Advanced-stage Knee Osteoarthritis Research Articles

Factors affecting the therapeutic effects of multiple intra-articular injections of platelet-rich-plasma for knee osteoarthritis

BackgroundPlatelet-rich-plasma (PRP) is rapidly spreading as a conservative treatment option for knee osteoarthritis (KOA), however, its therapeutic efficacy is controversial. This study aimed to investigate the factors affecting the therapeutic effect of intra-articular PRP therapy for KOA in patients who received multiple PRP injections (PRP-I). MethodsThis is a historical cohort study included 1057 knees of 701 patients who received PRP-I during KOA treatment from 2018 to 2020. The difference in visual analog scale (VAS) scores before and after PRP-I was defined as the amount of change in VAS (ΔVAS). A linear mixed-effects model was employed with ΔVAS as a random effect and age, sex, BMI, KL classification, pre-treatment VAS, treatment duration, and the number of PRP injections as fixed effects. Evaluations using the Kellgren-Lawrence (KL) classification were added. ResultsAge, KL grade, and VAS score before treatment and after three, four, and five PRP-I were significantly associated with ΔVAS score. According to KL grade, age was significantly associated with ΔVAS score in the KL grade 4 group. VAS score before treatment was significantly associated with ΔVAS score, regardless of KL grade. Three-time PRP-I were significantly associated with ΔVAS in the KL-grade 1 and 2 groups. For KL grade 4, two or more PRP-I were significantly associated with the high efficacy. ConclusionsAge, pain before treatment, KL grade and number of injections were associated with pain reduction after intra-articular PRP-I for KOA treatment. Pain reduction can be expected after PRP-I when patients are younger or experience severe pain before treatment. Three-time PRP-I are recommended to reduce pain in early-stage KOA and more than three times in advanced-stage KOA. Trial registrationRetrospectively registration.

Effects of total knee arthroplasty on skeletal muscle structure and function at the cellular, organellar, and molecular levels.

Total knee arthroplasty (TKA) is an important treatment option for knee osteoarthritis (OA) that improves self-reported pain and physical function, but objectively measured physical function typically remains reduced for years after surgery due, in part, to precipitous reductions in lower extremity neuromuscular function early after surgery. The present study examined intrinsic skeletal muscle adaptations during the first 5 weeks post-TKA to identify skeletal muscle attributes that may contribute to functional disability. Patients with advanced stage knee OA were evaluated prior to TKA and 5 weeks after surgery. Biopsies of the vastus lateralis were performed to assess muscle fiber size, contractility, and mitochondrial content, along with assessments of whole muscle size and function. TKA was accompanied by marked reductions in whole muscle size and strength. At the fiber (i.e., cellular) level, TKA caused profound muscle atrophy that was approximately twofold higher than that observed at the whole muscle level. TKA markedly reduced muscle fiber force production, contractile velocity, and power production, with force deficits persisting in myosin heavy chain (MHC) II fibers after expression relative to fiber size. Molecular level assessments suggest reduced strongly bound myosin-actin cross bridges and myofilament lattice stiffness as a mechanism underlying reduced force per unit fiber size. Finally, marked reductions in mitochondrial content were apparent and more prominent in the subsarcolemmal compartment. Our study represents the most comprehensive evaluation of skeletal muscle cellular adaptations to TKA and uncovers novel effects of TKA on muscle fiber size and intrinsic contractility early after surgery that may contribute to functional disability.NEW & NOTEWORTHY We report the first evaluation of the effects of total knee arthroplasty (TKA) on skeletal muscle at the cellular and subcellular levels. We found marked effects of TKA to cause skeletal muscle fiber atrophy and contractile dysfunction in older adults, as well as molecular mechanisms underlying impaired contractility. Our results reveal profound effects of TKA on muscle fiber size and intrinsic contractility early after surgery that may contribute to functional disability.

FACTORS AFFECTING THE FALL RISK AND ASSISTIVE WALKING DEVICE USE OF PATIENTS WITH KNEE OSTEOARTHRITIS

Objective
 In this study, we aimed to investigate the risk of falling
 in patients with advanced-stage knee osteoarthritis and
 the rates of assistive walking device use, and the factors
 affecting the use of these devices in such patients.
 Materials and Methods
 In this prospective, cross-sectional, observational
 study, we included 79 patients (72 females, 7 males;
 median age 60 years; range, 40 to 75) with advancedstage
 knee osteoarthritis. We assessed the balance
 status of the patients with the Berg Balance Scale,
 pain levels with the Numeric Rating Scale, selfreported
 disability scores with the Western Ontario
 and McMaster Universities Osteoarthritis Index.
 Our primary outcome measurements were balance
 status, and assistive walking device usage rates of
 the patients. Secondary outcome measures were
 age, obesity, disease severity, pain levels, disability
 scores, and fall history.
 Results
 According to Berg Balance Scale, 40 (50.6 %)
 patients had a risk of fall. Assistive walking device
 usage rates were 21.5 % and 42.5 % for the total
 of the patients and for the patients at risk of falling,
 respectively. There was a statistically significant
 difference in assistive walking device use between
 those at risk of falling and those without (P

The effectiveness of telerehabilitation in patients after total knee replacement: A systematic review and meta-analysis of randomized controlled trials

Background Total knee replacement is a commonly adopted surgical intervention to reduce physical limitations and pain in advanced-stage knee osteoarthritis. However, these patients may experience physical dysfunction to limit their access during conventional rehabilitation after total knee replacement. The use of telemedicine may be the promising solution. This study aims to compare the effectiveness of telerehabilitation with conventional in-person rehabilitation in patients who underwent a total knee replacement. Methods For this systematic review on randomized controlled trials, PubMed, Medline, EMBASE, Cochrane Library, ScienceDirect and CINAHL databases were searched for eligible articles published between 1 January 2003 and 28 February 2022. The eligibility criteria were patients who underwent total knee replacement, randomized controlled trials and publications in English. The main outcome measures were focused on pain and physical function. Reference lists of relevant studies were also manually checked to find additional studies. Two independent reviewers conducted study selection separately. PEDro scale was used to assess the methodological quality of the included randomized controlled trials. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. Results A total of 11 studies met the eligibility criteria and included 1825 participants in the systematic review. Overall, the results revealed that the effectiveness of telerehabilitation is comparable to conventional in-person rehabilitation in improving various pain and functional outcomes in patients who underwent a total knee replacement. In the meta-analysis with the fixed-effects model, no significant difference was found in the improvement of pain and physical function in patients with knee osteoarthritis compared with conventional rehabilitation (Standardized Mean Difference (SMD) –0.15, 95% CI −0.47 to 0.16, P = 0.34 and SMD –0.04, 95% CI −0.19 to 0.12, P = 0.62, respectively). In addition, the utilization of hospital resources and costs were significantly lower in telerehabilitation when compared with in-person rehabilitation. Conclusion Telerehabilitation was comparable to conventional in-person rehabilitation in improving clinical outcomes following total knee replacement. However, it might be a more preferable alternative rehabilitation intervention for patients following total knee replacement given the significantly lower cost of telerehabilitation.

Effectiveness of the Thermal Genicular Nerve Radiofrequency Ablation Therapy Under Fluoroscopy in Patients with Non-operative Advanced Stage Knee Osteoarthritis: 1-Year Follow-Up Results.

In this study, our aim was to present the 1-year results of the effect of thermal genicular nerve radiofrequency ablation (GNRFA) therapy on pain and functional outcomes in patients with advanced knee osteoarthritis. After retrospectively examining the hospital records, 49 knees of 35 patients who had undergone thermal RFA of the superior medial, superior lateral, and inferior medial branches of the genicular nerve under fluoroscopic guidance between July 2019 and December 2020 were included in the study. The visual analog scale (VAS) scores of the patients were recorded before RFA, on the day of RFA, and at the first, sixth, and 12th months postoperatively, as well as their Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores before RFA and at the 12th month postoperatively. Complications developed after the procedure and during the follow-up period were screened. Twenty-five of the patients were females and 10 males, with a mean age of 77.3 ± 7.9years (range 61-92years). The mean VAS score was 8.4 ± 0.9 before RFA, and as 1.7 ± 1.0 right after the procedure, 2.4 ± 1.7 at the first month, 3.4 ± 1.8 at the sixth month, and 4.4 ± 1.9 at the 12th month (p < 0.01). In terms of the WOMAC score, the average value was 69.7 ± 6.4 before the treatment and 36.1 ± 11.8 at the final follow-up at the 12th month (p < 0.01). No complications were observed in any patient during the treatment or the follow-up period. Non-surgical thermal GNRFA therapy of knee osteoarthritis provides significant outcomes in terms of pain and functionality, with no significant systemic or local side effects. Therefore, the technique can be considered as an alternative to other methods when treating advanced osteoarthritis.

Effect of Additional Hip Strengthening on Anterior Knee Pain, Strength, and Health Status in Patients with Total Knee Replacement: A Pilot Randomized Clinical Trial

Background: Total knee replacement (TKR) is a standard surgical option for advanced-stage knee osteoarthritis. The primary indication of TKR is incapacitating knee pain. 75% to 89% of patients undergoing TKR reports a satisfactory reduction in pain. However, some patients develop anterior knee pain post-TKR. Therefore, different treatment strategies are used for the management of pain post TKR. In the present study, we aimed to evaluate the additional effects of hip strengthening on pain, muscle strength, and health status in TKR patients.Methods: We randomized patients into two groups: knee group and knee hip group. The knee group (n=6) did knee flexors and extensors strengthening. The knee hip group (n=6) performed knee strengthening with additional hip abductors, lateral rotators, and extensors strengthening exercises. Both groups received four-session/week for six weeks. The pain was measured on NPRS, muscle strength on a hand-held dynamometer, and health status using the WOMAC scale. The data was collected at the baseline and post intervention (six weeks).Results: The knee hip group shows more marked improvements in pain than the knee group, t value =3.3 (p=0.012). The data did not suggest any difference in knee muscle strength between the groups. Hip muscle strength showed a significant difference. Health status significantly improved in the knee hip group compared to the knee group, t value = 4.68 (p=0.005).Conclusion: We can conclude that a six-week hip muscle strengthening exercise program effectively improves pain, muscle strength, and health status than a conventional knee strengthening program.

Association of Neutrophil to Lymphocyte Ratio with Patient Reported Outcomes in Knee Osteoarthritis

Background: Determining the association of neutrophil to lymphocyte ratio (NLR) and clinical disease severity in patients with mild and advanced stage knee osteoarthritis (OA).Method: We analyzed clinical scores and routine hematology panels of 111 subjects with symptomatic knee degeneration: mild OA (66) who underwent knee arthroscopy and advanced OA (45) who had total replacement. Results: Compared to the advanced OA group, the mild OA group was younger (54/67), had fewer females (1.75/5.43), and better scores: Euroqol EQ5D Index (0.50/0.25), VAS (visual analog scale) (65/44); International knee documentation committee subjective knee evaluation form—IKDC (31.6/20.24); Knee disability and osteoarthritis outcome score for joint replacement—KOOSJR (15.5/18.3); and better Kellgren–Lawrence stage (1.3/3.8). Patients with advanced disease had higher NLRs compared to mild OA group and controls: 2.82 versus 1.99 (p = 0.004) and 1.98 (p = 0.002). In the multiple regression model, NLR was only influenced by age (p &lt; 0.001). In the subgroup analysis, for the early OA cases, NLR was significantly dependent to VAS (p = 0.006), IKDC (p = 0.001) and KOOSJR (p &lt; 0.001). Conclusion: NLR was not associated with symptomatic knee OA, as determined by commonly used patient reported outcomes. However, for patients with mild degenerative modifications, EQ5D, VAS, and IKDC were independent predictors of NLR.

Kinematic analysis of ankle-foot complex mobility during weight acceptance functional tests in patellofemoral pain women

We examined the effect of knee osteoarthritis on the rate of torque development (RTD) of the knee extensors in older adults with advanced-stage knee osteoarthritis (OA; n = 15) and recreationally-active controls (n = 15) of similar age, sex and health status, as well as the relationship between RTD and the size and contractility of single muscle fibers. OA participants had lower RTD when expressed in absolute terms (Nm/ms). There were sex differences in peak RTD (P < 0.05), with greater RTD in men, but no group by sex interaction effects for any variables. The lower RTD in OA versus controls was not explained by variation between groups in the fiber type admixture of the muscle, and was mitigated when RTD was normalized to peak torque (PT). In knee OA volunteers, we found strong correlations between the RTD expressed relative to PT and the velocity of contraction of single myosin heavy chain (MHC) I and IIA/X muscle fibers (r = 0.652 and 0.862; both P < 0.05) and power output of MHC I fibers (r = 0.642; P < 0.05). In controls, RTD relative to PT was related to fiber cross-sectional area of MHC IIA/X fibers (r = 0.707; P < 0.05), but not measures of single fiber contractile performance. To our knowledge, these results represent the first demonstration that variation in whole muscle contractile kinetics in patients with advanced-stage knee osteoarthritis and healthy older adults is related, in part, to the size and function of single muscle fibers.

Reduced rate of knee extensor torque development in older adults with knee osteoarthritis is associated with intrinsic muscle contractile deficits

We examined the effect of knee osteoarthritis on the rate of torque development (RTD) of the knee extensors in older adults with advanced-stage knee osteoarthritis (OA; n=15) and recreationally-active controls (n=15) of similar age, sex and health status, as well as the relationship between RTD and the size and contractility of single muscle fibers. OA participants had lower RTD when expressed in absolute terms (Nm/ms). There were sex differences in peak RTD (P<0.05), with greater RTD in men, but no group by sex interaction effects for any variables. The lower RTD in OA versus controls was not explained by variation between groups in the fiber type admixture of the muscle, and was mitigated when RTD was normalized to peak torque (PT). In knee OA volunteers, we found strong correlations between the RTD expressed relative to PT and the velocity of contraction of single myosin heavy chain (MHC) I and IIA/X muscle fibers (r=0.652 and 0.862; both P<0.05) and power output of MHC I fibers (r=0.642; P<0.05). In controls, RTD relative to PT was related to fiber cross-sectional area of MHC IIA/X fibers (r=0.707; P<0.05), but not measures of single fiber contractile performance. To our knowledge, these results represent the first demonstration that variation in whole muscle contractile kinetics in patients with advanced-stage knee osteoarthritis and healthy older adults is related, in part, to the size and function of single muscle fibers.

Chronic disuse and skeletal muscle structure in older adults: sex-specific differences and relationships to contractile function.

In older adults, we examined the effect of chronic muscle disuse on skeletal muscle structure at the tissue, cellular, organellar, and molecular levels and its relationship to muscle function. Volunteers with advanced-stage knee osteoarthritis (OA, n = 16) were recruited to reflect the effects of chronic lower extremity muscle disuse and compared with recreationally active controls (n = 15) without knee OA but similar in age, sex, and health status. In the OA group, quadriceps muscle and single-fiber cross-sectional area were reduced, with the largest reduction in myosin heavy chain IIA fibers. Myosin heavy chain IIAX fibers were more prevalent in the OA group, and their atrophy was sex-specific: men showed a reduction in cross-sectional area, and women showed no differences. Myofibrillar ultrastructure, myonuclear content, and mitochondrial content and morphology generally did not differ between groups, with the exception of sex-specific adaptations in subsarcolemmal (SS) mitochondria, which were driven by lower values in OA women. SS mitochondrial content was also differently related to cellular and molecular functional parameters by sex: greater SS mitochondrial content was associated with improved contractility in women but reduced function in men. Collectively, these results demonstrate sex-specific structural phenotypes at the cellular and organellar levels with chronic disuse in older adults, with novel associations between energetic and contractile systems.

Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review.

Obesity is a major risk factor for the development of knee osteoarthritis, and over the past 30 years the prevalence of obesity has more than doubled. In an advanced-stage knee osteoarthritis is treated with total knee arthroplasty, and the demand for primary total knee arthroplasties is expected to grow exponentially. However, total knee arthroplasty in obese patients is associated with more complications, longer hospital stay and higher costs. We aimed to determine the effects of bariatric surgery on knee complaints in (morbidly) obese (body mass index >30 kg m(-2) ) adult patients. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRIP, BIOSIS-Previews and reference lists of retrieved publications were systematically searched from earliest available up to 20 April 2014 for any English, German, French and Dutch studies. There was no restriction on study design. We included studies on the effect of surgically induced weight reduction on knee complaints in (morbidly) obese adult patients, with a minimal follow-up of 3 months. Studies on the effects of lipectomy or liposuction and studies in which patients had already received a total knee arthroplasty were excluded. Thirteen studies were included in this systematic review with a total of 3,837 patients. Although different assessment tools were used, an overall significant improvement in knee pain was seen in 73% out of the used assessments. All studies measuring intensity of knee pain, knee physical function and knee stiffness showed a significant improvement after bariatric surgery. The quality of evidence was very low or too low for most of the included studies and moderate for one study. Bariatric surgery with subsequent marked weight loss is likely to improve knee pain, physical function and stiffness in (morbidly) obese adult patients. However, with the current available evidence, there is need for high-quality studies.

Bone turnover markers (BTMs) in the synovial fluid in the patients with osteoarthritis correlates with the serum level of BTMs though some patients with osteoporosis exhibit mismatched increase in bone resorption activity in synovial fluid

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S375 663 BONE TURNOVER MARKERS (BTMS) IN THE SYNOVIAL FLUID IN THE PATIENTS WITH OSTEOARTHRITIS CORRELATES WITH THE SERUM LEVEL OF BTMS THOUGH SOME PATIENTS WITH OSTEOPOROSIS EXHIBIT MISMATCHED INCREASE IN BONE RESORPTION ACTIVITY IN SYNOVIAL FLUID Y. Saita yz, K. Kurata z, T. Sato z, S. Fukasaku z, K. Kaneko y, M. Nemoto z. yDept. of Orthopaedics, Juntendo Univ., Tokyo, Japan; zDept. of Orthopedic Surgery, Kitanarashino Hanawa Hosp., Chiba, Japan Purpose: Little is known regarding the relationships between the osteoarthritis (OA) and osteoporosis especially for the link between the subchondral bone remodeling and pathology of OA. In the patients with severe OA, articular cartilages wear down and subchondral bones become exposed. We hypothesized that BTMs in the synovial fluid would be related to the pathology of OA, and evaluated them in the patients with knee OA. Methods: Twenty seven knees in twenty one postmenopausal women with advanced-stage knee osteoarthritis (Kellgren-Lawrence >2) were analyzed in this study. The average age of patients was 73.4 (range, 52– 83 years). Knee pain was evaluated using visual analogue scales (VAS) and outcome measure for Japanese patients with knee osteoarthritis (JKOM). Tartrate-resistant acidic phosphatase 5b (TRAcP5b) activity and procollagen 1 N-terminal peptide (P1NP) concentrationwere measured both in the serum and synovial fluid. Bone mineral density (BMD) was measured in digital image processing method at second metacarpal bone. In statistics, Spearman’s rank correlation coefficient (r) and statistical significance (p) were calculated using GraphPad Prismversion 6.0 (GraphPad Software). The Mann-Whitney U test was used to compare differences between two independent groups. The values of p 0.5 mm in the index knee) at 3 years was obtained using a Poisson regression model with robust error estimates to obtain relative risk (RR), with adjustment for baseline index JSW, gender, glucosamine use, age, BMI and centre. Each knee was graded according to the Kellgren and Lawrence (KL placebo 0.08 mm/year; 95% CI 0.15–0.30, p 1⁄4 0.51). In the lateral compartment, the equivalent difference between the two groups was 0.07 mm/year (vitamin D 0.11mm/year, placebo 0.18mm/year; 95% CI 0.15–0.30). 39% of patients in the treatment group and 37% of patients in the placebo group showed a clinically significant progression of JSN (>0.5 mm) at 3 years compared to baseline. The unadjusted relative risk of clinically significant progression of JSN for the vitamin D group relative to the placebo group was 1.05 (95% CI 0.77–1.44, p 1⁄4 0.76). The adjusted relative risk was 1.03 (95% CI 0.76–1.40, p 1⁄4 0.83). The odds ratio of a higher KL OVX with alendronate (ALN,

Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis

Impaired proprioceptive perception and the balance function are known to associate with knee osteoarthritis. The previous publications have reported the beneficial effects of proprioceptive exercises on mild or moderate knee osteoarthritis. Scientific data in the literature regarding their effects in advanced stages of knee osteoarthritis are lacking. The objective of this study is to investigate the impact of the proprioceptive exercises on balance, proprioceptive perception and clinical findings in advanced-stage knee osteoarthritis. Fifty-four patients diagnosed as having knee osteoarthritis according to the American Collage of Rheumatology criteria with grade of 3 or higher according to the Kellgren-Lawrence scale were enrolled in the study. Patients were allocated randomly into two groups. The study group included 30 patients, and the control group included 24 patients. The proprioceptive perception was assessed by the ability to reproduce the knee position. The balance function was assessed by stabilometric evaluation in static and dynamic patterns. The clinical evaluation was made by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were reevaluated after the three-week proprioceptive rehabilitation program. The improvement in the scores of static balance was significant statistically. No significant improvement in the dynamic balance scores was obtained. Although the measurements of proprioceptive perception showed a tendency toward improvement, the difference was not significant statistically. The WOMAC scores showed better improvements in the study group. As conclusion, in further stages of knee osteoarthritis, proprioceptive exercises have beneficial effects on static balance and to some extent on proprioceptive accuracy. In the treatment for advanced knee osteoarthritis, adding exercises specifically targeting the proprioceptive and balance dysfunction might be useful.