Improvement In WOMAC Scores Research Articles

Effect of Intra-Articular Injection of Platelet-Rich Plasma on the Serum Levels of Osteoarthritic Biomarkers in Patients with Unilateral Knee Osteoarthritis.

Background: The aim of this study is to determine the effect of three doses of intra-articular injection of platelet-rich plasma (PRP) into the osteoarthritic (OA) knee joint on the functional status and on the changes in the levels of specific OA biomarkers in blood serum. Methods: Forty patients with unilateral primary knee osteoarthritis were enrolled in this single center, prospective clinical trial. For each patient, three intra-articular PRP injections were administered one week apart. Clinical and laboratory assessment was performed before the first PRP injection (baseline), and 3 months after the third PRP application (3-month follow up). Pain in the affected knee joint was assessed with the Visual Analog Scale for Pain (VAS). Change in clinical status was evaluated with the Western Ontario and McMaster Universities Arthritis Index Questionnaire (WOMAC). Concentrations of 19 biomarkers (EGF, Eotaxin, FGF-2, GRO, IL-10, IL-1RA, IL-8, IP-10, MCP-1, PDGF-AB/BB, RANTES, MMP-3, MMP-13, Collagen type 2, BMP-2, TIMP-1, TIMP-2, TGF beta 1, and COMP) in the serum of studied patients were quantified. Results: At 3-month follow up, there was a significant decrease in the VAS score and significant improvement in the WOMAC score. There was a significant decrease in the levels of Eotaxin, MCP-1, MMP-1, IL-10, EGF, PDGF-AB/BB, TGF- β1 compared to baseline levels. A significant increase in markers BMP-2, COMP, Collagen type 2 and GRO was found at the same time point. There was no significant change in the concentrations of other biomarkers (FGF-2, IL-1RA, IL-8, IL-10, MMP-3, RANTES, TIMP-1, TIMP-3). Conclusions: We found an increase in specific pro-anabolic and anti-inflammatory biomarkers with a concomitant decrease in pro-inflammatory biomarkers at 3 months after three intra-articular applications of PRP. Significant improvement in VAS and WOMAC scores was observed. Treatment with PRP may be an effective therapeutic option with anti-inflammatory and regenerative potential in patients with primary knee OA.

Adipose Tissue-Derived Mesenchymal Stem Cells as a Potential Restorative Treatment for Cartilage Defects: A PRISMA Review and Meta-Analysis.

Cartilage defects are a predisposing factor for osteoarthritis. Conventional therapies are mostly palliative and there is an interest in developing newer therapies that target the disease’s progression. Mesenchymal stem cells (MSCs) have been suggested as a promising therapy to restore hyaline cartilage to cartilage defects, though the optimal cell source has remained under investigation. A PRISMA systematic review was conducted utilising five databases (MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science) which identified nineteen human studies that used adipose tissue-derived MSC (AMSC)-based therapies, including culture-expanded AMSCs and stromal vascular fraction, to treat cartilage defects. Clinical, imaging and histological outcomes, as well as other relevant details pertaining to cartilage regeneration, were extracted from each study. Pooled analysis revealed a significant improvement in WOMAC scores (mean difference: −25.52; 95%CI (−30.93, −20.10); p < 0.001), VAS scores (mean difference: −3.30; 95%CI (−3.72, −2.89); p < 0.001), KOOS scores and end point MOCART score (mean: 68.12; 95%CI (62.18, 74.05)), thus showing improvement. The studies in this review demonstrate the safety and efficacy of AMSC-based therapies for cartilage defects. Establishing standardised methods for MSC extraction and delivery, and performing studies with long follow-up should enable future high-quality research to provide the evidence needed to bring AMSC-based therapies into the market.

Safety and efficacy of a single intra-articular injection of a novel enhanced protein solution (JTA-004) compared to hylan G-F 20 in symptomatic knee osteoarthritis: a randomized, double-blind, controlled phase II/III study

BackgroundNew minimally invasive treatments are vital to delay joint replacement surgery in patients with knee osteoarthritis. This study was designed to select the most effective among three formulations of an enhanced protein solution containing clonidine, hyaluronic acid, and human plasma (JTA-004), and compare the safety and efficacy of intra-articular administration of the selected formulation with a reference treatment (hyaluronic acid) in symptomatic knee osteoarthritis patients.MethodsIn this two-stage, double-blind, phase II/III study conducted in 12 Belgian centers, 50–79-year-old patients with primary knee osteoarthritis were randomized (1:1:1:1) to receive one dose of one of three JTA-004 formulations (differing in clonidine concentration [50 or 100 μg/ml] and volume [2 or 4 ml]) or the reference treatment (hylan G-F 20). Patients were evaluated using Western Ontario McMaster Universities (WOMAC®) Scores and the Short-Form health survey up to 6 months post-injection (Month 6). Drug consumption and safety were evaluated.ResultsAmong 164 treated patients, 147 completed the study. The JTA-004 formulation containing 200 μg clonidine and 20 mg hyaluronic acid in 2 ml (JTA-200/2) was selected based on interim results at Month 6. The difference in adjusted mean change in WOMAC Pain Subscale Score from baseline (JTA-200/2 minus reference group) at Month 6 was − 9.49 mm; statistical superiority of JTA-200/2 over the reference was not demonstrated. No statistically significant differences in adjusted mean changes from baseline between JTA-200/2 and reference groups were observed for Pain, Physical Function and Stiffness Subscales WOMAC Scores, Total WOMAC Score, and Well-being Score at any timepoint, although JTA-200/2 induced larger improvements in WOMAC Scores than the reference. Statistically significantly larger improvements in WOMAC Pain Subscale Scores for JTA-004 versus the reference were observed in post-hoc analyses on pooled data from all JTA-004 formulations at Month 6 (p = 0.030) and Month 3 (p = 0.014). All JTA-004 formulations had clinically acceptable safety profiles.ConclusionsThis study provided preliminary evidence of the safety of intra-articular injection of JTA-004 in knee osteoarthritis patients. Phase III randomized controlled trials with larger sample sizes are needed to evaluate the efficacy of JTA-004 in knee osteoarthritis.Trial registrationClinicaltrials.gov/identifier NCT02740231; clinicaltrialsregister.eu/identifier 2015–002117-30. Retrospectively registered 13/4/2016.

Intra-articular platelet rich plasma in osteoarthritis knee

Background: Osteoarthritis is a slowly progressive disease of the diarthrodial joints. With articular cartilage degeneration, chondrocytes undergo mitosis and clustering. Degeneration of cartilage changes its biomechanical, biochemical, and structural properties. Numerous, non-invasive treatment options are available with emphasis on pain management, improvement in function and with a potential to modify the disease process and progress of cartilage degeneration. Platelets contain many growth factors, cytokines, and bioactive proteins which help regulate tissue healing and restoration. Autologous Platelet rich plasma contains a very high concentration of platelets above baseline levels and hence help in the improvement of disease. Methods: We conducted a study on 70 knees diagnosed as having Kellgren-Lawrence (KL) Grade 2-4 Osteoarthritis knee. Autologous Platelet Rich plasma was prepared and was injected into the affected knee joint. The study group was followed up at 1 week, 4 weeks, 12 weeks. Clinical outcome analysis was done for the efficacy on the basis of WOMAC score and NRS Score. Statistical analysis of data was performed and P-value was calculated. Results: Results obtained after statistical analysis suggested an overall improvement in WOMAC score in all grades of Osteoarthritis knee. Improvement in the patients having early stages was more in comparison to that seen in the patients in late stages.Conclusion: Platelet Rich Plasma therapy in an effective treatment option to improve the clinical outcomes in patients with Osteoarthritis knee. It has an advantage of giving satisfactory outcomes. Also, it is low cost, minimally invasive and safe in application.

Bipolar Radiofrequency Neurotomy of the Genicular Nerves for Chronic Pain Due to Knee Osteoarthritis.

Background: The current treatments for chronic knee osteoarthritis (OA), a disabling and costly healthcare condition in the United States, vary in their level of supporting evidence. Although total knee replacement is one of the best-supported interventions, its associated risks should not be taken lightly, especially in older patients with comorbidities. Genicular nerve block with subsequent genicular nerve radiofrequency neurotomy (GN-RFN) has emerged as a promising intervention for refractory pain in knee OA. Purposes/Questions: We sought to assess the pain and functional outcomes of genicular nerve bipolar radiofrequency neurotomy (B-RFN) for the treatment of chronic pain due to knee OA. Methods: A total of 21 patients who underwent unilateral genicular nerve B-RFN after positive diagnostic genicular nerve block (50% or greater pain relief) treated between July 2018 to December 2018 were included. Pain numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected at baseline, 3 months, and 6 months post-B-RFN. Changes at each time point were compared to baseline scores using paired sample t tests. Results: At 3 months, 62% of patients had a greater than 50% improvement in NRS scores and 57% of patients had a greater than 50% improvement in WOMAC scores. At 6 months, 81% of patients had a greater than 50% improvement in NRS scores and 67% had a greater than 50% improvement in WOMAC scores. The absolute change in mean NRS (± standard deviation) at 6 months went from 7.5 ± 1.9 to 2.5 ± 1.2. The absolute change in mean WOMAC scores at 6 months went from 46.9 ± 8.0 to 19.0 ± 6.2. Conclusion: Of 21 patients, 14 (67%) saw greater than 50% improvements in both NRS and WOMAC scores at 6 months after genicular nerve B-RFN. Further prospective studies are needed to determine the selection criteria of patients most likely to benefit from this procedure.

Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip

It is challenging to treat developmental dysplasia of the hip (DDH) classified Crowe III-IV using direct anterior approach (DAA) total hip arthroplasty (THA), and very little is known on its outcome. This study aimed to investigate the clinical result in this defined disorder with DAA versus posterolateral approach. Twenty-three consecutive hips with Crowe III-IV DDH who underwent DAA were retrospectively evaluated from 2016 through 2018. Outcomes were primarily assessed by HHS, WOMAC, and SF-12 physical scales. The second evaluations included leg length discrepancy, hip muscle strength, radiographic review, complications, and limp recovery. Results were compared to a control cohort of 50 hips underwent posterolateral THA concurrently within the observational period. At last follow-up (DAA 28.5 months; PLA 39.0 months), the mean increase of the HHS for DAA was 48.2 and 30.3 for PLA (p = 0.003). The improvement in WOMAC score in DAA cohort was 15.89 higher that of the PLA cohort after adjusting preoperative difference [R2 = 0.532, P = 0.000, 95% CI (10.037, 21.735)]. DAA had more rapid recovery of hip abductor strength at 1-month (p = 0.03) and hip flexor strength at 3 months (p = 0.007) compared to PLA. No significant differences were found in the radiographic analysis with the exception of increased acetabular anteversion in the DAA cohort (p = 0.036). Satisfactory improvement in limp, indicated by the percentage of limp graded as none and mild to the total, was much higher in DAA cohort (97.6%), compared to that of PLA cohort (90.0%, p = 0.032). DAA for high-dislocated dysplasia demonstrate a significant improvement in clinical result comparable to posterolateral approach. Improved clinical outcome in terms of increased HHS and WOMAC scores, rapid recovery of hip abductor and flexor strength, and enhanced limp recovery without an increased risk in complications, could be acquired when the surgeons were specialized in this approach.

Midterm results of modern patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral arthritis: systematic review and meta-analysis of comparative studies.

Both Patellofemoral Arthroplasty (PFA) and Total Knee Arthroplasty (TKA) are accepted surgical options for end-stage isolated patellofemoral osteoarthritis (PFOA). We performed a systematic review and meta-analysis to compare outcomes of PFA and TKA by evaluation of the patient-reported outcome measures (PROMs). We systematically identified publications reporting on patients that underwent either TKA or modern PFA for isolated PFOA. Meta-analysis software was used to screen for potential articles with at least two years' follow-up. Data were extracted and analysed for all PROMs operating time, postoperative inpatient time, complications and cost. We included five studies in our cumulative meta-analysis and reviewed them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. No significant difference was found between both TKA and PFA in the context of operating time. No significant difference after five years' follow-up was found between the two treatment options in terms of UCLA score and patient satisfaction. PFA showed significant improvement in WOMAC score at five-year follow-up, less postoperative inpatient time, better cost-effectiveness and significantly less blood loss. PFA seems to be a viable alternative to TKA for treatment of isolated PFOA in appropriately selected patients. PFA showed less postoperative inpatient time and blood loss with similar PROMs to the TKA. Moreover, it is an economically beneficial joint-preserving procedure.

Physical Therapy Use, Costs, and Value for Latent Classes of Good vs Poor Outcome in Patients Who Catastrophize About Their Pain Prior to Knee Arthroplasty

ObjectiveTo examine use, costs, and value of physical therapy (PT) among subgroups. DesignWe conducted an observational study of data from a randomized trial of a pain coping skills intervention. Good and poor outcome subgroups were determined based on Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores. The use and costs of PT care as well as changes in WOMAC Pain and Physical Function scores over 4 time periods during a 1-year follow-up were reported. We compared the number of PT visits, total PT costs, and cost per 1-unit improvement in WOMAC scores for the 2 latent subgroups. SettingFive academic medical centers. ParticipantsPatients who catastrophized about their pain prior to knee arthroplasty (N=384). InterventionsPain coping skills training, arthritis education, and usual care. Main Outcome MeasuresThe WOMAC Pain Scale was the primary outcome. ResultsThe value of PT was lower and the cost of PT was higher for poor vs good outcome subgroups beginning 2 months after knee arthroplasty. For example, during the 2- to 6-month period, participants in the poor outcome subgroup incurred a PT cost of $5181.22 per 1-unit improvement in WOMAC Pain compared with $437.87 per 1-unit improvement in WOMAC Pain for the good outcome subgroup (P<.001). From the 6- to 12-month period, WOMAC scores worsened for the poor outcome subgroup, indicating no benefit from PT. ConclusionsPatients in 2 latent classes demonstrated clinically important differences in value of PT. Future research should identify rehabilitation-based interventions that reduce utilization and enhance effectiveness for patients at high risk for poor outcome.

Comparing Intra-articular Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Low-Molecular Weight Hyaluronic Acid for the Treatment of Symptomatic Osteoarthritis of the Hip: A Double-Blind, Randomized Pilot Study.

Background:Hyaluronic acid (HA) and leukocyte-poor platelet-rich plasma (LP-PRP) are 2 nonoperative treatment options that have been studied in patients with hip osteoarthritis (OA).Purpose:To compare the efficacy of intra-articular injections of low–molecular weight (LMW) HA and LP-PRP in patients with hip OA.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 34 patients (36 hips) presenting with signs of hip OA were randomized to receive 3 blinded, weekly intra-articular injections of either LP-PRP or LMW-HA. Patients were prospectively evaluated before injections and at 6 weeks and then at 3, 6, 12, and 24 months. The primary outcome, conversion to total hip arthroplasty (THA) or a hip resurfacing procedure, was analyzed along with secondary outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and hip range of motion.Results:The final analysis included 33 hips (mean Kellgren-Lawrence grade, 2.73) (LMW-HA: n = 14; LP-PRP: n = 19) in 31 patients (18 male; mean age, 53.8 years). Significantly more patients converted to THA or a hip resurfacing procedure in the LMW-HA group (7/14; 50.0%) (mean, 1.3 years after first injection) than the LP-PRP group (3/19; 15.8%) (mean, 0.73 years after first injection) (P = .035). There was no significant improvement or decline in any outcome scores within the LMW-HA group from before injections to 6 weeks or 3, 6, and 12 months. For the LP-PRP group, WOMAC overall (P = .032), joint (P = .030), and function scores (P = .025) significantly improved from before injections to 6 weeks, and WOMAC joint scores significantly improved from before injections to 6 months (P = .036). When comparing the difference between groups in internal rotation at 90° of hip flexion from before injections to 6 months, the LP-PRP group demonstrated a mean 5.0° improvement, while the LMW-HA group showed a mean 1.5° decrease (P = .028).Conclusion:Intra-articular hip injections of LP-PRP in patients with hip OA resulted in an improvement in WOMAC scores and hip internal rotation at 6 months and delayed the need for THA or a hip resurfacing procedure compared with treatment with LMW-HA. A longer follow-up is necessary to further compare the effects of LP-PRP and LMW-HA injections in patients with hip OA.Registration:NCT01920152 (ClinicalTrials.gov identifier).

The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee

Osteoarthritis, a degenerative and debilitating joint disease, is one of the most prevalent diseases in the United States. Despite the significant burden osteoarthritis can place on an individual and society, nonoperative treatment options are still very limited. Little clinical data exists on the use of injectable macromolecules for the treatment of osteoarthritis of the knee. Alpha-2-macroglobulin (A2M), a naturally occurring macromolecule, inhibits the many endogenous and exogenous proteinases presenting in the pathogenesis of osteoarthritis. This macromolecule is not typically contained in high quantities in traditional PRP preparations. To date, no studies exist evaluating the effectiveness of A2M with other intra-articular injectables. The purpose of this study is to compare the clinical effectiveness of intra-articular injection of A2M against both platelet-rich plasma (PRP) and corticosteroids. This prospective randomized control trial was conducted at a single medical center. Seventy-five patients with symptomatic knee osteoarthritis with Kellgren-Lawrence grade 2 or 3 were randomized into one of three cohorts receiving intra-articular injection. One group was given PRP, one group was given A2M, and one group was given corticosteroids. All groups had blood drawn to simulate A2M preparation. Patient reported outcomes were collected prior to injection, 6 weeks and 12 weeks following injection. Several measures were used for clinical assessment including the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Seventy-five patients with a mean age of 61.08 (± 8.48) were enrolled between June 2018 and February 2019. At six weeks, the A2M group had the greatest improvements in VAS (-1.60) and WOMAC (-10.9) scoring, however, the differences were not statistically significant. Between the injection and the twelve week visit, the A2M group had a statistically significant improvement in WOMAC score compared with traditional PRP (-18.43 vs -5.70, p <0.02). Overall, both corticosteroid (-1.57) and A2M (-1.70) had a better improvements in VAS when compared with traditional PRP (-0.61). However, these were also not statistically significant. Our study demonstrates Alpha 2 Macroglobulin shows similar effectiveness to corticosteroids in the treatment of knee osteoarthritis. Both A2M and corticosteroids appear to show better effectiveness than traditional PRP injection, however the differences are small and did not reach statistical significance in most outcome measures. The extra preparation time required and cost associated with A2M may not warrant its routine use in the management of knee osteoarthritis.

Effectiveness of transcranial direct current stimulation on pain and function in knee osteoarthritis: a systematic review with meta-analysis based on PRISMA guidelines

IntroductionTo evaluate the effectiveness of transcranial direct current stimulation (tDCS) on pain and quality of life in patients with knee osteoarthritis (OA).MethodsThe meta-analysis data source were PubMed (MEDLINE) and Cochrane (Central). Randomized controlled trials comparing active tDCS (in combination with other interventions or alone in knee OA patients) with sham tDCS published in English till July 2019 were analysed. The outcome measures were pain intensity (visual analogue scale and numeric rating scale) and quality of life (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Mean difference with 95% confidence interval for the active tDCS and sham groups were investigated.ResultsFour articles with 171 patients were included in the qualitative systematic review and 2 articles with 55 patients were included in the quantitative meta-analysis. The results revealed a statistically significant reduction in pain (visual analogue scale) in the active tDCS group compared with the sham group (&lt;i&gt;Z&lt;/i&gt; = 7.32, &lt;i&gt;p&lt;/i&gt; &lt; 0.00001) and a significant improvement in WOMAC scores (&lt;i&gt;Z&lt;/i&gt; = 2.31, &lt;i&gt;p&lt;/i&gt; = 0.02), with high heterogeneity of 83%.ConclusionsThere is a significant improvement in pain and function in patients with knee OA after the application of active tDCS either alone or in combination. However, more studies are required to confirm the effectiveness of tDCS in knee OA. Owing to the promising results of tDCS in various pain conditions and in knee OA, it can be seen as a future tool for managing pain in the field of physiotherapy.

P.218 Apparent diffusion coefficient value of normal appearing white matter in prediction of NEDA loss in MS patients treated with interferon-β

Total hip (THA) and knee arthroplasty (TKA) are two of the most successful procedures in orthopedics. Current evaluation trends focus on patient-reported outcomes. We sought to compare the changing WOMAC scores from various time points from pre-operative to 1-year follow-up between separate THA and TKA cohorts. In addition, we compared THA and TKA patients’ joint perception, satisfaction, and function via a questionnaire.One hundred elective THA (n = 50) and TKA (n = 50) patients at one institution were randomly selected and contacted between 2 and 4 years after the index surgery. A questionnaire assessed joint perception, satisfaction and function of their total joint. Clinical function scores utilizing the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from the pre-operative, 3-month and 1-year post-arthroplasty visits were compared between groups.78% of the THA group perceived their replaced joint as “native” vs 32% of TKA patients. 54% of THA patients (vs 16% of TKA patients) reported uninhibited function of their total joint. 24% of TKA patients noted to be least satisfied with their total joint compared to 2% in the THA group. Both groups demonstrated significant improvement in WOMAC scores after surgery, but the mean 3-month (12.4 (THA) vs 19.3 (TKA)) and 1-year (6.5 (THA) vs 14.1 (TKA)) follow-up WOMAC scores were significantly better in the THA group.Evaluation of a patient’s joint perception is a valuable tool that should be used to assess function in conjunction with validated clinical functional scores. Our data suggest further improvements in total knee implant design and implantation strategies are necessary.

Standardized Platelet Rich Plasma Injections for Osteoarthritis of the Knee.

ObjectivePlatelet-rich plasma (PRP) and adipose-derived stem cells (ADSC) injections are non-surgical treatments for knee osteoarthritis (OA). The purpose of this study is to assess the effectiveness of serial PRP with or without ADSC injections in the treatment of refractory OA of the knee. DesignPatients who failed to achieve pain relief with conventional non-surgical treatments, with Kellgren-Lawrence grade 3 or 4 knee OA, were recruited from a private outpatient clinic. Over 67 patients were elected to receive serial PRP injections and 22 patients were elected to receive an ADSC+PRP injection. These patients completed Western Ontario and McMaster Universities Arthritis Index (WOMAC) surveys prior to each treatment and at follow-up appointments. These surveys were retrospectively reviewed to assess changes in functional status and pain over time.ResultsTwenty-nine patients from the PRP group and eight patients in the ADSC+PRP group had adequate follow-up for inclusion in the analysis. The PRP group had an improvement in WOMAC scores by 34.30%, 60.2%, and 58.5% for patients reporting at 1-3, 4-6, and >6 months of follow-up. The ADSC+PRP group experienced an improvement of 51% at an average of 4.66 months of follow-up.ConclusionsSerial PRP injections and a single ADSC+PRP injection yield improved and sustained functional outcome scores for patients with severe, refractory OA of the knee. Future studies should consider consistent orthobiologic preparation protocols to ensure reproducibility.

Level of Pain and Physical Function of Patients with Knee Osteoarthritis Receiving Physiotherapy with and without IntraArticular Injection in Pakistan: A Qusai Experimental Study

Background/objectives: Few Investigations include a comparison of a conservative approach in the effectiveness of treatment for OA of the knee. Advantageous interventions may reduce the disability associated with OA of knee and need for more invasive treatment. The objective of the current study was to determine and compare the level of pain and physical function of patients with knee osteoartthritis receiving physiotherapy with and without intra articular injections in Lahore, Pakistan. Material and method: This experimental study conducted among knee OA patients of orthopedic clinics, physiotherapy and rehabilitation centers of Pakistan. 44 patients participated in the study. Patients of knee OA were equally divided into two groups A and B for the treatment of physiotherapy and a combination of physiotherapy plus intra articular injection respectively. Before treatment patients, physical functioning and pain score was measured by WOMAC and VAS scale. The intervention was applied according to given protocols. After treatment of 8 weeks, physical function and pain score was measured again by WOMAC and VAS scale to compare the result of both treatments. Result: The Improvement in VAS score in Group A was 2.81 ± 1 and in Group B was 3.4 ± 0.69 whereas improvement in WOMAC score in Groups A was 13.23 ± 8.29 and in Group B was 19.14 ± 5.92. P value calculated through independent sample t-test (0.02 and <0.009) show that there is a significant difference in the improvement level in both groups and improvement in Group B is significantly better than in Group A. Conclusion: Patients in both groups showed improvement in terms of pain and disability but the improvement in Group B was more as compared to improvement in Group A.

Does Age Influence Patient-Reported Outcomes in Unilateral Primary Total Hip and Knee Arthroplasty?

BackgroundTotal hip arthroplasty (THA) and total knee arthroplasty (TKA) are used to treat patients with end-stage arthritis. Previous studies have not demonstrated a consistent relationship between age and patient-reported outcomes. The purpose of this study is to assess the impact of age on patient-reported outcomes after unilateral primary THA or TKA. MethodsA retrospective review of available data in Alberta Bone and Joint Health Institute (ABJHI) Data Repository was performed. We identified 53,498 unilateral primary THA and TKA between April 2011 and 2017. Patients were divided by age into 3 categories: <55, 55-70, and >70. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQoL 5-dimension (EQ-5D) Canada scores were obtained at presurgery, 3 and 12 months postoperatively. ResultsFor TKA, younger patients had larger improvements in WOMAC scores at 3 and 12 months (P = <.001-.033), and in EQ-5D scores at 3 months (P < .001). When adjusted, patients <55 had lower WOMAC and EQ-5D scores at 3 months postoperatively compared to those 55-70 or >70 (all P < .01). Outcomes at 12 months did not differ between age-groups.For THA, younger patients had larger improvements in WOMAC at 3 months (P = .03). When adjusted, patients <55 had higher WOMAC scores at 12 months postoperatively compared to those 55-70 or >70, and higher EQ-5D scores compared to those 55-70 (all P < .05). ConclusionWhile a multitude of factors go in to quantifying successful THA or TKA, this study suggests that patient age should not be a deterrent when considering the impact of age on patient-reported outcomes.

A Study on the effects of injection of platelet rich plasma (Autologous) in the management of osteoarthritis of knee joints

Aim & Objective Results: Total amount of sample infiltrated was 5 ml, in to each knee joint under aseptic conditions in Operation Theater. Each patient evaluated with WOMAC scoring on ‘0’ day, 1 month and six months. Out of 31 knee joints infiltrated with PRP, 12 knee joints are grade I and 19 knee joints are of grade II. On assessing the results there is a significant improvement in WOMAC score of all the patients and the results sustained for more than 6 months. Though there is clinically better results are seen in grade I knee joints than grade II knee joints, these results are statistically not significant. Conclusion: There were no long term local systemic complications noted through the course of the study except acute pain at the site of inject for immediate 10-15 minutes after the infiltration.

Individual Gait Features Are Associated with Clinical Improvement After Total Knee Arthroplasty.

Background:Over 20% of patients do not report clinically relevant pain relief or functional improvements after total knee arthroplasty (TKA). The aim of this study was to investigate the effect of demographics, pre-TKA knee-joint biomechanics, and postoperative changes in knee biomechanics on meaningful improvements in self-reported pain and function after TKA.Methods:Forty-six patients underwent 3-dimensional gait analysis and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before and 1 year after TKA. Response to treatment in terms of pain relief and functional improvement (“pain and function responders”) was defined as improvements in WOMAC scores that met minimal clinically important difference thresholds in the pain and function domains. Differences between responder and non-responder demographics, severity of the osteoarthritis as seen radiographically, and knee kinematics and kinetics before TKA were explored using the t test and Mann-Whitney U test. Correlations and regression models were used to examine demographics, baseline knee kinematics and kinetics, and post-TKA kinematic and kinetic improvements associated with being a pain responder and a function responder separately. Analyses were conducted using a hypothesis-driving approach.Results:Of the 46 patients, 34 were pain responders and 36 were function responders. Preoperatively, both responder groups had a higher radiographic severity (Kellgren-Lawrence) grade (p = 0.03) and pain responders were more symptomatic according to their WOMAC score (p < 0.04). Less preoperative stance-phase flexion-extension angle range (p ≤ 0.03), lower preoperative stance-phase adduction (varus) angle magnitude (p = 0.01), and less postoperative reduction in the adduction angle magnitude (p ≤ 0.009) were independently associated with more self-reported improvement in pain and function.Conclusions:Patients with a higher radiographic severity grade, with specific frontal and sagittal knee kinematic patterns during gait before TKA, and who demonstrated less reduction in frontal plane angles during gait after TKA had greater self-reported pain and function score improvements after standard TKA. Gait analysis may aid preoperative identification of kinematic subgroups associated with self-reported improvements after TKA, and provide evidence that may inform triaging, surgical planning, and expectation management strategies.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Posterior condylar offset changes and its effect on clinical outcomes after posterior-substituting, fixed-bearing total knee arthroplasty: anterior versus posterior referencing

BackgroundWe sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system.MethodsThis retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system.ResultsThe postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups.ConclusionsThere was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups.Trial registrationRetrospectively registered (Trial registration number: 06-2010-110).

Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

The aim of this prospective cohort study was to determine the effect of preoperative mental health status on functional outcome 1 year after total hip arthroplasty (THA). Data were collected for 677 patients from a randomized controlled trial in Alberta who received primary THA between April 2005 and June 2006 (sex, age, body mass index [BMI], comorbidities, back pain and need for another lower limb arthroplasty procedure within 1 yr after surgery). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and 36-Item Short Form Health Survey (SF-36) mental health component were administered before surgery and 1 year after. We conducted multiple linear regression to determine the effect of mental health on the WOMAC score at 1 year. The mean WOMAC and SF-36 mental health scores were significantly increased at 1 year (p < 0.001 and p = 0.01, respectively). There was a strong correlation between improvement in WOMAC score at 1 year and presurgery SF-36 mental health score (0.13, 95% confidence interval [CI] 0.06 to 0.2). Age (–0.34, 95% CI –0.45 to –0.24), obesity (–2.9, 95% CI –5.32 to –0.4), back pain (–5.75, 95% CI –8.04 to –3.46) and awaiting another joint arthroplasty operation (–6.18, 95% CI –8.9 to –3.47) had a negative impact on the WOMAC score. There was a strong correlation between presurgery mental health and the resolution of pain and improved functioning 1 year after THA. We recommend that patients receive appropriate counselling and, where appropriate, medical therapy before THA.

Efficacy of intra-articular hyaluronic acid in relief of pain in Kellgren and Lawrence grade 2 and 3 osteoarthritis knee

Introduction: Intra-Articular Hyaluronic Acid (IA-HA) supplementation not only improvises the synovial fluid flow dynamics and viscoelasticity but also potentially offers a positive effect on the arthritic disease process by promoting in vivo IAHA production and by providing an intra-articular anti-inflammatory effect. Objective: The primary objective of this study was to compare a single 6ml, intra-articular injection of hylan GF-20 with conservative treatment in patients with symptomatic mild to moderate knee Osteoarthritis (OA). Methodology: Patients with primary OA knee pain were randomly assigned to arthrocentesis plus a 6ml intra -articular injection of either hylan G-F 20 or conservative methods of treatment in a prospective, single-blinded (evaluator) randomised control study. Results were evaluated at Pre Injection, 3, 8, 16 and 24 weeks post-injection. The primary outcome criterion was change from baseline over 24 weeks in Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and VAS Score. Results: A total of 70 patients (Kellgren–Lawrence grade II or III) was randomly assigned. Patients receiving hylan G-F 20 experienced statistically significantly greater improvements in WOMAC scores and VAS scores, than patients receiving conservative treatment. No increased risk of local adverse events was observed. Conclusions: This prospective randomised control study demonstrated that, in patients with knee osteoarthritis, a single 6 ml intra-articular injection of hylan G-F 20 is safe and effective in providing statistically significant, clinically relevant pain relief over 24 weeks, with a modest difference versus conservative treatment.