***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: OBJECTIVE --To assess the efficacy of a single intra-articular injection of triamcinolone hexacetonide ( THA ) in knee osteoarthritis ( OA ) and examine factors which may relate to treatment efficacy . METHODS --Eighty four patients with clinical and radiographic evidence of knee OA were recruited and r and omly allocated to receive either THA ( 20 mg in 1 ml ) or placebo ( 0.9 % normal saline , 1 ml ) . Follow up assessment s evaluated the following outcome variables : patient opinion of overall change in the treated knee , visual analogue pain score ( VAS ) , distance walked in one minute ( WD ) , and Health Assessment Question naire modified for lower limb function ( HAQ ) . RESULTS --Seventy eight percent of THA and 49 % of placebo treated patients reported overall improvement at week 1 ( p < 0.05 ) . At week 6 , improvement was reported in 57 % and 55 % of patient groups , respectively . VAS improved in both groups at week 1 ( THA , p < 0.001 ; placebo , p < 0.05 ) and week 6 ( both p < 0.01 ) . Improvement in VAS was significantly greater among THA treated patients at week 1 only ( p < 0.01 ) . Subgroup analysis of THA treated patients revealed greater improvement in VAS among patients with clinical evidence of an effusion ( p < 0.05 ) , and those who had synovial fluid successfully aspirated at the time of injection ( p < 0.01 ) . WD improved in THA treated patients at week 1 ( p < 0.001 ) , and in both groups at week 6 ( THA , p < 0.001 ; placebo , p < 0.01 ) . Improvements in HAQ were seen in THA patients only at weeks 1 and 6 ( p < 0.05 ) . Regression analysis did not identify any additional clinical , radiographic , or synovial fluid characteristics which influenced the response . CONCLUSIONS --THA provided short term pain relief in knee OA . Increased benefit was associated with both clinical evidence of joint effusion and successful aspiration of synovial fluid at the time of injection BACKGROUND Glucosamine and chondroitin sulfate are used to treat osteoarthritis . The multicenter , double-blind , placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial ( GAIT ) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis . METHODS We r and omly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily , 1200 mg of chondroitin sulfate daily , both glucosamine and chondroitin sulfate , 200 mg of celecoxib daily , or placebo for 24 weeks . Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia . Assignment was stratified according to the severity of knee pain ( mild [ N=1229 ] vs. moderate to severe [ N=354 ] ) . The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24 . RESULTS The mean age of the patients was 59 years , and 64 percent were women . Overall , glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent . As compared with the rate of response to placebo ( 60.1 percent ) , the rate of response to glucosamine was 3.9 percentage points higher ( P=0.30 ) , the rate of response to chondroitin sulfate was 5.3 percentage points higher ( P=0.17 ) , and the rate of response to combined treatment was 6.5 percentage points higher ( P=0.09 ) . The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group ( P=0.008 ) . For patients with moderate-to-severe pain at baseline , the rate of response was significantly higher with combined therapy than with placebo ( 79.2 percent vs. 54.3 percent , P=0.002 ) . Adverse events were mild , infrequent , and evenly distributed among the groups . CONCLUSIONS Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee . Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain . ( Clinical Trials.gov number , NCT00032890 . ) OBJECTIVE A r and omised , double-blind study to compare the gastrointestinal ( GI ) tolerability , safety and efficacy of etoricoxib and diclofenac in patients with rheumatoid arthritis ( RA ) . PATIENTS AND METHODS A total of 4086 patients ( mean age 60.8 years ) diagnosed with RA were enrolled and received etoricoxib 90 mg daily ( n = 2032 ) or diclofenac 75 mg twice daily ( n = 2054 ) . Use of gastroprotective agents and low-dose aspirin was allowed . The prespecified primary end point consisted of the cumulative rate of patient discontinuations due to clinical and laboratory GI adverse experiences ( AEs ) . General safety was also assessed , including adjudicated thrombotic cardiovascular event data . Efficacy was evaluated using the Patient Global Assessment of Disease Status ( PGADS ; 0 - 4 point scale ) . RESULTS Mean ( SD ; maximum ) duration of treatment was 19.3 ( 10.3 ; 32.9 ) and 19.1 ( 10.4 ; 33.1 ) months in the etoricoxib and diclofenac groups , respectively . The cumulative discontinuation rate due to GI AEs was significantly lower with etoricoxib than diclofenac ( 5.2 vs 8.5 events per 100 patient-years , respectively ; hazard ratio 0.62 ( 95 % CI : 0.47 , 0.81 ; p < or=0.001 ) ) . The incidence of discontinuations for hypertension-related and oedema-related AEs were significantly higher with etoricoxib ( 2.5 % and 1.1 % respectively ) compared with diclofenac ( 1.5 % and 0.4 % respectively ; p<0.001 for hypertension and p<0.01 for oedema ) . Etoricoxib and diclofenac treatment result ed in similar efficacy ( PGADS mean changes from baseline -0.62 vs -0.58 , respectively ) . CONCLUSIONS Etoricoxib 90 mg demonstrated a significantly lower risk for discontinuing treatment due to GI AEs compared with diclofenac 150 mg . Discontinuations from renovascular AEs , although less common than discontinuations from GI AEs , were significantly higher with etoricoxib Great strides have been made in the field of total hip arthroplasty , but the issue of wear and osteolysis continue to be a problem , mostly for young adults . For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty . The purpose of this prospect i ve study was to describe the indications , the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia . We obtained very good results with a significant improvement of hip function and pain relief . We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis . RésuméDe nombreux problèmes ont déjà été étudiés dans le champ de la prothèse totale de hanche , néanmoins , le problème de l’usure et de l’ostéolyse continue à être un problème important chez l’adulte . L’ostéotomie de varisation dérotations reste une alternative acceptable dans le traitement de ces lésions . Le but de cette étude est de réaliser une étude prospect i ve afin de décrire les indications , la technique et le devenir fonctionnel de ces patients . Parmi les 52 patients opérés avec dysplasie cotyloïdienne nous pouvons rapporter de très bons résultats avec une amélioration de la fonction de la hanche et une amélioration des phénomènes douloureux . Après une sélection appropriée des patients ce traitement peut prévenir le développement trop précoce d’une arthrose secondaire à une dysplasie OBJECTIVES : To show whether intra-articular steroid injections are effective in osteoarthritis ; to determine factors that predict response ; and to determine whether injection has a beneficial effect on muscle strength . METHODS : Double blind , placebo controlled , crossover study in 59 patients with symptomatic osteoarthritis of the knee . Outcome measure- Primary outcome measure : change in visual analogue score for pain at three weeks . Predictors of response analysed using logistic regression with a 15 % decrease in pain score at three weeks defining response . RESULTS : Intra-articular methyl prednisolone acetate produced a significant reduction in visual analogue pain score at three weeks compared to both baseline ( median change -2.0 mm , interquartile range -16.25 to 4.0 ) and placebo ( median 0.0 mm , interquartile range -9.0 to 6.25 ) . No clinical predictors of response could be identified . Muscle strength was not significantly improved in the short term by intra-articular injection . CONCLUSIONS : Intra-articular corticosteroids are effective for short term relief of pain in osteoarthritis but predicting responders is not possible . There may be a place for their more widespread use OBJECTIVE We previously reported that monthly telephone contact by lay personnel , to promote self-care for patients with osteoarthritis ( OA ) , was associated with improved joint pain and physical function after 1 year of followup . The present study was a secondary analysis to determine whether improvement was contingent on intensified medical treatment . METHODS We reanalyzed control/treatment group differences in all 40 subjects with radiographically confirmed knee OA who had had no changes in antirheumatic drug therapy or institution of physical therapy during the period of observation . RESULTS Group differences in measured pain remained significant ( effect size [ ES ] = 0.65 SD , P less than 0.01 ) . The same trend was observed for physical function ( ES = 0.53 SD , P not significant ) . CONCLUSION The findings in this re analysis suggest that periodic telephone support interventions are effective enough to be regarded as an adjunctive treatment for OA BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee O 
    Output:
    
ES for pain relief varied from treatment to treatment .