Bilateral Knee Osteoarthritis Research Articles

Clinical application of unicompartmental knee arthroplasty and total knee arthroplasty in patient with bilateral knee osteoarthritis

To explore whether unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) or bilateral TKAs should be performed in patients with bilateral knee osteoarthritis. Between April 2015 and February 2017, 24 patients with bilateral knee osteoarthritis who met the selection criteria were included in the study and randomly divided into 2 groups ( n=12). The patients in observation group were treated with TKA of the multicompartmental osteoarthritis knee in the first-stage operation and UKA of the unicompartmental osteoarthritis knee in the second-stage operation; and the patients in control group were treated with bilateral TKAs in staging operation. The operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° were recorded. The difference of hemoglobin (Hb) before and after the second-stage operation was recorded, and the decrease of Hb was observed. The hospital stay after the second-stage operation was observed. The Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) were recorded at 7 days after the first-stage operation, and at 15 days, 45 days, and 6 months after the second-stage operation. At 1 year after the second-stage operation, the mean values of the above indexes of both knees were taken as the individual comprehensive evaluation. The X-ray films were taken regularly to examine the prosthesis and lower extremity force line. The incisions in both groups were healed by first intention after two stage operations. The differences in the operation time, the amount of postoperative drainage, and the time of active flexion of the knee joint at 90° between the two groups were not significant in the first-stage operation ( P>0.05) and were significant in the second-stage operation ( P<0.05). The decrease of Hb and hospital stay after the second-stage operation were significantly lower in observation group than in control group ( P<0.05). Both groups were followed up, the follow-up time was 12-18 months (mean, 14 months) in observation group and 12-21 months (mean, 16 months) in control group. During the follow-up period, X-ray films showed that the prosthesis positions of both sides were normal as well as the alignment line, and no infection, loosening or dislocation of prosthesis occurred. There was no significant difference in HSS score, VAS score, and ROM of multicompartmental osteoarthritis knee at 7 days after the first-stage operation between the two groups ( P>0.05), indicating that the two groups were still comparable. The HSS score, VAS score, and ROM of unicompartmental osteoarthritis knee in observation group were superior to control group ( P<0.05) after the second-stage operation. At 1 year, the HSS score, VAS score, and ROM in observation group were also superior to control group ( P<0.05). On the premise of strict indications, the patients with bilateral knee osteoarthritis should be treated according to their own pathological changes in order to obtain better short-term effectiveness.

Strontium ranelate as new modality in treatment of primary knee osteoarthritis

Background: Osteoarthritis is a degenerative disease that has an effect on the whole joint structure which includes the synovial layer, cartilage, subchondral bone, ligaments and muscle groups across the joint. Objective: to evaluate effectiveness of strontium ranelate in treatment of patients with primary knee osteoarthritis (KOA). Methods: This randomized clinical trial was done on 30 patients with bilateral Knee osteoarthritis, they were divided into 2 groups. Group 1: 15 patients received strontium ranelate 2 gram and physiotherapy programme. Group 2:15 patients received physiotherapy programme only. All patients were assessed using visual analogue scale for pain (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee MRI. Results: This study included 45 patients with Knee osteoarthritis, 15 patients were excluded based on exclusion criteria, only 30 patients were randomized into 2 groups, 1 patient in group 1 and 2 patients in group 2 didn't complete follow up duration, and statistical data were done only on 27 patients. At the beginning of the study no significant difference was found between both groups in all parameters. A significant improvement in VAS and WOMAC score was found in group 1(p=0.034,p=0.004) in comparison to group 2 after 6 months follow up. There was statistically significant improvement in group 1 in synovitis/effusion detected by MRI in comparison to group 2 after 6 months of treatment. Conclusion: Strontium ranelate (SrR) has great role in reducing pain, synovitis, improving function in primary knee osteoarthritis and could be considered a disease modifying osteoarthritis drug.

Cross-Validation of a Screening Tool to Distinguish Between Fallers and Nonfallers in Community-Dwelling Older Adults With Knee Osteoarthritis

ObjectivesThis study aimed to cross-validate a previously developed knee osteoarthritis falls (KOAF) screening tool to distinguish between fallers and nonfallers among community-dwelling older adults with knee osteoarthritis (OA). DesignCross-sectional survey study. SettingThree independent orthopedic clinics. ParticipantsOlder outpatients with knee OA (N=86; 71 women, 15 men; mean age, 75.2±6.2y). InterventionsNot applicable. Main Outcome MeasuresThe primary outcome was to identify fallers and nonfallers among outpatients with OA based on their history of falls within the past year. We investigated factors including sex, age, body mass index, Kellgren-Lawrence grade, affected side (bilateral or unilateral knee OA), number of comorbidities, pharmacotherapy, physical therapy, pain, and activity as individual predictors of falls. Participants performed the one-leg standing test and the 5 times sit-to-stand test to determine motor function. Sensitivity, specificity, likelihood ratio, and post-test probability of the KOAF screening tool were calculated using receiver operating characteristic (ROC) curve analysis. ResultsThe results of the one-leg standing test and 5 times sit-to-stand test differed significantly between the 2 groups (P<.05). ROC curve analysis showed that the area under the curve was 0.88 (95% confidence interval, 0.80-0.96; P<.001). The post-test probability of falls was 83.3% (positive likelihood ratio, 11.54) when the total score of KOAF screening tool was 2 points and 2.6% (negative likelihood ratio, 0.06) when the total score of KOAF screening tool was less than 1 point. ConclusionsCross-validation results for the KOAF screening tool were better, confirming that the screening tool could distinguish between fallers and nonfallers with high accuracy. Our findings suggest that this simple screening tool could be readily used in clinical practice and could aid in clinical decision-making through providing choices for physical therapy evaluation and recommendations for physical therapy programs.

The condition of the contralateral knee may induce different degrees of knee extensor strength asymmetry and affect functionality in individuals with unilateral or bilateral osteoarthritis

BackgroundLoss of knee extensor strength in individuals with knee osteoarthritis (KOA) may induce inter-limb strength asymmetries and alter functionality. The aims were to analyse whether the condition of the uninvolved knee (advanced to severe KOA or no affection) may induce different degrees of knee extensor strength asymmetry in individuals with KOA and to study whether functionality may differ in cases of unilateral or bilateral KOA. MethodsSixty-eight subjects with advance-to-severe KOA were categorized into two groups (unilateral or bilateral KOA). The knee extensor strength ratio (KESR), and self-reported and performance-based functionality were analysed and compared. Sex and age were independent factors. One- and two-way analysis of variance assessed for significant between-group differences (95% confidence interval (CI)). ResultsParticipants with unilateral KOA presented with 20% knee extensor strength asymmetry. The mean difference with the bilateral KOA group in terms of Knee Extensors Strength Ratio was 0.2 (95% CI 0–0.3; P = 0.021), of the Oxford Knee Scale score was 4.2 (95% CI 3.4–5.1; P = 0.037), and of the Timed Up and Go was 1.3 s (95% CI 0.5–2.2; P > 0.05). There were significant sex and age interactions (P < 0.05). ConclusionsIndividuals with unilateral or bilateral KOA present with different degrees of knee extensor strength asymmetry. The non-affected knee seems to help to better develop functional tasks in cases of unilateral condition. The findings may help the design of tailored strengthening interventions in which each knee condition in individuals with KOA should be considered.

Functional outcomes of simultaneous bilateral versus unilateral total knee arthroplasty.

Objectives: There is currently no clear consensus on the benefits of performing simultaneous bilateral total knee arthroplasty (SBTKA) for patients with bilateral knee osteoarthritis. The purpose of this study was to analyze whether SBTKA provides equivalent reduction in pain and functional outcome as comparable with unilateral surger­ies (UTKA). Study Design: Cross sectional study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2013 and July 2016. Material &amp; Methods. 637 TKAs in 386 consecutive patients, who underwent total knee arthroplasty for bilateral knee osteoarthritis between Patients were split into 2 groups: those who underwent unilateral TKA (n=135) and those who underwent si­multaneous bilateral TKA (n=251). Knee range of motion, Knee Society Scores (KSS) and knee function scores were obtained pre­operatively and 2 or more years postop­eratively. Results: Mean±SD flexion was 111.6°± 8.6° for patients in the bilater­al group and 110.8°± 9.02° for patients in the unilateral group (p=0.34). Mean±SD KSS was 86.4 ± 9.3 in the bilateral group and 85.34 ± 10.5 in the unilateral group (p=0.236). Mean±SD function score was 83.4± 5.4 in the bilateral group and 80.90 ± 7.2 in the unilat­eral group (p&lt;0.0001). Conclusion: In properly selected patients deemed fit for bilateral knee surgery, SBTKA provides significantly better functional outcomes compared to UTKA.

Effects of biodex balance training on symptomatic knee osteoarthritis in Rawalpindi: A randomized control trial.

To determine the effect of Biodex training on lower limb functional performance, balance, pain and proprioception in symptomatic knee osteoarthritis patients. The randomised controlled study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from February to June 2018, and comprised patients of both genders aged 35-65 years with bilateral knee osteoarthritis. The patients were randomised using sealed envelope method into two equal control and experimental groups. The former received traditional exercise programme, while the latter received balance training on Biodex and traditional exercise programme. Assessment was done at baseline and post-intervention, and the two values were compared both intra-group and inter-group. Data was analysed using SPSS 21. Of the 48 patients, there were 24(50%) in each of the two groups. Experimental group showed significant improvement in pain severity, overall stability and in terms of anteroposterior stability (p<0.05). There was significant improvement in both groups from the baseline (p<0.05). Biodex balance training was found to be more effective in improving functional performance, stability, proprioception and in decreasing sway and pain compared to the traditional exercise programme.

Leg-Length Change After Unilateral Unicompartmental Knee Arthroplasty in Varus Knee and Its Clinical Implications

BackgroundTo explore the magnitude of leg-length change after the unilateral index unicompartmental knee arthroplasty (UKA) in varus knee and its influence on clinical outcomes. MethodsA total of 114 patients with bilateral knee osteoarthritis who underwent unilateral UKA from June 2015 to June 2017 were included and followed up for at least 2 years. The leg length and hip-knee angle were measured on full-length standing films before and after the surgery. Flexion contracture was evaluated using a goniometer with the patient in the standing position preoperatively and postoperatively. Hospital for Special Surgery scores, perceived leg-length discrepancy (pLLD), the occurrence, and the time interval of subsequent contralateral knee arthroplasty were recorded and analyzed. ResultsThe average leg length increased after UKA was 9.39 ± 11.24 mm (range −21.00 to 33.79 mm), and 90 (78.9%) patients showed an increase in the leg length. 35 patients had LLD (defined as ≥10 mm), and 25 presented pLLD preoperatively; 25 patients had LLD, and 45 were suspected with pLLD postoperatively. At the last follow-up, 26 patients underwent subsequent contralateral knee arthroplasty. Postoperative LLD and pLLD were not associated with Hospital for Special Surgery scores of UKA but associated with subsequent contralateral knee arthroplasty. ConclusionsLLD and pLLD were common in patients both before and after UKA. Most patients showed leg lengthening after UKA. Postoperative LLD and pLLD were not associated with functional scores but associated with a subsequent contralateral knee arthroplasty.

Serum Calprotectin as a Blood-Based Biomarker for Monitoring Knee Osteoarthritis at Early but Not Late Stages.

The identification of early-stage osteoarthritis (OA) is crucial for the deceleration of its progression; however, no reliable biomarker is available for this purpose. The current study aimed to determine the role of serum calprotectin in the detection of early-stage knee OA. In a case-control study, serum samples were collected from 84 patients with primary bilateral knee OA and 52 healthy controls. The radiographic grading of knee OA was performed using the Kellgren-Lawrence classification system. Serum concentrations of calprotectin were measured using an enzyme-linked immunosorbent assay. The mean serum calprotectin level was 2908 ± 2516 ng/mL in OA patients and 901 ± 875 ng/mL in healthy control subjects (P < 0.001). Mean serum calprotectin levels were significantly higher in the lower stages of OA: 3740 ± 2728 ng/mL in OA grade I, 3100 ± 2084 ng/mL in OA grade II, 2246 ± 1418 ng/mL in OA grade III, and 2035 ± 765 ng/mL in OA grade IV (P = 0.047). Serum calprotectin levels were significantly higher in patients with a disease duration <42 months compared with those with a disease duration >42 months (P = 0.043). Serum calprotectin level increases significantly in the early stages of OA and shows a reverse association with disease severity. Therefore, it could be suggested as a promising blood-based marker for early-stage knee OA.

Regenerative Medicine for Knee Osteoarthritis - The Efficacy and Safety of Intra-Articular Platelet-Rich Plasma and Mesenchymal Stem Cells Injections: A Literature Review.

The prevalence of osteoarthritis (OA) has been rising exponentially in recent years. As the disease progresses, patients may eventually require surgical intervention to restore the functionality of the affected knees. The current literature review aims to explore two treatment options in regenerative medicine for OA by analyzing the efficacy and safety of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) use, as well as determining which population will benefit from these treatments. A total of 1093 patients who were diagnosed with unilateral or bilateral knee osteoarthritis (KOA) were recruited in 23 studies. The experimental groups received either PRP or MSCs injections in comparison to the control groups receiving either hyaluronic acid (HA) or placebo (saline or dextrose) injections. Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate all participants at different time intervals of the studies. Medical imaging evaluations (X-ray or MRI) were used to look for structural improvements. In conclusion, both PRP and MSCs treatments were well tolerated, effective and safe to use. Repeated administrations and higher concentrations resulted in superior clinical improvements. A decrease in cartilage loss was observed in some MSCs trials. No severe adverse effects were documented. PRP treatment proved to be more efficacious among patients with KOA Kellgren-Lawrence (KL) grade I-II, while MSCs treatment proved to be more beneficial among the KOA KL grade II-III group.

Kinematic and Kinetic Gait Analysis of bilateral Knee Osteoarthritis and Its Effects on ankle and hip Gait Mechanics

Kinematic and Kinetic Gait Analysis of bilateral Knee Osteoarthritis and Its Effects on ankle and hip Gait Mechanics

Changes in Experimental Pain Sensitivity from Using Home-Based Remotely Supervised Transcranial Direct Current Stimulation in Older Adults with Knee Osteoarthritis.

The present study examined the effects of home-based remotely supervised transcranial direct current stimulation on quantitative sensory testing measurements in older adults with knee osteoarthritis. Participants were hypothesized to experience improved pain measurements over time. Open-label, single-arm trial. Southeast Texas between March and November 2018 at a nursing school and participant homes. Older adults (aged 50-85 years) with self-reported unilateral or bilateral knee osteoarthritis pain who met eligibility criteria set by the American College of Rheumatology. The intervention was applied with a constant current intensity for 20 minutes every weekday for two weeks (10 total sessions). Quantitative measures of pain were collected three times over 10 days (days 1, 5, and 10) and included heat threshold and tolerance, pressure pain threshold, punctate mechanical pain, pain, and conditioned pain modulation. Analyses used nonparametric tests to evaluate differences between day 1 and day 10. Generalized linear mixed models were then used to evaluate change across all three time points for each measure. Bayesian inference was used to provide the posterior probability of longitudinal effects. Nonparametric tests found improvements in seven measures, and longitudinal models supported improvements in 10 measures, with some nonlinear effects. The home-based, remotely supervised intervention improved quantitative measurements of pain in older adults with knee osteoarthritis. This study contributes to the growing body of literature supporting home-based noninvasive stimulation interventions.

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown&#x0D; Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis&#x0D; Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. &#x0D; Results: The TUG time of aid-free walking is 4.75 (p &lt; 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p &lt; 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral.&#x0D; Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

Cellular and Clinical Analyses of Autologous Bone Marrow Aspirate Injectate for Knee Osteoarthritis: A Pilot Study.

Knee osteoarthritis (OA) is characterized by pain and functional deficits. Common conservative strategies include medications, physical therapy, and intra-articular injections. Recently, treatment using autologous cell injections has increased. To characterize the cellular content of bone marrow aspirate (BMA) and to evaluate the effect of intra-articular autologous BMA injections in patients with mild knee OA. Prospective pilot observational study. Academic institution. Eleven patients with unilateral or bilateral mild knee OA (15 knees) were included in the cellular analysis. Ten patients (13 knees) were included in the overall (cellular and clinical) analysis. BMA was aspirated from patients' iliac crests and then injected intra-articularly under fluoroscopic and/or ultrasound guidance. BMA samples were analyzed using flow cytometry, colony forming unit (CFU) assays, and enzyme-linked immunosorbent assays. Questionnaires assessing pain and function were administered preinjection and at 1, 3, 6, and 12 months postinjection. Side effects and satisfaction were assessed. Total nucleated cell (TNC) concentration, mesenchymal stem cell (MSC) concentration, CFU count, and interleukin-1 receptor antagonist (IL-1Ra) concentration. BMA sample analyses revealed wide ranges in TNC concentration (173300-4 491 050 cells/mL), MSC concentration (0-500 cells/mL), CFUs (0-19), and IL-1Ra concentration (2806-29 394 pg/mL). Improvements in Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement were observed throughout the 12-month follow-up period (F[4,12] = 12.29, P < .001). Additionally, current, usual, best, and worst numerical rating scale pain scores significantly decreased over time (P < .001). Patient satisfaction was high (range: 8.1 ± 2.1-8.8 ± 1.9), and side effects were uncommon. The cellular content of BMA samples varied widely between patients and was lower than the anticipated yield reported by the device's manufacturer. However, intra-articular BMA injections for knee OA in a small pilot cohort appeared to be safe with potential therapeutic value. Larger, prospective, double-blinded studies are warranted.

Dynamic ultrasonography of the medial meniscus during walking in knee osteoarthritis

BackgroundMedial meniscal extrusion (MME) is a risk factor for the progression of knee osteoarthritis (OA). MME evaluation is crucial and it is commonly performed using magnetic resonance imaging (MRI) or static ultrasonography. We developed a prototype flat-shaped ultrasound transducer to visualize the actual meniscal movements during walking. ObjectiveThe aim of this study was to investigate whether it is feasible to visualize and evaluate the meniscal movements during walking using the novel flat-shaped ultrasound transducer for dynamic ultrasonography. MethodsSix participants who were diagnosed with primary unilateral or bilateral tibiofemoral knee OA on radiography (mean age, 67.1 ± 9.9 years; males/females, 4/2) and six healthy volunteers without any symptoms in their knees (mean age, 26.3 ± 4.0 years; males/females, 4/2) were enrolled in this study. The movement of the medial meniscus during walking was visualized using the novel transducer and the gait motion was recorded as video images that were synchronized with the ultrasonogram. MME and ΔMME (the difference between the minimum and maximum MME during the stance phase of the gait cycle) were evaluated in those with OA and compared with those in healthy volunteers. ResultsIn both groups, MME was visualized clearly in the stance phase. The mean values of MME and ΔMME in the knee OA group were significantly greater than those in the control group (P < .01). ConclusionsDynamic meniscal movement during gait can be evaluated with the specially developed novel ultrasound transducer. Our approach will be helpful in unveiling unknown pathological mechanisms in knee OA.

Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study.

There is an increasing number of reports on the treatment of knee osteoarthritis (OA) using mesenchymal stem cells (MSCs). However, it is not known what would better drive osteoarthritis stabilization to postpone total knee arthroplasty (TKA): targeting the synovial fluid by injection or targeting on the subchondral bone with MSCs implantation. A prospective randomized controlled clinical trial was carried out between 2000 and 2005 in 120 knees of 60 patients with painful bilateral knee osteoarthritis with a similar osteoarthritis grade. During the same anaesthesia, a bone marrow concentrate of 40mL containing an average 5727MSCs/mL (range 2740 to 7540) was divided in two equal parts: after randomization, one part (20mL) was delivered to the subchondral bone of femur and tibia of one knee (subchondral group) and the other part was injected in the joint for the contralateral knee (intra-articular group). MSCs were counted as CFU-F (colony fibroblastic unit forming). Clinical outcomes of the patient (Knee Society score) were obtained along with radiological imaging outcomes (including MRIs) at two year follow-up. Subsequent revision surgeries were identified until the most recent follow-up (average of 15years, range 13 to 18years). At twoyear follow-up, clinical and imaging (MRI) improvement was higher on the side that received cells in the subchondral bone. At the most recent follow-up (15years), among the 60 knees treated with subchondral cell therapy, the yearly arthroplasty incidence was 1.3% per knee-year; for the 60 knees with intra-articular cell therapy, the yearly arthroplasty incidence was higher (p = 0.01) with an incidence of 4.6% per knee-year. For the side with subchondral cell therapy, 12 (20%) of 60 knees underwent TKA, while 42 (70%) of 60 knees underwent TKA on the side with intra-articular cell therapy. Among the 18 patients who had no subsequent surgery on both sides, all preferred the knee with subchondral cell therapy. Implantation of MSCs in the subchondral bone of an osteoarthritic knee is more effective to postpone TKA than injection of the same intra-articular dose in the contralateral knee with the same grade of osteoarthritis.

The Therapeutic Efficacy Of Platelet-Rich Plasma On Gait And Balance In Patients With Knee Osteoarthritis

The beneficial effects of leukocyte-rich platelet-rich plasma (LR-PRP) on subjective functional outcomes in knee osteoarthritis (KOA) is limiting, to this end there is a paucity of data about its efficacy on objective functional outcomes. PURPOSE: To examine the therapeutic efficacy of LR-PRP on gait and balance in patients with KOA. METHODS: Eight patients with unilateral and bilateral KOA (4 men; 55.3 ± 10.9 years; 31.22 ± 8.35 kg/m2) participated after signing a written informed consent. Participants visited the outpatient clinic in Baylor College of Medicine H. Ben Taub Department of Physical Medicine and Rehabilitation two times (baseline and follow-up; six to eight weeks apart). At baseline, the study physiatrist (PJ) provided a single ultrasound guided intra-articular LR-PRP injection. Our primary endpoint was balance using previously validated wearable sensors (BioSensics, Newton, MA) at 6-8 weeks post LR-PRP injection. Secondary endpoints included: pain symptoms, activity of daily life and quality of life using the 12-item Knee Injury and Osteoarthritis Score (KOOS-12), and gait speed. RESULTS: Results for outcome parameters are shown in Table 1. Pain symptoms, activity of daily life and quality of life improved 31%, 33% and 46%, respectively, but the improvements did not reach statistical significance level (all p > 0.05). Gait speed was very similar between baseline and follow-up (p > 0.05). Some balance parameters tended to improve. Medio-lateral center-of-mass sway and center-of-mass sway area decreased 34% and 41%, respectively. Medio-lateral hip sway and hip sway area decreased 40% and 46%, respectively. However, the improvements in balance parameters did not reach statistical significance level (all p > 0.05). CONCLUSIONS: Results suggest potential of LR-PRP on gait and balance. Based on the results, further study with a larger sample size is warranted.

Evaluation of distal femoral cartilage by B-mode ultrasonography and shear wave elastography in patients with knee osteoarthritis: a preliminary study

Degenerative change in articular cartilage is one of the most important factors in the development of osteoarthritis. Shear wave elastography can be used to identify pathologic cartilage. To evaluate distal femoral cartilage by shear wave elastography in patients with symptomatic knee osteoarthritis. Twenty patients with bilateral knee osteoarthritis (study group) and 20 volunteers with the same demographic characteristics but without symptomatic knee pain (control group) were included in the study. A total of 80 knee joints of 40 individuals were evaluated. At the medial, intercondylar, and lateral condylar levels distal femoral cartilage thickness was measured by B-mode ultrasonography and stiffness was measured by shear wave elastography. The medial, intercondylar, and lateral cartilage thickness measurements were similar between the two groups and no statistically significant difference was observed (P = 0.711, P = 0.766, and P = 0.575, respectively). The shear wave velocity values in the medial and intercondylar cartilage were significantly higher in the study group (P = 0.002). Shear wave velocity values measured from lateral cartilage were higher in the study group and the difference between the groups had a borderline statistical significance (P = 0.053). Shear wave elastography seems to be a reliable, non-invasive, and acceptable method for the assessment of pathologic cartilage.

ISOKINETIC RESPONSE, VISCOSUPPLEMENTATION AND STRENGTH TRAINING IN GONARTHROSIS

ABSTRACT Introduction Viscosupplementation and strength training are proposed interventions in the treatment of knee osteoarthritis. Objective To describe the isokinetic response in women with knee osteoarthritis who underwent both interventions. Methods A double-blind, randomized clinical trial involving thirty women diagnosed with grade II and III bilateral knee osteoarthritis using the radiological criteria of Kellgren &amp; Lawrence. The subjects were randomized into three groups of ten patients each: one group was submitted to viscosupplementation and strength training (VST), another was submitted to strength training (ST) only, and a third to viscosupplementation (VS) only. All evaluations followed the study phases defined as pre-procedure (PRE); after 48 hours of VS (POS-VS); after 12 weeks of training (POS T); and after eight weeks of detraining (POS D). Intra-articular knee infiltrations were performed with a single dose of Hylan GF-20 and isokinetic dynamometry to determine the maximum torque in knee extension and flexion. Pain was measured by the visual analogue scale (VAS). Results The interventions promoted improvements in the isokinetic response in all three groups and in both muscle groups, with advantage for the extensor group. A significant difference was noticed in the isokinetic response of the trained groups when compared only to the viscosupplemented group (p&lt;0.005), and the VST group showed better isokinetic response compared to the ST group. Conclusion Combined treatment with viscosupplementation and strength training, and treatment with strength training only, presented better results in terms of isokinetic response and pain reduction than viscosupplementation alone. Level of evidence I; Therapeutic studies-Investigating the results of treatment.

OP0187 DETERMINING OPTIMAL COOLING AND ADMINISTRATION METHODS FOR CNTX-4975 INTRA-ARTICULAR INJECTION IN SUBJECTS WITH MODERATE TO SEVERE OSTEOARTHRITIS KNEE PAIN

Background:CNTX-4975 is a highly purified, synthetic capsaicin being developed to provide long-term analgesia after a single intra-articular (IA) injection for patients with moderate to severe osteoarthritis (OA) knee pain. CNTX-4975 IA administration is associated with short-term post-procedural pain that can be attenuated with preemptive joint cooling.Objectives:To evaluate cooling and administration procedures for CNTX-4975 IA injection, with goals of balancing patient comfort and ease of use and assessing clinical response 8 weeks after injection.Methods:This phase 3, open-label, 8-week study (NCT03661996) enrolled subjects aged 40–95 y with Kellgren-Lawrence grade 1–4, BMI ≤45 kg/m2, and stable, moderate to severe OA knee pain and who failed ≥2 therapies. Subjects were assigned to unilateral/bilateral CNTX-4975 1 mg IA injections as determined by OA pain/joint replacement status, then randomized by study site to 1 of 5 treatment regimens (Figure). The primary outcome measure assessed Breg cooling control vs other cooling regimens on day 1 using a combined sum of 1) pain (0, none; 4, severe) 30 minutes after CNTX-4975 injection; 2) subject satisfaction (SS) with cooling/injection procedures; and 3) investigator satisfaction (IS) with procedures. SS and IS were measured on a 1–7 scale (1, completely dissatisfied; 7, completely satisfied); pain was reverse scored and normalized (1, severe; 7, none) for equal weighting. Geometric mean ratios (GMR) with 95% CIs were constructed for each regimen vs Breg control (ANCOVA); lower 95% CI &gt;0.7 was considered clinically acceptable. Secondary endpoints included percentage of subjects by subject type meeting criteria for Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders 8 weeks after injection. Safety assessments included TEAEs.Results:The intent-to-treat population included 848 subjects. The primary combined outcome showed that all cooling and administration regimens were clinically acceptable, with the evaluated cold gel wraps being at least as effective as the Breg circulating ice-water wrap (Table). For subjects with unilateral OA, OMERACT-OARSI response rates were 67% in those with no/mild nonindex knee pain and 81% in those with nonindex knee single joint replacement. For subjects with bilateral knee OA receiving bilateral injections, response rates for index and nonindex knees were 73% and 79%. TEAEs were reported in 22% of subjects; &lt;1% were serious. TEAEs occurring in &gt;2% of subjects were procedural pain (2.9%), arthralgia (2.2%), and nausea (2.1%), with no meaningful differences across groups.Conclusion:All cooling regimens for CNTX-4975 IA administration were clinically acceptable and well tolerated, offering feasible options for use in routine practice. Importantly, high levels of clinical response were observed 8 weeks after unilateral or bilateral knee injections for moderate to severe OA knee pain.Primary Combined Endpoint Outcome in the Index Knee, Normalized Scale, by Cooling and Administration Procedure (ANCOVA Model)Breg Cooling ControlN=162Gel Pack CoolingN=179Shortened Gel Pack CoolingN=175Single Needle Injection,Gel Pack Cooling,2% LidocaineN=160Single Needle Injection,Gel Pack Cooling,1% LidocaineN=172Mean (SD)17.23 (2.660)18.23 (2.023)16.81 (2.891)17.57 (3.049)16.43 (3.138)Geometric LS Mean (SE)17.18 (1.016)18.26 (1.015)16.48 (1.016)17.40 (1.016)16.00 (1.015)95% CI16.66, 17.7217.74, 18.8015.99, 16.9916.87, 17.9515.53, 16.49Comparison vs Breg CoolingGMR (SE)1.06 (1.022)0.96 (1.022)1.01 (1.022)0.93 (1.022)95% CI1.02, 1.110.92, 1.000.97, 1.060.89, 0.97Clinically Acceptable?YesYesYesYesLS, least squares; SD, standard deviation; SE, standard error.GMR lower 95% CI &gt;0.7 considered clinically equivalent.Disclosure of Interests:Randall Stevens Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Peter Hanson Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Paul Tiseo Employee of: Centrexion Therapeutics Corp, Kimberly Guedes Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Campbell Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Connolly Employee of: Centrexion Therapeutics Corp, Stephanie Ruggiero Employee of: Centrexion Therapeutics Corp, Meg Corliss Employee of: Centrexion Therapeutics Corp, Valerie Smith Consultant of: Centrexion Therapeutics Corp, Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer

Knee effusion evaluated by ultrasonography warns knee osteoarthritis patients to develop their muscle atrophy: a three-year cohort study

This study aimed to elucidate the relationship between the quantitative value of suprapatellar effusion and the longitudinal changes in lower-extremity muscle mass (MM) in a cohort with knee osteoarthritis (KOA). Fifty-three subjects (106 legs) with bilateral radiographic KOA at baseline (BL) were enrolled. MM was calculated by bioimpedance analysis three times at BL, and at the one-year (1Y) and three-year (3Y) follow-ups. The longitudinal change in the lower-extremity MM was calculated by subtracting MMBL from MM1Y, and MM1Y from MM3Y. Subjects with ≥1.0 z-score loss were defined as having severe MM loss (SMML). Effusion was evaluated as the sagittal area of suprapatellar pouch (mm2) by ultrasonography. The ROC curve was drawn to determine the cut-off of effusion area. General estimating equations (GEEs) were conducted with the prevalence of SMML as the dependent variable and with the cut-off of effusion area as the independent variable. Sixteen legs (15.1%) demonstrated SMMLBL-1Y and another sixteen legs demonstrated SMML1Y-3Y. GEEs revealed that individuals with ≥90 mm2 effusion had significantly higher odds of SMMLBL-1Y prevalence (Odds ratio: 21.561; P-value: 0.003). Individuals with leachate knee effusion at BL had a significant risk of losing MM through the first year of the initial knee effusion assessment.