Knee Osteoarthrosis Research Articles

Bone Tissue Metabolism in Dynamics of Experimental Knee Osteoarthrosis Induced by Dexamethasone and Talcum.

We studied remodeling of the bone tissue in the dynamics of experimental dexamethasoneand talcum-induced knee osteoarthrosis. Disturbed osteoclastogenesis accompanied by a decrease in the production of fibroblast growth factor-23 and elevation of serum osteoprotegerin and osteocalcin were observed at the early stages of the disease. During progression of degenerative and dystrophic processes in the joint tissues, an increase in sclerostin concentrations, a decrease in osteocalcin content, and changes in the force and direction of correlations between osteoblast processes and osteoclastogenesis as well as hierarchic distribution of the dominating mechanism of subchondral remodeling were revealed.

Protocol for the Request of Knee Magnetic Resonance Imaging in Elderly Patients with Suspected Osteoarthritis: Reduction in Test Requests and Impact on Management and Diagnosis.

Objective To develop an evidence-based protocol to guide magnetic resonance imaging (MRI) requests in elderly patients with suspected knee osteoarthrosis and to evaluate its effectiveness after implementation. Methods The institutional protocol was developed after reviewing the literature during the first semester of 2018. The control group was defined as patients cared for in the first semester of 2018, before the implementation/dissemination of the institutional protocol, and the study group was composed by patients cared for during the second semester of 2018 after the standardization of MRI requests for suspected knee osteoarthrosis. Results Our sample included 826 patients undergoing knee MRI, with a mean age of 69.3 years. Protocol implementation decreased MRI requests and increased radiograph requests ( p < 0.001). After the implementation of the protocol, the MRI changed the diagnosis or treatment in only 11.2% of the cases. Conclusion Protocol implementation resulted in a 47.5% reduction in the number of requests for knee MRI, with most (89%) patients with alteration in diagnosis or treatment. Level of evidence: case-control study (IIIB).

Osteoartrose do joelho e corrida recreativa: uma revisão baseada na evidência

Osteoarthritis is a major cause of joint pain and disability, with the knee joint being the most commonly affected. The aim of this study is to investigate the evidence about the possible association between recreational running and the development of this pathology which is still controversial and sparse. Of the 409 articles in the initial research, four were included in this review. It was concluded that recreational running does not predispose to the development of clinical or radiographic knee osteoarthrosis, on the contrary, it seems to have a protective effect.

The Risk of Knee Osteoarthritis in Professional Soccer Players—a Systematic Review With Meta-Analyses

We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis. A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria. The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%). A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.

Inflammatory Factor in Pathogenesis of Early Knee Osteoarthrosis

Osteoarthrosis (OA) is a polyetiologic pathology of the musculoskeletal system with various complicated mechanisms of progression, therefore making the investigation of an inflammatory factor role in the incidence of early primary knee osteoarthrosis in patients lacking clinical signs of the disease an important and promising research trend. We ran a complete examination of 27 patients with early OA lacking prominent clinical signs of the disease as well as 20 apparently healthy individuals (without musculoskeletal pathologies) using clinical (orthopedic status), instrumental (ultrasonography, X-ray radiography, MRI) and lab tests including quantification of main lymphocyte subpopulations, determination of inflammatory mediators – C-reactive protein, erythrocyte sedimentation rate, neopterin, proinflammatory cytokines as well as defining the specifics of cartilaginous tissue metabolism and free-radical oxidation condition. The investigation of the inflammatory factor role through the specifics of changes in its certain indicators in patients with early knee OA lacking clinical signs of the disease showed the presence of inflammatory response signs manifested in the certain increase of C-reactive protein, erythrocyte sedimentation rate and neopterin, relative activation of proinflammatory cytokines expression as well as an abnormality of cell immunity indicators and an emerging trend for the enhancement of free-radical oxidation along with the destructive changes in cartilaginous tissue proved with the increased cartilaginous glycoprotein-39 and cartilage oligomeric matrix protein in serum. The processes described above may accompany further activation of catabolic processes and facilitate the initiation of the immune response with cartilaginous tissue antigenic determinants. The immune response in its turn triggers the inflammatory destruction of the joint connective tissue components. The results are worth considering in the researches of pathogenetic mechanisms of primary OA progression at its early stages with no X-ray evidence, and therefore facilitate timely revealing of the disease and designing pathogenetic approaches for the administration of this cohort of patients.

Метаболизм субхондральной костной ткани при посттравматическом остеоартрозе у крыс

In rats with modeled posttraumatic knee osteoarthrosis, negative changes in subchondral bone metabolism were revealed: a tendency to an increase in osteocalcin concentration, a decrease in sclerostin and osteoprotegerin levels, and a significant increase in FGF-23 concentration accompanied by a slight elevation of inorganic phosphorous and significant increase in total calcium levels in comparison with the corresponding parameters in intact controls. These findings demonstrate crucial importance of structural integrity of the subchondral bone, because its protection improves the results of reconstructive therapy for local cartilage defects.

Laser Needling® and Natural origin, Highly Purifi ed Polynucleotides (PN-HPT™) in Knee Osteoarthrosis: Benefi ts in Physiatry and Sports Medicine

Background and Objectives: The purpose of the paper is to illustrate the real life clinical outcomes of a retrospective cohort of knee Osteoarthritis (OA) patients treated with a novel laser disease management program; at the same time, to defi ne the most effective operative procedure. The new laser technique mimics the in-vitro benefi ts of Low-Level Laser Therapies (LLLT). The study compared the 3month effi cacy and 6-month persistence of clinical and functional benefi ts after application of laser energy either externally with a standard High Power Laser Therapy (HPLT) laser device (AG1 device, FP3 version), or intra-articularly with the patented, low-energy AG8 intra articular fi ber device (ultrasound-guided, same wavelengths, no handpiece). This innovative laser device reduces to one hundredth the applied energy density. The pain suppressing effi cacy of the LLLT-like laser FP3 procedure is intended to act synergically with the strong biorestructuring and pain suppressing effi cacy of natural origin polynucleotides (PN-HPT™ or Highly Purifi ed Technology™) injected before the laser session. PN-HPT™ are widely used in knee OA management for their persistent viscosupplementation properties overlapping those of high molecular weight hyaluronic acid. Trial design: retrospective comparison of:  Short term 3 month effi cacy outcomes on pain and disability  6-month persistence of clinical improvements in two cohorts of patients with severe knee osteoarthritis. The active cohort knee OA patients (105 agonistic or recreative practitioners with persistent knee pain and disability resistant to conventional medical or physical therapies) were treated with an innovative intra articular low-energy AG8 physical therapy protocol (ambulatory “AG8 Protocol 3” combined with a preliminary PN-HPT™ knee injection); the control-cohort patients (109 patients with knee disease of similar severity) were treated with a standard, multi frequency HPLT ambulatory treatment protocol (FP3 device). Outcome parameters: Western Ontario and McMaster Universities (WOMAC) assessments at baseline (T0) and after 2 weeks (T2) and 3 months (T3). Secondary parameters: Nociceptive and neuropathic pain; assessment: standard 10 cm Visual Analogue Scale (VAS) immediately before and at the end of each treatment session. Results: Treatment with the AG8 protocol 3 / PN-HPT™ intra articular combination was associated with strongly signifi cant short term (2 weeks) and medium-term (3 months) benefi ts vs. controls treated with a conventional FP3 extra-articular treatment protocol both for the WOMAC Total Score and WOMAC Pain and Function subscores. Benefi ts for the WOMAC Stiffness subscore were borderline non-signifi cant. The subgroup analysis showed that the 2A (Grade-2 KL primary OA) and 2B (Grade-2 KL secondary (post-surgical) OA) mainly contributed to overall benefi ts. Conclusion: The study showed the intra-articular Laser Needling® technique (ultrasound-guided AG8 laser device, Protocol 3 plus infi ltration of a facilitating agent such as intra-articular PN-HPT™ gel) to be more effective on knee OA pain than the traditional extra-articular FP3 laser technique, with special reference to pain associated with primary OA.

Role of intra articular injection of autologous platelet rich plasma in osteoarthrosis of the knee joint

Osteoarthrosis (OA) represents a failure of the diarthrodial, synovial lined joint. Among the elderly, knee Osteoarthrosis is the most frequent cause of chronic disability [1]. Because of the increased life expectancy, the prevalence of osteoarthrosis is on the rise in the Indian population. Platelet rich plasma (PRP) is defined as a volume of plasma with a platelet concentration higher than average in peripheral blood. Many basic, preclinical and even clinical case studies and trails report PRP’s ability to improve musculoskeletal conditions including osteoarthrosis. Our study of platelet rich plasma has thrown up an exciting choice of treatment modality in knee osteoarthrosis, and it has proved efficient in observation period of one year.

Postural Stability and Regulation before and after High Tibial Osteotomy and Rehabilitation

Knee osteoarthrosis (OA) is a widespread orthopedic problem and a high tibial osteotomy (HTO) is a common treatment to minimize degeneration of the affected compartment. The primary aim of this study was to evaluate the postural regulation and stability among patients who underwent HTO and rehabilitation. This prospective study included 32 patients (55.3 ± 5.57 years) diagnosed with medial tibiofemoral OA. Each subject completed postural regulation and stability testing (Interactive Balance System), as well as pain intensity (visual analogue scale) and quality of life questionnaires (SF-36) prior to HTO (exam 1), and at six weeks (exam 2), twelve weeks (exam 3) and six months (exam 4) post HTO. For postural comparison, all patients were matched (sex, age, height) with asymptomatic subjects. Significant time effects (exam 1 vs. exam 4) were found for weight distribution index (WDI; ηp2 = 0.152), mediolateral weight distribution ηp2 = 0.163) and anterior–posterior weight distribution ηp2 = 0.131). The largest difference (exam 3: ηp2 = 0.251) and the most significant differences to the matched sample were calculated for the stability indicator (exam 1: ηp2 = 0.237; exam 2: ηp2 = 0.215; exam 3: ηp2 = 0.251; exam 4: ηp2 = 0.229). Pain intensity showed a significant reduction (ηp2 = 0.438) from exam 1 (50.7 ± 20.0 mm) to exam 4 (19.3 ± 16.0 mm). Physical pain was the quality of life parameter with the largest improvement between exams 1 and 4 (ηp2 = 0.560). HTO allows patients to improve their mediolateral weight distribution, whereas postural stability is consistently lower than in asymptomatic subjects. This surgery leads to marked improvements in quality of life and pain.

Functional outcome of intra articular platelet rich plasma injections in early osteoarthrosis knee

Functional outcome of intra articular platelet rich plasma injections in early osteoarthrosis knee - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.042, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Knee Osteoarthritis: Conservative or Surgical Treatment?

Osteoarthrosis (OA) or gonoarthrosis of the knee is a chronic disease with a high prevalence worldwide. As populations age, the number of affected increases, altering quality of life to varying degrees [1]. To determine the exact prevalence of knee OA, the definition of the disease used, the diagnostic method (clinical and/or imaging), and the affected joint are essential, for which reason the available data are diverse. Despite this, it is described that more than 50% of the population older than 65 years presents some type of OA, the most affected joint being the knee, with an incidence of 240/100,000 people/year [2]. This disease causes mechanical pain that is usually related to stiffness and progressively causes loss or decrease of joint function.

The influence of different concentration of proFLEX® INTRA on clinical progression and dynamics of laboratory test values in different age patients with knee osteoarthrosis

Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.

Application of pulse magnetotherapy in integrated treatment of patients with gonartrosis

Arthrosis is the most common joint disease in adults worldwide. Its incidence increases with age. In this study, the effectiveness of complex treatment was studied in 50 patients with an established diagnosis of stage I - III knee osteoarthrosis. All patients are non-steroidal anti-inflammatory drugs. Running along a pulsed magnetic field in the area of ​​the affected joint. The obtained clinical effects indicate the advisability of including magnetotherapy procedures in the treatment complex.

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

Background: Osteoarthrosis (OA) of the knee afflicts millions worldwide. Total Knee Arthroplasty (TKA) is common, but associated with substantial cost and morbidity. Prior studies of intra-articular injection of fat, bone marrow aspirate (BMA), and platelet rich plasma (PRP) have shown clinical benefit. We hypothesized that injection of autologous adipose tissue, BMA, and PRP would provide significant benefit for patients with moderate knee OA resulting in avoidance of total knee arthroplasty (TKA) in most, with discontinuance of NSAIDs and other drugs. Methods: 42 TKA candidate patients (47 knees) with moderate (Kellgren-Lawrence 2 and 3) knee OA who had failed conservative treatment had autologous adipose tissue, BMA, and PRP injection as an alternative to TKA in office using only local anesthetic. Patients had discontinuance of all nonsteroidal anti-inflammatory medicines (NSAIDs) and other analgesics, except acetaminophen, prior to treatment. Patients were evaluated with Knee injury and Osteoarthritis Outcome Score Physical Shortform (KOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Single Assessment Numeric Evaluation (SANE) prior to treatment, and at 6 months, 1, and 2 years after treatment. Results: Follow up exceeded 80% at all time points. There were no significant adverse events. TKA was avoided in 97% at one and 86% at two years after treatment. Mean SANE, KOOS-PS, and WOMAC scores significantly improved at 6 months, 1, and 2 years post-treatment. WOMAC and SANE scores were higher at two versus one year post-treatment. Conclusions: Combined fat, BMA, and PRP injection is a safe and effective treatment for moderate knee OA, with reliable avoidance of TKA and possible continued improvement at two year follow-up.

Magnetotherapy in patients with knee osteoarthrosis: thermographic efficacy indicators

Background. Osteoarthrosis is characterized by wide prevalence, especially among patients of older age groups, a high risk of restrictions on the musculoskeletal system function, which results in the patients impaired ability to work and reduced quality of life.&#x0D; Aim: investigate the possibilities of thermographic assessment of efficiency of magnetotherapy of the articular syndrome in osteoarthrosis of the knee joints.&#x0D; Methods. The study included 57 patients (46 women and 11 men) with osteoarthrosis of the knee joints (mean age 61.27.4 years). The patients were divided into two groups. In the group 1 (n=29), magnetotherapy with the ALMAG-01 apparatus was used, while in the group 2 (n=28), the placebo apparatus was applied.&#x0D; Results. The inclusion of magnetotherapy in the complex therapy of osteoarthrosis of the knee joints, according to thermographic data, increases significantly the efficiency of treatment and differs significantly from the placebo magnetotherapy procedures. In patients with osteoarthrosis of the knee joints of the X-ray stages I and II, a combination of course treatment using a traveling pulsed magnetic field and standard drug therapy revealed a positive dynamics in normalization of the temperature balance of the joints. In patients with osteoarthrosis of the X-ray stage I, the minimum efficiency of magnetotherapy was revealed according to thermography, which indicates low severity of the inflammatory joint syndrome.&#x0D; Conclusion. The method of infrared thermography can be used as a diagnostic technique, as it reflects the degree of activity of the inflammatory process in the joints with osteoarthrosis.

Treatment option for knee Osteoarthrosis: Influence of PU-spacers on pressure distribution in 3D-printed knee models

Aims and Objectives:What is the effect of polycarbonate-urethane (PU) interpositional knee spacers on load distribution in 3D printed knee models and can this be a potential treatment for knee osteoarthrosis (KOA)?KOA accounts for 83% of the total OA burden associated with tremendous physical and mental limitations in patients’ lives, but also with an enormous impact on health care systems worldwide [1]. An interpositional mimicked knee spacer could serve as an additional treatment in patients with medial KOA and postpone more invasive treatment options. To date, existing spacers failing to reveal satisfactory results, primarily due to dislocation and methodological issues [2, 3]. This study aimed to examine whether and to what extent a set of differently shaped PU-spacers can reduce stress in the medial knee compartment.Materials and Methods:A knee simulator was utilized to investigate the knee joint loading via pneumatic actuators with and without the insertion of four different spacer types into the medial compartment of six 3D printed knee models (material: PLA). The knee models corresponded to six cadaveric right limbs, which were segmented from CT-scans to create CAD models using a reverse engineering approach (Figure 1).Figure 1: Depiction of the performed work sections. The loading conditions were performed by applying simulated muscle forces (quadriceps: 700 N, hamstrings: 250) induced by pneumatic actuators. Joint contact stress and stress distribution were determined using Tekscan Pressure Mapping Sensors 4000 (50 Hz, Tekscan Inc., South Boston, USA). Thirty cycles of flexion-extension motion were recorded between 180-90° with each spacer-type in the each printed knee model.Results:All spacer types showed reduced mean stress values by 71-75% compared to the no-spacer test condition (Figure 2a, b). This result was associated with a redistribution of the acting force to a larger area (+145-295%) induced by the corresponding spacer-type.Figure 2: a) Time series representing the mean stress curve progressions for all test conditions b) Exemplary peak stress distribution map for no-spacer and spacer M1f125 condition. The mentioned relationship exhibits the major functional principal of the mimicked knee spacer, namely to reduce knee joint loads, hence providing pain relief in the osteoarthritic knee.Conclusion:The results of the current study demonstrate that a knee spacer could theoretically complement the common treatment options for KOA, avoiding loss of bone, preserving the natural bone stock, reducing pain, and extending the time to one of the other treatment methods without compromising the patient’s future knee replacement. However, several major aspects must be considered in future studies including, e.g. spacer geometry, testing in cadaveric knees, higher acting forces and limb kinematics.

PMS33 BUDGET IMPACT ANALYSIS OF KNEE JOINT REPLACEMENT DELAY IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS TREATED WITH HYLAN GF-20, LOW MOLECULAR WEIGHT HYALURONATES AND CORTICOSTEROIDS IN COLOMBIA

Calculate the budgetary impact of delaying total knee replacement (TKR) in patients with severe knee osteoarthrosis (KO) (grade III and IV), without adequate response to non-pharmacological therapy or simple analgesics, who are candidates for treatment with Hylan GF-20, in comparison with low molecular weight hyaluronates (LMWHA) and corticosteroids since the Colombian Healthcare System perspective.

The physical and psychosocial effect of moderate osteoarthrosis of the knee

To illustrate both physical and psychosocial effects of moderate gonarthrosis, clinical examination of patients has been supplemented with a questionnaire SIP (Sickness Impact Profile), to describe the functional health status. Sixty patients, 35 women and 25 men, mean age 63 years, with moderate medial osteoarthrosis of the knee and no symptoms from other joints, were included in the study. The mean BOA score and the self-selected walking speed were decreased in these patients compared to normal individuals. All patients graded pain during walking. The SIP revealed both physical and psychosocial changes in these patients with moderate gonarthrosis. Patients considered that their knee osteoarthrosis had great influence physically on ambulation, during recreation and pasttimes, during sleep and rest, and psychosocially on emotional behaviour. Significant correlations (p less than 0.01) were found between pain during walking and the psychosocial questions in the SIP, between the BOA score and questions in the SIP concerning the physical performance, and between self-selected walking speed and the physical questions. It is concluded that the SIP appears to be a measure with sufficient sensitivity to detect physical and psychosocial changes in patients with moderate osteoarthrosis of the knee. In clinical practice determination of self-selected walking speed and pain during walking will appropriately reflect general function

Role of platelet rich plasma in osteoarthrosis of knee joint among south Indian populaton

Aim: The purpose of this prospective study is to clinically evaluate the efficacy of treatment for knee osteoarthrosis using platelets rich plasma injection. Materials and Methods: This study was performed between January 2018 and June 2018 at the Government Coimbatore Medical College and Hospital as a day care procedure. Eighty patients with knee osteoarthrosis are treated with platelet-rich plasma and studied. Primary data collection was performed using questionnaire tool VAS and WOMAC. Results: All patients in this study completed a questionnaire on pre-injection, 8 weeks post-injection and12 weeks follow up visits using the VAS andWOMAC score. After 3 months the VAS score was 1.8 (p and the WOMAC score improved from 78 to 32 (p Conclusion: This study suggests using platelet rich plasma in osteoarthrosis of the knee joint as a cost effective and less complicated approach to relieve pain and improve day to day activities. Keywords: Knee osteoarthrosis, Knee joint, Platelet rich plasma.

Dose-response of hyaluronate-based viscoelastic hydrogels for the treatment of knee osteoarthrosis: a prospective, randomized, comparative clinical trial

Dose-response of hyaluronate-based viscoelastic hydrogels for the treatment of knee osteoarthrosis: a prospective, randomized, comparative clinical trial