Osteoarthritis of the Knee. When surgery is derived prosthesis?

In 2006 began at the Hospital of Jaén a new model monographic knee osteoarthritis (CMAR) to offer patients quality treatment based on clinical practice guidelines. The aim of this study was to analyze the performance of the unit, in terms of prolongation of time to the need for knee replacement surgery.

Patients and methods
We performed a retrospective cohort analysis of patients treated in the CMAR and the availability of an minimum data set. They performed a Kaplan-Meier analysis to evaluate the time to refer the patient to surgery and a Cox regression analysis to study factors related to the bypass time.

Participants 224 patients with a mean age of 65.7 years (95% CI, 64-67), 67.9% were women. 48.2% had a grade 3 involvement (Kellgren-Lawrence), 27.5% grade 2, 15.3% grade 4, and 9% of grade 1. The 90.2% (202) received treatment with viscosupplementation (hyaluronic acid, NASHA). The involvement of a single joint (p <0.0001, OR = 0.267, 95% CI, 0.130 to 0.549), increased severity of osteoarthritis (p = 0.048, OR = 0.410, 95%, from 0.169 to 0.992 ) and lower pain intensity (p <0.0001, OR = 1.091, 95% CI, 1.044 to 1.141) were the factors associated with shorter time to surgery. Viscosupplementation therapy increased the time to surgery in all patients.

Factors such as younger age of the patient and the involvement of a single joint influenced the decision to refer the patient for surgery. Viscosupplementation administration prolonged time until the patient was ultimately derived surgery.

 Manuel Romero Jurado et al. Rheumatol Clin. 2013;9(3)148-155


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