STUDY ON PRE AND POST OPERATIVE COMPLICATION IN OSTEOARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITALS
A Dissertation submitted to
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY Chennai-600 032
In partial fulfillment of the requirements for the award of the degree of MASTER OF PHARMACY
IN
BRANCH- IV-> PHARMACOLOGY
Submitted by R.KAVITHA
REGISTRATION No.: 261825551
Under the Guidance of
Mrs. P. MANIMEKALAI, M.Pharm.,Ph.D.
Department of Pharmacology
DEPARTMENT OF PHARMACOLOGY
SWAMY VIVEKANANDHA COLLEGE OF PHARMACY ELAYAMPALAYAM, TIRUCHENGODE-637 205,TAMILNADU
April – 2020
SWAMY VIVEKANANDHA COLLEGE OF PHARMACY
Elayampalayam, Tiruchengode-637205 Namakkal (Dt.), Tamilnadu.
Phone: 04288-234417 Fax: 04288-234417
Dr. G. MURUGANANTHAN, M.Pharm., Ph.D., PRINCIPAL
CERTIFICATE
This is to certify that the Dissertation entitled STUDY ON PRE AND POST OPERATIVE COMPLICATION ON OSTEOARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITALS submitted to The Tamilnadu Dr. M.G.R.
Medical University, Chennai, is a bonafide project work carried out by R.KAVITHA (Reg No: 261825551) carried out in the Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Tiruchengode, for the partial fulfillment for the degree of Master of Pharmacy under the guidance and direct supervision of Dr.P.MANIMEKALAI, M. Pharm.,PhD.., in the Department of Pharmacology, during the academic year of 2019 – 2020.
Date:
Place: Dr. G. MURUGANANTHAN, M.Pharm., Ph.D
SWAMY VIVEKANANDHA COLLEGE OF PHARMACY
Elayampalayam, Tiruchengode-637205 Namakkal (Dt.), Tamilnadu.
Phone: 04288-234417 Fax: 04288-234417 Dr. P. MANIMEKALAI, M.Pharm., Ph.D.,
Head, Department of Pharmacology
CERTIFICATE
This is to certify that the Dissertation entitled STUDY ON PRE AND POST OPERATIVE COMPLICATION ON OSTEOARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITALS submitted to The Tamilnadu Dr. M.G.R.
Medical University, Chennai, is a bonafide project work carried out by R.KAVITHA (Reg No:261825551) in the Department of Pharmacology,Swamy Vivekanandha College of Pharmacy,Tiruchengode for the partial fulfillment for the degree of Master of Pharmacy under the guidance and the direct supervision of Dr.P.MANIMEKALAI, M. Pharm.,PhD.., in the Department of Pharmacology during the academic year of 2019 – 2020.
Date:
Place: Dr. P. Manimekalai, M.Pharm., Ph.D
SWAMY VIVEKANANDHA COLLEGE OF PHARMACY
Elayampalayam, Tiruchengode-637205 Namakkal (Dt.), Tamilnadu.
Phone: 04288-234417 Fax: 04288-234417
Dr.P.MANIMEKALAI,M.Pharm..,PhD..,
Assistant Professor, Department of Pharmacology
CERTIFICATE
This is to certify that the Dissertation entitled submitted to The Tamilnadu Dr. M.G.R Medical University, Chennai, is a bonafide project work carried out by R.KAVITHA (Reg No: 261825551), in the Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Tiruchengode for the partial fulfillment for the degree of Master of Pharmacy under my guidance during the academic year of 2019- 2020.
This work is original and has not been submitted earlier for the award of any other Degree or Diploma of this or any other university.
Date:
Place: Dr.P.MANIMEKALAI, M.
Pharm.,PhD..,
EVALUATION CERTIFICATE
This is to certify that the Dissertation entitled on STUDY ON PRE AND POST OPERATIVE COMPLICATION ON OSTEOARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITALS submitted to The Tamil Nadu Dr. M.G.R Medical University, Chennai, in partial fulfillment for the degree of Master of Pharmacy. This was carried out by R.KAVITHA ( Reg. No: 261825551) under the guidance and direct supervision of Dr.P.MANIMEKALAI, M. Pharm.,PhD.., in the Department of Pharmacology, Swamy Vivekanandha College of Pharmacy, Tiruchengode during the academic year of 2019– 2020.
Internal Examiner External Examiner
Examination centre:
DECLARATION
This is certify that the dissertation entiled STUDY ON PRE AND POST OPERATIVE COMPLICATION ON OSTEOARTHRITIS PATIENTS IN A TERTIARY CARE HOSPITALS submitted to The Tamil Nadu Dr. M.G.R Medical University, Chennai, in partial fulfillment for the degree of Master of Pharmacy. This was carried out by R.KAVITHA ( Reg. No: 261825551) in the department of pharmacology, Swamy Vivekanandha College of Pharmacy, Elayampalayam, Tiruchengode for the partial fulfillment for the degree of master of pharmacy under the gudience and direct supervision of Dr.P.MANIMEKALAI, M.Pharm.,PhD.., in the Department of Pharmacology during the academic year of 2018-2020.
Hereby I declare that the work embedded in this thesis is orginal and not submitted in part or full for any other university .
R.KAVITHA
(REG.NO : 261825552)
ACKNOWLEDGEMENT
The joy, satisfaction and euphoria that come along with successful completion of any work would be incomplete unless we mention the names of the people who made it possible, whose constant guidance and encouragement served as a beam of light that crowned out effects. I fetch this sensible opportunity to express my heartfelt thanks to all the people who have shaped this thesis.
First and foremost, I bow down before Lord Almighty for his splendid blessings and care in completing my project work and throughout my life till this very second.
I feel it a great honor to express my deep sense of gratitude and indebtedness to my guide Dr. P.Manimekalai, M.Pharm., Ph.D., thanking for her willingness to offer continuous guidance, support and encouragement, which were the driving forces for me to complete this thesis. Her vast knowledge, attitude of research and skill of presentation had been an invaluable resource to me. She is an admirable professor and will always be a role model for me.
It is difficult to overstate my gratitude to Dr. G. MURUGANANTHAN, M.Pharm., Ph.D., Principal of this institution. His enthusiasm and integral view on research and his mission for providing ‘only high-quality work and not less’, has made a deep impression on me. I owe him lots of gratitude for having me shown this way of research.
I feel it a great honor to express my deep sense of gratitude and indebtedness to my Head of Department of Pharmacology of this institution Dr.
P.Manimekalai, M.Pharm., Ph.D., thanking for her support encouragement and her constructive ideas at each and every stage of the project which were the driving forces for me to complete this thesis. Her vast knowledge, attitude of research and skill of presentation had been an invaluable resource to me. She is an admirable professor and will always be a role model for me.
Generally, foundations are not visible anywhere. But it is the foundation that holds everything at place. I render my sincere thanks to the honorable Chairman & Secretary, Vidya Ratna, Prof. Dr. M. Karunanithi, M.S., Ph.D., D.Litt., for providing all facilities for our study and rendering his noble hand in the upliftment of women education in all disciplines.
I owe my sincere thanks to Mr. P. Sudhakar, M.Pharm., Mr.Anantha kumar, M.pharm., Department of Pharmacy Practice, Mr. C. Sabarinath, M.
Pharm., Ms. N. M. Gayathri, M.Pharm., Ms. Haripriya, M.Pharm., Department
of Pharmacology, Mrs. T. Kumutha, M. Pharm., Mrs.Kalaivani, M.Pharm., Mrs.Parkavi Rani, M.Pharm., Department of Pharmacy Practice for their immense support during the course of my project.
I also thank pharmacology lab assistant’s Mrs. L. Sathiya, Mrs.
Dhanalakshmi, Ms. Gowri, Mrs. Dhanabagyam for their help during my project work.
I owe my heartful gratitude to my respected Parents Mr. G. Ramasamy, Mrs. R. Maheswari and my Husband Mr. N. Sakthivel , who cared for my well- being and had spent their times in shaping my character, conduct and my life.
Without their moral support, I am nothing and I dedicate all my achievements at their feet.
Friends are Mrs.P.Ragavi,K.B.Suchithra, P.Shalini, V.Thenmozhi, S.Ajina, Pragadheeshwari, Meena Jeslia, Dhanalakshmi treasures to me and it is very difficult to iverstate my thanks to all my friends. It has been my happiest time to study, discuss, laugh and play with them all. I express my whole hearted thanks to my friends.
I would like to thanks The Tamil Nadu Dr. M. G. R. Medical University for providing a nice environment for learning.
I fell delighted to express my whole hearted gratitude to all those who gave their helping hands in completing my course and my project successful
R. KAVITHA (Reg. No: 261825551)
Abbreviation
ABBREVIATION
BD Twice Daily
DM Diabetic Mellitus
GI Gastrointestinal Effects
HTN Hypertension
NSAIDS Non Steroidal Anti Inflammatory Drugs
OA Osteoarthritis
TKR Total Knee Replacement
WHO World Health Organization
Content
CONTENT
S. No Contents Page No
1 INTRODUCTION 1
1.1 Osteoarthritis 5
1.2 Prevalence 5
1.3 Risk factors 6
1.4 Pathophysiology 7
1.5 Etiology 9
1.6 Clinical Presentation 10
1.7 Diagnosis 11
1.8
Management 15
1.8.1 Non Pharmacologic 16
1.8.2 Pharmacologic 17
1.9 Drug starting dose usual range 18
1.10 Alternative Second line agent 19
1.11 Alternative First line agent 20
1.12 Patient centered care 22
1.13 Education and self management 31
1.14 Invasive treatment 32
1.15 Referral for specialised services 32
2 LITERATURE REVIEW 22
3 PLAN OF STUDY 31
4 AIM AND OBJECTIVES 32
5 METHODOLOGY 33
5.1 Study design 33
5.2 Geographical centre of study 33
5.3 Duration of study 33
5.4 Inclusion criteria 33
5.5 Exclusion criteria 33
5.6 Ethical clearance 34
5.7 Study population 34
5.8 Source of study 34
5.9 Method of study 34
5.10 Statistical analysis 35
6 RESULT 36
6.1 Age wise distribution 36
6.2 Genter wise distribution 37
6.3 Body mass index 38
6.4 Education among the study 39
6.5 Associate disease 40
6.6 Social history of the study 41
6.7 Class of drugs persribed 42 6.8 Compliants of osteoarthritis patients 43
6.9 Scale of difficulty 44
6.10 Pre and post operative complication 45
7 DISCUSSION 46
8 CONCLUSION 48
9 REFERENCE 49
10 ANNEXURE I (IEC APROVAL FORM)
11 ANNEXURE II (INFORMED CONSENT FORM) ENGLISH
12 ANNEXURE III (INFORMED CONSENT FORM) TAMIL
13 ANNEXURE IV (DATA ENTRY FORM) 14 ANNEXURE V (WOMAC QUESSINARIES)
List of Tables &
Figures
LIST OF TABLES
TABLE
NO TITLE PAGE
NO 1 AGE WISE DISTRIBUTION AMONG THE STUDY
POPULATION
36
2 GENDER WISE DISTRIBUTION AMONG STUDY POPULATION
37
3 BODY MASS INDEX (BMI) AMONG THE STUDY POPULATION
38
4 EDUCATION AMONG THE STUDY POPULATION 39
5 ASSOCIATE DISEASE ALONG WITH
OSTEOARTHRITIS PATIENTS
40
6 SOCIAL HISTORY OF THE STUDY POPULATION WITH OSTEOARTHRITIS PATIENTS
41
7 CLASS OF DRUGS PERSRIBED WITH
OSTEOARTHRITIS TKR PATIENTS
42
8 COMPLIANTS OF OSTEOARTHRITIS PATIENTS IN RIGHT, LEFT AND BOTH KNEE STUDY POPULATION
43
9 SCALE OF DIFFICULTY WITH OSTEOARTHRITIS PATIENTS AMONG WITH STUDY POPULATION
44
10 PRE AND POST OPERATIVE COMPLICATION SCORE FOR OSTEOSRTHRITIS PATIENTS
45
LIST OF FIGURES
FIGURES
NO TITLE PAGE
NO 1 AGE WISE DISTRIBUTION AMONG THE STUDY
POPULATION
36
2 GENDER WISE DISTRIBUTION AMONG STUDY POPULATION
37
3 BODY MASS INDEX (BMI) AMONG THE STUDY POPULATION
38
4 EDUCATION AMONG THE STUDY POPULATION 39
5 ASSOCIATE DISEASE ALONG WITH
OSTEOARTHRITIS PATIENTS
40
6 SOCIAL HISTORY OF THE STUDY POPULATION WITH OSTEOARTHRITIS PATIENTS
41
7 CLASS OF DRUGS PERSRIBED WITH
OSTEOARTHRITIS TKR PATIENTS
42
8 COMPLIANTS OF OSTEOARTHRITIS PATIENTS IN RIGHT, LEFT AND BOTH KNEE STUDY POPULATION
43
9 SCALE OF DIFFICULTY WITH OSTEOARTHRITIS PATIENTS AMONG WITH STUDY POPULATION
44
10 PRE AND POST OPERATIVE COMPLICATION SCORE FOR OSTEOSRTHRITIS PATIENTS
45
Introduction
Introduction
1.INTRODUCTION
1.1.Osteoarthritis (OA) is one of the most prevalent conditions resulting to
disability particularly in elderly population. OA is the most common articular disease of the developed world and a leading cause of chronic disability, mostly as a consequence of the knee OA and/or hip OA.1
Osteoarthritis (OA) is a chronic disease involving the entire joint, although the main tissue implicated in osteoarthritis is the cartilage. The most common joints affected include the knees, hips, lower back and neck, small joints of the fingers, base of the thumb and big toe. Progressive degeneration, chronic pain, stiffness, joint instability and joint space narrowing are clinical features associated with the condition.2
• Primary (idiopathic) OA, the most common type, has no known cause.
• Secondary OA is associated with a known cause, such as trauma, metabolic or endocrine Disorders, and congenital factors.
• OA usually begins with damage to articular cartilage through injury, excessive joint
loading from obesity or other reasons, or joint instability or injury. Damage to cartilage
increases activity of chondrocytes in attempt to repair damage, leading to increased synthesis of matrix constituents with cartilage swelling. Normal
balance between cartilage breakdown and resynthesis is lost, with increasing destruction and cartilage loss.
• Subchondral bone adjacent to articular cartilage undergoes pathologic changes and
releases vasoactive peptides and matrix metalloproteinases (MMPs).
• Cartilage loss causes joint space narrowing and painful, deformed joints.
Remaining
cartilage softens and develops fibrillations, followed by further cartilage loss and exposure of underlying bone. New bone formations (osteophytes) at joint margins
distant from cartilage destruction are thought to help stabilize affected joints.
• Inflammatory changes can occur in the joint capsule and synovium. Crystals or cartilage shards in synovial fluid may contribute to inflammation. Interleukin-1, prostaglandin E2, tumor necrosis factor-α (TNF-α), and nitric oxide in synovial fluid may also play a role. Inflammatory changes result in synovial effusions and thickening.
• Pain may result from distention of the synovial capsule by increased joint fluid;
microfracture; periosteal irritation; or damage to ligaments, synovium, or the meniscus.
1.2.Prevalence
About 13% of women and 10% of men aged 60 years and older have symptomatic knee OA. The proportions of people affected with symptomatic knee OA is likely to increase due to the aging of the population and the rate of obesity or overweight in the general population. During a one year period, 25% of people over 55 years may demonstrate persistent episode of knee pain, in whom about one in six have to consult their general practitioner about it in the same time period. About 10% of people aged over 55 years have painful disabling knee OA of whom one quarter is severely disabled. Prevalence of knee OA in men is lower compared with women.3This was shown in a meta analysis of males and females in which the incidence of knee OA in males aged <55 years was lower than females. Females, particularly those ≥55 years, tended to have more severe OA in the knee after menopausal age.
1.3.Risk factors of knee osteoarthritis
Age
Genetic susceptibility
Obesity
Female gender
Trauma
Repetitive knee trauma
Muscle weakness
Joint laxity
Mechanical forces
Kneeling
Squatting
Miniscal injuries
1.4.Pathophysiology of osteoarthritis
Osteoarthritis is a complex, chronic inflammatory disease of synovial joints, 7 involving the articular cartilage, a unique tissue between the ends of bones in the joints.5,8 Below the cartilage is a layer of bone, the subchondral bone that acts as a shock absorber in weight-bearing joints (e.g. hips and knees).
Synovial fluid fills the joint space and contains abundant hyaluronic acid (HA) that acts as a lubricant. In OA patients, hyaluronan is both smaller in size (referring to
its molecular weight) and lower in concentration, providing less efficient lubrication.4 The subchondral bone plate thickens in patients suffering from OA causing the joint space to narrow. A combination of cellular changes and biomechanical stresses cause several secondary changes. The latter include subchondralbone remodeling, formation of osteophytes, development of bone marrow lesions, changes in the synovial, joint capsule, ligaments and periarticular muscles, and meniscal tears and extrusion.5
1.5.Etiology and risk factors of osteoarthritis
Idiopathic OA is the most common form of arthritis as the root cause of the disease is unknown. The development and progression of OA is multifactorial, precipitating from interplay between various risk factors:
• Advancing age – incidence of OA does increase with age, although not a definite consequence of aging.
• Female gender – women after menopause are more susceptible to knee arthritis because of an increasing level of osteocalcin and bone resorption.6 Osteocalcin is a noncollagenous protein hormone found in bone and dentin, also known as bone gamma-carboxyglutamic acid-containing protein (BGLAP)
• High bone density
• Reduced muscle strength
• Malalignment of joints
• Excessive mechanical stress
• Obesity
• Sports and other trauma to the joints
The normal joint is well adapted to withstand physiological loads, but abnormal loading can increase the risk of OA. Trauma, heavy manual labour, and obesity all carry an increased risk of OA:
-- Workers in certain occupations, such as coal miners, dockyard workers, and farmers have an increased risk of hip and knee OA
-- Obesity is a well-established risk factor in the development of knee OA
• Genetic predisposition – a study of monozygotic twins aged 48 to 70 years, having identical genes, showed 65% influence of genetic factors in developing osteoarthritis.27 between 39% and 65% of osteoarthritis in the general population can be attributed to genetic factors.
Clinical presentation of osteoarthritis
The main clinical symptoms of osteoarthritis are chronic pain,stiffness, joint instability and joint space narrowing Exertion exacerbates the pain associated with osteoarthritis, and may recur following rest. Joint stiffness may occur during morning hours, lasting up to 30 minutes. Locking or instability of joints may also be present.
1.6.Diagnosis
Osteoarthritis is one of the most common, costly and disabling forms of joint disease, and far more common than rheumatoid arthritis. The latter is an autoimmune disease that does not only affect the small joints, but also presents with extra-articular manifestations e.g. anaemia and cardiovascular diseases.
The clinical approach takes into consideration thorough history taking and physical examination for signs and symptoms. Imaging examinations used diagnostically, to help establish prognosisand monitor effects of therapy, include radiography, computed tomography, positron tomography, ultrasonography and magnetic resonance imaging.Laboratory indication of chronic inflammatory changes, with production of pro-inflammatory cytokines, is apparent during early development of osteoarthritis. Increases in circulating levels of C-reactive protein (CRP), interleukin (IL)-6 and IL-4, and tumour necrosis factor alpha (TNF-α) have been linked to OA and used as possible biomarkers. Interleukin-6 and IL-4 identify radiologically.le I.
• For hip OA, patient must have hip pain and two of the following: (1) ESR less than
20 mm/h, (2) radiographic femoral or acetabular osteophytes, and/or (3) radiographicjoint space narrowing.
• For knee OA, patient must have knee pain and radiographic osteophytes in additionto one or more of the following: (1) age more than 50 years, (2) morning stiffnesslasting 30 minutes or less, (3) crepitus on motion, (4) bony enlargement, (6) bonytenderness, and/or (7) palpable joint warmth.
• ESR may be slightly elevated if inflammation is present. Rheumatoid factor is negative.Analysis of synovial fluid reveals high viscosity and mild leukocytosis (<2000 white blood cells/mm3 [<2 × 109/L]) with predominantly mononuclear cells.
1.7.Management of osteoarthritis
Due to poor understanding of the disease pathology, no current treatment can prevent either initiation or progression of OA.17 Osteoarthritis cannot be cured,4 and appropriate management includes a combination of non- pharmacological and pharmacological measures with the ultimate goal to alleviate pain and improve functional status.
1.8.Non-pharmacological management
An OA-patient should agree to manage themselves by ensuring positive behavioral changes e.g. exercise, weight loss, and use of suitable footwear (including those with shock-absorbing properties). Physical activity, e.g. walking, can reduce pain and Help to maintain (or attain) a healthy weight. Excess weight adds additional stress to weight-bearing joints and by losing weight, it can reduce OA pain and limit further joint damage. Strengthening exercises build muscle around the OA-affected joints – this can ease the burden on the affected joints.
Exercise also improves joint flexibility and reduces joint stiffness. Gentle stretching of joints can further improve flexibility, decrease stiffness and lessen pain. Other non-pharmacological interventions include patient education, occupational therapy, and heat and cold therapies.
Goals of Treatment:
(1) Educate patient, family members, and caregivers;
(2) relieve pain and stiffness;
(3) Maintain or improve joint mobility;
(4) limit functional impairment;
(5) Maintain or improve quality of life.
1.8.1.NONPHARMACOLOGIC THERAPY
• Educate patient about disease process and extent, prognosis, and treatment.
Promote dietary counseling, exercise, and weight loss program for overweight patients.
• Physical therapy—with heat or cold treatments and an exercise program—helps Maintain range of motion and reduce pain and need for analgesics.
• Assistive and orthotic devices (canes, walkers, braces, heel cups, insoles) can be used during exercise or daily activities.
• Surgical procedures (eg, osteotomy, arthroplasty, joint fusion) are indicated for functional disability and/or severe pain unresponsive to conservative therapy.
1.8.2.PHARMACOLOGIC THERAPY General Approach
• Drug therapy is targeted at relief of pain. A conservative approach is warranted Because OA often occurs in older individuals with other medical conditions.
• Apply an individualized approach Continue appropriate nondrug therapies when initiating drug therapy.Knee and Hip OA
• Acetaminophen is a preferred first-line treatment; it may be less effective than oral
nonsteroidal anti-inflammatory drugs (NSAIDs) but has less risk of serious gastrointestinal(GI) and cardiovascular events.
• If a patient fails acetaminophen, nonselective NSAIDs or cyclooxygenase-2 (COX-2) selective inhibitors (eg, celecoxib) are recommended. COX-2 inhibitors pose less risk for adverse GI events than nonselective NSAIDs, but this advantage may not be sustained beyond 6 months and is substantially reduced for patients taking aspirin. Proton pump inhibitors (PPIs) and misoprostol reduce adverse GI events in patients taking NSAIDs.
• For knee OA, topical NSAIDs are recommended if acetaminophen fails and are
preferred over oral NSAIDs in patients older than 75 years. Topical NSAIDs provide
similar pain relief with fewer adverse GI events than oral NSAIDs but may be associated with adverse events at the application site.
• Intra-articular (IA) corticosteroid injections are recommended for both hip and
knee OA when analgesia with acetaminophen or NSAIDs is suboptimal.
Injections
can be given with concomitant oral analgesics for additional pain control. Do not administer injections more frequently than once every 3 months to minimize
• Educate patient about disease process and extent, prognosis, and treatment.
Promote dietary counseling, exercise, and weight loss program for overweight patients.
• Physical therapy—with heat or cold treatments and an exercise program—helps maintain range of motion and reduce pain and need for analgesics.
• Assistive and orthotic devices (canes, walkers, braces, heel cups, insoles) can be used during exercise or daily activities.
• Surgical procedures (eg, osteotomy, arthroplasty, joint fusion) are indicated for functional disability and/or severe pain unresponsive to conservative therapy.
1.9.PHARMACOLOGIC THERAPY General Approach
• Drug therapy is targeted at relief of pain. A conservative approach is warranted because OA often occurs in older individuals with other medical conditions.
• Apply an individualized approach Continue appropriate nondrug therapies when initiating drug therapy.Knee and Hip OA
• Acetaminophen is a preferred first-line treatment; it may be less effective than oral
nonsteroidal anti-inflammatory drugs (NSAIDs) but has less risk of serious gastrointestinal(GI) and cardiovascular events.
• If a patient fails acetaminophen, nonselective NSAIDs or cyclooxygenase-2 (COX-2) selective inhibitors (eg, celecoxib) are recommended. COX-2 inhibitors pose less risk for adverse GI events than nonselective NSAIDs, but this advantage may not be sustained beyond 6 months and is substantially reduced for patients taking aspirin. Proton pump inhibitors (PPIs) and misoprostol reduce adverse GI events in patients taking NSAIDs.
• For knee OA, topical NSAIDs are recommended if acetaminophen fails and are
preferred over oral NSAIDs in patients older than 75 years. Topical NSAIDs provide
similar pain relief with fewer adverse GI events than oral NSAIDs but may be associated with adverse events at the application site.
• Intra-articular (IA) corticosteroid injections are recommended for both hip and
knee OA when analgesia with acetaminophen or NSAIDs is suboptimal.
Injections
can be given with concomitant oral analgesics for additional pain control. Do not administer injections more frequently than once every 3 months to minimize
• Educate patient about disease process and extent, prognosis, and treatment.
Promote dietary counseling, exercise, and weight loss program for overweight patients.
• Physical therapy—with heat or cold treatments and an exercise program—helps
maintain range of motion and reduce pain and need for analgesics.
• Assistive and orthotic devices (canes, walkers, braces, heel cups, insoles) can be used during exercise or daily activities.
• Surgical procedures (eg, osteotomy, arthroplasty, joint fusion) are indicated for functional disability and/or severe pain unresponsive to conservative therapy.
1.10.Drug Starting Dose Usual Range
Oral analgesicsAcetaminophen 325–500 mg 3 times a day ;325–650 mg every 4–6 h or 1 g 3–4 times/dayTramadol 25 mg in the morning Titrate dose in 25-mg increments to reach a maintenance dose of 50–100 mg 3 times a day.
Tramadol ER100 mg daily Titrate to 200–300 mg daily Hydrocodone/
acetaminophen 5 mg/325 mg 3 times daily 2.5–10 mg/325–650 mg 3–5 times daily
Oxycodone/ acetaminophen 5 mg/325 mg 3 times daily 2.5–10 mg/325–650 mg 3–5 times daily
Topical analgesics
Capsaicin 0.025% or 0.075% Apply to affected joint 3–4 times per day.
Diclofenac 1% gel Apply 2 or 4 g per site as prescribed, 4times daily.
Diclofenac 1.3% patch Apply one patch twice daily to the site to be treated, as directed.
Diclofenac 1.5% solution Apply 40 drops to the affected knee, applying and rubbing in 10 drops at a time.Repeat for a total of 4 times daily.
Intra-articular corticosteroids
Triamcinolone 5–15 mg per joint 10–40 mg per large joint (knee, hip, shoulder)
Methylprednisolone acetate 10–20 mg per joint 20–80 mg per large joint (knee, hip, shoulder)
NSAIDs
Aspirin (plain, buffered, or entericcoated) 325 mg 3 times a day
Celecoxib 100 mg daily 100 mg twice daily or 200 mg daily
Diclofenac IR 50 mg twice a day 50–75 mg twice a day
Diclofenac XR 100 mg daily 100–200 mg daily
Diflunisal 250 mg twice a day 500–750 mg twice a day
Etodolac 300 mg twice a day 400 to 500 mg twice a day
Fenoprofen 400 mg 3 times a day 400–600 mg 3–4 times a day
Flurbiprofen 100 mg twice a day 200–300 mg/day in 2–4 divided doses Ibuprofen 200 mg 3 times a day 1200–3200 mg/day in 3–4 divided doses
Indomethacin 25 mg twice a day Titrate dose by 25–50 mg/day until pain
controlled or maximum dose of 50 mg 3 times a day (continued) Alternative second-line agents
• Opioid analgesics
• Surgery
• Duloxetine (knee only)
• Intra-articular hyaluronan Alternative 1st line agents
• Topical NSAIDs (knee only)
• Intra-articular corticosteroids
• Tramadol
• Oral NSAIDs (if <75 years or low CV and GI risk)
• Tramadol is recommended for hip and knee OA in patients who have failed scheduled full-dose acetaminophen and topical NSAIDs, who are not appropriate candidates for oral NSAIDs, and who are not able to receive IA corticosteroids.
Tramadol can be added to partially effective acetaminophen or oral NSAID therapy.
• Opioids should be considered in patients not responding adequately to nonpharmacologic and first-line pharmacologic therapies. Patients who are at high surgical risk
and cannot undergo joint arthroplasty are also candidates for opioid therapy.
Adverse
events limit routine use of opioids for treatment of OA pain.
• Duloxetine can be used as adjunctive treatment in patients with partial response to
first-line analgesics (acetaminophen, oral NSAIDs). It may be a preferred second-line
medication in patients with both neuropathic and musculoskeletal OA pain.
• IA hyaluronic acid is not routinely recommended for knee OA pain. Injections do
not provide clinically meaningful improvement and may be associated with serious
adverse events (eg, increased pain, joint swelling, and stiffness).
1.11.Patient-centred care
Treatment and care should take into account patients’ needs and preferences. People with osteoarthritis should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If patients do not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines –
‘Reference guide to consent for examination or treatment’ (2001). Healthcare professionals should also follow a code of practice accompanying the Mental Capacity Act . Good communication between healthcare professionals and patients is essential. It should be supported by evidence-based written information tailored to the patient’s needs. Treatment and care, and the information patients are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English.
• Exercise should be a core treatment for people with osteoarthritis, irrespective of age, comorbidity, pain severity or disability. Exercise should include: local muscle strengthening, and general aerobic fitness.
• Referral for arthroscopic lavage and debridement† should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (not gelling, ‘giving way’ or X-ray evidence of loose bodies).
1.12.Education and self-management Patient information
Healthcare professionals should offer accurate verbal and written information to all people with osteoarthritis to enhance understanding of the
condition and its management, and to counter misconceptions, such as that it inevitably progresses and cannot be treated. Information sharing should be an ongoing, integral part of the management plan rather than a single event at time of presentation.
1.13.Patient self-management interventions
Individualised self-management strategies should be agreed between healthcare professionals and the person with osteoarthritis. Positive behavioural changes, such as exercise, weight loss, use of suitable footwear and pacing, should be appropriately targeted.
Acupuncture
Electro-acupuncture should not be used to treat people with osteoarthritis3.
Aids and devices
Healthcare professionals should offer advice on appropriate footwear (including shock-absorbing properties) as part of core treatment (see recommendation 1.1.5) for people with lower limb osteoarthritis.
People with osteoarthritis who have biomechanical joint pain or instability should be considered for assessment for bracing/joint supports/insoles as an adjunct to their core treatment.
Assistive devices (for example, walking sticks and tap turners) should be considered as adjuncts to core treatment for people with osteoarthritis who have specific problems with activities of daily living. Healthcare professionals may need to seek expert advice in this context (for example, from occupational therapists or Disability Equipment Assessment Centres).
Nutraceuticals
The use of glucosamine or chondroitin products is not recommended for the treatment of osteoarthritis.
1.14.Invasive treatments for knee osteoarthritis
Referral for arthroscopic lavage and debridement4 should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis
with a clear history of mechanical locking (not gelling, ‘giving way’ or X-ray evidence of loose bodies).
Referral for specialist services 1.15.Referral criteria for surgery
Clinicians with responsibility for referring a person with osteoarthritis for consideration of joint surgery should ensure that the person has been offered at least the core (non-surgical) treatment options.
Referral for joint replacement surgery should be considered for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. Referral should be made before there is prolonged and established functional limitation and severe pain.
Patient-specific factors (including age, gender, smoking, obesity and comorbidities) should not be barriers to referral for joint replacement surgery.
Decisions on referral thresholds should be based on discussions between patient representatives, referring clinicians and surgeons, rather than using current scoring tools for prioritisation.
Review of
Literature
2. LITERATURE REVIEW
Behzad Heidari et al., (2011) conducted a study on Osteoarthritis (OA) a common disease of aged population and one of the leading causes of disability.
Incidence of knee OA is rising by increasing average age of general population.
Age, weight, trauma to joint due to repetiting movements in particular squatting and kneeling are common risk factors of knee OA. Several factors including cytokines, leptin, and mechanical forces are pathogenic factors of knee OA. In patients with knee pain attribution of pain to knee OA should be considered with caution. Since a proportion of knee OA are asymptomatic and in a number of patients identification of knee OA is not possible due to low sensitivity of radiographic examination. In this review data presented in regard to prevalence, pathogenesis, risk factors.8
Juan C Mora et al., (2019) conducted a study for decades, multiple attempts to fully understand knee osteoarthritis pathophysiology and natural history have been attempted. Despite the extensive amount of research regarding this topic, there are still marked controversies. This multifactorial condition gets influenced by local, systemic, and external factors and its progression and/or response to treatments widely varies from patient to patient.
Multiple therapies have been studied in the past, low impact physical activity seems to be supported by all the current medical societies while other interventions have shown conflicting findings. Newer therapies and routes of administration are under investigation and some of them have shown promising preliminary reports. This review intends to give an overview of the current knowledge of pathophysiology and non-surgical therapies available for knee osteoarthritis.9
Wardhana et al., (2013) conducted a study to describe Osteoarthritis (OA) is a condition found worldwide, is strongly associated with aging and is the most common type of arthritis. Because of its effect on ambulation and mobility, it has significant functional impact and is associated with considerable medical costs. Because of the aging of the society and the obesity epidemic, the burden
of OA can be expected to increase over the next 20 years. Although OA has been regarded primarily as a non- inflammatory arthropathy, symptoms of local inflammation and synovitis are present in many patients and have been observed and even in the absence of classical inflammation, which is characterized by infiltration of neutrophils and macrophages into joint tissue, elevated levels of inflammatory cytokines have been measured in OA synovial fluid. Although the cartilage lesion is present at sites remote from synovium, the fibroblast- and macrophage - like synovial cells, as well as the chondrocytes itself, are potential sources of cytokines that could induce chondrocytes to synthesize and secrete cartilage-degrading proteases, cytokines, and other inflammatory mediators. The bio-identical progesterone shows its anti-inflammatory effects in OA by suppressing gene expressions in the production of inflammatory cytokines through the negative interaction between nuclear transcription factor and the progesterone receptor and/or the progesterone–induced increase of nuclear transcription factor inhibition in the nucleus. The bio-identical progesterone may indirectly regulate bone remodeling and may also play a role in the development and maintenance of cartilage. This review will discuss about transdermal bio- identical progesterone cream as suggested hormonal treatment of OA, based on its pathogenic process.10
O. Stundner et al., (2013) conducted a study on perioperative outcomes among the subset of patients undergoing total hip arthroplasty (THA) for a diagnosis of rheumatoid arthritis (RA) rather than osteoarthritis (OA). We sought to 1) identify the prevalence of RA in patients undergoing THA, 2) compare their demographics to those being operated on for OA, 3) determine differences in perioperative outcomes and 4) analyse if RA represents an independent risk factor for complications, mortality, utilisation of resources, increased length of stay and cost.11
Ilana N Ackerman et al., (2004) conducted a systematic review on randomised controlled trials was performed to evaluate the effectiveness of pre- operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The
methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.12
Ananthila Anandacoomarasamy et al., (2010) conducted a study on Osteoarthritis (OA) is the most common form of arthritis and the leading cause of chronic disability among older people. The burden of the disease is expected to rise with an aging population and the increasing prevalence of obesity. Despite this, there is as yet no cure for OA. However, in recent years, a number of potential therapeutic advances have been made,in part due to improved understanding of the underlying pathophysiology. This review provides the current evidence for symptomatic management of OA including nonpharmacological, pharmacological and surgical approaches. The current state of evidence for disease-modifying therapy in OA is also reviewed.13
Amy Bronstone et al.,(2013) conducted a study on concerns about the safety of systemic oral pharmacologic treatments for knee osteoarthritis (OA) mount, clinicians have increased the use of intra-articular hyaluronic acid (IA-HA) in managing mild-to-moderate knee OA. Supartz (sodium hyaluronate;
Seikagaku Corporation, Tokyo, Japan) is the first IA-HA product to be approved in the world and has the longest history of global use. In this review, we summarize evidence supporting Supartz efficacy and safety, including data from pivotal clinical trials that resulted in approval of Supartz in the United States and Japan, the safety of single and repeated courses of Supartz, and Supartz efficacy using objective outcomes and in special populations. There is strong evidence that single 5-week courses of Supartz provide clinically meaningful reductions in pain and improved function for up to 6 months without risk of serious side effects or complications. Repeated courses of Supartz are as safe as single courses and have an extremely low risk of infection. Findings from promising initial studies, which suggest that Supartz may improve muscle strength, gait pattern, and balance, should be confirmed in randomized controlled trials.14
Karaca Sinan et al.,(2015) conducted a study on Cement extrusion at Unicompartmental Knee Arthroplasty (UKA) procedure, into the anterolateral compartment of the knee is rare. Complications after a UKA procedure, such as bearing dislocations, polyethylene wear, aseptic loosening and progressive arthritis have been reported. We would like to report a case of cement extrusion into the anterolateral compartment on a patient with UKA. With the direct arthroscopic visualization method this complication was treated successfully.
When cementing the prosthesis, it is important to take attention to remove extruded cement, visualize all parts of the knee and wash the surgical area to prevent this complication during UKA.15
Grennan, J Gray et al.,(2020) conducted a study to determine whether continued methotrexate treatment increases the risk of postoperative infections or of surgical complications in patients with rheumatoid arthritis (RA) within one year of elective orthopaedic surgery.16
Shinichi Yoshiya et al., (2001) studied efficacy of Total knee arthroplasty (TKA) is an excellent surgical procedure that can make severely damaged knees painless and stable, but it can be associated with many complications. Once complications develop, their management is not necessarily easy. The major complications include loosening, wear and breakage of the prosthetic
components, patellar problems, fracture in the vicinity of the prosthesis, disruption of the extensor mechanism of the knee, and infection. Complications can often be prevented if TKA is performed after adequate preparation, such as thorough evaluation of the appropriateness of surgery, and if the technique used for TKA is meticulous. Great care must be taken both before and during the operation. When complications occur despite such precautions, early detection, accurate evaluation, and appropriate treatment are important.17
Van Manen et al., (2012) conducted a study on Osteoarthritis (OA) of the knee, one of the most common causes of disability, continues to increase in prevalence as the older adult and obese populations grow. Often, the general practitioner is the first to evaluate a patient with a painful knee that has arthritis.
Evidence-based evaluation and treatment guidelines recommend the use of nonoperative treatments before surgical treatment options such as total knee arthroplasty (TKA) are considered. Understanding available nonoperative treatment options is critical for physicians who first encounter patients with OA of the knee. The authors provide an overview of nonoperative treatment options for patients with OA, including weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. The authors also discuss operative treatment options to be considered before TKA and review indications for TKA when other treatment options have been exhausted.18
Moin Khan et al.,(2018) conducted a study on Osteoarthritis has a high global health and economic burden and will become the fourth leading cause of disability by the year 2020, according to data from the World Health Organization.1 Official Canadian statistics estimate that 1 in 10 Canadians aged 15 years or older suffers from osteoarthritis and prevalence increases with age.2 Symptomatic osteoarthritis most commonly affects the knee; 29% of all Canadian cases of osteoarthritis involve the knee. As the population ages and rates of obesity rise, it is estimated that the number of individuals affected will increase to one in five by 2031. A recent study estimated that loss of productivity from chronic pain and loss of mobility owing to the disease costs the Canadian economy $17.5 billion annually.3 Total knee replacement represents the
definitive treatment for disabling knee osteoarthritis that has not responded to nonoperative treatments, which include analgesics, weight loss, bracing, modification of activity, physiotherapy and intraarticular injections. However, this treatment is not always advisable, particularly in young patients. Treating young patients who have pain and functional limitation owing to knee involvement is a clinical challenge; these patients have been referred to as falling into a “treatment gap,” as they are too young or may be
unwilling to undergo total knee replacement.4 Available clinical practice guidelines vary substantially in both their quality and specific treatment recommendations for younger patients with osteoarthritis.19
Brian C. Werner et al .,(2016) conducted a study to evaluate the outcomes of primary total knee arthroplasty (TKA) in patients with rheumatoidarthritis, very little has been reported on the outcomes of this procedure in patients with other inflammatory arthritides.20
Per-Göran Larsson et al., (2002) conducted a study on Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy. Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV.21
Wei Zhang et al., (2015) conducted a study on Osteoarthritis (OA) is a degenerative joint disorder commonly encountered in clinical practice, and is the leading cause of disability in elderly people. Due to the poor self-healing capacity of articular cartilage and lack of specific diagnostic biomarkers, OA is a challenging disease with limited treatment options. Traditional pharmacologic therapies such as acetaminophen, non-steroidal anti-inflammatory drugs, and opioids are effective in relieving pain but are incapable of reversing cartilage damage and are frequently associated with adverse events. Current research focuses on the development of new OA drugs (such as sprifermin/recombinant human fibroblast growth factor-18, tanezumab/monoclonal antibody against β- nerve growth factor), which aims for more effectiveness and less incidence of adverse effects than the traditional ones. Furthermore, regenerative therapies (such as autologous chondrocyte implantation (ACI), new generation of matrix- induced ACI, cell-free scaffolds, induced pluripotent stem cells (iPS cells or
iPSCs), and endogenous cell homing) are also emerging as promising alternatives as they have potential to enhance cartilage repair, and ultimately restore healthy tissue. However, despite currently available therapies and research advances, there remain unmet medical needs in the treatment of OA.
This review highlights current research progress on pharmacologic and regenerative therapies for OA including key advances and potential limitations.22
Husam Abdulrahman AlTahan et al., (2018) conducted a study on Total knee arthroplasty (TKA) is one of the most commonly performed surgeries globally, particularly for patients with moderate-to-severe osteoarthritis.
Predictors of postoperative outcomes have been thoroughly studied. Morbid obesity is one of the predictors that has shown controversy in the literature. A retrospective cohort chart review study was done to further explore the effect of morbid obesity on postoperative outcomes following TKA. Methods : After applying the inclusion/exclusion criteria, 507 patients were included and stratified based on the WHO body mass index classification. Demographic data was analyzed between 3 groups (non-obese, obese, and morbid obese), and post- operative complications were analyzed and compared between morbid obese and non-morbid obese. Results : In total, 14 (2.6%) patients required revision, with postoperative deep tissue infection being the most common reason.
Postoperative deep tissue infection developed in 4 (4.3%) patients with morbid obesity and in 2 (0.05%) without, which was a statistically significant difference (P = 0.012). Furthermore, 5 (5.4%) patients with morbid obesity and 7 (1.7%) without required revision, which showed a statistically significant difference (P = 0.034). The overall need for red blood cells (RBC) transfusion due to postoperative anemia was recorded in 11 (11.9%) patients with morbid obesity and 100 (24.1%) without, which was a statistically significant difference (P = 0.008). Conclusion : Patients with morbid obesity are less likely to require RBC transfusion due to postoperative anemia but have a higher risk of developing postoperative deep tissue infection and undergoing revision for their prostheses when compared with those without morbid obesity.23
Giuseppe Musumeci et al., (2012) conducted a study on Osteoarthritis (OA) is a degenerative process involving the progressive loss of articular
cartilage, synovial inflammation and structural changes in subchondral bone that lead to loss of synovial joint structural features and functionality of articular cartilage. OA represents one of the most common causes of physical disability in the world. Different OA treatments are usually considered in relation to the stage of the disease. In the early stages, it is possible to recommend physical activity programs that can maintain joint health and keep the patient mobile, as recommended by OA Research Society International (OARSI) and European League Against Rheumatism (EULAR). In the most severe and advanced cases of OA, surgical intervention is necessary. After, in early postoperative stages, it is essential to include a rehabilitation exercise program in order to restore the full function of the involved joint. Physical therapy is crucial for the success of any surgical procedure and can promote recovery of muscle strength, range of motion, coordinated walking, proprioception and mitigate joint pain. Furthermore, after discharge from the hospital, patients should continue the rehabilitation exercise program at home associated to an appropriate diet. In this review, we analyze manuscripts from the most recent literature and provide a balanced and comprehensive overview of the latest developments on the effect of physical exercise on postoperative rehabilitation in OA. The literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar, using the
keywords ‘osteoarthritis’, ‘rehabilitation’, ‘exercise’ and ‘nutrition’. The available data suggest that physical exercise is an effective, economical and accessible to everyone practice, and it is one of the most important components of postoperative rehabilitation for OA.24
Ananthila Anandacoomarasamy et al., (2010) conducted a study on Osteoarthritis (OA) is the most common form of arthritis and the leading cause of chronic disability among older people. The burden of the disease is expected to rise with an aging population and the increasing prevalence of obesity. Despite this, there is as yet no cure for OA. However, in recent years, a number of potential therapeutic advances have been made, in part due to improved understanding of the underlying pathophysiology. This review provides the current evidence for symptomatic management of OA including
nonpharmacological, pharmacological and surgical approaches. The current state of evidence for disease-modifying therapy in OA is also reviewed.25
Olszewska-Słonina et al., (2010) conducted a study on Osteoarthritis is often accompanied by disturbance of oxidative equilibrium. The aim of the study was to analyze antioxidant defense system function in patients with hip and knee osteoarthritis by assessing superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activity in erythrocytes.26
Bachmeier et al., (2001) conducted a study to assess changes in physical function and quality of life with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the instrument of the Medical Outcomes Study SF-36 Health Survey (MOS SF-36), respectively, in patients undergoing hip and knee joint replacement surgery and to compare the responsiveness of these two outcome measures 1 year after surgery.27
Plan of the study
4. PLAN OF STUDY
The study was carried out a period from the month of October 2019 to November 2020. The proposed study has been designed below.
This Prospective-Observational study has to be conducted for a period of six months from October 2019 to March 2020. The patients are selected based on the inclusion in and their medical records are used to document the required data using a well designed data collection form.
Aim and
Objectives
3. AIM AND OBJECTIVES AIM:
To access the complication of pre and postoperative osteoarthritis patients in tertiary care hospital.
OBJECTIVE:
To explore the risk factors, prevalence and treatment pattern for patients with osteoarthritis.
To estimate the overall osteoarthritis patients in tertiary care hospital
Statistical analysis of osteoarthritis patients among male and female
To survey the socio demographic information of the patients
To determine the preoperative treatments
To analyse the preoperative treatment failure
To identify the postoperative patients related factors after surgical procedure.
To identify and analyse the postoperative drug related factors.
Methodology
5. METHODOLOGY STUDY DESIGN:
The study was a Prospective-Observational study Geographical center of study:
Vivekananda medical care and hospital (VMCH), Elayampalayam, Tiruchengode, TamilNadu (for practical reasons included in and outpatients).
DURATION OF STUDY:
The study was conducted from October 2019 to March 2020 in the Department of Orthopaedics.
INCLUSION CRITERIA:
Patients with the 35 to 60 years of age
Both males and females suffering from osteoarthritis
Patients with diet plan and OA with TKA.
EXCLUSION CRITERIA:
Age more than 60 years old
Who are co-operative and not willing to participate in the study
Pregnancy patients and lactating patients
Patients with bleeding disorders
Critically ill patients
ETHICAL CLEARENCE:
The study was approve (Ref.No:VMCH/IEC/JAN/2020/03) by Institutional Ethical Committee of Vivekanandha Medical Care Hospital (Annexure-1)
STUDY POPULATION:
The total number of patients is 65 medical and medication history was reviewed. From that 20 patients were included in the study as per the inclusion and exclusion criteria. Out of which 15 patients were withdrawn from this study due to poor compliance and missed follow up. Finally 65 patients were completed the study.
SOURCE OF DATA:
Patients medical record
Designed data entry
Drug chart and medication chart
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire
METHOD OF STUDY:
Patients were selected randomly to the study as per the inclusion and exclusion criteria. Selected patients were divided in to Pre and Post operative groups. The patient demographics data was collected by using data entry form.
The baseline score of pain, Stiffness, and Physical function of assessed by using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, to enrolled subjects were asked to answer (WOMAC) questionnaire.
The initial score was considered as a baseline. The study subjects were followed once in 60 days for 6 months and they were asked to answer the same questionnaire. The effect of the treatment was assessed by comparing the baseline score with follow up score.
STATISTICAL ANALYSIS
All results were analyzed using computerized statistical package of graph Pad instat Version. Values are represented as Mean ± SD (standard Deviation).
Scores of WOMAC Questionnaire and Visual Analogue Scale (VAS) were compared by using the Student’s t-test. It was considered as statistically significant.
Results
6. RESULTS
A number of 65 Osteoarthritis patients after Total Knee Replacement were selected as per inclusion and exclusion criteria. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The study subjects were followed once in 60 days for 6 months.
6.1. AGE WISE DISTRIBUTION AMONG THE STUDY POPULATION
Among 65 patients, 4.61% (5) were in the age group of 40 – 55 years, 61.53 % (62) were in the age group of 56 – 70 years, 33.84 % (34) were in the age group of 71 – 85 years. (Table 1, Figure 4)
Table 1: AGE WISE DISTRIBUTION AMONG STUDY POPULATION (n = 65) Age(years) No. of patients Percentage
40-55 3 5
56-70 40 62
71-85 22 34
Figure 1: AGE WISE DISTRIBUTION PERCENTAGE AMONG STUDY POPULATION (n = 65)
6.2.GENDER WISE DISTRIBUTION AMONG STUDY POPULATION (n = 65) A total of 65 osteoarthritis patients, males were 46.15% (46) and Females were 53.84 % (54). (Table 2, Figure 5)
Table 2: GENDER WISE DISTRIBUTION AMONG THE STUDY POPULATION (n = 65)
Gender No of Patients Percentage of Patients
Male 30 46
Female 35 54
Figure 2: GENDER WISE DISTRIBUTION PERCENTAGE AMONG THE STUDY POPULATION (n=65)
6.3.BODY MASS INDEX (BMI) AMONG THE STUDY POPULATION
A total of 65 osteoarthritis patients, 52.30% (52) were in normal body weight, 33.84% (34) were in over body weight, 10.76% (11) were in obesity, 3.07% (3) were in mild thinness.
Table 3: BMI AMONG THE STUDY POPULATION (n = 65)
BMI No of patients Percentage
Normal weight 34 52
Over weight 22 34
Obesity 7 11
Mild thinness 2 3
BMI - Body Mass Index
Figure 3: BMI AMONG THE STUDY POPULATION (n = 65)
6.4.EDUCATION AMONG THE STUDY POPULATION
A total of 65 osteoarthritis patients, 46.69% (48) were in illiterate, 23.07%
(23) were in Primary, 24.61% (25) were in Secondary, 4.61% (5) were in Graduate.
Table 4: EDUCATION AMONG THE STUDY POPULATION (n = 65) Education No. of patients Percentage
Illiterate 31 48
Primary 15 23
Secondary 16 25
Graduate 3 5
Figure 4: EDUCATION AMONG THE STUDY POPULATION (n = 65)
6.5.ASSOCIATE DISEASE ALONG WITH OSTEOARTHRITIS PATIENTS (n = 65)
A total of 65 osteoarthritis patients, 55.38% (55) were in Osteoarthritis patients, 27.69% (28) were in Hypertension patients, 12.30% (12) were in Hypertension and diabetic patients, 4.61% (5) were in Diabetic patients.
Table 5: ASSOCIATED DISEASE ALONG WITH THE STUDY POPULATION (n = 65)
Associate disease No .of Patients Percentage
OA 36 55
OA,HTN 18 28
OA,HTN,DM 8 12
OA,DM 3 5
Where OA-Osteoarthritis, HTN-hypertension, DM-Diabetic Mellitus
Figure 5: ASSOCIATE DISEASE ALONG WITH OSTEOARTHRITIS PATIENTS AMONG THE STUDY POPULATION (n = 65)
