Knee Osteoarthritis Grade Research Articles

Association Between Pain and Radiological Changes in Patients with Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is a leading cause of disability worldwide, characterized by joint degeneration, pain, and functional limitations. Despite the prevalence of knee OA, the relationship between radiographic changes and the severity of pain remains complex. Previous studies have offered conflicting views on the association between structural joint alterations and clinical symptoms. Objective: The aim of this study was to investigate the association between radiographic degenerative changes in the knee, as classified by the Kellgren and Lawrence grading system, and the severity of resting pain measured using the Numeric Pain Rating Scale (NPRS). Methods: This cross-sectional study was conducted on 70 patients diagnosed with knee OA at multiple healthcare facilities in Lahore, Pakistan, from July 2022 to January 2023. Participants aged between 40 and 80 years, both males and females, were included. The severity of knee OA was determined using the Kellgren-Lawrence grading system through X-ray evaluations. Pain severity was assessed using the NPRS. Data were analyzed using SPSS version 25.0, with chi-square tests applied to explore the association between radiographic grades of knee OA and pain severity. Results: The distribution of knee OA severity among participants was as follows: Grade I (22.9%), Grade II (25.7%), Grade III (32.9%), and Grade IV (18.6%). Pain severity reported by participants was predominantly mild (55.7%), followed by moderate (37.1%) and severe (7.1%). Statistical analysis revealed a significant association between the grade of knee OA and the severity of resting pain (Chi-square = 30.06, p < 0.0001), indicating that higher grades of knee OA were correlated with increased pain severity. Conclusion: The study confirmed a significant association between radiographic degenerative changes in knee OA and the severity of resting pain. These findings suggest the need for comprehensive clinical assessments in patients with knee OA, incorporating both radiographic evaluations and pain severity measures to guide management and treatment strategies.

Detection of kinematic abnormalities in persons with knee osteoarthritis using markerless motion capture during functional movement screen and daily activities.

Background: The functional movement screen (FMS) has been used to identify deficiencies in neuromuscular capabilities and balance among athletes. However, its effectiveness in detecting movement anomalies within the population afflicted by knee osteoarthritis (KOA), particularly through the application of a family-oriented objective assessment technique, remains unexplored. The objective of this study is to investigate the sensitivity of the FMS and daily activities in identifying kinematic abnormalities in KOA people employing a markerless motion capture system. Methods: A total of 45 persons, presenting various Kellgren-Lawrence grades of KOA, along with 15 healthy controls, completed five tasks of the FMS (deep squat, hurdle step, and in-line lunge) and daily activities (walking and sit-to-stand), which were recorded using the markerless motion capture system. The kinematic waveforms and discrete parameters were subjected to comparative analysis. Results: Notably, the FMS exhibited greater sensitivity compared to daily activities, with knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge emerging as the most responsive indicators. Conclusion: The knee flexion, trunk sagittal, and trunk frontal angles during in-line lunge assessed via the markerless motion capture technique hold promise as potential indicators for the objective assessment of KOA.

Thigh muscle and fat volumes are associated with knee cartilage abnormalities and bone marrow edema-like lesions: data from the osteoarthritis initiative.

To investigate the associations of thigh muscle and fat volumes with structural abnormalities on MRI related to knee osteoarthritis. MRI studies of the thighs and knees from 100 individuals were randomly selected from the Osteoarthritis Initiative Cohort. Whole Organ MR Scoring (WORMS) and effusion-synovitis scoring were performed in all knee MRI. Thigh muscles, intermuscular fat, and subcutaneous fat were manually segmented in 15 consecutive MR thigh images. Radiographic Kellgren-Lawrence grades (KLG) were also obtained in all knee radiographs. Independent t-tests were used to investigate the associations between thigh muscle and fat volumes, and sex. Mixed-effects analyses were obtained to investigate the associations between thigh muscle and fat volumes, KLG, WOMAC pain score, cartilage and bone marrow WORMS, as well as effusion-synovitis scores. Women had higher subcutaneous fat volume than men (616.82 vs. 229.13 cm3, p < 0.01) and men had higher muscle volumes than women (p < 0.01). Quadriceps (coef = -2.15, p = 0.01) and vastus medialis (coef = -1.84, p = 0.03) volumes were negatively associated with the WORMS cartilage scores. Intermuscular fat volume (coef = 0.48, p = 0.01) was positively associated with WORMS bone marrow edema-like lesion (BMEL) scores. The quadriceps (coef = -0.99, p < 0.01) and hamstring (coef = -0.59, p = 0.01) volumes were negatively associated with WORMS BMEL scores. No evidence of an association was found between thigh muscle and fat volumes with KLG and effusion-synovitis grading (p > 0.05). Increased quadriceps and hamstring volumes were negatively associated with cartilage lesion and BMEL scores while no evidence of an association was found between thigh muscle and fat volumes, and radiographic knee osteoarthritis or effusion-synovitis grading.

DOES LOWER EXTREMITY SKELETAL MUSCLE MASS DETERMINE OSTEOARTHRITIS RISK?

Osteoarthritis (OA) of the knee joint is a complex peripheral joint disorder with multiple risk factors. We aimed to examine the relationship between the grade of knee OA and anterior thigh length (ATL).A total of 64 geriatric patients who had no total hip or knee replacement with a BMI of ≥30 were evaluated. Patients' OA severity was determined by two independent experts from bilateral standing knee radiographs according to the Kellgren-Lawrence (KL) grade. Joint cartilage structure was assessed using ultrasonography (US). The ATL, the gastrocnemius medialis (GC), the rectus femoris (RF) and the rectus abdominis (RA) skeletal muscle thicknesses as well as the RF cross-sectional area (CSA) were measured with US. Sarcopenia was diagnosed using the handgrip strength (HGS), 5× sit-to-stand test (5xSST) and bioelectrical impedance analysis.The median (IQR) age of participants was 72 (65–88) years. Seventy-one per cent of the patients (n=46) were female. They were divided into the sarcopenic obese (31.3 %) and the non-sarcopenic obese (68.8%) groups. KL grade of all patients correlated negatively with the ATL (mm) and the thickness of GC (mm) (r= -0,517, p&lt;0.001 and r= -0.456, p&lt;0.001, respectively). In the sarcopenic obese and the non-sarcopenic obese groups, KL grade of the all patients was negatively correlated with ATL (mm) and thickness of GC (mm) (r= -0,986, p&lt;0.001; r= -0.456, p=0.05 and r= -0,812, p=0.002; r= −0,427, p=0.006). KL grade negatively correlated with the RF thickness in the sarcopenic obese group (r= -0,928, p=0.008).In conclusion, OA risk may decrease as the lower extremity skeletal muscle mass increases.Acknowledgments: Feza Korkusuz MD is a member of the Turkish Academy of Sciences (TÜBA).

Adult Stem Cell Therapy as an Alternative Treatment in Knee Osteoarthritis

Objective: Osteoarthritis (OA) of the knee, also known as degenerative joint disease of the knee because of progressive loss of articular cartilage, is the most common disabling conditions of the knee joint, which often presents with pain and stiffness and progresses to affect activity of daily living. The prevalence of knee OA will continue to rise due to factors like obesity and increased life expectancy. Roughly 13% of women and 10% of men 60 years and older have symptomatic knee osteoarthritis. Among those older than 70 years of age, the prevalence rises to as high as 40%. Our aim is to evaluate the importance of adult stem cell therapy (ADSC) as an alternative treatment in knee osteoarthritis. Patient, Materials and Methods: A case of an elderly patient with early right knee osteoarthritis (grade 2). Right knee severity was assessed using the Western Ontario and McMaster universities osteoarthritis index (WOMAC) scale. Radiologic studies (X-ray and MRI) were done. Patient had a session of autologous adult stem cell therapy - Mesenchymal stem cells retrieved from the fat and bone marrow along with platelet rich plasma (PRP) from blood which was administered intra-articularly via ultrasound guidance. Procedure was done on an outpatient basis and was well tolerated with no complications. Results: Patient was observed in the first 6 months under the instructions of no physiotherapy to preserve new maturing cells. The WOMAC assessed on the 0 and 6 months showed quality improvement from an initial score of 48/96 to a score of 8/96. Post procedure X-ray of the Right knee on the sixth month showed marked progressive changes. Conclusion: Adult stem cell therapy is promising to be an effective alternative treatment in knee osteoarthritis. It is minimally invasive, safe with no major treatment related adverse effect. Case study showed a positive outcome according to all the grading systems used in this study for the initial 6 months.

The Relationship Between Echocardiographic Calcification Score and Grade of Knee Osteoarthritis.

Background and objective It has been suggested that knee osteoarthritis (KOA) is associated with the development of calcification and an increased risk of cardiovascular (CV) disease, while the contribution of KOA grade is not clearly known enough. This study aimed to investigate the relationship between the grade of KOA, the echocardiographic calcification score (echo-CCS), and CV risk assessment. Methods This cross-sectional study involved 204 patients diagnosed with KOA and classified according to the Kellgren-Lawrence staging criteria. Echo-CCS was obtained according to the presence of calcification in the aortic valve, aortic root, mitral ring, papillary muscle and ventricular septum. Framingham risk score (FRS) was used for CV risk assessment. Results Calcification was detected in 79.4% of patients. The median FRS, echo-CCS, andhigh-sensitivityC-reactive protein (hs-CRP) levels increased as the KOA grade increased (p<0.05). A one-grade increase in KOA increased the odds of echo-CCS 1-2 group by 5.15 fold (vs. no calcification group) (OR=5.15, p=0.003), while it increased the odds of echo-CCS ≥3 group by 4.61 fold (vs. echo-CCS 1-2 group) (OR=4.61, p=0.003). Median echo-CSS and hs-CRP were higher in the high CV risk group than in the moderate and low CV risk groups. Conclusion The majority of patients with KOA had intracardiac calcification.An increased KOA grade was associated with higher echo-CSS and FRS. These findings indicate that patients with higher grades of KOA may be predisposed to developing subclinical atherosclerosis.

Assessment of a novel deep learning-based software developed for automatic feature extraction and grading of radiographic knee osteoarthritis

BackgroundThe Kellgren-Lawrence (KL) grading system is the most widely used method to classify the severity of osteoarthritis (OA) of the knee. However, due to ambiguity of terminology, the KL system showed inferior inter- and intra-observer reliability. For a more reliable evaluation, we recently developed novel deep learning (DL) software known as MediAI-OA to extract each radiographic feature of knee OA and to grade OA severity based on the KL system.MethodsThis research used data from the Osteoarthritis Initiative for training and validation of MediAI-OA. 44,193 radiographs and 810 radiographs were set as the training data and used as validation data, respectively. This AI model was developed to automatically quantify the degree of joint space narrowing (JSN) of medial and lateral tibiofemoral joint, to automatically detect osteophytes in four regions (medial distal femur, lateral distal femur, medial proximal tibia and lateral proximal tibia) of the knee joint, to classify the KL grade, and present the results of these three OA features together. The model was tested by using 400 test datasets, and the results were compared to the ground truth. The accuracy of the JSN quantification and osteophyte detection was evaluated. The KL grade classification performance was evaluated by precision, recall, F1 score, accuracy, and Cohen's kappa coefficient. In addition, we defined KL grade 2 or higher as clinically significant OA, and accuracy of OA diagnosis were obtained.ResultsThe mean squared error of JSN rate quantification was 0.067 and average osteophyte detection accuracy of the MediAI-OA was 0.84. The accuracy of KL grading was 0.83, and the kappa coefficient between the AI model and ground truth was 0.768, which demonstrated substantial consistency. The OA diagnosis accuracy of this software was 0.92.ConclusionsThe novel DL software known as MediAI-OA demonstrated satisfactory performance comparable to that of experienced orthopedic surgeons and radiologists for analyzing features of knee OA, KL grading and OA diagnosis. Therefore, reliable KL grading can be performed and the burden of the radiologist can be reduced by using MediAI-OA.

Development of an automated optimal distance feature-based decision system for diagnosing knee osteoarthritis using segmented X-ray images

Knee Osteoarthritis (KOA) is a leading cause of disability and physical inactivity. It is a degenerative joint disease that affects the cartilage, cushions the bones, and protects them from rubbing against each other during motion. If not treated early, it may lead to knee replacement. In this regard, early diagnosis of KOA is necessary for better treatment. Nevertheless, manual KOA detection is time-consuming and error-prone for large data hubs. In contrast, an automated detection system aids the specialist in diagnosing KOA grades accurately and quickly. So, the main objective of this study is to create an automated decision system that can analyze KOA and classify the severity grades, utilizing the extracted features from segmented X-ray images. In this study, two different datasets were collected from the Mendeley and Kaggle database and combined to generate a large data hub containing five classes: Grade 0 (Healthy), Grade 1 (Doubtful), Grade 2 (Minimal), Grade 3 (Moderate), and Grade 4 (Severe). Several image processing techniques were employed to segment the region of interest (ROI). These included Gradient-weighted Class Activation Mapping (Grad-Cam) to detect the ROI, cropping the ROI portion, applying histogram equalization (HE) to improve contrast, brightness, and image quality, and noise reduction (using Otsu thresholding, inverting the image, and morphological closing). Besides, the focus filtering method was utilized to eliminate unwanted images. Then, six feature sets (morphological, GLCM, statistical, texture, LBP, and proposed features) were generated from segmented ROIs. After evaluating the statistical significance of the features and selection methods, the optimal feature set (prominent six distance features) was selected, and five machine learning (ML) models were employed. Additionally, a decision-making strategy based on the six optimal features is proposed. The XGB model outperformed other models with a 99.46 % accuracy, using six distance features, and the proposed decision-making strategy was validated by testing 30 images.

Deep Learning Based Severity Grading of Knee Osteoarthritis Based on Radiological Images

Abstract: Knee OA is a prevalent degenerative joint condition affecting a significant portion of the global population, and timely identification and accurate grading are crucial for optimal patient care and treatment planning. This system aimed at developing an advanced clinical decision support system for the early detection and precise grading of knee osteoarthritis (OA) using cutting-edge deep learning techniques. Traditionally, the diagnosis of knee osteoarthritis has relied on manual assessments of radiological images, which can be resource-intensive and subject to variations among evaluators. Deep learning, a subset of artificial intelligence, offers a promising solution by automating this process with exceptional precision. The core objectives of this project include the development of a CNN model based on the EfficientNet-B5 architecture, designed to autonomously analyze radiological images of knee joints. Additionally, a user-friendly web-based interface is being constructed to facilitate image uploads and present severity grades. The project involves rigorous training and fine-tuning of the EfficientNet-B5 using a dataset of knee OA images to achieve a high degree of accuracy in severity grading. The system will ultimately be deployed on a scalable and secure cloud platform for practical utility.

The effect of combined balance and strength exercise program in patients with different grades of primary knee osteoarthritis

BackgroundKnee osteoarthritis (KOA) is a degenerative disease that affects all parts of the joint including the surrounding ligaments, tendons, and muscles. Biomechanical changes that occur in KOA cause aggravation of symptoms with further joint damage. Thus, modifying the biomechanics of the knee joint may help in the prevention and treatment of KOA. For that reason, our aim was to assess the effect of combined balance and strengthening exercise programs in patients with different grades of primary KOA.ResultsAll studied groups showed comparable significant improvement in quadricep muscle strength, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (< 0.001), time-up and go score (< 0.001), 6-m walk time (< 0.001), and dynamic balance (< 0.001) at the end of exercise program. Furthermore, patients with mild-moderate KOA showed a significant improvement in pain, physical function, total WOMAC scores, and dynamic balance compared to those with more severe KOA.ConclusionCombined balance and strengthening exercise programs may help improve pain, physical function, and dynamic balance in patients with KOA regardless of its severity. However, following exercise patients with milder forms of KOA may show greater improvement compared to patients with severe KOA.

Efficacy of Intraarticular Knee Injection of PRP (Platelet Rich Plasma) vs Steroid (Triamcinolone Acetate) for the Treatment of Primary Knee Osteoarthritis Grade I &amp; II

Objective: To assess the effectiveness of PRP (Platelet Rich Plasma), and to compare with Triamcinolone 40mg (Steroid) on functional activity, stiffness and pain in Grade I &amp; II Knee OA. Method: A comparative cross sectional study was conducted at outdoor departments of Advanced Pain Relief Center, Lifeline Hospital Lahore (Pakistan) from January 2022 to December 2022. The present study included a total of 235 participants, out of whom 190 individuals were deemed eligible for inclusion based on predetermined criteria. The remaining 45 participants were excluded from the study due to non-adherence to eligibility criteria and lack of approval from institutional ethical committee. Out of a total of 190 subjects enrolled in the study, 64 (33%) were characterized as male while 126 (67%) were classified as female. The participants' mean age was 53.5 ± 6.4 years. Alternative patients were treated with intra-articular injection of either triamcinolone 40mg or PRP. Patients randomized in Steroid group (n=95) were gives intraarticular 40mg Triamcinolone acetate (1ml) along with 2ml of Local anaesthetic Lignocaine 1%, whereas patients randomized in PRP group (n=95) were injected 5ml PRP. “The Western Ontario and McMaster Universities Arthritis Index” (WOMAC) Scale was used for functional disability and pain before and after the therapy for the targeted knee joint at the baseline 1 week, 5 weeks, 8 weeks and 20 weeks follow-ups. Visual Analogue Scale (VAS) scores were also recorded for pain. Data analysis was done by using SPSS version 20. Results: There wasn't any serious adverse effect observed during the study and follow-ups. 25 WOMAC functional activity scale showed statistically significant improvement with Intraarticular knee injection of PRP compared to steroids(40.64±1.87vs.27.17±6.01)(p=0.000). WOMACpainscaleresultsalsodemonstrated that intraarticular knee injection of PRP was more effective in reducing knee pain than steroids (p = 0.000) at 20 weeks follow-up. Conclusion: On the basis of the results of our study, we concluded that platelet rich plasma is more effective than intra-articular steroids in terms of improvement in functional activity and reduction of pain in patients with Grade I &amp; II knee osteoarthritis. Both PRPand steroid intraarticular injections are safe.

Towards a Transferable Modeling Method of the Knee to Distinguish Between Future Healthy Joints from Osteoarthritic Joints: Data from the Osteoarthritis Initiative.

Computational models can be used to predict the onset and progression of knee osteoarthritis. Ensuring the transferability of these approaches among computational frameworks is urgent for their reliability. In this work, we assessed the transferability of a template-based modeling strategy, based on the finite element (FE) method, by implementing it on two different FE softwares and comparing their results and conclusions. For that, we simulated the knee joint cartilage biomechanics of 154 knees using healthy baseline conditions and predicted the degeneration that occurred after 8 years of follow-up. For comparisons, we grouped the knees using their Kellgren-Lawrence grade at the 8-year follow-up time and the simulated volume of cartilage tissue that exceeded age-dependent thresholds of maximum principal stress. We considered the medial compartment of the knee in the FE models and used ABAQUS and FEBio FE softwares for simulations. The two FE softwares detected different volumes of overstressed tissue in corresponding knee samples (p < 0.01). However, both programs correctly distinguished between the joints that remained healthy and those that developed severe osteoarthritis after the follow-up (AUC = 0.73). These results indicate that different software implementations of a template-based modeling method similarly classify future knee osteoarthritis grades, motivating further evaluations using simpler cartilage constitutive models and additional studies on the reproducibility of these modeling strategies.

Deep learning-assisted knee osteoarthritis automatic grading on plain radiographs: the value of multiview X-ray images and prior knowledge.

Knee osteoarthritis (OA) is harmful to people's health. Effective treatment depends on accurate diagnosis and grading. This study aimed to assess the performance of a deep learning (DL) algorithm based on plain radiographs in detecting knee OA and to investigate the effect of multiview images and prior knowledge on diagnostic performance. In total, 4,200 paired knee joint X-ray images from 1,846 patients (July 2017 to July 2020) were retrospectively analyzed. Kellgren-Lawrence (K-L) grading was used as the gold standard for knee OA evaluation by expert radiologists. The DL method was used to analyze the performance of anteroposterior and lateral plain radiographs combined with prior zonal segmentation to diagnose knee OA. Four groups of DL models were established according to whether they adopted multiview images and automatic zonal segmentation as the DL prior knowledge. Receiver operating curve analysis was used to assess the diagnostic performance of 4 different DL models. The DL model with multiview images and prior knowledge obtained the best classification performance among the 4 DL models in the testing cohort, with a microaverage area under the receiver operating curve (AUC) and macroaverage AUC of 0.96 and 0.95, respectively. The overall accuracy of the DL model with multiview images and prior knowledge was 0.96 compared to 0.86 for an experienced radiologist. The combined use of anteroposterior and lateral images and prior zonal segmentation affected diagnostic performance. The DL model accurately detected and classified the K-L grading of knee OA. Additionally, multiview X-ray images and prior knowledge improved classification efficacy.

Clinical Demographics Characteristic of Total Knee Arthroplasty at Prof IGNG Ngoerah General Hospital, Bali, Indonesia

Background: Total knee arthroplasty (TKA) is a widespread surgical procedure for severe arthritis. By 2030, primary TKA would reach over 1.2 million procedures annually in the United States. In Indonesia, the prevalence of joint disease is about 19.5 million cases. This study aims to evaluate the clinical demographics characteristics of TKA in Prof. Ngoerah General Hospital, Bali, Indonesia.Subjects and Method: This is a descriptive study using a Cross-Sectional method with a total 57 adult patients undergoing TKA caused by Osteoarthritis grade III/IV in Prof IGNG Ngoerah Hospital from June 2020-June 2022. The dependent variable is the TKA procedure. Independent Variable is Age, gender, grade of knee osteoarthritis, comorbidities, and complications Data from the medical record was collected and stored in a Microsoft Office Excel 365 spreadsheet, the distributive table was analyzed and collected by using SPSS.Results: Patient characteristic is dominated by an elderly female (84.2%), with age group 61-70 (38.6%). Comorbidities in this study include hypertension (28.1%), type II diabetes (10.5%), and rheumatoid disease (1.8%). The main complication recorded in this study includes joint stiffness (3.5%), and persistent pain (5.3%).Conclusion: After Total Knee Arthroplasty was performed on 57 patients with a wide range of comorbidities, only a small number of complications occurred. This study implied that TKA could be performed even if the patient had some comorbidities as long as the patient pursued a complete pre and post-operative evaluation algorithm of the procedure.Keywords: knee arthroplasty, osteoarthritis, human and medicine, rehabilitationCorrespondence: IGN Wien Aryana, Consultant of Sports Medicine, Dept. Orthopaedic and Traumatology, Prof IGNG Ngoerah General Hospital, Faculty of Medicine, Udayana University. Jl. Diponegoro, Dauh Puri Klod. Denpasar City, Bali 80113 Email: wienaryanaortho@gmail.com. Mobile: +62811385263.Indonesian Journal of Medicine (2023), 08(02): 128-135https://doi.org/10.26911/theijmed.2023.08.02.01

Hybrid Techniques of X-ray Analysis to Predict Knee Osteoarthritis Grades Based on Fusion Features of CNN and Handcrafted.

Knee osteoarthritis (KOA) is a chronic disease that impedes movement, especially in the elderly, affecting more than 5% of people worldwide. KOA goes through many stages, from the mild grade that can be treated to the severe grade in which the knee must be replaced. Therefore, early diagnosis of KOA is essential to avoid its development to the advanced stages. X-rays are one of the vital techniques for the early detection of knee infections, which requires highly experienced doctors and radiologists to distinguish Kellgren-Lawrence (KL) grading. Thus, artificial intelligence techniques solve the shortcomings of manual diagnosis. This study developed three methodologies for the X-ray analysis of both the Osteoporosis Initiative (OAI) and Rani Channamma University (RCU) datasets for diagnosing KOA and discrimination between KL grades. In all methodologies, the Principal Component Analysis (PCA) algorithm was applied after the CNN models to delete the unimportant and redundant features and keep the essential features. The first methodology for analyzing x-rays and diagnosing the degree of knee inflammation uses the VGG-19 -FFNN and ResNet-101 -FFNN systems. The second methodology of X-ray analysis and diagnosis of KOA grade by Feed Forward Neural Network (FFNN) is based on the combined features of VGG-19 and ResNet-101 before and after PCA. The third methodology for X-ray analysis and diagnosis of KOA grade by FFNN is based on the fusion features of VGG-19 and handcrafted features, and fusion features of ResNet-101 and handcrafted features. For an OAI dataset with fusion features of VGG-19 and handcrafted features, FFNN obtained an AUC of 99.25%, an accuracy of 99.1%, a sensitivity of 98.81%, a specificity of 100%, and a precision of 98.24%. For the RCU dataset with the fusion features of VGG-19 and the handcrafted features, FFNN obtained an AUC of 99.07%, an accuracy of 98.20%, a sensitivity of 98.16%, a specificity of 99.73%, and a precision of 98.08%.

Comparative study between platelet-rich plasma intraarticular injection versus hyaluronic acid in knee osteoarthritis

Background Osteoarthritis (OA) is a major public health problem that causes pain and disability in one-third of all affected patients. It primarily affects the elderly populations. This study aimed to evaluate the efficacy of intraarticular injections of platelet-rich plasma (PRP) versus hyaluronic acid (HA) in knee OA. Patients and methods This was a prospective study that included 40 adult patients with knee OA grades II and III, where 20 patients were treated with PRP intraarticular injection two injections 1 month apart (group A), and 20 patients were treated with HA injections generally administered as a weekly injection for 3 weeks (group B). Data were collected from January 2017 till February 2018. In group A, the age of patients ranged from 45.0 to 67.0 years; five (25%) patients were males and 15 (75%) patients were females; unilateral side was affected in four (20%) patients, and bilateral side was affected in 16 (80%) patients; and grade II OA cases were 12 patients, and grade III OA cases were seven (40%) patients. In group B, the age of patients ranged from 49 to 75 years; five (25%) patients were males and 15 (75%) patients were females; unilateral side was affected in eight (40%) patients, and bilateral side was affected in 12 (60%) patients; and grade II OA cases were 11 (55%) patients, and grade III OA patients were nine (45%) patients. The procedure was done on an outpatient basis and under complete aseptic technique. PRP or HA was injected intraarticularly through an anterolateral or anteromedial portal. Follow-up with the patients was for at least 6 months, and the results of treatment were assessed by the knee injury and osteoarthritis outcome score (KOOS). Results At the end of the follow-up period, which was 6 months, the KOOS in group A had improved to a mean score of 64.89 ± 17.97 points, as compared with the pre-injection score, which was 49.95 ± 14.21 points. In group B, at end of follow-up, the period score was 58.60 ± 19.10 points and the pre-injection score was 49.39 ± 19.97 points. Conclusion Both PRP and HA injections show significant improvement in grades II and III OA. The KOOS symptom subscale showed that PRP injections were more effective than HA injections in patients with grade II arthritis.

Patients in high- and low-revision hospitals have similar outcomes after primary knee arthroplasty: 1-year postoperative results from the Danish prospective multicenter cohort study, SPARK

PurposeIt is well-known that revision rates after primary knee arthroplasty vary widely. However, it is uncertain whether hospital revision rates are reliable indicators of general surgical quality as defined by patients. The SPARK study compared primary knee arthroplasty surgery at three high-volume hospitals whose revision rates differed for unknown reasons.MethodsThis prospective observational study included primary knee arthroplasty patients (total, medial/lateral unicompartmental and patellofemoral) in two low-revision hospitals (Aarhus University Hospital and Aalborg University Hospital Farsø) and one high-revision hospital (Copenhagen University Hospital Herlev-Gentofte). Patients were followed from preoperatively (2016–17) to 1-year postoperatively with patient-reported outcome measures including Oxford Knee Score (OKS), EQ-5D-5L and Copenhagen Knee ROM (range of motion) Scale. The surgical outcomes were compared across hospitals for patients with comparable grades of radiographic knee osteoarthritis and preoperative OKS. Statistical comparisons (parametric and non-parametric) included all three hospitals.Results97% of the 1452 patients who provided baseline data (89% of those included and 56% of those operated) responded postoperatively (90% at 1 year). Hospitals’ utilization of unicompartmental knee arthroplasties differed (Aarhus 49%, Aalborg 14%, and Copenhagen 22%, p < 0.001). 28 patients had revision surgery during the first year (hospital independent, p = 0.1) and were subsequently excluded. 1-year OKS (39 ± 7) was independent of hospital (p = 0.1), even when adjusted for age, sex, Body Mass Index, baseline OKS and osteoarthritis grading. 15% of patients improved less than Minimal Important Change (8 OKS) (Aarhus 19%, Aalborg 13% and Copenhagen 14%, p = 0.051 unadjusted). Patients with comparable preoperative OKS or osteoarthritis grading had similar 1-year results across hospitals (OKS and willingness to repeat surgery, p ≥ 0.087) except for the 64 patients with Kellgren–Lawrence grade-4 (Aarhus 4–6 OKS points lower). 86% of patients were satisfied, and 92% were “willing to repeat surgery”, independent of hospital (p ≥ 0.1). Hospital revision rates differences diminished during the study period.ConclusionsPatients in hospitals with a history of differing revision rates had comparable patient-reported outcomes 1 year after primary knee arthroplasty, supporting that surgical quality should not be evaluated by revision rates alone. Future studies should explore if revision rate variations may depend as much on revision thresholds and indications as on outcomes of primary surgery.Level of evidenceLevel II (Prospective cohort study).

Effect of hip joint mobilisations and strength training on pain, physical function and dynamic balance in patients with Knee Osteoarthritis: A randomized controlled trial.

To determine the effects of hip joint mobilisations and strengthening exercises on pain, physical function and dynamic balance in patients with knee osteoarthritis. The single-blind three-arm parallel randomised controlled trial was conducted at Sindh Institute of Physical Medicine and Rehabilitation, the outpatient department of Dow University of Health Sciences' Ojha Campus, Rabia Moon Memorial Welfare Trust and the Civil Hospital, Karachi, from January to July 2021. The sample comprised patients aged at least 50 years having knee osteoarthritis grade 1-3. The patients were randomised into 3 equal groups, with group A receiving hip mobilisations along with strengthening exercises of hip and conventional knee exercises, group B receiving strengthening exercises of hip along with conventional knee interventional exercises, and group C receiving conventional knee exercises only. Pain, physical function and dynamic balance were assessed using visual analogue scale, knee injury osteoarthritis outcome score and four-step square test, respectively, at baseline and after 18th session. Data was analysed using SPSS 21. Of the 74 subjects assessed, 66(89.2%) were included; 22(33.3%) in each of the three groups. The sample had 19(28.8%) male subjects and 47(71.2%) female. The mean age in groups A, B and C were 55.64±3.56 years, 53.64±4.65 years and 54.91±4.30 years, respectively. There was significant difference among groups post-treatment (p<0.001). Significant improvement was also found in inter-group analyses of all outcomes (p<0.001). Addition of hip joint mobilisations provided better results compared to the other two groups. https://clinicaltrials.gov/ct2/show/NCT04769531.

Effects of Iliotibial Band Myofascial Release with/without Stretching with Iliotibial Band Tightness Secondary to Knee Osteoarthritis

Background: Knee osteoarthritis (OA), also referred to as degenerative joint disease of the knee, is brought on by wear-and-tear and the slow loss of articular cartilage. The term "iliotibial band" (IT band) also refers to the iliotibial tract or Maissiat's band. Methodology: This study was conducted using randomized clinical trial, quasi experimental research design as we need to make 2 groups and evaluate the effects of Iliotibial band myofascial release and stretching on the patients of knee OA. Study population was 36 individuals of ages 50-70 having knee osteoarthritis grade II or III characterized by Kellgren-Lawrence grades, visiting the physical therapy department of Mumtaz physiotherapy clinic. It was a randomized clinical trial with convenient sampling where participants were randomly allocated in two groups by simple random sampling, one group was experimental that received IT band myofascial release other than the stretching and baseline treatment and second group received the myofascial release and baseline treatment only. Data collection tools were Visual Analogue Scale (VAS) and Woman Osteoarthritis index. For the within group analysis of VAS, Friedman test was used and wilcoxon signed rank test was used for the within group analysis of the WOMAC. For the between group analysis of variables, Mann-whitney U test was used. Results: Both groups showed some significant improvement in all outcome measures (p&lt;0.05), but the results produced by IT band Myofascial release along with stretching group was statistically significant in terms of reduced pain and disability (p&lt;0.0005) as compared to myofascial release alone group. The iliotibial band myofascial release along with stretching has statistically significant effect in improving the pain and disability among knee osteoarthritis patients. Practical Implication: Iliotibial band tightness can potentially lead to the alterations in the mobility of patella and disturb the overall knee complex. Proper arthrokinematics of joint is necessary for ambulation. So, this study focused to draw results from combined therapy of IT band myofascial release and stretching will redound to the benefit of physiotherapy field considering that knee plays an important role in better Quality of life. Conclusions: The iliotibial band myofascial release along with stretching has statistically significant effect in improving the pain and disability among knee osteoarthritis patients. Keywords: IT Band; Myofascial Release; Stretching; WOMAC; VAS.

Analgesic Effectiveness of Physical Therapy Combining the Use of Electromagnetic Fields with Light Radiation Emitted by LEDs along with the Use of Topical Herbal Ointment in Patients with Gonarthrosis

(1) Background: The aim of the study is to evaluate the analgesic effectiveness of a physical therapy regimen that combines the use of an electromagnetic field with light radiation emitted by LEDs, along with the use of Traumeel S ointment, in patients with gonarthrosis. (2) Methods: The study included 90 patients with knee osteoarthritis (grade 2 Kellgren and Lawrence osteoarthritis). They were divided into three groups: Group I, 30 patients treated with magnetic stimulation plus LED therapy; Group II, 30 patients treated with Traumeel S ointment; and Group III, 30 patients treated with magnetic stimulation plus LED therapy with Traumeel S ointment. Pain intensity was assessed using the VAS and Laitinen scales before and after a series of treatments. (3) Results: Significant results in terms of pain reduction before and after treatment were obtained in each of the study groups, as there were significant differences in the VAS pain intensity scores before and after the procedures between the groups. In group I, with electromagnetic field and LED light treatment, the difference was 35.5; in group II, which received Traumeel S® ointment, the difference was 18.5; and in group III, with electromagnetic field and LED light treatment as well as Traumeel S ointment, the difference was 26.5. In the Laitinen scale, the differences were insignificant, although the size distribution was similar. (4) Conclusions: The therapy used in this study showed that magnetic stimulation plus LED therapy and the use of Traumeel S ointment gave positive results in terms of pain reduction in each of the study groups. The strongest analgesic factor seems to be magnetic and LED therapies used separately. Traumeel S in magnetoledophoresis does not work synergistically with the magnetic field of LED light, and even worsens the effect of the therapy used.