Evidence-Based Practice Group Answers to Clinical Questions

Transcription

1 Evidence-Based Practice Group Answers to Clinical Questions Is There Any Evidence On The Causal Association Between Transfemoral Amputation And The Development Of Contra-Lateral Hip Osteoarthritis? A Rapid Systematic Review By WorkSafeBC Evidence-Based Practice Group Dr. Craig Martin Manager, Clinical Services Chair, Evidence-Based Practice Group September 2015 Clinical Services Worker and Employer Services

2 Lateral Hip Osteoarthritis? i About this report Is there any evidence on the causal association between transfemoral amputation and the development of contra-lateral hip osteoarthritis? Published: July 2013 About the Evidence-Based Practice Group The Evidence-Based Practice Group was established to address the many medical and policy issues that WorkSafeBC officers deal with on a regular basis. Members apply established techniques of critical appraisal and evidence-based review of topics solicited from both WorkSafeBC staff and other interested parties such as surgeons, medical specialists, and rehabilitation providers. Suggested Citation WorkSafeBC Evidence-Based Practice Group, Martin CW. Is There Any Evidence On The Causal Association Between Transfemoral Amputation And The Development Of Contra-Lateral Hip Osteoarthritis? Richmond, BC: WorksafeBC Evidence-Based Practice Group; September Contact Information Evidence-Based Practice Group WorkSafeBC PO Box 5350 Stn Terminal Vancouver BC V6B 5L5 craig.martin@worksafebc.com Phone Toll-free ext 7417 View other systematic reviews by the EBPG online at:

3 Lateral Hip Osteoarthritis? 1 Objective To determine whether there is any evidence on the causal association between transfemoral amputation and the development of contra-lateral hip osteoarthritis. Methods A systematic literature search was conducted on July 8, The search was done on commercial medical databases, including BIOSIS Previews, Embase, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Daily Update and OLDMEDLINE, that are available through OvidSP interface. First search was conducted, in several stages, by employing a combination of keywords: o (transfemoral amputation) AND ((contra lateral) OR contralateral OR (contra-lateral)) AND (hip osteoarthritis). No studies were identified through this search. o (transfemoral amputation) AND ((contra lateral) OR contralateral OR (contra-lateral)) AND osteoarthritis No studies were identified through this search. o (contralateral hip osteoarthritis) Two studies (ref. 1 and 2) were identified through this search. Upon examination of the titles and abstracts, none of these studies were relevant in answering our objective. Since the first, specific, search was not able to identify any published studies to answer our question, a second, more general, search was done. The second search employed the following keyword combination: amputation AND ((contralateral OR (contra-lateral) OR (contra lateral) AND osteoarthritis)) o 12 published studies (ref. 3-14) were identified through this search.

4 Lateral Hip Osteoarthritis? 2 o Upon examination of the titles and abstracts of these studies, 6 (ref. 3,4,6-9) were thought to be relevant and were retrieved in full. Upon examination of the full article, it was determined that the study by Karam et. al. (ref. 6) did not discuss the development of osteoarthritis among amputees, and as such this study is not presented further. A manual search was also conducted among articles retrieved in full. Two (ref ) studies identified from this manual search were thought to be relevant and were retrieved in full. Upon examination of the full article, only one (ref. 15) was thought to be relevant and presented below. No limitations, such as on the date or language of publication, were implemented in this search.

5 Lateral Hip Osteoarthritis? 3 Results In a small case series (level of evidence 5. Appendix 1), Ammar and Piera (ref. 3) presented 26 post-world War I and II veterans with amputations that were living in the 'Institution Nationale des Invalides' in Paris. Of these 26 amputee veterans, they reported that 5 (of 26 = 19.2%) developed hip osteoarthritis (OA) and another 5 developed knee OA on the contra-lateral limb after a mean follow-up period of 60 years. It should be noted that it is not clear whether this figure of 19.2% of veterans having developed contra-lateral hip OA was significantly higher than expected given the authors did not provide further information. Burke et. al. (ref. 4), in a small case series (n=42) (level of evidence 5. Appendix 1) reported the outcomes of clinical and radiological surveys of lower limb amputees. These 42 amputees, with a mean age of 48.4 years (range years) had an average duration of 24.6 years (range 7-51 years) post-amputation. Of these 42 amputees, 2 (4.8%) and 5 (11.9%) showed radiological signs of OA on the amputated and unamputated leg, respectively (this difference was not statistically significant). It should be noted that this is just a crude sample of prevalence data on the occurrence of hip OA. Even though Kulkarni et. al. (ref. 7) stated that their report was a retrospective cohort (level of evidence 3. Appendix 1) among British male World War II veterans with major lower limb amputations, it should be noted that their paper was a small (n=44) case series (level of evidence 5. Appendix 1) since the authors did not provide any information on this supposedly cohort of British male veteran with major lower limb amputations. With regards to hip OA, the authors reported that 61% of the hips on the amputated side and 23% on the non-amputated side were positive for hip OA based on the Kellgren- Lawrence criteria of 2 (it was not clear whether this was a clinical or radiological diagnosis). The authors further stated that based on data from general population surveys ( the characteristics of the general population surveyed were not clarified), only 4 (11%) cases of hip OA would have been expected on both the amputated and non-amputated limb. In a small case-control study (level of evidence 3. Appendix 1), Melzer et. al. reported the prevalence of OA of the contra-lateral knee of men with traumatic amputation who did- and did not participate in regular, vigorous physical activity. There were 3 groups of patients assessed; group 1 consisted of 8 male amputee volley ball players, group 2

6 Lateral Hip Osteoarthritis? 4 consisted of 24 males amputees who did not play volley ball and group 3 consisted of 24 healthy controls matched for age and weight. The authors found that 50% of group 1, 70.8% of group 2 and 37.5% of group 3 participants were diagnosed with OA according to the Kellgren-Lawrence criteria of 2. It should be noted that there was no data on hip OA presented in this paper; as well, the comparison being made was a crude comparison on prevalence of knee OA without further adjustment for other confounders such as history of injury in the non-amputated knee, occupations etc. Norvell et. al. (ref. 9), in a small case control study (level of evidence 3. Appendix 1), investigated the association between amputation (traumatic transfemoral or transtibial) and the development of knee pain or knee OA among US veterans who had registered at one of the US Veteran Affairs heath care offices in Washington State. Sixty-two amputees served as cases while 94 non-amputees served as controls in this study. The authors found that the age and average weightadjusted prevalence ratio of knee pain among transtibial amputees, compared with non-amputees, was 1.3 (95% CI ) for the knee of the intact limb and 0.2 (95% CI, ) for the knee of the amputated limb. The standardized prevalence ratio of knee pain in the intact limb and symptomatic OA among transfemoral amputees, compared with nonamputees, was 3.3 (95% CI, ) and 1.3 (95% CI, ), respectively. It should be noted that except for age and weight, no other potential confounders for the development of knee pain or knee OA was taken into account in the calculation of these prevalence ratios. In an abstract-only publication, Hungerford and Cockin (ref. 15) reported a study of a 117 amputees (63 below knee and 54 above knee), comparing them with a matched group of controls (the information provided in this abstract-only publication was very short and as such many important data including the characteristics of the amputees and the controls were not available); presumably this was a case-control study (level of evidence 3, Appendix 1). The group of amputees was reported to have significantly more complaints to the contra-lateral hip, but only the above knee amputees had more radiographic changes compared to controls. The radiographs of this hip showed more abnormality in both above- and below knee amputees, with characteristic findings of osteoporosis, concentric joint space narrowing and absence of osteophytes.

7 Lateral Hip Osteoarthritis? 5 Summary At present, there is no published evidence on the (causal) association between transfemoral amputation and the development of contralateral hip osteoarthritis In general, there is some (low quality) anecdotal evidence (level of evidence 5. Appendix 1) on the higher prevalence of contra-lateral hip OA among those amputated.

8 Lateral Hip Osteoarthritis? 6 References 1. Nankaku, M.; Tsuboyama, T.; Akiyama, H.; Kakinoki, R.; Fujita, Y.; Nishimura, J.; Yoshioka, Y.; Kawai, H., and Matsuda, S. Preoperative prediction of ambulatory status at 6 months after total hip arthroplasty. Physical. therapy. 93 (1) (pp 88-93), Quintana J.M.; Escobar, A.; Aguirre, U.; Lafuente, I., and Arenaza J.C. Predictors of health-related quality-of-life change after total hip arthroplasty. Clinical. Orthopaedics and Related Research. 467 (11) (pp ), Ammar, A. and Piera J.B. Ageing problems for the amputee of the lower limb. Revue. de Geriatrie. 6 (1) (pp 27-30), Burke M.J.; Roman, V., and Wright, V. Bone and joint changes in lower limb amputees. Annals. of the Rheumatic Diseases. 37 (3) (pp ), Dailiana Z.H.; Malizos K.N.; Varitimidis, S.; Hantes, M.; Basdekis, G., and Rigopoulos, N. Low-molecular-weight heparin for prevention of thrombosis: Inverted role. Journal. of Trauma - Injury, Infection and Critical Care. 63 (5) (pp E111-E115), Karam M.D.; Willey, M., and Shurr D.G. Total knee replacement in patients with below-knee amputation. The. Iowa orthopaedic journal. 30 (pp ), Kulkarni, J.; Adams, J.; Thomas, E., and Silman, A. Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations. Clinical. Rehabilitation. 12(4):348-53, 1998 Aug. 8. Melzer, I.; Yekutiel, M., and Sukenik, S. Comparative study of osteoarthritis of the contralateral knee joint of male amputees who do and do not play volleyball. Journal. of Rheumatology. 28 (1) (pp ), Norvell D.C.; Czerniecki J.M.; Reiber G.E.; Maynard, C.; Pecoraro J.A., and Weiss N.S. The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. Archives. of Physical Medicine and Rehabilitation. 86 (3) (pp ), Papa J.A. and Myerson M.S. Pantalar and tibiotalocalcaneal arthrodesis for posttraumatic osteoarthrosis of the ankle and hindfoot. Journal. of Bone and Joint Surgery - Series A. 74 (7) (pp ), Perret, K.; Werner, K.; Everding, V., and Wolf, E. Power knee shows improved knee and ankle powers in stepping up task. Parkinsonism. and Related Disorders. Conference: 3rd International Congress on Gait and Mental Function Washington, DC United States. 12. Saltzman C.L. Total ankle arthroplasty: state of the art. Instructional. course lectures. 48 (pp ), Sommerville, S. M.; Patton, J. T.; Luscombe, J. C., and Grimer, R. J. Contralateral total hip arthroplasty after hindquarter amputation. Sarcoma. 2006:28141, Tan, C.; Allan G.S.; Barfield, D.; Krockenberger M.B.; Howlett, R., and Malik, R. Synovial osteochondroma involving the elbow of a cat. Journal. of Feline Medicine and Surgery. 12 (5) (pp ), Hungerford DS and Cockin J. The fate of the retained lower limb joints in World War II amputees (available as abstract only). Journal of Bone and Joint Surgery. 1975;37-B: Harrington IJ and Harris R. Can favouring one leg damage the other? Journal of Bone and Joint Surgery. 1994;76-B:

9 Lateral Hip Osteoarthritis? 7 Appendix 1 WorkSafeBC - Evidence-Based Practice Group Levels of Evidence (adapted from 1,2,3,4) Evidence from at least 1 properly randomized controlled trial (RCT) or systematic review of RCTs. Evidence from well-designed controlled trials without randomization or systematic reviews of observational studies. Evidence from well-designed cohort or case-control analytic studies, preferably from more than 1 centre or research group. Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees. References 1. Canadian Task Force on the Periodic Health Examination: The periodic health examination. CMAJ. 1979;121: Houston TP, Elster AB, Davis RM et. al.. The US Preventive Services Task Force Guide to Clinical Preventive Services, Second Edition. AMA Council on Scientific Affairs. American Journal of Preventive Medicine. May 1998;14(4): Scottish Intercollegiate Guidelines Network (2001). SIGN 50: a guideline developers' handbook. SIGN. Edinburgh. 4. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ. Aug 5, 2003;169(3):