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Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE‐CAN) study, a community‐based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/m2relative to a group‐based health education (HE) intervention. We sought to determine the incremental cost‐effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the “next‐best” strategy ranked by increasing lifetime cost. We used the Osteoarthritis Policy Model to project long‐term clinical and economic benefits of the WE‐CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE‐CAN trial. Our outcomes included quality‐adjusted life years (QALYs), cost, and incremental cost‐effectiveness ratios (ICERs). In a cohort with mean age 65 years, BMI 37 kg/m2, and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0–100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY. The community‐based D + E program for persons with knee OA and BMI >27kg/m2could be cost‐effective for willingness‐to‐pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community‐based D + E programs into OA care may be beneficial for public health.

Patients with meniscal tears reporting meniscal symptoms such as catching or locking have traditionally undergone arthroscopy. The present study was undertaken to investigate whether patients with meniscal tears who report meniscal symptoms have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT). We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each meniscal symptom (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6 months. We used linear regression models to determine whether the difference in improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score at 6 months between patients treated with APM versus PT was modified by the presence of each meniscal symptom. We also determined the percentage of participants with resolution of meniscal symptoms by treatment group. We included 287 participants. The presence (versus absence) of any of the meniscal symptoms did not modify the improvement in KOOS pain score between APM versus PT by >0.5 SD (all Pinteraction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% versus 46%, clicking 41% versus 25%). No difference in resolution of the other meniscal symptoms was observed. Meniscal symptoms were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of meniscal symptoms in isolation should not inform clinical decisions surrounding APM versus PT in patients with meniscal tear and knee OA.

Synovitis is a prevalent feature in patients with knee osteoarthritis (OA) and meniscal tear and is associated with pain and cartilage damage. Patient‐reported swelling is also prevalent in this population. The aim of this study was to investigate the cross‐sectional association between patient‐reported swelling and effusion‐synovitis detected by magnetic resonance imaging (MRI) in patients with OAand meniscal tear. We used baseline data from a multicenter, randomized controlled trial, Meniscal Tear in Osteoarthritis Research (METEOR). MRI‐identified effusion‐synovitis, a proxy for effusion and synovitis on noncontrast MRIs, was graded as none/small versus medium/large. Using MRI‐identified effusion‐synovitis as the gold standard, we assessed the sensitivity, specificity, and positive predictive value of patient self‐reported swelling in the previous week (none, intermittent, constant) to detect effusion and synovitis. We analyzed data from 276 patients. Twenty‐five percent of patients reported no swelling, 40% had intermittent swelling, and 36% had constant swelling. Fifty‐two percent had MRI‐identified medium/large–grade effusion‐synovitis. As compared with MRI‐identified effusion‐synovitis, any patient‐reported swelling (versus none) had a sensitivity of 84% (95% confidence interval [95% CI] 77–89), a specificity of 34% (95% CI26–43), and a positive predictive value of 57% (95% CI54–61). A history of constant swelling (versus none or intermittent) showed a sensitivity of 46% (95% CI37–54), a specificity of 75% (95% CI67–82), and a positive predictive value of 66% (95% CI58–74). We found that the sensitivity and specificity of patient‐reported swelling were modest when compared with effusion‐synovitis detected by MRI. These data urge caution against using patient‐reported swelling as a proxy of inflammation manifesting as effusion‐synovitis.

Most persons who undergo total knee replacement (TKR) do not increase their physical activity following surgery. We assessed whether financial incentives and health coaching would improve physical activity in persons undergoing TKR. We designed a factorial randomized controlled trial among persons undergoing TKRfor osteoarthritis. Subjects underwent normal perioperative procedures, including postoperative physical therapy, and were assigned to 1 of 4 arms: attention control, telephonic health coaching (THC), financial incentives (FI), or THC+ FI. We objectively measured step counts and minutes of physical activity using a commercial accelerometer (Fitbit Zip) and compared the changes from pre‐TKRto 6 months post‐TKRacross the 4 study arms. Of the 202 randomized subjects, 150 (74%) provided both pre‐TKRand 6 months post‐TKRaccelerometer data. Among completers, the mean ± SEdaily step count at 6 months ranged from 5,619 ± 381 in the THCarm to 7,152 ± 407 in the THC+ FIarm (adjusting for baseline values). Daily step count 6 months post‐TKRincreased by 680 (95% confidence interval [95% CI] −94, 1,454) in the control arm, 274 (95% CI−473, 1,021) in the THCarm, 826 (95% CI89, 1,563) in the FIarm, and 1,808 (95% CI1,010, 2,606) in the THC+ FIarm. Weekly physical activity increased by mean ± SE14 ± 10, 14 ± 10, 16 ± 10, and 39 ± 11 minutes in the control, THC,FI, and THC+ FIarms, respectively. A dual THC+ FIintervention led to substantial improvements in step count and physical activity following TKR.

To evaluate the utility of clinical history, radiographic findings, and physical examination findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45 years, in whom concomitant osteoarthritis is prevalent. In a cross‐sectional study of patients from 2 orthopedic surgeons' clinics, we assessed clinical history, physical examination findings, and radiographic findings in patients age >45 years with knee pain. The orthopedic surgeons rated their confidence that subjects' symptoms were due to meniscal tear; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT, and we used the regression results to construct an index of the likelihood of SMT. In 174 participants, 6 findings were associated independently with the expert clinician having ≥70% confidence that symptoms were due to meniscal tear: localized pain, ability to fully bend the knee, pain duration <1 year, lack of varus alignment, lack of pes planus, and absence of joint space narrowing on radiographs. The index identified a low‐risk group with 3% likelihood of SMT. While clinicians traditionally rely upon mechanical symptoms in this diagnostic setting, our findings did not support the conclusion that mechanical symptoms were associated with the expert's confidence that symptoms were due to meniscal tear. An index that includes history of localized pain, full flexion, duration <1 year, pes planus, varus alignment, and joint space narrowing can be used to stratify patients according to their risk of SMT, and it identifies a subgroup with very low risk.

To establish the efficacy of motivational interviewing–based postoperative care navigation in improving functional status after total knee arthroplasty (TKA) and to identify subgroups likely to benefit from the intervention. We conducted a parallel randomized controlled trial in TKA recipients with 2 arms: postoperative care with frequent followup by a care navigator or usual care. The primary outcome was the difference between the arms in Western Ontario and McMaster Universities Osteoarthritis Index function score change, over 6 months postsurgery. We performed a preplanned subgroup analysis of differential efficacy by obesity and exploratory subgroup analyses on sex and pain catastrophizing. We enrolled 308 subjects undergoing TKA for osteoarthritis. Mean ± SD preoperative function score was 41 ± 17 (0–100 scale, where 100 = worst function). At 6 months, subjects in the navigation arm improved by mean ± SD 30 ± 16 points compared to 27 ± 18 points in the usual‐care arm (P= 0.148). Participants with moderate to high levels of pain catastrophizing were unlikely to benefit from navigation compared to those with lower levels of pain catastrophizing (P= 0.013 for interaction). Subjects assigned to the navigation intervention did not demonstrate greater functional improvement compared to those in the control group. The negative overall result could be explained by the large effect on functional improvement of TKA itself compared to the smaller, additional benefit from care navigation, as well as by potential differential effects for subjects with moderate to high degrees of pain catastrophizing. Greater focus on developing programs for reducing pain catastrophizing could lead to better functional outcomes following TKA.