Brest - Too many prostheses for knee osteoarthritis?  Response in three years in Brest

Brest – Too many prostheses for knee osteoarthritis? Response in three years in Brest

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“If a surgeon suggests knee surgery, give us a call! “. This message will be disseminated throughout France for the purpose of a coordinated study in Brest. The first patient enrollments will take place within six months to a year, to recruit a thousand people suffering from osteoarthritis of the knee.

Financing of almost 1 million euros

“When a person over 50 years of age complains about the knee, it is most often osteoarthritis. If you go to see a surgeon, you will get a prosthesis fitted more quickly than if you see a rheumatologist. And if a patient goes to see two different surgeons, one will say they have to operate and the other will go to a rheumatologist. In fact, there is no precise rule to know who should be operated on and when”, says Pr. Alain Saraux, rheumatologist at Brest University Hospital and head of research.

From this observation was born the idea of ​​investigating whether intensive medical treatment would make it possible to delay or avoid knee prostheses in the case of osteoarthritis. This study, called Incredible, has just been funded by a clinical research program (PHRC) worth €919,051. It is one of the most important of the ten Brest projects financed this year by the State.

Prosthesis or treatment? Randomly selected patients

“Of the thousand included patients followed for two years, half will be in a situation where surgical treatment is questionable. Out of these 500, it will be proposed to draw a group of patients who will undergo surgery and another group who will benefit from pharmacological and, above all, non-pharmacological treatments. In the end, we will compare, in the two groups, the pain and the function of the knee”, explains Pr. Alain Saraux, coordinator of this national study. Patients will contact investigators to enroll in the study. “But if a doctor knows about the study and thinks that this patient’s case can be discussed between surgery or treatment, he can also contact us.”

More and more knee surgery

The French society of rheumatology has just published recommendations for the management of knee osteoarthritis, thanks to diversified treatments by stages.

“There are more and more patients undergoing knee surgery, probably even a little in excess, without having tried the full medical treatment. This includes physio, physical activity, weight loss, insoles, orthoses, pain relievers, intra-articular injections, transcutaneous electrical nerve stimulation (TENS) that relieves pain… There are many solutions, but patients often only try one or two options”, he adds. Professor Alain Saraux, who has asked his fellow orthopedic surgeons to join.

“Everyone agrees: this question must be answered. If not, we will continue to put prostheses on patients somewhat randomly and, for some, it is a shame because there are still 10 or 20% of people operated on who have a bad result”.

in complement

In Brest, ten medical research projects win 4 million euros

One of the research programs concerns the prevention of alcohol abuse. It is about making an early identification, thanks to a network of citizens trained in prevention.

The Ministry of Health published, on July 21, 2022, the list of research projects to be financed in France. The Brest CHRU teams stand out with seven projects selected for 3.60 million euros, plus an interregional program and two general medicine projects. Last year, only three themes were selected for a total amount of €1.50 million.

Two hospital clinical research programs (PHRC) are financed: knee osteoarthritis (€919,000) and treatment of the risk of thrombosis after childbirth (€992,000).

Of the 24 research programs dedicated to the performance of the health system (PREPS), financed at the national level, four are from Brest. The first refers to the value of monitoring in a sports health center for chronic respiratory diseases (€451,563). The second is dedicated to preventing the risk of alcohol abuse (€304,791). The third is an application dedicated to the rehabilitation of children with chronic illnesses (€403,360). And the fourth is an application that wants to connect the patient and their caregivers during the emergency management of stroke (CVA) (€440,568).

In addition, a hospital nursing and paramedical research program (PHRIP) refers to the impact of respiratory rehabilitation on the quality of life of patients with lung cancer (€84,993).

Added to this is an interterritorial PHRC for the identification of germs of bone and joint infections (€223,000), and two general medicine projects, on clinical decision-making (€57,000) and on the identification of frailty in the elderly (financed with an amount of €220,000).

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