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Publication In Arthritis Care & Research

Disparities in total knee replacement: Population losses in quality-adjusted life years due to differential offer, acceptance, and complication rates for Black Americans.

This article was published in January 2018 in Arthritis Care & Research.

Publication in Arthritis Care & Research

Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament (ACL) Tear in Early Adulthood

This article was published in February 2017 in Arthritis Care & Research.

Why ACL Tears Are Important for Knee Osteoarthritis

The incidence of ACL injuries is increasing; an estimated 5% of competitive year-round athletes experience an ACL injury each year. These injuries mostly occur in young, active people, and they have serious implications for developing knee OA later in life. However, because injuries occur many decades prior to OA development, studies estimating the lifetime risk of knee OA after injury are limited.

Study Design

We used the OAPol model to forecast the lifetime risk of knee OA and total knee replacement eligibility in persons with a complete ACL tear at age 25. We compared this to lifetime risk of knee OA and total knee replacement eligibility in an non-injured cohort.

Our Results

In our simulation model, people with ACL injury and meniscal tears had a 34% estimated lifetime risk of knee OA, while those who did not have injuries had a 14% lifetime risk of developing knee OA. Estimated lifetime risk of TKR was 22% for persons with ACL and meniscal tears, compared to 6% for those without injuries.

Publication in Arthritis Care & Research

Cost-effectiveness of tramadol and oxycodone in the treatment of knee osteoarthritis

This evaluation of the cost-effectiveness of two frequently used opioids was published in Arthritis Care & Research in February 2017.

Why Opioid Cost-Effectiveness Matters

The United States spends over 1.5 billion dollars on prescription opioids for knee OA patients, and the cost of illicit use of opioids has been estimated at over 28 billion dollars.  It is essential to understand if opioids are providing enough benefit to warrant these costs.

Study Design

We used the OAPol model to evaluate the cost effectiveness of tramadol and oxycodone in persons with no major comorbidities. We tested three treatment options: 1) no opioids; 2) tramadol; 3) tramadol followed by oxycodone.

Our Results

Neither tramadol nor tramadol plus oxycodone were cost-effective for knee OA in our base case, primarily because opioids worsen outcomes for total knee replacement. If patients are unwilling or unable to undergo total knee replacement, opioids may be cost-effective.

Publication in Arthritis Care & Research

The number of persons with symptomatic knee osteoarthritis in the United States: Impact of race/ethnicity, age, sex, and obesity

In this paper, published in December 2016 in Arthritis Care & Research, we used the OAPol model to estimate the number of persons with symptomatic knee OA in the United States.

Why This Estimate Matters

Previous estimates of the burden of knee osteoarthritis in the United States have not provided age and sex stratified estimates. Understanding the demographic characteristics of people with OA and severe OA will allow better predictions about what healthcare resources will be necessary in the coming years.

How the Study Was Designed

We used the National Health Interview Survey (NHIS) to calculated the proportion of adults with  knee OA in 2007-2008. We used the OAPol model and published data on knee OA progression to estimate the proportion of people living with severe OA. We then multiplied the proportions by population estimates from the US Census bureau.

Our Conclusions

We found that 14 million people have symptomatic knee OA, and half are under 65 years old. These results suggest that health care utilization for knee OA will increase over the coming decades and they emphasize the need for new prevention and treatment strategies.

OA Risk Calculator

This month, OrACORe and PIVOT released an updated model of the Osteoarthritis Risk Calculator (OA Risk C). This interactive, web-based education tool calculates a user’s risk of OA and of undergoing TKR, based on demographic and risk factor information. For more about how we developed this tool, click here.

Risk calculators exist for many prevalent conditions with modifiable risk factors, such as heart disease, cancer, and diabetes. However, no risk calculators previously existed for OA. The OA Risk Calculator provides information about risk factors and the chance of developing OA if these factors are modified. For those already diagnosed with OA, the calculator gives information about the user’s risk of total joint replacement.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Spotlight

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) features a recent publication on the cost-effectiveness of several pain medications among older adults with OA and co-existing diabetes and heart disease.

The study, published in Osteoarthritis and Cartilage, found that naproxen-based treatments were more cost-effective in this study population than either tramadol or celecoxib. Click here to learn more.

Losina Earns International Osteoarthritis Clinical Research Award

Elena Losina, PhD, co-director of the Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) in the Department of Orthopedic Surgery, and director of the Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center has received the Osteoarthritis Research Society International (OARSI) Clinical Research Award for health policy and medical decision-making research in osteoarthritis. She received the award at the 2016 OARSI Congress in March in Amsterdam.

Losina is a founding director of BWH’s Policy Innovation eValuations in Orthopedic Treatments (PIVOT) Research Center and a principal investigator in the Methodology Core of the Robert Brigham Multidisciplinary Clinical Research Center at BWH. She also directs the Statistical Center for Biomarkers Consortium, an international collaboration to establish the prognostic value of biomarkers in osteoarthritis. She has published more than 300 peer-reviewed articles and leads a National Institutes of Health-funded multi-site project to conduct health policy evaluations related to surgical and non-surgical management of knee osteoarthritis.

OARSI is the leading osteoarthritis research organization in the world. The OARSI Clinical Research Award is given to one member each year in recognition of a body of clinical research of significant international impact

Policy and Innovation eValuation in Orthopedic Treatments (PIVOT) Center launched in BWH’s Department of Orthopedic Surgery

Affecting more than half of adults in the U.S., low back pain, osteoarthritis and musculoskeletal trauma are the three most common musculoskeletal conditions leading to emergency department and physician visits and hospital stays. Nearly $800 billion, or about 5 percent of the U.S. economy, goes towards diagnosing, treating, and managing musculoskeletal conditions.

“America spends more money on managing musculoskeletal conditions than it does on Social Security benefits for retired persons and their families,” said Elena Losina, PhD, professor of Orthopedic Surgery at BWH’s Department of Orthopedic Surgery and Harvard Medical School. “As people live longer and baby boomers age, this burden will increase.”

To help address these issues, BWH has launched the Policy and Innovation eValuation in Orthopedic Treatments (PIVOT) Center in the Department of Orthopedic Surgery. The research conducted by the PIVOT Center will help policy makers, physicians and patients to maximize treatment health benefits while reducing the overall economic burden of musculoskeletal diseases.

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