The effects of guided imagery on post-operative pain and state anxiety in total knee arthroplasty patients.

Background: After total knee arthroplasty, adequate management of postoperative pain and anxiety without adverse side effects is improving advanced patients’ outcomes. Objective: This study aimed to examine the effects of guided imagery on postoperative pain and state anxiety in total knee arthroplasty patients. Methods: The study employed a quasi-experimental research design. The sample consisted of 64 patients who underwent total knee arthroplasty divided into two groups, with 32 subjects in each group. The subjects in the control group received routine nursing care, whereas those in the experimental group received routine nursing care plus guided imagery therapy. Outcome measures were the numeric rating scale for pain score and the State Anxiety Inventory for anxiety score. Results: The experimental group had significantly lower scores of pain and anxiety than the control group (p-value = .0035 and .012 respectively). Conclusion: Guided imagery is an alternative treatment that can be used to supplement pharmacological treatment to effectively reduce pain and anxiety in patients undergoing total knee arthroplasty.

Cost analysis of intra-articular sodium hyaluronate treatment in knee osteoarthritis patients who failed conservative treatment.

BACKGROUND: Failed conservative treatments of knee osteoarthritis (OA) in the elderly have traditionally been treated with TKA (Total Knee Arthroplasty). Although TKA is a gold standard and cost-effective treatment in elderly patients, it should be considered as the last resource for patients with pain that cannot be controlled by the usual conservative therapeutic approaches. Numerous studies showed that intra-articular Sodium Hyaluronate (IA-HA) (Hyalgan) is effective for treatment in various stages of knee OA. OBJECTIVES: To compare cost of treatment between two groups of knee OA patients who failed conservative treatments. The first group includes the patients who responded to IA-HA treatment leading to delay or cancel surgical treatments (response group). The second group includes the patients who did not respond to IA-HA treatment and they had to undergo surgical procedures (non-response group). MATERIAL AND METHOD: A cost analysis from the retrospective data in Police General Hospital from year 2001-2004. One hundred and eighty three patients with knee OA (208 knees) who failed conservative treatments and did not have contraindications for surgery were enrolled. All patients were treated with one course of three IA-HA injections (500-730 KDA, Hyalgan) at weekly intervals and followed up for a minimum 2-year period. In case of successful treatment (response group), repeated doses were recommended. If the patients did not improve in the average Western Ontario and McMaster Universities Osteoarthritis Index (the average WOMAC) score within one month after completion of the injections, they would be classified as a non-response group and the surgical procedures would be considered. Cost of direct medical costs (drugs), hospitalization, and resource utilization were recorded and analyzed. RESULTS: One hundred and forty six patients (164 knees) responded to the treatment and did not need any surgical procedures within the 2-year follow-up period. Thirty-seven patients (44 knees) did not respond and needed surgical procedures. In the response group, 83 patients repeated the second course of treatment and 14 patients repeated the third course. The total average cost for the response group were 47,044.18 Baht per patient, which was an average cost of IA-HA; 12,240.41 Baht and an average cost of other medications following the injection of 34, 803.77 Baht. The ratio of the IA-HA cost and medications following the injection cost was 1:2.84. In the non-response group, the total average cost was 144,884 Baht per patient including average cost of surgery of 135,559.95 Baht per patient or 113,993.59 Baht per knee and cost of IA-HA treatment of 9,324 Baht per patient, which was only 6.44% of the total costs of treatment. However, when considered in the response group, the IA-HA treatment provided cost saving from cancellation or delayed surgical procedures at 63.26%. CONCLUSION: IA-HA should be considered as a medical intervention before surgical procedures in knee OA patients who failed conservative treatments. Even though the cost of IA-HA treatment would increase the total costs of treatment and some patients might fail, it was only 6.44% of the total costs. On the other hand, if patients responded to IA-HA treatment, then the surgical procedures were not required. This treatment could save the cost from cancellation or delayed surgical procedures at 63.26%.

Outcomes of intra-articular injection of sodium hyaluronate for the treatment of osteoarthritis of the knee.

BACKGROUND: Intra-articular injection of hyaluronic acid has become an intervention step between conservative and operative treatment of knee osteoarthritis. This is recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). However, the expected outcomes and the selection criteria are undetermined and controversial. A few articles have mentioned the long-term result of Sodium Hyaluronate in failed conservative treatment. OBJECTIVE: Determine the clinical outcomes of treatment with three intra-articular Sodium Hyaluronate injections (500-730 kilodalton (KDA), Hyalgan) in knee-osteoarthritis patients who failed conservative treat-ment. MATERIAL AND METHOD: This was an uncontrolled, retrospective-cohort study with at least a 24-month followup period. The outcomes of the treatment were evaluated by questionnaires and telephone calls. The primary efficacy parameter was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the secondary efficacy parameter was delay or cancellation of any surgical treatments during the followup period. Patients who had undergone surgical treatments were placed in the non-response group. The response group has repeated treatment every year. RESULTS: One hundred and eighty-three patients (208 knees) treated with intra-articular Sodium Hyaluronate were classified into three groups according to radiographic assessment. In group 1, narrowing joint space (Ahlback grade 1-2), WOMAC score improved from 70.46 to 26.55 (p < 0.0001), 41 in 46 patients (44/49 knees) did not require any surgical treatments. In group 2, bony attrition (Ahlback grade 3-4), WOMAC score improved from 70.19 to 40.38 (p < 0.0001), 47 in 70 patients (51/78 knees) did not require surgical treatment. In group 3, lateral subluxation (Ahlback grade 5) WOMAC score improved from 64.71 to 32.67 (p < 0.0001), 58 in 67 patients (69/81knees) did not require surgical treatment. The result from WOMAC subscale analysis revealed an improvement in pain, stiffness, and function in all groups (p < 0.0001), but did not improve in ambulatory status. CONCLUSION: Intra-articular Sodium Hyaluronate injection, used in knee-osteoarthritis patients who failed conservative treatment, was effective in visible cartilage patients (Ahlback grade 1, 2) without mechanical problems involved. In severe osteoarthritis patients (Ahlback grade 3, 4, 5), this treatment was of less benefit if those patients were young, active, and expected independent ambulation. Surgical treatment may be a procedure of choice to meet patient expectation in improving function and ambulatory status. On the other hand, if patients were old and inactive with household ambulation, using intra-articular Sodium Hyaluronate was beneficial in improving pain, stiffness, and function but not ambulation level with 86.56% of excellent or good in overall satisfaction level. Thus, the radiographic evaluation, age, ambulatory status, and patient expectation may be the key factors to determine successful outcomes.