohort modelling. Demographic characteristics and management were described for incident cases in each calendar year. Sensitivity analyses explored the robustness of the findings to key assumptions.Results: Between 1992 and 2013 the annual age-sex standardized incidence rate for clinical OA increased from 29.2 to 40.5/1000 person-years. After controlling for period effects, the consultation incidence of clinical OA was higher for successive cohorts born after the mid-1950s, particularly women. In contrast, with the exception of hand OA, we observed no increase in the incidence of diagnosed OA: 8.6/1000 person-years in 2004 down to 6.3 in 2013. In 2013, 16.4% of clinical OA cases had an X-ray referral. While NSAID prescriptions fell from 2004, the proportion prescribed opioid analgesia rose markedly (0.1% of diagnosed OA in 1992 to 1.9% in 2013).Conclusion: Rising rates of clinical OA, continued use of plain radiography and a shift towards opioid analgesic prescription are concerning. Our findings support the search for policies to tackle this common problem that promote joint pain prevention while avoiding excessive and inappropriate health care.
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