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1

Rhematology, British Society of. Guidelines: Diagnosis and management of osteoarthritis of the hip and knee. London: Royal College of Physicians of London, 1993.

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2

J, Allen Ronald. Arthritis of the hip & knee: The active person's guide to taking charge. Edited by Brander Victoria Anne, Stulberg S. David, and Lee Patricia A. Atlanta: Peachtree Publishers, 1998.

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3

J, Allen Ronald. Arthritis of the hip and knee: The active person's guide to taking charge. Edited by Stulberg S. David, Brander Victoria Anne, and Lee Patricia A. Atlanta: Peachtree Publishers, 1998.

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4

Pencharz, James Nathan Onslow. Development of process-based quality indicators for non-pharmacological care of knee and hip osteoarthritis. Ottawa: National Library of Canada, 2003.

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5

Ratnasingham, Sujitha. The effect of body mass index on the change in disability and pain in hip and knee osteoarthritis. Ottawa: National Library of Canada, 2003.

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6

Scott, David Lindsay. Diagnosis and management of osteoarthritis of the hip and knee: Report of a joint working group of the British Society of Rheumatology and the Research Unit of the Royal College of Physicians. London: Royal College of Physicians, 1993.

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7

Anne, Brander Victoria, ed. Hip and knee rehabilitation. Philadelphia: Hanley & Belfus, Inc., 2002.

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8

Dekker, Joost, Daniel Bossen, Jasmijn Holla, Mariëtte de Rooij, Cindy Veenhof, and Marike van der Leeden. Psychological strategies in osteoarthritis of the knee or hip. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0025.

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Characteristic clinical presentations of osteoarthritis (OA) include pain and activity limitations. These presentations are dependent on psychological processes. The literature reviewed in this chapter leads to the following conclusions: (1) symptoms of depression, anxiety, and fatigue are more prevalent among patients with OA than among the general population. Recently, a depressive mood phenotype has been identified in knee OA. (2) Symptoms of depression, anxiety, and fatigue, as well as other psychological variables are established risk factors for future worsening of pain and activity limitations. (3) Psychological interventions such as depression care and pain coping skills training have been demonstrated to improve pain and activity limitations, as well as psychological outcomes. Self-management may have beneficial effects, although there is clearly room for improvement. Interventions combining psychological interventions with exercise therapy have been shown to be effective; improved outcome over exercise therapy alone stills needs to be demonstrated. (4) Psychological interventions are effective in improving exercise adherence and promoting physical activity. Overall, it can be concluded that the psychological approach towards OA is fruitful: the psychological approach has resulted in substantial contributions to the understanding and management of clinical presentations of OA, including pain and activity limitations.
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9

Exercise And Physical Functioning In Osteoarthritis Medical Neuromuscular And Behavioral Perspective. Springer-Verlag New York Inc., 2013.

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10

Doherty, Michael. Osteoarthritis. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0266.

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Osteoarthritis (OA) is a disorder of synovial joints and is characterized by the combination of focal hyaline cartilage loss and accompanying subchondral bone remodelling and marginal new bone formation (osteophyte). It has genetic, constitutional, and environmental risk factors and presents a spectrum of clinical phenotypes and outcomes. OA commonly affects just one region (e.g. knee OA, hip OA). However, multiple hand interphalangeal joint OA, usually accompanied by posterolateral firm swellings (nodes), is a marker for a tendency towards polyarticular ‘generalized nodal OA’.
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11

Thorlund, Jonas Bloch, and L. Stefan Lohmander. Other surgical approaches in the management of osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0034.

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Joint replacement is often considered the surgical treatment for patients with osteoarthritis (OA). However, several other surgical treatments, of which some are more frequently performed, have been advocated for patients with OA in order to relieve symptoms, stall progression, and avoid or postpone joint replacement. This chapter briefly describes the most common procedures such as knee and hip arthroscopy and knee and hip osteotomy. It also reviews the evidence for the efficacy of these treatments compared with non-surgical alternatives, which is frequently insufficient due to lack of controlled low-risk-of-bias studies. The risk of adverse events is also reported when data is available. Some of the more recent surgical techniques such as implantation of chondrocytes or stem cells are also described and discussed but their utility for treating osteoarthritis remains uncertain. There is a great need for continued innovation and development of surgical techniques for managing in particular the earlier stages of osteoarthritis. To reduce the risk of future costly failures, a stepwise introduction of new surgical procedures and devices must be encouraged.
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12

Effect of land and water exercise on hip and knee flexibility in female osteoarthritic elderly. 1991.

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13

Goldring, Steven R. Pathophysiology of periarticular bone changes in osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0005.

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Under physiological conditions, the subchondral bone of diarthrodial joints such as the hip, knee, and phalanges forms an integrated biocomposite with the overlying calcified and hyaline articular cartilage that is optimally organized to transfer mechanical load. During the evolution of the osteoarthritic process both the periarticular bone and cartilage undergo marked changes in their structural and functional properties in response to adverse biomechanical and biological signals. These changes are mediated by bone cells that modify the architecture and properties of the bone through active cellular processes of modelling and remodelling. These same biomechanical and biological factors also affect chondrocytes in the cartilage matrix altering the composition and structure of the cartilage and further disrupting the homeostatic relationship between the cartilage and bone. This chapter reviews the structural alterations and cellular mechanisms involved in the pathogenesis of osteoarthritis bone pathology and discusses potential approaches for targeting bone remodelling to attenuate the progression of the osteoarthritic process.
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14

Effect of land and water exercise on hip and knee flexiblilty in female osteoarthritic elderly. 1991.

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15

Effect of land and water exercise on hip and knee flexiblilty in female osteoarthritic elderly. 1991.

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16

Effect of land and water exercise on hip and knee flexiblilty in female osteoarthritic elderly. 1989.

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17

Bennell, Kim L., Ans Van Ginckel, Fiona Dobson, and Rana S. Hinman. Exercise for the person with osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0022.

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Because of its beneficial effects on pain and physical dysfunction commonly reported by afflicted individuals, all clinical guidelines of osteoarthritis (OA) advocate exercise therapy as a vital component of conservative management strategies. Although the optimal exercise modalities in terms of dosage, exercise type, or delivery mode are not yet known, clinical benefits can be achieved with a wide range of exercise types. While treatment effect sizes may be considered small to moderate, they are similar to those of common analgesic drugs or oral non-steroidal anti-inflammatories but seem to elicit fewer side effects. To achieve optimal treatment outcomes, programme parameters should be individualized to the patient’s clinical characteristics and preferences. Where validated instruments could assist the clinician in monitoring the progress of an exercise intervention programme, adherence to exercise in the longer term is a prerequisite to maintain symptom relief over time. Whereas the current body of evidence mainly comprises clinical trials in people with knee OA, future studies should continue to address efficacy and safety of exercise therapy in individuals suffering from hand or hip OA and should further determine its ability to postpone the need for costly arthroplasty surgery.
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18

Jordan, Joanne M., Kelli D. Allen, and Leigh F. Callahan. Age, gender, race/ethnicity, and socioeconomic status in osteoarthritis and its outcomes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0010.

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Osteoarthritis (OA) is the most common joint condition worldwide. It can impair mobility and result in significant disability, need for total joint replacement, and healthcare utilization. OA is unusual in those younger than 40 years, then commonly the result of an underlying metabolic disorder or a prior joint injury. Some geographic and racial/ethnic variation exists in the prevalence and incidence of OA for specific joints, likely due to variation in genetics, anatomy, and environmental exposures. Many OA outcomes vary by socioeconomic status and other social factors. This chapter describes demographic and social determinants of knee, hip, and hand OA, including how these factors impact radiographic and symptomatic OA, OA-related pain and function, and its treatment.
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19

Nguyen, Christelle, and François Rannou. Addressing adverse mechanical factors. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0024.

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Non-pharmacological approaches are widely and consistently recommended for the management of osteoarthritis (OA). This recommendation is based on biomechanical observations and emphasizes the therapeutic interest of biomechanical interventions able to modulate adverse mechanical factors affecting the symptomatic OA joint. Therapeutic approaches include braces, orthoses, insoles, joint protection, joint-preserving surgical procedures, walking sticks, and other aids. Overall, biomechanical interventions aim to modulate joint biomechanics, in order to improve joint mechanosensitivity, decrease mechanical joint loading, and eventually reduce pain. These interventions must be adjusted to the biomechanical specificities of each joint, and of the individual patient. This chapter uses an evidence-based approach, including the most recent European League Against Rheumatism, Osteoarthritis Research Society International, and American College of Rheumatology recommendations, to describe and to review non-pharmacological strategies available in daily clinical practice, designed to modulate mechanical joint loading, with a focus on the management of hand, hip, and knee OA. The interest of weight loss, specific and non-specific exercises, patient education, and self-care programmes is discussed elsewhere in this book.
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20

Holden, Melanie A., Martin J. Thomas, and Krysia S. Dziedzic. Miscellaneous physical therapies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0026.

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Miscellaneous physical therapies, such as assistive devices, thermotherapy, manual therapy, and electrotherapy are commonly used to treat patients with osteoarthritis (OA) in addition to written information and exercise. However, the evidence underpinning specific miscellaneous physical therapies is often limited, with small study sizes, heterogeneous populations, and differing study designs making it difficult to draw firm conclusions about their effectiveness. One or more miscellaneous physical therapies feature within 15 current clinical guidelines for OA. The specific types of physical therapies addressed are variable, as are their recommendations. There is most agreement for miscellaneous physical therapies in hand OA, with multiple guidelines addressing and consistently recommending joint protection, splinting, and thermotherapy in addition to core treatment. However these recommendations are predominantly based on a small number of randomized controlled trials (RCTs). Use of walking aids and footwear is commonly addressed and recommended for patients with hip and knee OA, although recommendations are predominantly based on expert opinion. Other physical therapies recommended for hip and knee OA range from orthoses to less conventional leech therapy. When a recommendation for a miscellaneous physical therapy is not made, it is commonly due to limited clinical evidence, rather than evidence of harm. Due to limited evidence and lack of consensus between clinical guidelines, for some therapies, use of specific miscellaneous physical therapies in clinical practice should be based upon the best available evidence, a holistic, individualized clinical assessment and shared decision-making with the patient. Further large-scale, high-quality RCTs would be useful to inform future guideline recommendations and clinical practice.
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21

Bannwarth, Bernard, and Francis Berenbaum. Systemic analgesics (including paracetamol and opioids). Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0029.

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Apart from non-steroidal anti-inflammatory drugs (NSAIDs), there are only two categories of systemic analgesics, namely paracetamol (acetaminophen) and opioids, that are currently available worldwide for clinical use. Paracetamol is poorly effective in relieving pain and improving function in patients with symptomatic osteoarthritis (OA). Furthermore, its safety profile is less favourable than classically thought. In fact, there is evidence paracetamol acts as a weak inhibitor of the cyclooxygenase enzymes. Given that paracetamol poses a lower risk of severe adverse events than NSAIDs while being better tolerated than opioids, it is usually considered as the first-line systemic analgesic for OA. Commonly prescribed opioids are primarily agonists of the mu receptors, thereby producing similar desirable (analgesia) and untoward effects. Meta-analyses of short-term clinical trials showed that, on average, the modest clinical benefits of opioids did not outweigh the side effects in patients with knee or hip OA. Accordingly, most current guidelines support the use of opioids for selected OA patients only (e.g. patients who have not had an adequate response to other treatment modalities and are not candidates for total joint arthroplasty). In view of the limited efficacy and/or potential harms of available analgesics, particular attention was paid to novel painkillers, especially nerve growth factor (NGF) antagonists. Although these agents provided clinically meaningful improvements in pain and physical function in patients with hip or knee OA, they lead to severe side effects, including rapidly destructive arthropathies and neuropathies. Thus, if approved for marketing, NGF antagonists would be reserved for selected and well-defined patients with OA.
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22

Aspden, Richard, and Jenny Gregory. Morphology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0011.

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The study of joint morphology can help us to understand the risk factors for osteoarthritis (OA), how it progresses, and aids in developing imaging biomarkers for study of the disease. OA results in gross structural changes in affected joints. Growth of osteophytes, deformation of joint components, and loss of joint space where cartilage has broken down are all characteristics of the disorder. Certain bone shapes as well as malalignment predispose people to future OA, or may be a marker for early OA. Geometrical measures, such as the alpha angle or Wiberg’s CE angle, used to be the primary tool for investigating morphology. In recent years, however, statistical shape modelling (SSM) has become increasingly popular. SSM can be used with any imaging modality and has been successfully applied to a number of musculoskeletal conditions. It uses sets of landmark points denoting the anatomy of one or more bones to generate new variables (modes) that describe and quantify the shape variation in a set of images via principal components analysis. With the aid of automated search algorithms for point placement, the use of SSMs is expanding and provides a valuable and versatile tool for exploration of bone and joint morphometry. Whilst the majority of research has focused on hip and knee OA, this chapter provides an overview of joint morphology through the whole skeleton and how it has helped our ability to understand and quantify the risk and progression of osteoarthritis.
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23

Wyatt, Laura A., and Michael Doherty. Morphological aspects of pathology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0003.

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Osteoarthritis (OA) is the commonest condition to affect synovial joints, but although any synovial joint can be affected, most studies of pathology relate to large joints (knees and hips). OA involves the whole joint and pathological alterations typically occur in all joint tissues. Established OA is characterized by a mixture of tissue loss and new tissue production resulting in focal loss of articular hyaline cartilage together with bone remodelling and osteophyte formation. Articular cartilage may show increased thickness in the earliest stages of OA with increased numbers of hypertrophic chondrocytes, followed by progressive decline in matrix components, thickness, and chondrocyte number. Surface fibrillation and vertical clefts become evident in mid- to end-stage OA and eventual complete loss of cartilage can occur, predominantly in maximum load-bearing regions, with subsequent eburnation and furrowing of bone. Bone remodelling may lead to alteration of bone shape and variable trabecular thickness in subchondral bone, whilst subchondral microfractures may result in localized osteonecrosis, fibrosis, and ‘cysts’. Endochondral ossification of new fibrocartilage produced predominantly at the joint margin produces characteristic bony osteophytes. The synovium shows areas of hyperplasia with varying amounts of lymphocyte aggregates and inclusion of osteochondral ‘loose’ bodies, and the outer fibrous capsule thickens to help stabilize the compromised joint. Synovial fluid increases in volume but decreases in viscosity. Periarticular changes include type II muscle atrophy and enthesophytes.
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