Treatment Of Knee Osteoarthritis Research Articles

Effects of tranexamic acid on postoperative knee activity and stress, and inflammation cytokines in patients undergoing total knee arthroplasty.

Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, with postoperative bleeding and the inflammation-stress response being key factors that influence its outcomes. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in controlling perioperative bleeding. This study was to examine the effects of different doses of TXA on postoperative knee mobility and the inflammation-stress response in patients undergoing TKA METHODS: Ninety-eight patients undergoing unilateral TKA were randomly grouped based on the dose of TXA administered: 10mg/kg (AG), 15mg/kg (BG), and 20mg/kg (CG). The bleeding, coagulation function, inflammation-stress cytokines, pain visual analogue scale (VAS) scores, knee mobility, and knee function hospital for special surgery (HSS) scores of the subjects were compared. As the dose of TXA increased, the postoperative drainage volume, hidden bleeding, and total bleeding in TKA patients decreased, the levels of inflammatory factors interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were reduced, the levels of stress factors malondialdehyde (MDA), angiotensin II (Ang II), and cortisol (Cor) were reduced, pain VAS scores decreased, and knee mobility increased, with an increase in functional HSS scores (P < 0.05). The administration of 20mg/kg TXA in TKA patients visibly reduced bleeding following operation, improved the inflammation-stress response, and enhanced the function of the affected knee, which is beneficial to the postoperative recovery process.

Ozone therapy for knee osteoarthritis: a literature visualization analysis of research hotspots and prospects.

Medical ozone is a molecule composed of three oxygen atoms with anti-inflammatory, analgesic, and antioxidant functions. Ozone therapy (O3 or O2- O3) for knee osteoarthritis has gradually received increasing attention from researchers in recent years. Here, we discuss the research hotspots and development trends of ozone therapy for knee osteoarthritis through literature visualization and analysis. (1) From 2012 to the present, the overall trend of publications on ozone treatment for knee osteoarthritis has been increasing annually, and it has received widespread attention, especially in Iran and China. (2) Keyword analysis revealed that the keywords with the greatest number of citations for ozone treatment of knee osteoarthritis are "osteoarthritis," "ozone," "knee osteoarthritis," "ozone therapy," and "hyaluronic acid." (3) The results of the cocitation analysis revealed that the themes of the cocited literature are concentrated in 11 directions: intra-articular injections, intra-articular oxygen ozone, treatment of knee osteoarthritis, rehabilitation studies, time effects, pain function, comprehensive review, growth factors, rheumatic diseases, ultrasound-guided corticosteroid injections, and placebo. (4) The hotspots of the available highly cited literature have focused mainly on the efficacy and safety of ozone or growth factors alone in the treatment of knee osteoarthritis. Most of the literature suggests that intra-articular injections are the most common form of ozone therapy, and the accuracy and safety of ozone injections can be ensured using ultrasound-guided techniques. Ozone therapy has a positive short-term effect on pain control and functional recovery within 6 months after injection, but how to maintain the long-term efficacy of ozone therapy has rarely been described. It is hypothesized that the combination of ozone and growth factors may be beneficial for prolonging the efficacy of ozone therapy. (5) Ozone therapy has no advantages over other therapies in terms of therapeutic efficacy. Compared with ozone therapy, platelet-rich plasma and growth factor-rich plasma have better long-term outcomes in the treatment of knee osteoarthritis, whereas stromal vascular components have the best effects on pain relief and functional improvement. Few studies address the combination of ozone and growth factors for the treatment of knee osteoarthritis, and a few clinical studies registered have explored other treatments (e.g., corticosteroids). (6) Future studies could further explore the specific mechanisms and optimal dosing regimens of ozone combined with different growth factors in the treatment of knee osteoarthritis to compensate for the short-term efficacy of ozone therapy and to validate the long-term efficacy and safety of this combination therapy. It is also imperative to develop international guidelines for ozone therapy for osteoarthritis of the knee as soon as possible.

Causal effects of circulating inflammatory proteins on knee and hip osteoarthritis: A two sample Mendelian randomization study.

Numerous circulating proteins are linked to the presence or severity of joint inflammation. However, traditional studies could not explain whether these protein biomarkers are proximate to disease progression. We conducted a study to explore the causal effects of 91 circulating inflammation-related proteins (CIPs) on knee osteoarthritis (KOA) and hip osteoarthritis (HOA), using two-sample Mendelian randomization (MR). The primary analysis utilized the inverse variance weighted (IVW) method, augmented by complementary approaches including weighted median, weighted mode, simple median, MR-Egger, and MR-PRESSO analysis. Sensitivity analysis validated the robustness of the results and ensured the absence of heterogeneity and horizontal pleiotropy. We identified 2 CIPs with a causal effect on KOA, including CXCL9 (OR = 1.249, 95% CI = 1.046-1.492, P = 0.014) and TNF-β (OR = 1.105, 95% CI = 1.014-1.204, P = 0.023). Additionally, 3 CIPs were found to have a causal effect on HOA, including CXCL6 (OR = 1.058, 95% CI = 1.004-1.116, P = 0.035), RANKL (OR = 1.067, 95% CI = 1.002-1.137, P = 0.044), and VEGFA (OR = 1.072, 95% CI = 1.008-1.140, P = 0.027). In the current study, our findings indicated that CXCL9 and TNF-β had the potential to influence the risk of KOA, while CXCL6, RANKL, and VEGFA could impact the risk of HOA. These discoveries underscored the significance of these proteins as potential targets for intervention in the prevention and treatment of KOA and HOA. Key Points •We presented genetic evidence supporting a causal link between circulating inflammatory proteins associated with joint inflammation using MR methods. •5 CIPs have demonstrated promotive effects on the occurrence of KOA and HOA.

Efficacy of generic versus branded diacerein for treatment of knee osteoarthritis: A randomized control trial.

Several studies have proved that diacerein effectively treats knee osteoarthritis (OA). All studies used branded diacerein. Recently, generic diacerein has been available in several countries, with limited studies comparing the efficacy of generic and branded diacerein for knee OA treatment. Among 200 eligible patients, 94 were randomized to take a daily 50 mg of generic diacerein (Diaceric®); group A or branded diacerein (Artrodar®); group B for treating mild to moderate knee OA. All patients were assigned 5-visit assessments and followed until 24 weeks. The primary outcome was a visual analog scale (VAS) on the motion. The secondary outcomes were 2 patient-report outcome measures (PROMs): the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Short Form-12 (SF-12), as well as 3 performance-based measures (PBMs): 5-time sit to stand test (5 × SST), the time up and go test (TUGT), and the 3-minute walk test (3MWT). There were 47 patients in group A and 47 in group B, with no patients lost for FU. Among all patients, 79.8% were female with a mean age of 63.2 years in group A and 64.8 years in group B. The Kellgren and Lawrence (KL) grade II was the most common in both groups. There were no differences in all demographic data. At 24-week follow-up (FU), both groups had significantly improved VAS, with a 12-week earlier improvement in the branded diacerein. In addition, the PBMs, including 5 × SST and 3MWT, significantly improved from 12-week FU in both groups, with insignificantly improved WOMAC and SF-12 and no serious adverse events in either group. After a 24-week FU, the generic diacerein had similar efficacy as the branded diacerein in significantly improving VAS and PBMs: 5 × SST and 3MWT. However, the latter had a faster statistically improved VAS than the former.

Knowledge and utilization of manual therapy in the management of knee osteoarthritis by physical therapists in Saudi Arabia: a cross-sectional study

BackgroundThe knowledge and utilization of manual therapy in treating knee osteoarthritis (OA) may help explain the effective utilization of manual therapy for managing knee OA. Little is known about the knowledge and utilization of manual therapy in the management of knee OA by physical therapists (PTs) in Saudi Arabia. The present study aimed to evaluate the knowledge and utilization of manual therapy by PTs in Saudi Arabia via a survey method.MethodsA cross-sectional study design was used. PTs working in various hospitals in Saudi Arabia participated. A 29-item questionnaire was developed based on previous studies. One hundred ninety-seven participants returned the completed questionnaire (response rate, 78.8%). Descriptive statistics were utilized to summarize and present the study participants’ characteristics and responses.ResultsApproximately one-third (35.2%) of the participants did not receive any formal manual therapy training, whereas the others received formal manual therapy training in undergraduate (23.8%) or postgraduate (40.9%) studies. Only approximately one-third of the participants (29.9%) were qualified as certified manual therapy practitioners. Most participants (57%) reported using manual therapy according to the patient’s condition. Most of the participants cited several treatment goals for manual therapy, including pain reduction (84.8%), improved range of motion (77.2%), increased mobility (58.2%), and improved function (55.4%).ConclusionsPTs in Saudi Arabia showed a positive attitude toward using manual therapy for treating knee OA. However, they suggested combining exercise and manual therapy as the best treatment option for knee OA.Trial registrationNot applicable.

Posterior iliac crest vs. proximal tibia: distinct sources of anti-inflammatory and regenerative cells with comparable 6-month clinical outcomes in treatment of osteoarthritis

BackgroundHuman bone marrow is a source of mesenchymal stem cells (MSCs), other progenitor cells, and factors with anti-inflammatory and regenerative capacity. Though the fraction of MSCs out of the nucleated cells is very small, bone marrow aspirate (BMA) for osteoarthritis (OA) has noteworthy effects. BMA is usually collected from the posterior or anterior iliac crest, and rarely from the proximal tibia. We investigated the clinically beneficial concentration of ex vivo MSCs, derived from BM harvested from the posterior iliac crest and proximal tibia by Marrow Cellution™ Aspiration System, and their phenotypic differences, in comparison to autologous Platelet-Rich Plasma (PRP) treatment prepared with a manual, closed system.MethodsA single-center, parallel, randomized controlled study was designed to investigate the efficacy of BMA from the posterior iliac crest compared to BMA from the proximal tibia, against a control group treated with PRP, in knee OA. Thirty patients with knee OA grade I-IV, according to Kellgren-Lawrence (KL), were distributed into each group. Visual Analog Scale (VAS) and Western Ontario & McMaster Universities Arthritis Index (WOMAC) score were used for clinical outcome evaluation.ResultsData from an intermediate analysis of 6-months follow-up, involving 15 patients in each arm, showed that the posterior iliac crest was significantly more densely populated with mononuclear cells, than the proximal tibia (p = 0.005). Flow cytometric analysis on ex vivo BMA showed a significantly greater number of MSCs in the BM-derived from the posterior iliac crest when compared with the proximal tibia (p < 0.001), together with a significantly higher number of platelets (PLTs) (p < 0.001). Surprisingly, despite these differences in cells number, the improvement in early pain and function scores, after each treatment, were statistically significant within each of the three arms. BM from the proximal tibia showed the highest ΔWOMAC, while BM from the posterior iliac crest showed the highest ΔVAS; however, these differences were not statistically significant across the three arms (p > 0.05). A better outcome, in terms of ΔVAS, was observed in patients classified as KL I-II, when treated with BMA from crest (p < 0.001) and PRP (p = 0.004). Moreover, the effect of BMA treatment on ΔVAS depends on MSCs % only in the Tibia Arm (r = -0.59, p = 0.021), where we also found a correlation between ΔWOMAC and monocytes (r = 0.75, p = 0.016).ConclusionThe results indicate that the iliac crest yields a higher concentration of MSCs compared to the proximal tibia, however both BM, independently of the MSCs concentration, show a beneficial clinical outcome in the treatment of knee OA. Furthermore, BMA is not superior to PRP treatment.

Infiltration of micro-fragmented adipose tissue under local anesthesia for knee osteoarthritis treatment is a safe procedure: A case series

IntroductionKnee osteoarthritis is a debilitating disease that has been increasing in prevalence, especially due to the aging population and rising incidence of obesity. Biological therapies (orthobiologics) have emerged, demonstrating efficacy in improving functional scores, including the injection of microfragmented Adipose Tissue (mFAT). The purpose of this study is to evaluate the safety of adipose tissue harvesting and mFAT injection under local anesthesia. Materials/methodsA case series involving 34 patients who underwent adipose tissue collection from the abdomen under local anesthesia, without sedation, in a sterile environment, and who received the infiltration of microfragmented adipose tissue after single-time preparation, using a fat washing and microfragmentation kit. ResultsEvaluation was performed at the time of the procedure and after 7 days of follow-up. Only ecchymosis (76.5 %) and mild discomfort at the harvested site (70.6 %), as well as mild discomfort at the infiltrated knee (61.8 %), were identified. No major adverse events were identified. ConclusionThe harvesting and injection of mFAT under local anesthesia is safe, with no major adverse events identified during this procedure.

Complications following bilateral simultaneous versus staged total knee arthroplasty in the Japanese population: a propensity-matched case-control study

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. This study aimed to determine the differences in perioperative parameters and complication rates between BSTKA and staged TKA in the Japanese population. We retrospectively reviewed 531 patients who underwent BSTKA or staged TKA between 2012 and 2021. Propensity score matching, performed on a 1:1 nearest neighbor basis for age, BMI, diagnosis, ASA score, and age-adjusted Charlson Comorbidity Index, yielded matched cohorts of 94 patients (188 knees) for each group. Outcome measures included operative time, perioperative blood loss, length of hospital stay, and nonmechanical complications after surgery. The BSTKA group had a shorter median operative time and hospital stay (111 min and 16 days) than the staged TKA group (159 min and 33 days) (p < 0.001). Overall complication rates were higher in the BSTKA group than in the staged TKA group (26% vs. 13%, p = 0.026), with anemia requiring transfusion being the most common. Cardiovascular complications were more frequent in the BSTKA group (4.3% vs. 0%, p = 0.043). These findings emphasize the importance of careful patient selection and risk assessment when considering BSTKA.

Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.

Osteoarthritis (OA) poses a significant global burden, with conventional treatments like corticosteroid and hyaluronic acid (HA) injections commonly used. Emerging injectable biologics, including bone marrow aspirate concentrate (BMAC), show promise in OA management. To investigate the clinical efficacy of BMAC injection compared with other injection treatments for knee OA. Systematic review; Level of evidence, 1. A systematic review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar to identify randomized controlled trials with Level 1 evidence that compared the clinical efficacy of BMAC with other injections. The visual analog scale for pain and the Pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) were used as clinical scores representing pain. For functional assessment, the Western Ontario and McMaster Universities Osteoarthritis Index and the International Knee Documentation Committee subjective form were used. For studies comparing BMAC with HA, each clinical score was standardized to pain and function scales based on the minimal clinically important difference (MCID). Eight studies, consisting of a total of 937 patients, were included. Patients treated with BMAC showed a significant improvement in clinical scores compared with baseline, starting at 1 month postinjection. For pain scores at 6-month (P = .033) and 12-month follow-up (P = .011), BMAC demonstrated favorable results over HA, with a statistically significant difference. However, these differences did not exceed the MCID. When BMAC was compared with other injections, no significant differences were observed in the degree of clinical score improvement. No serious adverse events or events significantly associated with BMAC compared with other treatments were reported. BMAC injections demonstrated effectiveness in providing pain relief and functional improvement for patients with knee OA. When BMAC was compared with other intra-articular injection options, distinct differences surpassing the MCID were not evident. Further research is deemed necessary to investigate the role of BMAC in the treatment of knee OA.

Impact of Health Education Programme on Adherence to Treatment in Knee Osteoarthritis: An Interventional Study on Egyptian Patients.

To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence. A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed. One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p=0.016) and improved function as measured by WOMAC (p=0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%). Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

Conservative and joint-preserving therapy for knee osteoarthritis

The treatment of knee osteoarthritis requires a multimodal approach and depends on the symptoms and stage of the disease. Conservative therapy is the first-line treatment and includes life-style changes (weight loss, exercise therapy), topical and oral pain medication, and intraarticular application of hyaluronic acid or platelet-rich plasma. Surgical joint-preserving therapies comprise knee arthroscopy to remove unstable meniscus tears or foreign bodies as well as osteotomy for unicompartmental arthrosis in case of leg malalignment.

The Molecular Mechanism Investigation of HBP-A Slows Down Meniscus Hypertrophy and Mineralisation by the Damage Mechanical Model.

HBP-A is the main active component of a traditional Chinese medicine Huaizhen Yanggan Capsule, for the remarkable treatment of knee osteoarthritis (KOA). This study aimed to elucidate the ameliorative effect of HBP-A on meniscus hypertrophy and mineralisation in KOA and the molecular mechanism of its action. An Hartley guinea pig model of KOA that underwent anterior cruciate ligament transection (ACLT) and a model of rat primary meniscus fibrochondrocytes (PMFs) were used to investigate the ameliorative effect of HBP-A on meniscal hypertrophy and calcification and its signal transduction mechanism of action. The results show that Guinea pig's meniscus width, as well as the area of meniscus calcification and meniscus and articular cartilage injury score, were significantly reduced in the HBP-A intervention group compared to the ACLT group. The expression levels of mtrix metalloproteinase 13 (MMP13), runt-related transcription factor 2 (Runx2), Indian hedgehog (Ihh), alkaline phosphatase (ALP), and ankylosis homologue (ANKH) at the protein and gene level significantly decreased in the HBP-A intervention group compared to the ACLT group. Invitro study, apoptosis, hypertrophy, and calcification of rat PMFs after 10% stretch force were significantly improved with HBP-A intervention. Western blot and RT-qPCR showed that hypertrophy, calcification, and p38 MAPK signalling pathway-related markers of PMFs were incredibly depressed in the HBP-A intervention group compared to the 10% stretch force group. In conclusion, HBP-A can slow down meniscus hypertrophy and mineralisation induced by abnormal mechanical loading, and its mechanism of action may be through the p38-MAPK signalling pathway.

Exploring the correlation between knee osteoarthritis and musculoskeletal ultrasound manifestations based on changes in traditional Chinese medical syndrome types.

This study explores the correlation between knee osteoarthritis and musculoskeletal ultrasound manifestations based on changes in traditional Chinese medicine (TCM) syndrome types. The study enrolled 104 patients with knee osteoarthritis admitted to the Gansu Provincial Hospital of TCM between January 2019 and January 2021. According to the principle of syndrome differentiation and treatment in TCM, the patients were divided into wind-cold-damp obstruction (n = 17), damp-heat accumulation (n = 22), qi-stagnation and blood stasis (n = 31), and liver and kidney deficiency (n = 34) types. The degrees of cartilage injury, synovial hyperplasia, synovial blood flow, and joint effusion in patients with different TCM syndrome types were compared using ultrasound. There were no significant differences in the degree of cartilage injury or synovial hyperplasia among the 4 TCM syndrome types (P > .05). The proportion of grade III blood flow signals in the liver and kidney deficiency group was lower than that in the damp-heat accumulation and wind-cold-damp obstruction groups, and the proportion of no blood flow and grade I blood flow signals were higher than those in the damp-heat accumulation and wind-cold-damp obstruction groups (P < .05). The proportion of non-joint effusion in the liver and kidney deficiency and wind-cold-damp obstruction groups was higher than that in the damp-heat accumulation and qi-stagnation and blood stasis groups (P < .05), and the proportion of grade I effusion in the damp-heat accumulation group was higher than that in the liver and kidney deficiency group (P < .05). Musculoskeletal ultrasound manifestations of knee osteoarthritis are related to TCM syndrome differentiation and classification and can provide a reference for TCM syndrome differentiation and treatment of knee osteoarthritis.

Efficacy of serum-free cultured human umbilical cord mesenchymal stem cells in the treatment of knee osteoarthritis in mice.

We investigated the efficacy of intra-articular injection of human umbilical cord mesenchymal stem cells (hUC-MSCs) for the treatment of osteoarthritis (OA) progression in the knee joint. Although many experimental studies of hUC-MSCs have been published, these studies have mainly used fetal bovine serum-containing cultures of hUC-MSCs; serum-free cultures generally avoid the shortcomings of serum-containing cultures and are not subject to ethical limitations, have a wide range of prospects for clinical application, and provide a basis or animal experimentation for clinical experiments. To study the therapeutic effects of serum-free hUC-MSCs (N-hUCMSCs) in a mouse model of knee OA. Fifty-five male C57BL/6 mice were randomly divided into six groups: The blank control group, model control group, serum-containing hUC-MSCs (S-hUCMSC) group, N-hUCMSC group and hyaluronic acid (HA) group. After 9 weeks of modeling, the serum levels of interleukin (IL)-1β and IL-1 were determined. Hematoxylin-eosin staining was used to observe the cartilage tissue, and the Mankin score was determined. Immunohistochemistry and western blotting were used to determine the expression of collagen type II, matrix metalloproteinase (MMP)-1 and MMP-13. The Mankin score and serum IL-1 and IL-1β and cartilage tissue MMP-1 and MMP-13 expression were significantly greater in the experimental group than in the blank control group (P < 0.05). Collagen II expression in the experimental group was significantly lower than that in the blank control group (P < 0.05). The Mankin score and serum IL-1 and IL-1β and cartilage tissue MMP-1 and MMP-13 levels the experimental group were lower than those in the model control group (P < 0.05). Collagen II expression in the experimental group was significantly greater than that in the model control group (P < 0.05). N-hUCMSC treatment significantly alleviate the pathological damage caused by OA. The treatment effects of the S- hUCMSC group and HA group were similar.

Effect of the Zushima patch combined with celecoxib on pain and inflammatory factor expression in knee osteoarthritis with cold‐dampness obstruction

AbstractBackgroundKnee osteoarthritis (KOA) is a chronic degenerative joint disease that frequently occurs in middle‐aged and older individuals. Although celecoxib is a commonly used drug for the treatment of KOA, its efficacy and safety have limitations. Zushima, a traditional Chinese medicine, is commonly used for treating joint pain and has anti‐inflammatory and analgesic properties. This study aims to explore the effect of the Zushima patch combined with celecoxib on pain and inflammatory factor expression in knee osteoarthritis (KOA) patients with cold‐dampness obstruction.MethodsA total of 100 patients with KOA of cold‐dampness obstruction were randomly divided into a treatment group (n = 50) and a control group (n = 50). Patients in the control group received oral administration of celecoxib capsules, whereas the treatment group received the Zushima patch combined with oral administration of celecoxib capsules. Then, the efficacy and safety were compared, together with the traditional Chinese medicine (TCM) syndrome score, pain, and knee joint function. We also determined the concentrations of osteoprotegerin (OPG), insulin‐like growth factor (IGF‐1), osteocalcin (OC), and inflammatory factors such as interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6), and C‐reactive protein (CRP). Finally, the safety between the two groups was compared.ResultsThe total effective rate in the treatment group was significantly higher than that in the control group. After treatment, the levels of the TCM syndrome score, pain score, IL‐1, IL‐6, and CRP in the treatment group showed significant decreases compared with those in the control group, while the scores of OPG, IGF‐1, OC, and knee joint function in the treatment group showed significant increases compared with those in the control group. There was no significant difference in adverse events between the two groups.ConclusionsThe Zushima patch combined with celecoxib could relieve the pain of KOA with cold‐dampness obstruction and improve knee joint function. These effects may be the result of the downregulation of inflammatory factors and the regulation of joint fluid‐related indices.

Exploration of the molecular mechanism of Wufu Yin in the treatment of knee osteoarthritis based on network pharmacology and experimental validation

Wufu Yin (WFY) exhibits significant clinical effectiveness in knee osteoarthritis (KOA) treatment, yet its therapeutic mechanisms are still unclear. This study aimed to explore the active ingredients and potential mechanism of WFY in the treatment of KOA. The network pharmacology-based approach was adopted to investigate the underlying mechanism of WFY in treating KOA. Molecular docking analysis was performed using Auto Vina software. An in vitro model of KOA inflammation was established by inducing chondrocyte cultures with interleukin-1 beta (IL-1β). Cell viability was quantified through the cell counting kit-8 assay, inflammatory cytokine levels were measured via ELISA, and protein expressions were assessed by Western blot analysis. A total of 225 active ingredients and 265 targets of WFY were identified, of which 88 were identified as potential targets against KOA. Enrichment analysis showed that these targets were associated with oxidative stress, cell proliferation and apoptosis, and inflammatory response, and were involved in the regulation of Th17 cell differentiation, IL-17 signaling pathway, tumor necrosis factor signaling pathway, and other signaling pathways. Topology analysis showed that PTGS2, NOS2, ESR11, PPARG, and MAPK14 had higher degree values and were key targets of WFY in the treatment of KOA. Molecular docking analysis showed that these key targets and active ingredients had low binding energies, indicating that they had potential binding activity. Furthermore, IL-1β-induced elevation of inflammatory cytokines, PTGS2 protein expression, and phosphorylated p38/p38 ratios in chondrocytes were significantly attenuated upon WFY intervention. Our study systematically elucidated the pharmacological basis and molecular mechanism underlying WFY’s therapeutic effects in KOA, substantiating its ability to suppress inflammation and regulate PTGS2 expression and p38 phosphorylation.

Acupotomy therapy for knee osteoarthritis: An overview of systematic reviews

Background: This study aimed to evaluate the methodological quality, report quality, and evidence quality of a meta-analysis (MA) and systematic review (SR) of the efficacy of acupotomy in the treatment of knee osteoarthritis (KOA), and provided a reference for clinical decision-making. Methods: We searched 8 databases to collect systematic reviews and meta-analyses on the efficacy of acupotomy in the treatment of KOA from January 30, 2018, to January 31, 2023. The methodological quality of the studies was assessed using the assessment of multiple systematic reviews (AMSTAR) 2 scale, the quality of the literature reports was scored using the Preferred Reporting Items for Systems Reviews and Meta-Analyses 2020 Version (PRISMA 2020),and the quality of the evidence was graded using the grading of recommendations assessment, development, and evaluation (GRADE) scale. Results: Nine systematic reviews including 35 outcome indicators were included. AMSTAR 2 evaluated the methodological quality of the included studies, and 1 was of low quality, 8 were of very low quality, and the entries with poor scores were 2, 3, 4, 8, 10, 12, and 13. By PRISMA 2020, there were some reporting deficiencies, and quality problems were mainly reflected in the abstract, information sources, search strategy, synthesis methods, reporting bias assessment, certainty assessment, reporting biases, certainly of evidence, registration and protocol. The GRADE classification results showed that there were 2 medium-quality evidences, 7 low-quality evidences, and 26 very low-quality evidences. The main factors of degradation were limitations, imprecision, and publication bias. Conclusion: Acupotomy had been a promising complementary treatment for KOA. However, due to the low quality of the SRs/MAs supporting these results, high-quality studies with rigorous study designs and larger samples were needed before widespread recommendations could be made.

Weight loss for obese patients as a treatment of hip and knee osteoarthritis: A scoping review

Background: The American Academy of Orthopaedic Surgeons (AAOS) has been recommending a weight loss of 5% of body weight or more as a treatment for those who have osteoarthritis (OA). However, the AAOS does not recommend or guide clinicians in the best weight loss strategies, leaving the clinician and the patients on their own to navigate the weight loss process.Aim: This scoping review addresses the most effective ways to reach the recommended weight loss and achieve symptomatic improvement through various methods, including diet, exercise, meal replacements and specific diet types, with or without the help of a trained professional.Methods: In a scoping literature review, this author investigated medication use, diet, exercise or a combination of diet and exercise as an effective method for weight loss to treat hip and knee osteoarthritis and whether the delivery method (i.e., telehealth or application-based versus in-person) played a role in the effectiveness of weight loss.Results: A loss of body weight between 10% and 20% results in more significant symptomatic improvement and is safe and effective with the help of a trained health care professional and meal replacement foods.Conclusion: A clear dose response exists between the amount of weight lost and symptomatic improvement, with better symptomatic improvement seen in patients losing more than the typically recommended 5% body weight.Contribution: This review shows that a weight loss of 10–20% of body weight through a low carbohydrate diet combined with exercise can effectively be used as symptomatic management of hip or knee osteoarthritis.

Multi-omics joint analysis reveals the mechanism underlying Chinese herbal Yougui Pill in the treatment of knee osteoarthritis

Ethnopharmacological relevanceYougui Pill (YGP), originating from Jingyue Quanshu, comprises 10 traditional Chinese medicines (TCMs). This classic prescription is renowned for its ability to tonify the kidney, warm the kidney, promote yang, warm the interior, and dispel cold. YGP has proven effective in treating degenerative knee arthritis, osteoporosis, delayed fracture healing, and other orthopedic conditions, making it a widely used clinical prescription for knee osteoarthritis (KOA).Aim of the study: Although YGP is commonly used in clinical practice, its pharmacodynamic material basis and anti-arthritis mechanisms remain unclear. This study aims to comprehensively analyze the chemical constituents of YGP and elucidate its anti-arthritis mechanisms. Materials and methodsUltra-high performance liquid chromatography coupled with electrospray ionization-triple quadrupole-linear ion trap mass spectrometry(ESI-Q TRAP-MS/MS) was used to identify the chemical constituents of YGP. The Hulth method was utilized to establish KOA rat model, and pathological examinations were performed to assess the anti-arthritis effects of YGP. Integrated metabolomics and transcriptomics analyses were conducted to explore the anti-arthritis mechanisms of YGP. Key targets were confirmed via immunohistochemistry. ResultsA total of 1981 chemical components were identified in YGP, predominantly phenolic acids and flavonoids. Compared with the model group, 422 differentially expressed metabolites and 214 differentially expressed genes were identified, primarily involving the MAPK signaling pathway, FoxO signaling pathway, and PI3K-Akt pathway. YGP exerted an anti-osteoarthritis effect by inhibiting the excessive activation of the EGFR/ERT/FOS signaling pathway. ConclusionsTCM offers significant advantages in the treatment of KOA, addressing the shortcomings of current clinical medications. YGP displayed exceptional pharmacodynamic effects. This study elucidated its pharmacodynamic material basis and anti-osteoarthritis mechanisms, providing substantial support for its clinical application and the development of related drugs.

Effects of the umbilical cord mesenchymal stem cells in the treatment of knee osteoarthritis: A systematic review and meta-analysis.

This study aimed to evaluate the effects of umbilical cord mesenchymal stem cells (UC-MSCs) in the treatment of knee osteoarthritis. PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure and Wanfang databases were searched from inception to March 31, 2024. RevMan 5.3 was used to conduct meta-analyses of the final included studies. Three randomized controlled studies were conducted. Western Ontario and McMaster Universities Osteoarthritis Index was reduced in the UC-MSCs group compared that in to the control group (mean difference: -25.85; 95% confidence interval: -41.50, -10.20; P = .001). Knee Lysholm Score was improved in the UC-MSCs group compared with the control group (mean difference: 18.33; 95% confidence interval: 12.89, 23.77; P < .00001). Egger test showed P = .583, indicating no publication bias. Sensitivity analysis indicated that the results were stable. Intra-articular injection of UC-MSCs improved function and reduced pain in patients with knee osteoarthritis. However, the number of included studies was small and more studies are needed to confirm this.