Advanced Knee OA Research Articles

Is There a Role for Ordering a DEXA (Dual Energy X-Ray Absorptiometry) Scan for Patients with Symptomatic Advanced Knee Osteoarthritis?

Osteoarthritis of the knee (OA) and osteoporosis are two conditions that have a significant impact on society, have a great impact on quality of life, and can lead to functional impairment. However, the relationship between knee OA and osteoporosis is unclear. The aim of this study was to examine if there is a link between symptomatic advanced knee osteoarthritis and low bone mineral density. A total of 430 patients with symptomatic and advanced radiographic knee OA served as participants in this study. Plain radiographs were used to screen participants for osteoarthritis, and a Dual Energy X-ray Absorptiometry (DEXA) scan was used to determine each participant's bone mineral density (BMD). The lumbar spine, whole femur, and femoral neck BMD levels were statistically higher in the early OA (Kelldren-Lawrence (KL) I and II) group compared with the advanced (III and IV) OA group. Higher BMD at the whole femur and femoral neck but not at the lumbar spine was observed when comparing patients with grades I, II, and III with patients with grade IV after adjustment for body mass index. The findings of this study indicate that the degree of knee OA is correlated with a decline in BMD. These findings lend credence to the theory that the two conditions may be linked to one another. Our study concluded that patients with advanced knee osteoarthritis are at risk of developing osteoporosis. As a result, orthopedic doctors are required to screen for osteoporosis in patients with advanced knee osteoarthritis to both prevent and treat osteoporosis at an earlier stage.

Clinical outcomes of hybrid closed wedge high tibial osteotomy for advanced osteoarthritis of the knee compared with total knee arthroplasty.

To evaluate clinical outcomes between hybrid closed wedge high tibial osteotomy (HCWHTO) and total knee arthroplasty (TKA) for advanced medial compartmental osteoarthritis of the knee (advanced knee OA). In more than grade 3 OA based on the Kellgren-Lawrence classification, when patients' age was less than 60years or activity level was more than level 5 based on the UCLA activity score, 22 knees (18 patients) underwent HCWHTO. The other 22 knees (18 patients) that underwent TKA were evaluated retrospectively. Muscle strength was evaluated preoperatively and at 1 year postoperatively. The visual analogue scale (VAS) and Japanese version of the Knee injury and Osteoarthritis Outcome Score (J-KOOS) were used to evaluate clinical outcomes preoperatively and at a mean 66-months follow-up. All postoperative muscle strength measures improved to preoperative equivalent levels in the HCWHTO group; they were significantly higher in the HCWHTO group than in the TKA group (p < .05). The VAS score and total J-KOOS significantly improved in both groups (HCWHTO, p = .001; TKA, p = .040); there were no significant differences in the scores between the groups at the final follow-up. Hybrid closed wedge HTO significantly improved the activities of daily living and sport/recreation scores, whereas TKA did not at the final follow-up. In advanced knee OA, HCWHTO led to improved muscle strength, and its midterm clinical outcomes were equivalent to those of TKA. To postpone or even to avoid TKA, HCWHTO is considered an appropriate treatment for young and high-activity patients with advanced knee OA. Therapeutic Level III.

DIHYDRONICOTINAMIDE RIBOSIDE (NRH), AN ORALLY BIOAVAILABLE NICOTINAMIDE ADENINE DINUCLEOTIDE (NAD) PRECURSOR, SIGNIFICANTLY INHIBITS POST-TRAUMATIC OSTEOARTHRITIS (OA) DEVELOPMENT AND ASSOCIATED PAIN IN MICE

Purpose: Nicotinamide adenine dinucleotide (NAD+) is a key metabolite that serves as a cofactor for numerous enzymes involved in cellular energy metabolism and critically regulates multiple cell-signaling pathways. We previously observed that upregulation of expression of CD38, the main NADase (NAD+ consuming enzyme) in mammalian tissues, is associated with decline of cellular NAD+ levels in advanced human knee OA chondrocytes/cartilage. In addition, CD38 expression is markedly induced by proinflammatory cytokine IL-1β, correlated with reduced ratio of NAD and NADH.

Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy

IntroductionTo compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results.Materials and methodsSixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy.ResultsDuring the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05).ConclusionCompared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.

Prevalence and Risk Factors of Osteoporosis in Chinese Postmenopausal Women Awaiting Total Knee Arthroplasty.

BackgroundTotal knee arthroplasty (TKA) complications associated with low bone quality are challenging for orthopaedic surgeons to treat, but little is known about bone quality in Chinese postmenopausal women awaiting TKA. This study investigated the incidence of osteoporosis (OP) and explored the preoperative risk factors for OP in this population.MethodsWe retrospectively reviewed the data of Chinese postmenopausal women who were indicated for TKA between May 2017 and June 2020. The bone mineral density (BMD) of the hip and lumbar spine and multiple preoperative parameters were collected and analyzed. Binary logistic regression analysis was performed to identify independent risk factors for OP in this population.ResultsA total of 204 postmenopausal women with advanced knee OA were included in the study (age: 69.7±8.5 years; body mass index [BMI]: 25.5±4.0 kg/m2). The OP prevalence among all participants was 59.8%, and the patients aged 60–80 years had a significantly lower BMD than did the age/ethnicity-adjusted population. An age ≥60 years, a BMI<25, and the presence of a varus knee deformity were independent risk factors for preoperative OP in the postmenopausal women awaiting TKA.ConclusionThe prevalence of OP in Chinese postmenopausal women awaiting TKA is higher than that in the age/ethnicity-adjusted normal population. An age ≥60 years, a BMI<25, and the presence of a varus knee deformity are independent risk factors that can be used to predict preoperative OP in this population.

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide.

Background With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P < 0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P < 0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

BackgroundThe purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO.MethodsThirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery.ResultsRadiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups.ConclusionsTCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.

Promoter polymorphism (T‐1486C) of TLR‐9 gene is associated with knee osteoarthritis in a Turkish population

In this study, we aimed to determine whether TLR-9 T-1486C SNP was associated with susceptibility to OA in the Turkish population. The study group comprised 272 patients with Grade 2-3-4 knee OA according to the Kellgren-Lawrence scoring system and the control group was formed of 296 individuals with Grade 0-1. The TLR-9 genotype were assessed by real-time polymerase chain reaction. An analysis of TLR-9 promoter -1486T/C polymorphism revealed that the -1486CC genotype appeared to have a higher risk for OA and -1486TT and -1486CT genotypes have a protective effect against the development of OA (crude OR = 0.473, 95% CI = 0.297-0.754, p = 0.002, adjusted OR = 0.531, 95% CI = 0.326-0.864, p = 0.011). This study indicate that there is a correlation of TLR-9 T-1486C gene polymorphism with advanced knee OA in a Turkish population. Changed in TLR expression due to different allelles may cause osteoarthrith development outcome cartilage degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2484-2489, 2017.

Lysophosphatidylcholines to phosphatidylcholines ratio predicts advanced knee osteoarthritis.

To identify novel biomarker(s) for predicting advanced knee OA. Study participants were derived from the Newfoundland Osteoarthritis Study and the Tasmania Older Adult Cohort Study. All knee OA cases were patients who underwent total knee replacement (TKR) due to primary OA. Metabolic profiling was performed on fasting plasma. Four thousand and eighteen plasma metabolite ratios that were highly correlated with that in SF in our previous study were generated as surrogates for joint metabolism. The discovery cohort included 64 TKR cases and 45 controls and the replication cohorts included a cross-sectional cohort of 72 TKR cases and 76 controls and a longitudinal cohort of 158 subjects, of whom 36 underwent TKR during the 10-year follow-up period. We confirmed the previously reported association of the branched chain amino acids to histidine ratio with advanced knee OA (P = 9.3 × 10(-7)) and identified a novel metabolic marker-the lysophosphatidylcholines (lysoPCs) to phosphatidylcholines (PCs) ratio-that was associated with advanced knee OA (P = 1.5 × 10(-7)) after adjustment for age, sex and BMI. When the subjects of the longitudinal cohort were categorized into two groups based on the optimal cut-off of the ratio of 0.09, we found the subjects with the ratio ⩾0.09 were 2.3 times more likely to undergo TKR than those with the ratio <0.09 during the 10-year follow-up (95% CI: 1.2, 4.3, P = 0.02). We identified the ratio of lysoPCs to PCs as a novel metabolic marker for predicting advanced knee OA. Further studies are required to examine whether this ratio can predict early OA change.

Lysophosphatidylcholines to phosphatidylcholines ratio predicts advanced knee osteoarthritis

OBJECTIVE To identify novel biomarker(s) for predicting advanced knee OA. METHODS Study participants were derived from the Newfoundland Osteoarthritis Study and the Tasmania Older Adult Cohort Study. All knee OA cases were patients who underwent total knee replacement (TKR) due to primary OA. Metabolic profiling was performed on fasting plasma. Four thousand and eighteen plasma metabolite ratios that were highly correlated with that in SF in our previous study were generated as surrogates for joint metabolism. RESULTS The discovery cohort included 64 TKR cases and 45 controls and the replication cohorts included a cross-sectional cohort of 72 TKR cases and 76 controls and a longitudinal cohort of 158 subjects, of whom 36 underwent TKR during the 10-year follow-up period. We confirmed the previously reported association of the branched chain amino acids to histidine ratio with advanced knee OA (P = 9.3 × 10(-7)) and identified a novel metabolic marker-the lysophosphatidylcholines (lysoPCs) to phosphatidylcholines (PCs) ratio-that was associated with advanced knee OA (P = 1.5 × 10(-7)) after adjustment for age, sex and BMI. When the subjects of the longitudinal cohort were categorized into two groups based on the optimal cut-off of the ratio of 0.09, we found the subjects with the ratio ⩾0.09 were 2.3 times more likely to undergo TKR than those with the ratio <0.09 during the 10-year follow-up (95% CI: 1.2, 4.3, P = 0.02). CONCLUSION We identified the ratio of lysoPCs to PCs as a novel metabolic marker for predicting advanced knee OA. Further studies are required to examine whether this ratio can predict early OA change.

Infra-patellar fat pad morphology and MRI signal distribution in advanced radiographic knee OA – Data from the OAI

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A219 349 INFRA-PATELLAR FAT PAD MORPHOLOGY AND MRI SIGNAL DISTRIBUTION IN ADVANCED RADIOGRAPHIC KNEE OA e DATA FROM THE OAI F. Eckstein yz, J. Diepold y, A. Ruhdorfer y, T. Dannhauer yz, W. Wirth yz, A. Guermazi xk. y Paracelsus Med. Univ., Salzburg & Nuremberg, Austria; zChondrometrics GmbH, Ainring, Germany; xBoston Univ. Sch. of Med., Boston, MA, USA; kBoston Imaging Core Lab, Boston, MA, USA Purpose: Recent studies suggest that obesity-related risk of knee OA is not fully explained by mechanical challenge, i.e. increased body weight. Yet, adipokines (e.g. leptin) secreted from fat tissue appear to cause lowgrade inflammation, and to contribute to the release of metallo-proteinases and growth factors, which are known to promote cartilage loss and osteophyte formation. The infra-patellar fat pad (IPFP) is unique in representing intra-articular adipose tissue, and is a source of intraarticular leptin. Only few studies, however, have studied the role of the IPFP in human knee OA. Here we explore whether quantitative imaging measures of IPFP size and MRI signal differ between painful knees with and without advanced radiographic knee OA in the same person, and between OA and healthy reference knees. Methods: The sample was drawn from the Osteoarthritis Initiative (OAI) cohort and fulfilled the following criteria: OARSI medial JSN in one knee, no-JSN in the contra-lateral knee, BMI>25, frequent knee pain in both knees. The 28 participants who displayed OARSI JSN grades 2 or 3 in one (and grade 0 in the other) knee were matched 1:1 with subjects from the OAI healthy reference cohort without knee pain radiographic signs, or risk factors of incident knee OA, based on the same sex and similar body height. A sagittal fat-suppressed IM-weighted TSE sequence was used for segmentation of the entire IPFP (J.D.), volumetric 3D analysis of its morphology and signal, and for semi-quantitative evaluation of MOAKS synovitis scores (A.G.). Paired t-tests were used to compare JSN with contra-lateral non-JSN knees, and with matched reference knees. Results: The 28 JSN participants (21 medial JSN grade 2 and 7 grade 3; 21 women, 7 men) were 165±11 cm tall (age 61±10y; weight 87±14 kg, BMI 32.2±4.4). The matched healthy reference subjects were of similar height (165±10cm), but younger (54±6y) and less heavy (70±13 kg; BMI 26±2.7). No significant differences in IPFP volume, surface areas, or thickness were observed between JSN and no-JSN knees. Compared with healthy reference knees, JSN knees displayed a 10% larger IPFP anterior surface area (p<0.01), but a slightly lower thickness, and no significant difference in IPFP volume (Table 1). JSN knees displayed a significantly greater mean MRI signal intensity (SI) and greater MRI SI heterogeneity (i.e. standard deviation [SD]) than the no-JSN knees; further JSN knees displayed a substantially and significantly greater SD SI than healthy reference knees (Table 1: (b) 1⁄4 p<0.01; (c) 1⁄4 p<0.001)).

Synovial chemokine expression and relationship with knee symptoms in patients with meniscal tears

In patients with knee OA, synovitis is associated with knee pain and symptoms. We previously identified synovial mRNA expression of a set of chemokines (CCL19, IL-8, CCL5, XCL-1, CCR7) associated with synovitis in patients with meniscal tears but without radiographic OA. CCL19 and CCR7 were also associated with knee symptoms. This study sought to validate expression of these chemokines and association with knee symptoms in more typical patients presenting for meniscal arthroscopy, many who have pre-existing OA. Synovial fluid (SF) and biopsies were collected from patients undergoing meniscal arthroscopy. Synovial mRNA expression was measured using quantitative RT-PCR. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was administered preoperatively. Regression analyses determined if associations between chemokine mRNA levels and KOOS scores were independent of other factors including radiographic OA. CCL19 in SF was measured by ELISA, and compared to patients with advanced knee OA and asymptomatic organ donors. 90% of patients had intra-operative evidence of early cartilage degeneration. CCL19, IL-8, CCL5, XCL1, CCR7 transcripts were detected in all patients. Synovial CCL19 mRNA levels independently correlated with KOOS Activities of Daily Living (ADL) scores (95% CI [-8.071,-0.331], P=0.036), indicating higher expression was associated with more knee-related dysfunction. SF CCL19 was detected in 7 of 10 patients, compared to 4 of 10 asymptomatic donors. In typical patients presenting for meniscal arthroscopy, synovial CCL19 mRNA expression was associated with knee-related difficulty with ADL, independent of other factors including presence of radiographic knee OA.

Effects of intra-articular application of pulsed radiofrequency on pain, functioning and quality of life in patients with advanced knee osteoarthritis.

The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42◦C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05). It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs.

Many patients undergoing TKA have both knee and ankle pathology, and it seems likely that some compensatory changes occur at each joint in response to deformity at the other. However, it is not fully understood how the foot and ankle compensate for a given varus or valgus deformity of the knee. (1) What is the compensatory hindfoot alignment in patients with end-stage osteoarthritis who undergo total knee arthroplasty (TKA)? (2) Where in the hindfoot does the compensation occur? Between January 1, 2005, and December 31, 2009, one surgeon (JJC) obtained full-length radiographs on all patients undergoing primary TKA (N=518) as part of routine practice; patients were analyzed for the current study and after meeting inclusion criteria, a total of 401 knees in 324 patients were reviewed for this analysis. Preoperative standing long-leg AP radiographs and Saltzman hindfoot views were analyzed for the following measurements: mechanical axis angle, Saltzman hindfoot alignment and angle, anatomic lateral distal tibial angle, and the ankle line convergence angle. Statistical analysis included two-tailed Pearson correlations and linear regression models. Intraobserver and interobserver intraclass coefficients for the measurements considered were evaluated and all were excellent (in excess of 0.8). As the mechanical axis angle becomes either more varus or valgus, the hindfoot will subsequently orient in more valgus or varus position, respectively. For every degree increase in the valgus mechanical axis angle, the hindfoot shifts into varus by -0.43° (95% confidence interval [CI], -0.76° to -0.1°; r=-0.302, p=0.0012). For every degree increase in the varus mechanical axis angle, the hindfoot shifts into valgus by -0.49° (95% CI, -0.67° to -0.31°; r=-0.347, p<0.0001). In addition, the subtalar joint had a strong positive correlation (r=0.848, r2=0.72, p<0.0001) with the Saltzman hindfoot angle, whereas the anatomic lateral distal tibial angle (r=0.450, r2=0.20, p<0.0001) and the ankle line convergence angle (r=0.319, r2=0.10, p<0.0001) had a moderate positive correlation. The coefficient of determination (r2) shows that 72% of the variance in the overall hindfoot angle can be explained by changes in the subtalar joint orientation. These findings have implications for treating patients with both knee and foot/ankle problems. For example, a patient with varus arthritis of the knee should be examined for fixed hindfoot valgus deformity. The concern is that patients undergoing TKA, who also present with a stiff subtalar joint, may have exacerbated, post-TKA foot/ankle pain or disability or malalignment of the lower extremity mechanical axis as a result of the inability of the subtalar joint to reorient itself after knee realignment. A prospective study is underway to confirm this speculation. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

AB1124 The Importance of the Early Rehabilitation after Total Knee Replacement in Osteoarthritis and Rheumatoid Arthritis Patients

BackgroundTotal knee replacement (TKR) revolutionized management of patients with advanced knee osteoarthritis and rheumatoid arthritis, in order to help them overcome pain and functional limitation, with very good long-term results.ObjectivesOur...

Repair of Injury to Articular Cartilage with Chondrocyte Progenitor Cells

were found in the synovial fluid of OA patients [15] and these proinflammatory cytokines promote matrix metalloproteinase gene up-regulation [16] and apoptosis [17] to name only two of the many cellular events relevant to the progression of OA. Despite these findings, only an IL-1 receptor antagonist (IL-1Ra) [18] has been rigorously assessed in a phase II double-blinded non-controlled clinical trial of 13 patients with knee OA. In this study [19] patients received intraarticular injections of 150 mg of a recombinant form of human IL-1Ra. The results indicated a significant improvement in pain (using a visual analog scale) and in the Western Ontario and McMaster Universities (WOMAC) OA index over a 3-month period. However, assessments relative to the extent to which IL-1Ra altered the pathology of OA remain to be fully evaluated. Recently, anti-Nerve Growth Factor (NGF) receptor monoclonal antibodies were evaluated for their capacity to reduce pain in clinical trials involving patients with advanced hip and knee OA and in patients with chronic back pain [reviewed in 20]. These NGF receptor antagonists were efficacious for reducing pain, but these agents were also associated with serious adverse effects including the development of osteonecrosis in some patients treated with anti-NGF and NSAIDs. NGF is a neurotrophin having strong regulatory activity towards peripheral nocioception. In that regard, the expression of Substance P, calcium-related peptide and serotonin are the expected targets for NGF-receptor blockade. However, it remains to be determined whether the blocking of metabolic pathways by these anti-NGF receptor monoclonal antibodies can alter the progression of OA pathology. Importantly, the number of recent studies focused on testing antiNGF receptor antagonists in OA pale by comparison with the targeted approaches employed by the biopharmaceutical industry in developing and successfully marketing for use in the clinic a multitude of biological agents designed to block the immune-mediated inflammation of rheumatoid arthritis [21,22]. In view of the relative paucity of drug development strategies

Total knee replacement: pursuit of the paramount result

Total knee replacement: pursuit of the paramount result

Efficacy of Periosteal Stimulation Therapy for the Treatment of Osteoarthritis‐Associated Chronic Knee Pain: An Initial Controlled Clinical Trial

To examine the efficacy of periosteal stimulation therapy (PST, osteopuncture) for the treatment of chronic pain associated with advanced knee osteoarthritis. Randomized, controlled clinical trial. Outpatient pain clinic. Eighty-eight community-dwelling older adults with moderate knee pain or greater for 3 months or longer and Kellgren-Lawrence (K-L) grade 2 through 4 radiographic severity (80% had K-L 4). Participants were randomized to receive PST or control PST once a week for 6 weeks. Pain severity and self-reported function (Western Ontario and McMasters University Osteoarthritis Index (WOMAC)) and physical performance (Short Physical Performance Battery (SPPB)) were assessed at baseline, after the last PST session (post), and 3 months later (follow-up). Pain severity was also assessed monthly using the multidimensional pain inventory short form. Pain was reduced significantly more in the PST group than in the control PST group at post (P=.003; mean WOMAC pain subscale baseline 9.4 vs 6.4) and 1 month later (P<.001), but by 2 months, pain levels had regressed to pre-intervention levels. The group-by-time interaction for the WOMAC function scale was significant at post (P=.04) but not at follow-up (P=.63). No significant group differences were found for the SPPB. Neither analgesic use nor global improvement differed between groups. There were four treatment dropouts. PST affords short-term modest pain reduction for older adults with advanced knee OA. Future research should test the effectiveness of booster treatments in sustaining analgesic benefits and of combining PST with therapeutic exercise in ameliorating disability risk.