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, call us! “. This message will be broadcast throughout France for the purposes of a study coordinated in Brest. The first inclusions of patients will take place in six months to a year, to recruit a thousand people suffering from knee osteoarthritis.

Funding of nearly €1 million

“When a person over 50 complains of the knee, most often it is osteoarthritis. If she goes to see a surgeon, she will be fitted with a prosthesis more quickly than if she consults a rheumatologist. And if a patient goes to see two different surgeons, one will say that it is necessary to operate and the other will direct towards a rheumatologist. In fact, there is no precise rule to know who should be operated on and when”, assures Pr Alain Saraux, rheumatologist at the University Hospital of Brest and head of research.

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

Prosthesis or treatment? Patients drawn at random

“Of the thousand patients included followed for two years, half will be in a situation where surgical treatment is debatable. At these 500, it will be proposed to be drawn by lot to have a group of patients who will be operated on and another group who will benefit from drug and especially non-drug treatments. At 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 the researchers to enroll in the study. “But if a doctor is aware of the study and believes that the case of this patient can be discussed between surgery or treatment, he can also contact us”.

More and more knee surgery

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

“There are more and more patients having knee surgery, probably even a little in excess, without having tried the full medical treatment. This includes physio, physical activity, weight loss, insoles, orthotics, pain medication, intra-articular injections, transcutaneous electrical neurostimulation (Tens) which relieves pain… There are plenty of solutions, but patients often only test one or two options,” adds Professor Alain Saraux, who has asked his fellow orthopedic surgeons to join.

“Everyone agrees: this question must be answered. Otherwise we will continue to put prostheses on patients somewhat at random and, for some, it’s a shame because there are still 10 to 20% of people operated on for whom the result is bad”.

in complement

In Brest, ten medical research projects win €4 million

One of the research programs concerns the prevention of alcohol misuse. This involves carrying out early identification, thanks to a network involving citizens trained in prevention.

The Ministry of Health published, on July 21, 2022, the list of research projects that will be funded in France. The Brest CHRU teams stand out with seven projects selected for €3.60 million, 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 funded: osteoarthritis of the knee (€919,000) and treatment of the risk of thrombosis after childbirth (€992,000).

Of the 24 research programs devoted to the performance of the healthcare system (PREPS), funded nationally, four are from Brest. The first concerns the value of follow-up in a health sports center for chronic respiratory diseases (€451,563). The second is dedicated to preventing the risk of alcohol misuse (€304,791). The third is an application dedicated to the rehabilitation of children with a chronic illness (€403,360). And the fourth is an application that wants to connect the patient and caregivers during emergency management of cerebrovascular accident (CVA) (€440,568).

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

Added to this is an interregional PHRC to identify the germs of bone and joint infections (€223,000), and two general medicine projects, on clinical decision-making (€57,000) and on identifying the fragility of elderly people (funded at amount of €220,000).


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