Lequesne Score Research Articles

Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial

BackgroundEfforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. MethodsThroughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n=28) or control group (n=28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca® footwear for at least 6h/day, 7days/week, over 6months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient. FindingsIntervention group showed improvement in pain (effect size: 1.41, p<.001), function (effect size: 1.22, p=.001), stiffness (effect size: 0.76, p=.001), Lequesne score (effect size: 1.07, p<.001), and reduction by 21.8% in the knee adduction moment impulse (p=.017) during gait wearing Moleca®. The analgesic intake was lower in the intervention group. InterpretationThe long-term use of Moleca® footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca®, refrains the increase of analgesic intake in elderly women with knee osteoarthritis and can be considered as a conservative mechanical treatment option. ClinicalTrials.gov (NCT01342458)

Does Metabolic Syndrome or its Individual Components Affect Pain and Function in Knee Osteoarthritis Women?

Current studies and research support the role of metabolic syndrome (MetS) in knee osteoarthritis (OA). However, few studies have focused on its impact on knee OA parameters. The aim of this study was to investigate if metabolic syndrome or its individual components affect the intensity of pain, functional disability, and radiographic severity in knee osteoarthritis women. We conducted a cross sectional study including confirmed radiographic knee osteoarthritis according to Kellgren and Lawrence scale, with and without metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The two groups were compared for pain Visual Analogue Scale (VAS), Lequesne index, Womac function, and radiological grade after adjusting for significant covariates. Multiple regression analysis was used to identify the independent effects of each specific component for metabolic syndrome on knee osteoarthritis parameters. One hundred thirty women were included. The mean age was 56.68 ±8.07 [34-75] years, and the mean BMI was 32.54±2.92 [23-37] kg/m2. The prevalence of metabolic syndrome was 48.5%. Women with and without metabolic syndrome had similar knee osteoarthritis parameters. However, accumulation of MetS components was associated with higher level of pain (OR = 3.7, CI = [1.5-5.9], p=0.001), independently of age and BMI. Multiple regression analyses showed, after adjusting for all covariates, that hyperglycemia had a positive impact on pain (p=0.009), waist circumference was positively associated with Lequesne index (p=0.04), high triglycerides level was significantly associated with increased pain (p=0.04) and higher Lequesne score (p=0.05), and Systolic blood pressure was positively correlated with Lequesne index (p=0.01). In addition to weight reduction, appropriate treatment of metabolic syndrome needs to become an important management strategy for knee pain and functional impairment.

Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation.

Open wedge high tibial osteotomy is a widespread treatment option in patients with varus malalignment and medial compartment osteoarthritis. There is no standardised protocol for post-operative rehabilitation available. The purpose of this study was to compare two post-operative rehabilitation protocols and to evaluate the clinical outcome of early full weight-bearing after open wedge HTO. One hundred and twenty consecutive patients with varus malalignment and medial compartment osteoarthritis received an open wedge HTO using an angular locking plate fixation between December 2008 and December 2011. All patients were assigned randomly into one of two groups with different post-operative rehabilitation protocols (11-day vs. 6-week 20-kg partial weight-bearing). Clinical outcome was evaluated using established instruments (Lequesne, Lysholm, HSS and IKDC scores) preoperatively, 6, 12 and 18months post-operatively. Deformity analysis was performed preoperatively and during follow-up. All clinical scores showed a significant pre- to post-operative improvement. After 6months, there was a higher improvement in the group of early full weight-bearing. The difference between preoperative and 6-month follow-up for the group with early full weight-bearing and for the group with 20-kg PWB for 6weeks was 28±26 and 18±22, respectively, for the Lysholm score and -5.0±5.1 and -3.0±3.6, respectively, for the Lequesne score. Early full weight-bearing (11-day 20-kg partial weight-bearing) after open wedge HTO without bone graft leads to earlier improvement of the clinical results and can be recommended for post-operative rehabilitation after open wedge HTO and fixation with an angular locking plate. Therapeutic study, Level I.

Analysis of anthropometric measurements and dietary intake in patients undergoing a multi-professional program osteoarthritis treatment (parqve – project arhtritis recovering quality of life by means of education)

Purpose: To evaluate the effect of the care and educational multi-professional treatment in patients with knee osteoarthritis (KOA) by anthropometric measurements, variation of percentage of body fat, and questionnaires and correlate results obtained. Methods: One hundred and ninety-eight patients in usual treatment for KOA were randomized to 4 groups. All groups received a booklet and a DVD with information regarding KOA (causes and treatment modalities). Three groups (1,2 and 3) also attended two days of lectures 1,2 and 3 months apart, respectively. All groups were divided in subgroups A (bimonthly telephone calls) and B (no telephone calls). All patients were evaluated at baseline and at one year with height, weight (BMI estimation), waist and hip circumference (waist-hip ratio), percentage of body fat, through the measurement of seven skinfolds, calorie intake, from 24 hours recording, and asked to answer WOMAC, LEQUESNE, VAS and SF-36 questionnaires. Results: The waist-hip ratio showed a predominance of android obesity at baseline (89.4% of androids and 10.6% of ginecoids) and at one year (87.9% and 12.1% respectively) with no significant improvement (p=0.38). The average percentage of body fat decreased 0.44 from baseline to 12 months, regardless of group or telephone calls. Telephone calls determined average lower calorie intake at 12 months on group 1 (1005.4, CI 314.6,1696.3, p<0.001), and at 12 months Group 1A had on average lower calorie intake than the groups 2A (-781.8, CI -1472.7, -91.0, p=0.008) and 3A (-885.8, CI -1599.3, -172.2, p = 0.001). There was no correlation between calories intake and waist-hip ratio at baseline and reassessment with any of the questionnaires. BMI and percentage of body fat correlated with WOMAC, WOMAC pain, VAS and Lequesne scores at baseline and at reassessment. Only changes in BMI correlated weakly with one-year results of the WOMAC (r=-0.172, p=0.016), WOMAC pain (r=-0.193, p=0.007), LEQUESNE (r=-0.197, p=0.006) and SF-36-MCS (r=0.160, p=0.027); and with changes in WOMAC (r=0.220, p=0.002), WOMAC pain (r=0.199, p=0.006), VAS (r=0.170, p=0.018). Changes in porcentage of body fat did not correlate with any of the pain, function and quality of life changes. Conclusions: The multi-professional treatment improved percentage of body fat at one year. This improvement does not correlate with classes, telephone calls or improvements in pain, function and quality of life questionnaires (WOMAC, WOMAC pain, VAS, LEQUESNE and SF-36). Calorie intake improved and was influenced by telephone calls and classes one month apart, and does not correlate with changes in pain, function and quality of life. Changes in BMI correlated with changes in pain and function but not with quality of life.

Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: a systematic review and network meta-analysis.

BackgroundTo conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aims of comparing relevant clinical outcomes (that is, visual analog scores (VAS), total and sub-Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, Lequesne algofunctional index, joint space width change, and adverse events) between diacerein, glucosamine, and placebo.MethodsMedline and Scopus databases were searched from inception to 29 August 2014, using PubMed and Scopus search engines and included RCTs or quasi-experimental designs comparing clinical outcomes between treatments. Data were extracted from original studies. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.ResultsThirty-one of 505 identified studies were eligible. Compared to placebo, glucosamine showed a significant improvement with unstandardized mean differences (UMD) in total WOMAC, pain WOMAC, function WOMAC, and Lequesne score of −2.49 (95% confidence interval (CI) −4.14, −0.83), −0.75 (95% CI: −1.18, −0.32), −4.78 (95% CI: −5.96, −3.59), and −1.03 (95% CI: −1.34, −0.72), respectively. Diacerein clinically improves visual analog scores, function WOMAC, and stiffness WOMAC with UMD values of −2.23 (95% CI: −2.82, −1.64), −6.64 (95% CI: −10.50, −2.78), and −0.68 (95% CI: −1.20, −0.16) when compared to placebo.ConclusionsThe network meta-analysis suggests that diacerein and glucosamine are equally efficacious for symptom relief in knee OA, but that the former has more side effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s40001-015-0115-7) contains supplementary material, which is available to authorized users.

Effects of intra-articular application of pulsed radiofrequency on pain, functioning and quality of life in patients with advanced knee osteoarthritis.

The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42◦C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05). It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

The effectiveness of ultrasound treatment for the management of kneeosteoarthritis: a randomized, placebo-controlled, double-blind study

A randomized, placebo-controlled, double-blind study was designed to investigate the effectiveness of ultrasound therapy in primary knee osteoarthritis. Ninety patients between 40 and 65 years of age having grade 2 and 3 bilateral knee osteoarthritis enrolled in the study were randomly assigned into 3 groups: continuous ultrasound, pulsed ultrasound, and placebo ultrasound. All patients were given a home exercise program. Patients were evaluated at baseline, at the end of the treatment, and at the second month after the treatment by a range of motion measurement, visual analog scale, Lequesne index for knee osteoarthritis, and Short Form-36 quality of life scale. The increase in the knee range of motion was similar in both ultrasound groups, while the change in the placebo group was not statistically significant. Visual analog scale scores and Lequesne scores of the placebo group at the second month were significantly greater than both ultrasound groups' scores (P < 0.01 and P < 0.05, respectively). Significant improvements in terms of pain, function, and quality of life scales were noted in both ultrasound groups in comparison with the placebo group. No statistically significant difference was found in terms of efficacy between the continuous and pulsed ultrasound.

Effect of Combined Balance and Isotonic Resistive Exercises Versus Isotonic Resistive Exercise alone on Proprioception and Stabilizing Reactions of Quadriceps and Hamstrings and Functional Capacity of Knee Osteoarthritis Patients

Objectives: To compare the effect of combined balance and dynamic resistive exercise versus dynamic resistive exercise alone on proprioception and stabilizing actions of the quadriceps and hamstrings and functional capacities in patients with knee osteoarthritis. Design: Randomized clinical trial. Participants: Fifty nine patients with knee osteoarthritis randomized to group I (resistive exercise) (n=21) and group II (combined resistive +balance exercise) n=38. Intervention: All patients had electrotherapy, flexibility and resistive exercises for the legs, 3 times weekly for 8 weeks. Group II also added balance exercises. Main outcome measures: Knee examination, knee pain by visual analogue scale, Lequesne index, one repetition maximum for quadriceps, body mass index, recording of postural evoked surface EMG for quadriceps and hamstrings, and measurement of knee proprioception inaccuracy. Results: Knee effusion improved in both groups with significantly higher improvement in group II (P=0.017). Knee pain significantly decreased in both groups with higher mean percent change in group II (-50.9 ± 29.59) than in group I (-41.2± 10.89) with no significant difference in between groups (P=0.48). Lequesne score significantly decreased in both groups without difference in between groups (P value within groups =0.000). One repetition maximum for quadriceps significantly increased in both groups with higher mean percent change in group II (50.43 ± 16.6) than in group I (47.02 ± 41.97) (P value within group =0.000, P in-between groups=0.64). There were limited significant changes of quadriceps and hamstring reflex EMG in both groups. There were significant improvements of knee joint proprioception inaccuracy at the three measured angles 10, 30, 60 in both groups. However the mean percentage of changes was higher in group II than in group I at the measured angle 10 and 30. Group I had significantly higher improvement at angle 60. Conclusion: Balance exercises add to the benefits of resistive exercise to knee osteoarthritis patients.

Quality of Life of Patients with Knee Osteoarthritis with Questionnaire OAKHQOL (OsteoArthritis of Knee Hip Quality of Life) in Rheumatology Consultation in Burkina Faso (West Africa)

Objective: To study the quality of life of patients with knee OA with the questionnaire OAKHQOL (OsteoArthritis of Knee Hip Quality Of Life). Patients and Methods: This was a cross-sectional study over a period of six months, in patients with symptomatic knee osteoarthritis. All patients met the clinical and radiological criteria of the ACR. The OAKHQOL questionnaire was used to investigate the quality of life of patients. Results: One hundred and six patients were included. There were 94 (88.7%) women and 12 (11.3%) men with a sex ratio of 0.12. The average age of patients was 55 ± 10.4 years. The average pain intensity was 55.1 ± 22.4. The majority of patients (69.8%) had stage 3 of Kellgren and Lawrence classification. The dimension “pain” had the lowest normalized score (60.6). There was a significant correlation between the age range of 30 to 40 years and declining mental health (49.5) . The patients with over 60 years of age had a decrease in pain tolerance and reduced social activities. Lequesne score was associated with severe all dimensions except “social support” of the patient. Conclusion: The knee has an impact on quality of life of patients followed in rheumatology by OAKHQOL questionnaire.

Quality of life and self-reported disability in patients with knee osteoarthritis

Objectives Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The aims of this study are to assess quality of life (QoL) in patients with knee OA using the generic instrument Short Form-36 (SF-36) and to determine its relationships with conventional clinical measures and self-reported disability.Methods Patients with knee OA (n = 112) with median age of 60 (45–76) years and 40 sex- and age-matched healthy controls were included in the study. Age, sex, body mass index (BMI), symptom duration, and Kellgren–Lawrence scores were recorded. QoL, disability, and pain were assessed using the SF-36, the Western Ontario and McMaster (WOMAC) index, the Lequesne index, and a visual analog scale (VAS) in patients. Also, QoL was assessed using the SF-36 in controls.Results Patients with knee OA had lower scores in all subgroups of SF-36 compared with controls. In patients, the SF-36 physical function (PF) and pain areas significantly correlated with effusion, VAS pain, and Lequesne and WOMAC subgroup scores (p < 0.05). The pain area of QoL did not show correlation with comorbidity with knee OA. We found that SF-36 and WOMAC pain scores were more severe in female patients.Conclusions Patients with knee OA had significantly poorer QoL compared with healthy controls. SF-36 is related to the clinical status and functional ability of patients with OA and can be used as a sensitive health status measure for clinical evaluation. Also WOMAC can be used as a sensitive measure for disability of patients with knee OA.

Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial.

The purpose of this study was to compare the efficacy and safety in a randomized, clinical trial of 3 injections of PRGF-Endoret (BTI Biotechnology Institute, Vitoria, Spain) versus one single intra-articular injection of Durolane hyaluronic acid (HA) (Q-MED AB, Uppsala, Sweden) as a treatment for reducing symptoms in patients with knee osteoarthritis (OA). Ninety-six patients with symptomatic knee OA were randomly assigned to receive PRGF-Endoret (3 injections on a weekly basis) or one infiltration with Durolane HA. The primary outcome measures were a 30% decrease and a 50% decrease in the summed score for the pain, physical function, and stiffness subscales of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne scores from baseline to weeks 24 and 48. The percentage of OMERACT-OARSI (Outcome Measures for Rheumatology Committee and Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative) responders was also documented. As secondary outcomes, pain, stiffness, and physical function by use of the WOMAC and the Lequesne score were considered and overall safety of the injection themselves. The mean age of the patients was 63.6 years. Treatment with PRGF-Endoret was significantly more efficient than treatment with Durolane HA in reducing knee pain and stiffness and improving physical function in patients with knee OA. The rate of response to PRGF-Endoret was significantly higher than the rate of response to HA for all the scores including pain, stiffness, and physical function on the WOMAC, Lequesne index, and OMERACT-OARSI responders at 24 and 48 weeks. Adverse events were mild and evenly distributed between the groups. Our findings show that PRGF-Endoret is safe and significantly superior to Durolane HA in primary and secondary efficacy analysis both at 24 and 48 weeks; provides a significant clinical improvement, reducing patients' pain and improving joint stiffness and physical function with respect to basal levels in patients with knee OA; and should be considered in the treatment of patients with knee OA.

AB0345 Osmic acid synovectomy; is there still a need for this treatment?

BackgroundOsmic acid synovectomy has been shown to be an effective and safe treatment for patients with chronic knee inflammatory arthritis unresponsive to intra-articular glucocortcoids and DMARDs. With the introduction of...

AB0951 Can a clinician predict clinical presentation of osteoarthritis knee by knee radiology?

BackgroundDiscordance between clinical and radiological profiles in knee osteoarthritis has been reported.ObjectivesThis study essentially analyzed radiological features of osteoarthritis knee in order to seek an association between clinical and radiographic...

SAT0285 Hip involvement in moroccan patients with ankylosing spondylitis

ObjectivesWe aimed to assess the prevalence of hip involvement and its characteristics, its correlates and its impact on patients’ quality of life (QoL) in Moroccan ankylosing spondylitis (AS).MethodsOne-hundred-twenty patients with...

Quality of life and self-reported disability in patients with knee osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The aims of this study are to assess quality of life (QoL) in patients with knee OA using the generic instrument Short Form-36 (SF-36) and to determine its relationships with conventional clinical measures and self-reported disability. Patients with knee OA (n = 112) with median age of 60 (45–76) years and 40 sex- and age-matched healthy controls were included in the study. Age, sex, body mass index (BMI), symptom duration, and Kellgren–Lawrence scores were recorded. QoL, disability, and pain were assessed using the SF-36, the Western Ontario and McMaster (WOMAC) index, the Lequesne index, and a visual analog scale (VAS) in patients. Also, QoL was assessed using the SF-36 in controls. Patients with knee OA had lower scores in all subgroups of SF-36 compared with controls. In patients, the SF-36 physical function (PF) and pain areas significantly correlated with effusion, VAS pain, and Lequesne and WOMAC subgroup scores (p < 0.05). The pain area of QoL did not show correlation with comorbidity with knee OA. We found that SF-36 and WOMAC pain scores were more severe in female patients. Patients with knee OA had significantly poorer QoL compared with healthy controls. SF-36 is related to the clinical status and functional ability of patients with OA and can be used as a sensitive health status measure for clinical evaluation. Also WOMAC can be used as a sensitive measure for disability of patients with knee OA.

Levels of Metalloproteinase (MMP-3, MMP-9), NF-kB Ligand (RANKL), and Nitric Oxide (NO) in Peripheral Blood of Osteoarthritis (OA) Patients

The aim of this study was to judge whether there is a correlation between some biochemical features of knee osteoarthritic blood and clinical characteristics and to evaluate the potential relationship between osteoarthitis (OA) severity and putative biomarkers for the disease. 105 patients suffering from knee OA were analyzed clinically (Lequesne's index) and radiographically (Kellgren and Lawrence, K&L). Plasma and peripheral blood mononuclear cells (PBMC) were harvested separately. Specimens were analyzed for concentrations of nitric oxide (NO), matrix metalloproteinase-3 (MMP-3), and matrix metalloproteinase-9 (MMP-9). Transcript levels of the receptor activator of NF-kB ligand (RANKL) mRNA, MMP-3mRNA, and MMP-9mRNA were measured using real-time quantitative RT-PCR. Data certified significantly increasing concentrations of plasma MMP-3, MMP-9, and NO as well as transcript levels of RANKL mRNA and MMP-9 mRNA in early OA (at grade I). There was a positive correlation of MMP-3 and MMP-9 content in plasma and MMP-9 mRNA expression levels in PBMC with the severity of clinical symptoms (total Lequesne's scores) in early OA. NO content in plasma correlated with total Lequesne's scores, pain scores in response to pressure, and swelling scores of early OA patients (atgGrade I). Analogously, there were positive correlations of RANKL mRNA expression with total Lequesne's scores, pain scores in response to pressure, and swelling scores in OA patients at Grade I. [corrected] Some biochemical factors, including content of NO, MMP-3, MMP-9, and transcript levels of some genes, including MMP-9 mRNA and RANKL mRNA, may be specific and sensitive enough to diagnose OA diseases at an early stage in the pathological process of OA when radiological features do not reflect degradation of articular cartilage. Therefore, proper regulation of these factors may be a promising and realistic new target for the treatment of degenerative osteoarticular diseases.

Efficacy of oral administration of yoghurt supplemented with a preparation containing hyaluronic acid (Mobilee™) in adults with mild joint discomfort: a randomized, double-blind, placebo-controlled intervention study

A prospective, randomized, double-blind, placebo-controlled study was designed with 40 healthy individuals with joint discomfort. The effect of oral supplementation with a natural product containing hyaluronic acid included in a yoghurt matrix was evaluated in terms of functional and quality-of-life parameters. An isokinetic dynamometer was used to measure maximum muscle strength, total work and mean power. Participants were divided into 2 groups (n = 20) and ate yoghurt that was either supplemented or not supplemented with the hyaluronic acid product daily for a period of 90 days. The increase in the maximum peak torque of the knee extensors compared to baseline values was 7.6 ± 7.6 Nm for the supplemented yoghurt group and 2.5 ± 4.7 Nm for the control group at 180°/s (P = 0.0582), and 6.5 ± 5.8 Nm for the supplemented yoghurt group and −1.0 ± 7.1 Nm for the control group at 240°/s (P < 0.05). The same pattern of response was observed in total work and in mean power (P < 0.05). Differences were less pronounced in the knee flexors. No differences were detected in the Lequesne score and SF-36 survey except for the social functioning subscale at 1 month follow-up. This prospective placebo-controlled nutritional study confirmed that 3 months of oral administration of a natural product containing HA (Mobilee™) in healthy individuals with joint discomfort of the knee provides improvements in muscle strength.

Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

BackgroundRecent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA.Methods/DesignFifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes— Moleca®—for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women’s double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention-to-treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment–time interactions (α = 5%).DiscussionThis is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.Trial registrationNCT01342458

The impact of treatment with hylan G-F 20 on progression to total hip arthroplasty in patients with symptomatic hip OA: a retrospective study

Introduction:There is scarce data available on intra-articular hyaluronan’s ability to modify the progression of osteoarthritis (OA).Objective:The purpose of this retrospective pilot study was to assess the impact of treatment with hylan G-F 20 on progression to total hip replacement (THR) in patients with symptomatic hip OA.Research design and methods:The records of patients presenting with symptomatic hip OA and treated with hylan G-F 20 were analysed. Endpoints were the number of THRs performed and the survival time (in months) between commencement of treatment and THR, if performed. Endpoints were evaluated for the entire study population and for those sub-groups of patients which were, or were not, defined as candidates for THR prior to intra-articular treatment. Predictive factors of progression to THR were also assessed.Results:A total of 850 patients’ records were evaluated and 224 patients’ data were included in the study and evaluated. Eighty-four patients (37.5%) progressed to THR, 206 patients (92.0%) achieved 12 months survival, 170 patients (75.9%) achieved 24 months survival, and 69 patients (30.8%) achieved 5 years survival. Mean survival time was 36 months. Classification as a THR candidate, Lequesne score, ultrasound pattern and the presence of diabetes were predictive factors for progression to THR.Conclusions:These results suggest that hylan G-F 20 could be included in the management of symptomatic hip OA before recommendation for THR, particularly in patients presenting with milder symptoms, or in patients where, due to comorbidities or personal choice, THR is not a feasible option. Limitations of this study include the retrospective study design and the lack of a control group to determine any placebo effect of hylan G-F 20. Further prospective studies are therefore needed to corroborate these results.

Green-lipped mussel (Perna canaliculus) extract efficacy in knee osteoarthritis and improvement in gastrointestinal dysfunction: a pilot study

Clinical data demonstrating efficacy for nutraceutical compounds marketed for the symptom relief of osteoarthritis (OA) have been largely contentious. Furthermore, no association has been linked between clinical trial inconsistencies and gastrointestinal (GI) dysfunction. The aim of this study was to primarily investigate the efficacy of a high-dose New Zealand green-lipped mussel (GLM) extract in patients diagnosed with OA of the knee and concurrently assess GLM impact on GI function. An open label, single group allocation study was conducted, that administered 3,000 mg/day of GLM extract over 8 weeks to 21 subjects diagnosed with knee OA. Outcome measures were scored using the WOMAC, the Lequesne algofunctional index, and the Gastrointestinal Symptom Rating Scale (GSRS) tools. An intention-to-treat analysis was employed and subject data collected at T₀, T₄ and T₈ weeks. Paired t tests showed significant improvement for the Lequesne, WOMAC (p < 0.001) and GSRS (p = 0.005) scores. A repeated measures ANOVA analysis showed significant improvement in scores for the Lequesne (F = 20.317, p < 0.001), WOMAC (F = 28.383, p < 0.001) and the GSRS (F = 9.221, p = 0.002). Green-lipped mussel significantly improved knee joint pain, stiffness and mobility. We report for the first time that the administration of GLM extract also significantly improved GI symptoms by 49% in OA patients. Given that GI dysfunction is linked to analgesic medication use, we further conclude that the therapeutic efficacy of the GLM extract used was possibly correlated to its effects on GI function by improving GSRS scores from baseline. Results from this trial highlight the requisite for further clinical investigations of gastrointestinal tract function in OA patients.