Improve Joint Function Research Articles

Osteogenic properties of nanohydroxyapatite/polyamide 66-Coated femoral stem prosthesis and its efficacy in total hip replacement combined with staged functional rehabilitation exercises

To evaluate the efficacy of nanohydroxyapatite/polyamide 66 (nHA/Pa66)-coated femoral stem prosthesis in total hip arthroplasty (THA) and the advantages of combined post-operative staged rehabilitation functional exercises (SRFE) in restoring hip function, 112 patients with femoral neck fractures were enrolled in the clinical study. Patients were randomized to routine and nHA/Pa66 groups. Patients in the nHA/Pa66 group were treated with nHA/Pa66-coated femoral stem prosthesis and the post-operative SRFE program. We evaluated the physical properties, cytotoxicity, and osteogenic capacity of nHA/Pa66 in an in vitro trial, and the clinical treatment, postoperative improvement in joint function (Barthel score, VAS score, Harris score), imaging performance, and incidence of adverse events were compared between groups. The porosity of nHA/Pa66 was ∼75% and its pore size was in the range of 300–500 μm. Moreover, nHA/Pa66 had good biocompatibility and could improve bone marrow stem cells (BMSCs) activity and enhance the osteogenic function of BMSCs, effectively increasing the levels of COL I, ALP, and OCN. A combination of nHA/Pa66 and SRFE could effectively shorten hospital stay, better restore hip function, and reduce the incidence of complications. Therefore, nHA/Pa66-coated femoral stem prosthesis combined with SRFE showed great potential in THA for femoral neck fractures.

Upper limb and lower limb radiofrequency treatments in orthopaedics.

Radiofrequency (RF) is a minimally invasive technique for disrupting or altering nociceptive pathways to treat musculoskeletal neuropathic and nociplastic pain. RF has been employed to treat painful shoulder, lateral epicondylitis, knee and hip osteoarthritis, chronic knee pain, Perthes disease, greater trochanteric pain syndrome, plantar fasciitis, and painful stump neuromas; it has also been employed before and after painful total knee arthroplasty and after anterior cruciate ligament reconstruction. The benefits of RF include the following:it is safer than surgery; there is no need for general anaesthesia, thereby reducing adverse effects; it alleviates pain for a minimum of 3-4 months; it can be repeatable if necessary; and it improves joint function and minimizes the need for oral pain medication. RF is contraindicated for pregnant women; unstable joints (hip, knee, and shoulder); uncontrolled diabetes mellitus; presence of an implanted defibrillator; and chronic joint infection (hip, knee, and shoulder). Although adverse events from RF are unusual, potential complications can include infection, bleeding, numbness or dysesthesia, increased pain at the procedural site, deafferentation effect, and Charcot joint neuropathy. Although there is a risk of damaging non-targeted neural tissue and other structures, this can be mitigated by performing the technique under imaging guidance (fluoroscopy, ultrasonography, and computed tomography). RF appears to be a valuable technique for alleviating chronic pain syndromes; however, firm proof of the technique's efficacy is still required. RF is a promising technique for managing chronic musculoskeletal of the limbs pain, particularly when other techniques are futile or not possible.

Current and Novel Therapeutics for Articular Cartilage Repair and Regeneration.

Articular cartilage repair is a sophisticated process that has is being recently investigated. There are several different approaches that are currently reported to promote cartilage repair, like cell-based therapies, biologics, and physical therapy. Cell-based therapies involve the using stem cells or chondrocytes, which make up cartilage, to promote the growth of new cartilage. Biologics, like growth factors, are also being applied to enhance cartilage repair. Physical therapy, like exercise and weight-bearing activities, can also be used to promote cartilage repair by inducing new cartilage growth and improving joint function. Additionally, surgical options like osteochondral autograft, autologous chondrocyte implantation, microfracture, and others are also reported for cartilage regeneration. In the current literature review, we aim to provide an up-to-date discussion about these approaches and discuss the current research status.

Effect of Prior Knee Arthroscopy on Midterm Outcomes After Medial Opening-Wedge High Tibial Osteotomy: A Propensity Score–Matched Analysis

Background: Knee arthroscopy is frequently performed to improve joint function and relieve pain. However, there is no consensus regarding the effect of prior arthroscopy on outcomes following medial opening-wedge high tibial osteotomy (MOWHTO). Purpose: To compare midterm clinical outcomes and survival rates after MOWHTO between patients with and without a history of knee arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled patients who underwent MOWHTO between March 2008 and February 2017 and had ≥4 years of follow-up. Patients who had undergone knee arthroscopy were included in an arthroscopy group, and those who had not were included as controls. After propensity score matching based on age, sex, body mass index, and lesion size, 80 patients in each group were included. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey, and Tegner Activity Scale. Furthermore, survival rates and relevant risk factors that affected joint survivorship were analyzed, wherein conversion to total knee arthroplasty was considered the endpoint. Results: Although the pre- to postoperative improvement in clinical outcomes did not differ significantly between the groups, there were significant between-group differences in final postoperative scores on the KOOS–Activities of Daily Living (arthroscopy vs control, 78.1 ± 10.6 vs 81.0 ± 9.8; P = .031), KOOS–Sport and Recreation (45.4 ± 12.8 vs 48.7 ± 13.5; P = .045), 36-Item Short Form Health Survey Physical Component Summary (65.1 ± 12.7 vs 69.3 ± 11.8; P = .017), and Tegner Activity Scale (4.1 ± 1.1 vs 4.5 ± 1.0; P = .007). The survival rate was 96.8% at a mean follow-up of 8 years, and survival was not associated with a history of arthroscopy ( P = .697; log-rank test). Conclusion: Although patients with prior arthroscopy had some inferior patient-reported outcome scores after MOWHTO, the overall clinical improvements were similar in the arthroscopy and control groups.

Evaluation of the efficacy and safety of pegloticase for the treatment of chronic refractory gout through meta-analysis.

Gout is the most common arthritis that affects more than 2% of adults in developed countries. 3% to 4% of gout is chronic refractory gout. Conventional treatments are considered invalid. A new drug, pegloticase is used to treat chronic refractory gout, and there are still many questions about efficacy and safety. We searched PubMed, web of science, and the Cochrane Library. Preprints and references of related literature were also considered. Related efficacy and safety indicators were statistically analyzed by Review Manager 5.4 to conduct meta-analysis. A total of one article and one clinical trial were included. Pegloticase is able to reduce serum uric acid and reduce tender joints, thereby improving joint function. But pegloticase has more adverse events. Pegloticase can be used to treat chronic refractory gout. However, Pegloticase has a higher risk of adverse events. Considering the efficacy and safety, the scope of clinical applications of pegloticase can be further widened in patients in good medical condition.

Effect of omega-3 polyunsaturated fatty acids supplementation for patients with osteoarthritis: a meta-analysis

BackgroundOmega-3 polyunsaturated fatty acids (n-3 PUFAs) confers anti-inflammatory efficacy, which has been suggested to be effective for patients with osteoarthritis (OA). However, previous studies evaluating the influence of n-3 PUFAs supplementation in patients with OA showed inconsistent results. We performed a systematic review and meta-analysis to comprehensively evaluate the influence of n-3 PUFAs on symptom and joint function of patients with OA.MethodsRelevant randomized controlled trials (RCTs) were obtained by searching PubMed, Embase, and Cochrane Library databases. A random-effects model was employed to combine the results.ResultsNine RCTs with 2070 patients with OA contributed to the meta-analysis. Pooled results showed that n-3 PUFAs supplementation could significantly relieve the arthritis pain as compared to placebo (standardized mean difference [SMD]: − 0.29, 95% confidence interval [CI] − 0.47 to − 0.11, p = 0.002, I2 = 60%). Besides, supplementation with n-3 PUFAs was also associated with improved joint function (SMD: − 0.21, 95% CI − 0.34 to − 0.07, p = 0.002, I2 = 27%). Subgroup analysis showed consistent results of studies with arthritis pain and joint function evaluated by the Western Ontario-McMaster University Osteoarthritis Index and other scales (p for subgroup difference = 0.33 and 0.34, respectively). No severe treatment-related adverse events (AEs) were observed in the included patients, and the incidence of overall AEs was similar between groups (odds ratio: 0.97, 95% CI 0.64–1.45, p = 0.86, I2 = 0%).ConclusionsSupplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA.

Wheel Running Exacerbates Joint Damage after Meniscal Injury in Mice, but Does Not Alter Gait or Physical Activity Levels.

Exercise and physical activity are recommended to reduce pain and improve joint function in patients with knee osteoarthritis (OA). However, exercise has dose effects, with excessive exercise accelerating OA development and sedentary behaviors also promoting OA development. Prior work evaluating exercise in preclinical models has typically used prescribed exercise regimens; however, in-cage voluntary wheel running creates opportunities to evaluate how OA progression affects self-selected physical activity levels. This study aimed to evaluate how voluntary wheel running after a surgically induced meniscal injury affects gait characteristics and joint remodeling in C57Bl/6 mice. We hypothesize that injured mice will reduce physical activity levels as OA develops after meniscal injury and will engage in wheel running to a lesser extent than the uninjured animals. Seventy-two C57Bl/6 mice were divided into experimental groups based on sex, lifestyle (physically active vs sedentary), and surgery (meniscal injury or sham control). Voluntary wheel running data were continuously collected throughout the study, and gait data were collected at 3, 7, 11, and 15 wk after surgery. At end point, joints were processed for histology to assess cartilage damage. After meniscal injury, physically active mice showed more severe joint damage relative to sedentary mice. Nevertheless, injured mice engaged in voluntary wheel running at the same rates and distances as mice with sham surgery. In addition, physically active mice and sedentary mice both developed a limp as meniscal injury progressed, yet exercise did not further exacerbate gait changes in the physically active mice, despite worsened joint damage. Taken together, these data indicate a discordance between structural joint damage and joint function. Although wheel running after meniscal injury did worsen OA-related joint damage, physical activity did not necessarily inhibit or worsen OA-related joint dysfunction or pain in mice.

3D-printed, patient-specific cutting guides improve femoral and tibial cut alignment in canine total knee replacement.

The purpose of this cadaveric study was to determine whether patient-specific guides (PSGs) improve the accuracy of tibial and femoral cut alignment in canine total knee replacement (TKR), as compared with generic cutting guides. Original research. Sixteen pelvic limbs from skeletally mature medium- to large-breed canine cadavers. Specimens were randomly allocated to one of two groups (PSG or Generic; N = 8/group). In the Generic group, femoral and tibial ostectomies were made using the standard canine TKR femoral cutting blocks and tibial alignment guide. In the PSG group, the cuts were made using a series of custom 3D-printed cutting guides. "Planned" and "actual" tibial and femoral cut alignments were compared in the frontal and sagittal planes, and errors were calculated by subtracting actual from planned values. Use of 3D-printed PSGs improved tibial cut alignment in the frontal plane but not the sagittal plane. PSGs also improved the alignment of the cranial and distal femoral ostectomies but did not impact varus-valgus alignment. These findings support the use of PSGs for TKR in dogs. Clinical trials are now needed to determine whether the benefits of PSGs translate into measurable improvements in joint function and implant longevity. PSGs have the potential to improve femoral and tibial component alignment in canine TKR.

IMPROVING THE METHODOLOGY OF PHYSICAL THERAPY IN ATHLETES WITH INJURIES OF THE KNEE JOINT CONNECTIVE APPARATUS

Description and results of the action developed programs of kinesiotherapy with a combination of kinesiotape to restore impaired locomotor functions of the knee joint and the possibility of continuation playing sports after arthroscopic operations for damage to the ligamentous apparatus.
 Injuries of the musculoskeletal system (MS) are quite common, especially in athletes. According to statistics, up to 50-70% of all ORA injuries occur in the knee joint. Most often, this type of injury is received by athletes, representatives of complex coordination sports and martial arts. Among injuries to the knee joint, injuries to the ligaments, which later cause post-traumatic instability, take second place after damage to the menisci.
 35 patients with injuries of the ligamentous apparatus of the CS (12 women and 23 men) who underwent arthroscopic surgery took part in our study. The patients were active athletes in various sports, in particular game sports. Patients were divided into two groups (the main group and the comparison group) depending on the kind of restorative treatment program. The main group included 23 people whose average age was (24.3±3.0) years. Patients of this group received a rehabilitation program in the conditions of an educational and scientific center Department of Physical Therapy, Occupational Therapy of PNU named after Vasyl Stefanyk. The comparison group (CP) consisted of 12 people, the average age of which was (23.8±3.1) years, who underwent rehabilitation in the polyclinic department of the 1st city polyclinic.
 The individual program of physical therapy for OG patients included kinesiotherapy and massage muscles of the lower limb, physiotherapeutic procedures and the use of kinesiotape. Kinesiotherapy included therapeutic gymnastics of independent classes, massage for the prevention of contracture of the CS and atrophy of the thigh muscles. Various types of massage were used - classic manual massage with passive movements in the joints, self-massage and hydro massage. Physiotherapy procedures were aimed at reducing swelling and pain, preventing the development of the inflammatory process. Patients were prescribed electrophoresis of painkillers, UV irradiation, and UHF or laser therapy, applications of ozokerite or paraffin. These procedures contribute to the stimulation of lymph and blood circulation, trophic processes in the joints, increasing the amplitude of movements and restoring the strength of the muscles of the limb.
 In order to objectify the results of the restorative treatment, the functional ability of the lower limb was assessed using the Lovett muscle test (six-point assessment of muscle strength), the amplitude of movements in the knee joint (goniometry) and the visual analog pain scale (VAS) on the 14th day, 1.5 months, 3 and 5 months after the operation. This part of the study showed the advantages of the developed rehabilitation program using elements of kinesiotaping, as only a few patients with functional disorders were found in OG while in the comparison group their number was up to 20%. Improvement of joint function and normalization of muscle strength and goniometry indicators occurred earlier in OG patients by 2 weeks, compared to patients who underwent restorative treatment according to the traditional method of the city polyclinic.
 A special place in the assessment of results is given to determining the quality of life using the SF-36 questionnaire. The dynamics of quality of life indicators showed a gradual and likely improvement of all components of quality of life at the entire stage of post-hospital rehabilitation. We proved that the proposed rehabilitation program is more effective compared to the traditional methods of restorative treatment of a medical institution and allows achieving better results in restoring the functions of the knee joint in the shortest possible time after the injury and can be recommended for wide use.

A comparative study of the efficacy of intra-articular injection of different drugs in the treatment of mild to moderate knee osteoarthritis: A network meta-analysis.

Knee osteoarthritis (KOA) has a high clinical prevalence and frequently interferes with patients normal lives. In KOA patients, evidence suggests that intra-articular (IA) injection improves joint function and decreases discomfort. Several IA injection treatments are used in daily practice to improve symptomatic control of knee osteoarthritis, but their efficacy is frequently disputed. This network meta-analysis compares the efficacy of different IA injections for mild to moderate knee osteoarthritis. Seven databases (PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine disc, WanFang, and China National Knowledge Infrastructure) were searched for randomized controlled trials published up to and including December 20, 2021, and final follow up indicators were used. Visual analogue scale (VAS) score and The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (WOMAC) score change from baseline were the primary outcomes. We used the Cochrane risk of bias tool to assess the quality and risks of biases of papers. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for each outcome. State (Version 15.1, Texas, USA) and SPSS (Version 20, Chicago, USA) was used in all statistical analyses, and Review Manager (version 5.4) was used in assessing the risks of biases. Our study included 16 randomized controlled trials with a total of 1652 patients. platelet-rich plasma (PRP) IA injection therapy had the highest likelihood of being the best intervention in reducing WOMAC pain (surface under the cumulative ranking area [SUCRA] 84.7%), stiffness (SUCRA 95.1%), and function (SUCRA 98.5%) scores, according to the SUCRA. The best measures for lowering the WOMAC total and VAS scores were IA injection platelet-rich plasma-derived growth factor (SUCRA 84.9%) and hyaluronic acid and platelet-rich plasma (SUCRA 84.9%). In the VAS score group, PRP outperformed hyaluronic acid (HA) (WMD 1.3, 95% CI 0.55-2.55) and corticosteroids (CS) (WMD 4.85, 95% CI 4.02-5.08), according to the forest map results. PRP also outperformed CS (WMD 14.76, 95% CI 12.11-17.41), ozone (WMD 9.16, 95% CI 6.89-11.43), and PRP + HA (WMD 2.18, 95% CI 0.55-3.81) in the WOMAC total score group. Furthermore, PRP outperforms other drugs in terms of reducing WOMAC function, stiffness, and function score. In patients with mild to moderate KOA, IA injection PRP outperformed IA injection ozone, HA, CS, platelet-rich plasma-derived growth factor, and hyaluronic acid and platelet-rich plasma in terms of pain, stiffness, and dysfunction.

Effectiveness of Dermis Fat Graft Versus Temporalis Myofascial Flap for Interposition in Temporomandibular Joint Ankylosis: A Systematic Review.

Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions. The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials. PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale. A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive. Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications. The online version contains supplementary material available at 10.1007/s12663-023-01869-9.

Intra-Articular Injection of Autologous Micro-Fragmented Adipose Tissue for the Treatment of Knee Osteoarthritis: A Prospective Interventional Study.

To investigate the efficacy and safety of autologous micro-fragmented adipose tissue (MF-AT) for improving joint function and cartilage repair in patients with knee osteoarthritis. From March 2019 to December 2020, 20 subjects (40 knees) between 50 and 65 years old suffering from knee osteoarthritis were enrolled in the study and administered a single injection of autologous MF-A. The data of all patients were prospectively collected. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee society score (KSS), hospital for special surgery (HSS) score, visual analogue score (VAS) pain score, changes in cartilage Recht grade on magnetic resonance imaging (MRI) and adverse events were analyzed before and 3, 6, 9, 12 and 18 months after injection. The WOMAC, VAS, KSS and HSS scores at 3, 6, 9, 12 and 18 months after injection were improved compared with those before injection (p < 0.05). There was no significant difference in WOMAC scores between 9 and 12 months after injection (p > 0.05), but the WOMAC score 18 months after injection was worse than that at the last follow-up (p < 0.05). The VAS, KSS and HSS scores 9, 12 and 18 months after injection were worse than those at the last follow-up (p < 0.05). The Recht score improvement rate was 25%. No adverse events occurred during the follow-up. Autologous MF-AT improves knee function and relieves pain with no adverse events. However, the improved knee function was not sustained, with the best results occurring 9-12 months after injection and the cartilage regeneration remaining to be investigated.

The Role of Tocotrienol in Arthritis Management—A Scoping Review of Literature

Arthritis is a cluster of diseases impacting joint health and causing immobility and morbidity in the elderly. Among the various forms of arthritis, osteoarthritis (OA) and rheumatoid arthritis (RA) are the most common. Currently, satisfying disease-modifying agents for arthritis are not available. Given the pro-inflammatory and oxidative stress components in the pathogenesis of arthritis, tocotrienol, a family of vitamin E with both anti-inflammatory and antioxidant properties, could be joint-protective agents. This scoping review aims to provide an overview of the effects of tocotrienol on arthritis derived from the existing scientific literature. A literature search using PubMed, Scopus and Web of Science databases was conducted to identify relevant studies. Only cell culture, animal and clinical studies with primary data that align with the objective of this review were considered. The literature search uncovered eight studies investigating the effects of tocotrienol on OA (n = 4) and RA (n = 4). Most of the studies were preclinical and revealed the positive effects of tocotrienol in preserving joint structure (cartilage and bone) in models of arthritis. In particular, tocotrienol activates the self-repair mechanism of chondrocytes exposed to assaults and attenuates osteoclastogenesis associated with RA. Tocotrienol also demonstrated strong anti-inflammatory effects in RA models. The single clinical trial available in the literature showcases that palm tocotrienol could improve joint function among patients with OA. In conclusion, tocotrienol could be a potential anti-arthritic agent pending more results from clinical studies.

Meta-analysis of different joint interfaces in total hip arthroplasty under long-term follow-up

To compare the long-term follow-up effect and complications of ceramic on ceramic (CoC) interface and ceramic on polyethyleneon ceramic (CoP) interface in primary total hip arthroplasty, and provide clinical evidence. Search PubMed, EMBase, the CoChrane Library databases, Web of science, Wanfang database, and CNKI from January 2000 to September 2021, screening and inclusion of randomized controlled trials (RCTs) comparing the long-term efficacy and complications of CoC interface and CoP interface in total hip arthroplasty. Literature screening, quality evaluation and data extraction were carried out according to the inclusion and exclusion criteria, using Review Manager 5.3 statistical software. The software was used to perform statistical analysis on joint function, revision, prosthesis fracture, abnormal joint noise, and prosthesis wear rate after CoC or CoP. Seven RCTs studies were included, including 390 cases of hips with CoC artificial joints and 384 cases of hips with CoP artificial joints. The long-term joint function improvement of CoC and CoP artificial joints was similar and there was no significant differences, with an average difference was MD=0.63, 95%CI=(-1.81, 3.07), P=0.61. About the postoperative complications, CoC artificial joints have higher incidence rate of abnormal joint noise, with odds ratio (OR)=11.05, 95%CI=(2.04, 59.84), P=0.005. CoP artificial joints wear faster, with an average MD=-87.11, 95%CI=(-114.40, -59.82), P<0.000 1. There was no significant difference between the two groups in the replacement-related complications such as joint dislocation, prosthesis loosening, osteolysis, and the rate of prosthesis revision caused by various reasons. The clinical function results and complications of CoC artificial joints are comparable to those of CoP artificial joints. Although CoP artificial joint prosthesis has a faster wear rate, it does not affect joint function and increase complications, and there is no abnormal joint noise. CoC is expensive and the long-term efficacy is equivalent to CoP. Clinicians should consider cost performance when choosing CoC.

The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: A protocol for systematic review and meta-analysis.

Knee osteoarthritis (OA) is a common clinical degenerative disease of the joints, which is prone to occur in middle-aged and elderly people. At present, the disease cannot be cured, it is mostly treated with drugs to relieve symptoms, improve joint function, protect cartilage, such as glucosamine, anti-inflammatory and analgesic drugs, and but the efficacy is not lasting and the recurrence rate is high. Hydrotherapy has become a long-term alternative therapy in China and is receiving increasing attention. We perform a protocol for systematic review and meta-analysis to determine the efficacy and safety of a hydrotherapy program in individuals living with knee OA. This protocol will be designed in accordance with the preferred reporting items for systematic reviews and meta-analysis protocols. It is registered on the international prospective register of systematic reviews (No. CRD42022365564). We will search the following databases: The Cochrane Skin Group Trials Register, MEDLINE, EMBASE, The Cochrane central register of controlled trials, Chinese biomedical literature database, Chinese medical current content and China national knowledge infrastructure. The risk of bias of the included studies will be appraised using the Cochrane collaboration tool. Statistical analysis will be performed using IBM SPSS Statistics (Armonk, NY). This systematic review will summarize the short- and long-term clinical outcomes of hydrotherapy for knee OA. The findings from this review will establish the quality of currently available evidence, which will determine the need for further studies to establish the true effect size of hydrotherapy in knee OA.

Efficacy of etanercept in rheumatoid arthritis patients and its effects on interleukin 6 and serum tumor necrosis factor α

Purpose: To study the effects of etanercept (ETA) on the clinical manifestations and serum levels of TNF-α and IL-6 in rheumatoid arthritis (RA) patients.&#x0D; Methods: A retrospective analysis was performed on the medical files of 138 active RA patients admitted to Guangdong Second Provincial General Hospital, Guangzhou, China for rheumatic diseases from January 2016 to February 2019. Out of the total subjects, 58 patients were administered conventional methotrexate (MTX) as routine treatment (control group), while the remaining 80 patients (classified as study group) received subcutaneous injection of etanercept (ETA). Health Assessment Questionnaire (HAQ) score, and TNF-α and IL-6 serum concentrations of the two groups before and after treatment were assessed.&#x0D; Results: Pre-treatment HAQ score was comparable in both groups (p &gt; 0.05). However, at 3, 6, 9 and 12 weeks post-treatment, HAQ scores decreased in the two groups. The mean score was significantly lower in study group than in control group (p &lt; 0.001). Pre-treatment serum levels of IL-6 and TNF-α in both groups were comparable. However, after treating for 3, 6, 9 and 12 weeks, serum IL-6 and TNF-α decreased significantly, with lower values in the study group than in control group (p &lt; 0.001).&#x0D; Conclusion: ETA has a higher efficacy and safety than MTX for the treatment of joint inflammation and and also achieved greater improvement of joint function. However, further clinical trials are recommended prior to wider application in clinical practice.

Low molecular weight hyaluronates: biological action, efficacy, safety and clinical experience in the treatment of musculoskeletal pain syndromes (literature review and clinical observations)

Hyaluronic acid (HA) drugs are ingrained in complex treatment of osteoarthritis (OA). They have not only lubricant, but also anti-inflammatory properties, and ability to slow down the progression of OA. The article summarizes current data on the efficacy and safety of low molecular weight HA. The possibilities of using it both intra-articularly (i/a) and for the treatment of tendinopathies are considered. The authors present their own clinical experience in the treatment of patients with musculoskeletal (MS) pain syndromes.It has been shown that i/a administration of HA can effectively reduce the intensity of pain and improve joint function, and when injected into the synovial sheaths of tendons, it can also relieve pain of extra-articular localization. The peculiarities of the surgical technique, preparing for manipulation and post-injection period management are described.The existing evidence base indicates the expediency of active use of HA drugs not only for OA treatment, but also for various extra-articular musculoskeletal pain syndromes.

Arthroscopic synovectomy of the wrist

The theoretical rationale of synovectomy is to reduce or eliminate the aggressive inflammatory cell mass, thereby reducing swelling, decreasing pain, and improving joint function. Traditionally, open-wrist synovectomy is the standard treatment, as it allows an inspection of all compartments and extensor tendons. Arthroscopic synovectomy of the wrist was first introduced by Roth and Poehling in 1990. Since then, it has been successfully performed in selected patients. Arthroscopic synovectomy might be indicated in any disease that leads to long-standing synovitis of the wrist and when other treatment modalities do not provide satisfactory symptom reduction or may be contraindicated. Arthroscopic synovectomy is a surgical procedure with minimal morbidity. It results in less damage to the joint capsule and ligaments, thereby hastening rehabilitation and shortening the hospital stay. Therefore, we think that understanding the surgical technique for wrist arthroscopic synovectomy and appropriately applying it to patients could prevent disease progression in patients with wrist arthritis and overcome incapacitating dysfunction of the upper limb, including the wrist, hand, and forearm.

Cognitive behavioral therapy achieves better benefits in relieving postoperative pain and improving joint function: A systematic review and meta-analysis of randomized controlled trials

BackgroundCognitive behavioral therapy (CBT) is a structured, short-term psychotherapy approach that may have positive effects in terms of relieving postoperative pain. The main objective of this study was to determine the effect of CBT on pain and joint function in patients after total joint arthroplasty. MethodsWe searched 3 electronic databases including randomized controlled studies (RCTs) using CBT as an intervention. The main results of this study were to determine pain intensity by NRS, VAS, WOMAC pain Scale, PCS, and joint function by HHS, OKS, EQ-5D, ROM. Data extraction and quality assessment of included RCTs were independently performed by the authors and date analysis was performed by RevMan V.5.4. ResultsAmong the 605 studies, 9 RCTS were included in this systematic review and meta-analysis. The study showed that the difference between CBT and usual care groups in PCS (≤3months), NRS, VAS (≤3months) were statistically significant (P < 0.05); the difference between CBT and usual care groups in PCS (≥12months), WOMAC Pain Scale, and VAS (≥12months) were not statistically significant (P > 0.05), indicating that CBT can improve pain in patients after arthroplasty in the early term. In addition, the difference between CBT and usual care groups in OKS (≤3months), HSS, ROM (≤3months), EQ-5D (≤3months) were not statistically significant (P > 0.05); the difference between CBT and usual care groups in EQ-5D (≥12months) were statistically significant (P < 0.05), indicating that the quality of life in patients after total joint arthroplasty were improved with the extension of follow-up time. ConclusionsThis study shows that CBT can relieve pain in patients with total joint arthroplasty in the early postoperative period and improve quality of life to some extent over time.

Research Advances in the Application of AI for Preoperative Measurements in Total Knee Arthroplasty

Total knee arthroplasty (TKA) is widely used in clinical practice as an effective treatment for end-stage knee joint lesions. It can effectively correct joint deformities, relieve painful symptoms, and improve joint function. The reconstruction of lower extremity joint lines and soft tissue balance are important factors related to the durability of the implant; therefore, it is especially important to measure the joint lines and associated angles before TKA. In this article, we review the technological progress in the preoperative measurement of TKA.