***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes . However , some people experience long-term pain . Objectives To review published studies in representative population s with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity . Data sources MEDLINE and EMBASE data bases search ed to January 2011 with no language restrictions . Citations of key articles in ISI Web of Science and reference lists were checked . Study eligibility criteria , participants and interventions Prospect i ve studies of consecutive , unselected osteoarthritis patients representative of the primary total hip or knee replacement population , with intensities of patient-centred pain measured after 3 months to 5-year follow-up . Study appraisal and synthesis methods Two authors screened titles and abstract s. Data extracted by one author were checked independently against original articles by a second . For each study , the authors summarised the proportions of people with different severities of pain in the operated joint . Results Search es identified 1308 articles of which 115 reported patient-centred pain outcomes .  Fourteen articles describing 17 cohorts ( 6 with hip and 11 with knee replacement ) presented appropriate data on pain intensity . The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7 % to 23 % after hip and 10 % to 34 % after knee replacement . In the best quality studies , an unfavourable pain outcome was reported in 9 % or more of patients after hip and about 20 % of patients after knee replacement . Limitations Other studies reported mean values of pain outcomes . These and routine clinical studies are potential sources of relevant data . Conclusions and implication s of key findings After hip and knee replacement , a significant proportion of people have painful joints . There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes OBJECTIVE To evaluate the association between vitamin C supplementation and the incidence and progression of radiographic knee osteoarthritis ( OA ) .  DESIGN Prospect i ve cohort study . SETTING Clearwater Osteoarthritis Study ( COS ) : ( 1988 to the present ) a longitudinal study . SUBJECTS Male and female COS participants aged 40 years and above ( n 1023 ) . The study exposure was the participants ' self-reported history of vitamin C supplementation .  The participants underwent biennial , sequential knee radiographs , which were assessed using the Kellgren-Lawrence ordinal scale to determine evidence of the study 2 outcomes : incident radiographic knee OA ( RKOA ) and progression of RKOA . RESULTS Individuals without baseline knee OA who self-reported vitamin C supplement usage were 11 % less likely to develop knee OA than were those individuals who self-reported no vitamin C supplement usage ( risk ratio (RR)=0.89 , 95 % CI 0.85 , 0.93 ) . Among those participants with RKOA at baseline , vitamin C supplement usage did not demonstrate an association with RKOA progression ( RR=0.94 , 95 % CI 0.79 , 1.22 ) . CONCLUSIONS In the present prospect i ve cohort study , we found no evidence to support a protective role of vitamin C in the progression of knee OA . However , after controlling for confounding variables , these data suggest that vitamin C supplementation may indeed be beneficial in preventing incident knee OA . Given the massive public health burden of OA , the use of a simple , widely available and inexpensive supplement to potentially reduce the impact of this disease merits further consideration OBJECTIVE To evaluate the symptomatic effects of highly purified chondroitin 4 and chondroitin 6 sulfate ( CS ) therapy in patients with osteoarthritis ( OA ) of the h and . METHODS This investigator-initiated , single-center , r and omized , double-blind , placebo-controlled clinical trial included 162 symptomatic patients with radiographic evidence of h and OA ( American College of Rheumatology criteria ) . Inclusion criteria included patient 's assessment of global spontaneous h and pain of at least 40 mm on a 0 - 100-mm visual analog scale ( VAS ) and functional impairment of at least 6 ( 0 - 30 scale ) on the Functional Index for H and OA ( FIHOA ) in the most symptomatic h and . Patients received either 800 mg of CS ( n = 80 patients ) or placebo ( n = 82 patients ) once daily for 6 months and were analyzed in an intent-to-treat approach . The two primary outcomes were the change in the patient 's assessment of global spontaneous h and pain and in h and function ( by FIHOA score ) from baseline to month 6 . Secondary outcomes were improvement in grip strength , duration of morning stiffness , acetaminophen consumption , and the investigator 's global impression of treatment efficacy . RESULTS There was a significantly more pronounced decrease in the patient 's global assessment of h and pain in the CS group than in the placebo group ( difference VAS scores -8.7 mm ; P = 0.016 ) . H and function improved significantly more in the CS group than in the placebo group ( difference in FIHOA scores -2.14 ; P = 0.008 ) . There was a statistically significant between-group difference in favor of CS for the duration of morning stiffness and for the investigator 's global impression of treatment efficacy . Changes in grip strength , acetaminophen consumption , and safety end points were not significantly different between the two groups . CONCLUSION This study demonstrates that CS improves h and pain and function in patients with symptomatic OA of the h and and shows a good safety profile OBJECTIVE To investigate whether early changes in biochemical markers of bone ( NTX-I ) and cartilage ( CTX-II [ C-terminal crosslinking telopeptide of type II collagen ] ) degradation are associated with radiological progression in patients with knee osteoarthritis ( OA ) receiving risedronate .  DESIGN Two thous and four hundred and eighty three patients with medial compartment knee OA were r and omized in two 24-month studies in North America ( NA ) and European Union ( EU ) . Studies evaluated risedronate 5 mg/day , 35 mg/week ( EU ) , 50 mg/week ( NA ) , and 15 mg/day ( NA and EU ) , compared to placebo in reducing signs and symptoms and in slowing radiographic progression . One thous and eight hundred and eighty five patients from the pooled EU and NA studies with available NTX-I/CTX-II at both baseline and 6 months and radiographs at baseline and at 24 months were analyzed . RESULTS Risedronate produced a dose-dependent reduction of NTX-I and CTX-II observed at 6 months which continued up to 24 months . Patients who had CTX-II levels returned to low levels ( < 150 ng/mmol creatinine ) at 6 months had a lower risk of radiographic progression at 24 months than patients whose CTX-II levels were increased both at baseline and 6 months [ odds-ratio ( 95 % confidence interval ) : 0.57 ( 0.39 - 0.85 ) after adjustment for demographics and joint space width ] . The lowest risk of progression was observed in patients who had low CTX-II levels both at baseline and at 6 months [ odds-ratio 0.36 ( 0.21 - 0.63 ) ] . No significant association between NTX-I levels and radiological progression was observed . CONCLUSION CTX-II decreased with risedronate in patients with knee OA and levels reached after 6 months were associated with radiological progression at 24 months . Monitoring a marker of cartilage degradation 6 months after initiating treatment may be instructive in identifying patients with low progression Objective To determine the effect of chondroitin sulphate ( CS ) treatment on cartilage volume loss , subchondral bone marrow lesions ( BML ) , synovitis and disease symptoms in patients with knee osteoarthritis ( OA ) . Methods In this pilot multicentre , r and omised , double-blind , controlled trial in primary knee OA , 69 patients with clinical signs of synovitis were r and omised to receive CS 800 mg or placebo once daily for 6 months followed by an open-label phase of 6 months in which patients in both groups received CS 800 mg once daily . Cartilage volume and BML were assessed by MRI at baseline and at 6 and 12 months ; synovial membrane thickness was assessed at baseline and at 6 months . Results The CS group showed significantly less cartilage volume loss than the placebo group as early as 6 months for the global knee ( p=0.030 ) , lateral compartment ( p=0.015 ) and tibial plateaus ( p=0.002 ) , with significance persisting at 12 months . Significantly lower BML scores were found for the CS group at 12 months in the lateral compartment ( p=0.035 ) and the lateral femoral condyle ( p=0.044 ) . Disease symptoms were similar between the two groups . Conclusion CS treatment significantly reduced the cartilage volume loss in knee OA starting at 6 months of treatment , and BML at 12 months . These findings suggest a joint structure protective effect of CS and provide new in vivo information on its mode of action in knee OA Background Knee osteoarthritis ( OA ) is a major cause of pain and functional limitation in older adults , yet longer-term studies of medical treatment of OA are limited . Objective To evaluate the efficacy and safety of glucosamine and chondroitin sulphate ( CS ) , alone or in combination , as well as celecoxib and placebo on painful knee OA over 2 years . Methods A 24-month , double-blind , placebo-controlled study , conducted at nine sites in the US ancillary to the Glucosamine/chondroitin Arthritis Intervention Trial , enrolled 662 patients with knee OA who satisfied radiographic criteria ( Kellgren/Lawrence grade 2 or 3 changes and baseline joint space width of at least 2 mm ) . This subset continued to receive their r and omised treatment : glucosamine 500 mg three times daily , CS 400 mg three times daily , the combination of glucosamine and CS , celecoxib 200 mg daily , or placebo over 24 months . The primary outcome was a 20 % reduction in Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) pain over 24 months . Secondary outcomes included an Outcome Measures in Rheumatology/Osteoarthritis Research Society International response and change from baseline in WOMAC pain and function . Results Compared with placebo , the odds of achieving a 20 % reduction in WOMAC pain were celecoxib : 1.21 , glucosamine : 1.16 , combination glucosamine/CS : 0.83 and CS alone : 0.69 , and were not statistically significant . Conclusions Over 2 years , no treatment achieved a clinical ly important difference in WOMAC pain or function as compared with placebo . However , glucosamine and celecoxib showed beneficial but not significant trends . Adverse reactions were similar among treatment groups and serious adverse events were rare for all treatments Background The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process . A multifaceted strategy may offer an effective knowledge translation ( KT ) intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis ( OA ) . Methods A single-blind , r and omized control trial was conducted . Patients with mild to moderate ( OA ) of the knee ( n=222 ) were r and omized to one of three KT groups : 1 ) Walking and Behavioural intervention ( WB )  ( 18 males , 57 females ) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA ; 2 ) Walking intervention ( W )  ( 24 males , 57 females ) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet ; 3 )  Self-directed control ( C ) ( 32 males , 52 females ) wherein participants only received the educational pamphlet . One-way analyses of variance were used to test for differences in quality of life , adherence , confidence , and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period . Results Short-term program adherence was greater in WB compared to C ( p<0.012 ) after 3 months . No statistical significance ( p > 0.05 ) was observed for long-term adherence ( 6 to 12 months ) , and total adherence between the three groups . The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA .  Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months . Conclusion The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines on walking over a short-term period . More studies are needed to improve the long-term walking adherence or longer guidelines uptake on walking among participants with OA . Particular attention should be taken into account related to patient ’s characteristic and preference . OA can be managed through the implementation of a walking program based on clinical practice guidelines in existing community-based walking clubs as well as at home with the minimal support of an exercise therapist or a trained volunteer . Trial Registration Current Controlled Trials OBJECTIVE Synovitis is very common in knee OA and associated with pain . This open- 
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RESULTS Both " strong " and " conditional " recommendations are given for management of h and , hip , and knee OA and nonpharmacological , pharmacological , and surgical modalities of treatment are presented according to the different levels of agreement .