MacMaster Universities Osteoarthritis Index Research Articles

Long-term results after medial patellotibial ligament reconstruction for the treatment of patellofemoral instability.

To evaluate long-term clinical outcomes and redislocation rate after medial patellotibial ligament reconstruction. A total of 26 knees with mean age 26.3 ± 10.6 years (25 patients, 7 males and 18 females) treated for patellar instability (at least two objective dislocations) with medialization of the patellar tendon medial third were evaluated with an intermediate clinical follow-up (FU) at a mean of 6.5 ± 2.1 years and with a final telephone interview follow-up at mean of 15.6 ± 2.5 years (11.4-20.1). Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC), Kujala, Visual Analog Scale (VAS) for pain and Tegner activity scores were used. Information about further redislocation and knee surgery was also collected. All the clinical scores had a significant improvement compared to preoperative status (WOMAC pre-op 55.9 ± 27.2 vs. WOMAC final FU 80.8 ± 22.2; KUJALA pre-op 41.0 ± 24.0 vs. KUJALA final FU 77.2 ± 24.1; VAS pre-op 6.0 ± 3.1 vs. VAS final FU 3.44 ± 2.35; TEGNER pre-op 2.1 ± 2.0 vs. TEGNER final FU 3.6 ± 1.8; p < 0.001), and the outcomes remained stable at the final follow-up compared to the intermediate follow-up (p > 0.05). A total of 4 knees had at least one redislocation at the final follow-up, while 3 knees underwent total knee replacement surgery. The redislocation-survival rate at 5 years is 92%, meanwhile is 84% at 10 and 15 years. MPTL reconstruction produced good clinical results and a survival rate of 84% at a mean of 16 years follow-up and could be considered as associated procedure in case of patellofemoral instability. Level IV.

Eight weeks of a lower limb resistance training protocol and gait performance in patients with symptomatic mild to moderate knee osteoarthritis

BackgroundThe role of strengthening the lower limbs to optimize the biomechanics of the hip, knee and ankle during walking in patients with knee osteoarthritis, is still unclear. This study aimed to analyse the walking biomechanics of individuals with symptomatic mild to moderate knee osteoarthritis before and after a simplified lower limb resistance training protocol, focused on knee joint exercises with individualized load. MethodsForty-one patients with symptomatic and radiographic mild to moderate knee osteoarthritis underwent 3D gait analysis pre-post 8 weeks lower limb resistance training protocol performed 3 times a week. Parameters investigated were spatiotemporal, sagittal range of motion, flexion and extension minimum and maximum values, power and moment of hip, knee and ankle, as well as self-reported pain and physical function by the Western Ontario MacMaster University Osteoarthritis Index. Paired t test, Wilcoxon, Spearman's correlation and a logistic model were used for statistical analysis, with p < 0.05. Pain improvement more than 2 points was considered clinically relevant. The effect size (ES) was calculated using Cohen's d. ResultsPost protocol walking speed increased 6.7% (ES: 0.711), cadence 3.7% (ES: 0.655), stride length 2.6% (ES: 0.542), and double support time reduced 6.9% (ES:0.459). It was also observed a significant increase in one maximum repetition test for legpress 46%, knee extension 23% and knee flexion chair 27% (p < 0.001). Patients reported a 62.5% reduction in pain (ES:1.518) and 64.9% improvement in physical function (ES:1.376). 82% of the patients presented more than 2 points improvement in pain. No evidence of strong correlations between pain, strength gains and gait parameters were found. ConclusionsThere was a significant and clinical improvement of spatiotemporal gait parameters, pain, physical function, and strength after 8-week lower limb resistance training protocol. Patients who had a clinically relevant pain improvement presented better gait performance.

Total knee arthroplasty without patella resurfacing leads to worse results in patients with patellafemoral osteoarthritis Iwano Stages 3-4: a study based on arthroplasty registry data.

To determine whether the preoperative degree of degeneration of the patellofemoral joint really affects the outcome of total knee arthroplasty (TKA) surgery without patella resurfacing and thus to establish a parameter that might serve as a guiding factor to decide whether or not to perform retropatellar resurfacing. It was hypothesized that patients with preoperative mild patellofemoral osteoarthritis (Iwano Stages 0-2) would significantly differ from patients with preoperative severe patellofemoral osteoarthritis (Iwano Stages 3-4) in terms of patient-reported outcome (Hypothesis 1) and revision rates/survival (Hypothesis 2) after TKA without patella resurfacing. Application of a retrospective-comparative design on the basis of Arthroplasty Registry data that included patients with primary TKA without patella resurfacing. Patients were allocated to the following groups based on preoperative radiographic stage of patellofemoral joint degeneration: (a) mild patellofemoral osteoarthritis (Iwano Stage ≤ 2) and (b) severe patellofemoral osteoarthritis (Iwano Stages 3-4). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) score was assessed preoperative and 1 year postoperative (0: best, 100 worst). In addition, implant survival was calculated from the Arthroplasty Registry data. In 1209 primary TKA without patella resurfacing, postoperative WOMAC total and WOMAC subscores did not differ significantly between groups, but potentially suffered from type 2 error. Three-year survival was 97.4% and 92.5% in patients with preoperative mild and severe patellofemoral osteoarthritis, respectively (p = 0.002). Five-year survival was 95.8% vs. 91.4% (p = 0.033) and 10-year survival was 93.3% vs. 88.6% (p = 0.033), respectively. From the study findings, it is concluded that patients with preoperative severe patellofemoral osteoarthritis have significantly higher risks for reoperation than do those with preoperative mild patellofemoral osteoarthritis-when treated with TKA without patella resurfacing. Hence, it is recommended that patella resurfacing be applied in patients with severe Iwano Stage 3 or 4 patellofemoral osteoarthritis during TKA. III, Retrospective comparative.

The clinical outcome of total knee arthroplasty is compromised by a previously implanted medial unicondylar knee arthroplasty

ObjectiveTo investigate the clinical outcome of patients that underwent conversion of a medial unicondylar knee arthroplasty (UKA) to a total knee arthroplasty (TKA) and to compare that outcome to patients that underwent primary TKA. It was hypothesized that those groups would significantly differ in terms of knee score outcome and implant survival.MethodsA retrospective-comparative study was conducted utilizing data from the Federal state’s arthroplasty registry. Included were patients from our department that undergone a conversion of a medial UKA to a TKA (UKA-TKA group). The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) from preoperative and 1-year postoperative was used. Moreover, the implant survival was analyzed.ResultsIn the UKA-TKA group, there were 51 cases (age 67 ± 10, 74% women), and in the TKA group, there were 2247 cases (age 69 ± 9, 66% women). The one-year postoperative WOMAC total score was 33 in the UKA-TKA group und 21 in the TKA group (p < 0.001). Similarly, the WOMAC pain, WOMAC stiffness, and WOMAC function scores were significantly worse in the UKA-TKA. After 5 years, the survival rates were 82% and 95% (p = 0.001). The 10-years prosthesis survival was 74% and 91% in the UKA-TKA and TKA groups, respectively (p < 0.001).ConclusionsBased on our findings it is concluded that patients who received a TKA after UKA have inferior results than those that directly receive a TKA. This is true for both patient-reported knee outcome and prosthesis survival. Converting UKA to TKA should not be seen as an easy operation, but should rather be done by surgeons with considerable experience in both primary and revision knee arthroplasty.

Photobiomodulation Therapy Using Infrared (808 nm) Low Level Laser Therapy Associated with Strength Training in Knee Osteoarthritis: A Randomized placebo-controlled clinical trial

Mechanisms for significant clinical and statistical benefits of photobiomodulation (PBMT) in the treatment of knee osteoarthritis (KOA) include anti-inflammatory effects, optimization of tissue repair, improved muscle function and analgesia. The effectiveness of (PBMT) associated with strength training (ST), in the form of strength training, has been investigated in randomized clinical trials, but the results are not well clarified. The aim of this study was to evaluate the effects of ST associated with PBMT on joint pain intensity, range of motion, physical function and muscle strength of the quadriceps femoris and hamstrings in patients diagnosed with KOA. Twenty-eight adult patients of both genders with KOA were randomly distributed in 2 treatment groups, performed 3 times a week, for 6 weeks: ST Group (ST), submitted to stretching, self- mobilization, muscle strengthening and sensorimotor training and ST and STP Group (STP), submitted to the same program as the ST followed by infrared laser irradiation (Therapy XT, DMC, São Carlos, Brasil, l= 808 nm, P= 100mW, 5 points in the medial joint region and 4 points lateral, 3 J/point, 30 s/point). Blinded evaluators assessed pain at movent and no movement and range of motion using Analogic Visual Scale and goniometry, respectively. To assess physical function, the WOMAC questionnaire (Western Ontario and MacMaster University Osteoarthritis Index) and functional tests were used: Sit and stand test; 2 min-walk test. The muscular strength of the quadriceps and hamstrings were measured using an isometric dynamometer. The evaluations were performed in 4 moments: before (EV0), during (EV1: 3 weeks of treatment), at the end (EV2: after 6 weeks of treatment) and 30 days after the end of treatment (follow-up). The STP group showed a significant reduction in pain intensity at rest and at movement in EV1, as well as, significant improvement in relation to stiffness, total WOMAC and knee flexion amplitude, an improvement in physical function and an increase in muscle strength of quadriceps femoris when compared to ST group (p &lt;0.05). In the assessment of the strength of the hamstring muscles, there was no significant difference between the groups at any time evaluated (p&gt; 0.05). ST associated with PBMT had greater effects in reducing joint pain intensity, active knee flexion, physical function and muscle strength, especially in the quadriceps femoris, than strength training alone in patients with KOA.

Effect of acupuncture combined with moxibustion on serum matrix metalloproteinase-9 and matrix metalloproteinase inhibitor-1 in patients with knee osteoarthritis

To observe the effect of acupuncture combined with moxibustion on serum bone metabolism indexes in patients with knee osteoarthritis (KOA), so as to evaluate its clinical efficacy on KOA. Ninety-six patients with KOA were randomly divided into control and observation groups, with 48 cases in each group. The patients in the control group were treated with acupuncture at Zusanli(ST36), Neixiyan(EX-LE4), Heding(EX-LE2) and Xuanzhong(GB39) etc. on the affected side for 30 min once daily. Patients in the observation group were given moxibustion on the above-mentioned acupoints on the basis of treatment in the control group. The course of treatment for both groups was 4 weeks. The Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) scores were compared before and after treatment and the clinical efficacy of the two groups were calculated according to the WOMAC scores after treatment. Ultrasound examination of the knee joint was used to analyze the thickness of joint effusion and synovial membrane thickness of the patients. Enzyme-linked immunoassay was used to detect the serum type Ⅰ collagen C-terminal foreign body peptide (CTX-Ⅰ), insulin-like growth factor (IGF), bone gla protein (BGP), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase inhibitor-1 (TIMP-1) levels. Compared with those before treatment, WOMAC score, knee joint synovial thickness and joint effusion thickness, serum CTX-Ⅰ, MMP-9, TIMP-1 levels, and MMP-9/TIMP-1 ratio were all down-regulated (P<0.05), while the levels of serum IGF and BGP up-regulated (P<0.05) in the two groups after treatment. The improvements of the above indexes in the observation group were superior to those in the control group (P<0.05). The total effective rate in the observation group was 95.83% (46/48), which was higher than 81.25% (39/48) in the control group(P<0.05). Acupuncture combined with moxibustion can regulate bone metabolism and effectively improve the symptoms of KOA patients, which may be related to its effect in regulating the dynamic balance of MMP-9 and TIMP-1 in serum.

Effect of continuous passive motion on the early recovery outcomes after total knee arthroplasty

IntroductionContinuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period.MethodsEighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC).ResultsThe mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control).ConclusionThese findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability.

RADIOLOGICAL AND CLINICAL ANALYSIS OF BIPLANE OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR MEDIALLY ARTHRITIC VARUS KNEES FIXED BY LOCKING PLATE

Background: High tibial osteotomy is an established and helpful treatment for unicompartmental osteoarthritis associated with varus deformity. However, asupratubercle high tibial osteotomy leads to a decrease in patellar height making the technique not suitable in the case of concomitant patella Baja. Moreover, this kind of osteotomy can change in situ forces at the patellofemoral joint and the lateral patellar tilt. To widen the indication of high tibial osteotomy was proposed a biplane opening wedge high tibial osteotomy with a distal tuberosity osteotomy (B-OWHTO). Objective: To assess the clinical and radiological outcome of biplane open wedge high tibial osteotomy in the treatment of medially arthritic varus knees. Patient and Methods: Twenty varus knees (20) patients, with MCOA, were operated upon from 2019 to 2020 at Al-Azhar University Hospital (Assiut). They all had Medially Opening Wedge High Tibial (MOWHTO) using the biplanar technique and fixed by locking plates. We compared the data fetched preoperatively (at day 0 = D0) with data one year or more after surgery with a mean of 14.5 months (at year 1=Y1). The mean age was 49.39 ± 8.15 years old, 13 were females, while others were males. Eleven were right knees, and 7 were left. Types of occupation were; 9 employed, 7 unemployed. Sixteen were no sportive, and 2 were recreational athletes. Seven patients were normal weight, while 11 were overweight. Two patients were diabetic, and 2 were perceived as treated HCV infection. According to the MCOA K-L scale; 5 were grade 3, 9 were grade 2 and 4 were grade 1. Results: The mean western Ontario and Macmaster universities osteoarthritis index (WOMAC), value was 51.44 ± 26.8 and then dropped to 24. 39 ± 17.41. The difference was statistically significant (p-value was <0.001). The mean Cincinnati score was 40.36 ± 19.28 at D0, then 81.88 ± 14.45 at Y1. The rising pattern from D0 to Y1 was significant statistically (p-value was <0.001). For radiological results, the mean amount of correction was 10.56o ± 2.97o. The mean TS for the18 patients was 10.78o ± 2.92o and changed to 10.49o ± 2.51o, and this was statistically insignificant. Regarding the patellar height (PH), there was a statistically significant decreasing tendency from a mean of 1.02 ± 0.16 to 0.97 ± 0.15. LPT showed a statistically significant decrease, although quite small, from 10.48 o ± 6.18 o to 9.43o ± 4.27o. MOWHTO using biplanar technique and fixed by the locking plate without BG filling was a very efficient modality of treatment for adult patients suffering from medially arthritic varus knees in terms of clinical and radiological aspects. Conclusion: Medial Open Wedge High Tibial Osteotomy (MOWHTO) using biplanar technique and fixed by the locked plate without bone graft filling was a very efficient modality of treatment for adult patients suffering from medially arthritic varus knees in terms of clinical and radiological aspects.

Effectiveness of Mobilization with Movement on the Management of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.

Background Osteoarthritis is becoming a global major cause of pain and functional disability worldwide, especially in the elderly population. Nowadays, evidence shows that mobilization with movement (MWM) has a beneficial effect on knee osteoarthritis subjects. However, its adequacy remains unclear. Objective To review the best available evidence for the effectiveness of MWMs on pain reduction and functional improvement in patients with knee osteoarthritis. Methods A comprehensive search of literature was conducted using the following electronic databases: Google Scholar, PubMed, Physiotherapy Evidence Database (PEDro), Science Direct, Cochrane Library, and Scopus. Only randomized controlled trials (RCTs) were included, and the methodological quality of the studies was appraised using the PEDro scale. It was reported according to the guideline of the PRISMA statement. Results A total of 15 RCTs having 704 participants were included. The present systematic review suggests that there were significant differences between MWM groups and control groups in terms of visual analogue scale (VAS), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) scale, and flexion range of motion. Conclusions This systematic review demonstrated that MWM was effective to improve pain, range of motion, and functional activities in subjects with knee osteoarthritis.

Psychometric properties of the Polish version of the 36-item WHODAS 2.0 in patients with hip and knee osteoarthritis

PurposeTo examine psychometric properties of the Polish version of the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the population with hip and knee osteoarthritis (OA).MethodsThis was a longitudinal study with repeated measures during retest examinations. Subjects from a Polish Specialist Hospital (age = 68.3 ± 9.2years, 71% female, 44.2% knee OA, 55.8% hip OA) were tested three times. They completed the Polish version of the 36-item WHODAS 2.0, the SF-36 Health Survey 2.0, the Western Ontario and Macmaster Universities Osteoarthritis Index 3.1, the Hospital Anxiety and Depression Scale, and the Numerical Rating Scale.ResultsThe 36-item WHODAS 2.0—Polish version demonstrated high internal consistency (Cronbach’s alpha for total = 0.94), and test–retest reliability (Total ICC2,1 = 0.98). High construct validity was found as 12 out of 15 a priori hypotheses (80%) were confirmed. Most domains and Total Scores in the 36-item WHODAS 2.0 (Total ES = − 0.62, SMR = − 1.09) showed a moderate degree of responsiveness. Minimal clinically important difference (MCID) for the Total WHODAS 2.0 was 3.29 in patients undergoing rehabilitation for knee or hip OA.ConclusionsThe Polish version of the 36-item WHODAS 2.0 assesses disability according to ICF in a reliable, valid and responsive way. Therefore, it provides considerable support in clinical practice and national and international scientific research of patients with hip or knee OA.

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

PurposeCombined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively.Materials and methodsThis prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively.ResultsSignificant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p < 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups.ConclusionThe magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

Effectiveness of Kinesio Taping on the Management of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.

The purpose of this review was to summarize the current best evidence for the effectiveness of Kinesio Taping in reducing pain and increasing knee function for patients with knee osteoarthritis. A comprehensive search of literature published between 2014 and 2019 was conducted using the following electronic databases: PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Science Direct, and Scopus. Only randomized controlled trials evaluating the effect of Kinesio Taping on knee osteoarthritis were included. PEDro was used to assess the risk of bias of included trials. This study was reported according to the guideline of the PRISMA statement. The methodological quality of the studies was done using the PEDro scale and GRADE approach. The overall quality of evidence was rated from moderate to high. Eighteen randomized trials involving 876 patients were included. The present systematic review demonstrated that there were significant differences between Kinesio Taping groups and control groups in terms of visual analog scale (VAS), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) scale and flexion range of motion. Kinesio Taping is effective in improving pain and joint function in patients with knee OA.

Platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: A meta-analysis with the consistent ratio of injection.

Osteoarthritis (OA) is an extremely common form of chronic joint disease which can affect the knees and other joints of older adults, leading to debilitating disability in the knee and consequent reduction in quality of life. Intra-articular platelet-rich plasma (PRP) or hyaluronic acid (HA) injections are effective for maintaining long-term beneficial effects without increasing the risk of intra-articular infection. However, few studies have compared the relative value of HA and PRP for OA treatment. PRP is more effective than HA for OA treatment in recent studies of this topic. We systematically searched Medline, SpringerLink, Embase, Pubmed, Clinical Trials.gov, the Cochrane Library, and OVID for all articles published through May 2018. Any study was included that compared the effect of HA and PRP (consistent treatment cycle and frequency of injection) on patient's pain levels and functionality improvements. Review Manager 5.3 was used to analyze data regarding these two primary outcomes. We included 10 total studies in the present meta-analysis. International Knee Documentation Committee (IKDC; MD: 10.37, 95% confidence interval (CI): 9.13 to 11.62, p < 0.00001), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC; MD: -20.69, 95% CI: -24.50 to -16.89, p < 0.00001, I2 = 94%), and Visual Analogue Scale (VAS; MD: -1.50, 95% CI: -1.61 to -1.38, p < 0.00001, I2 = 90%) differed significantly between the PRP and HA groups. Knee Osteoarthritis Outcome Scores (KOOSs) did not differ significantly (χ2 = 23.53, I2 = 41%, p = 0.11). Our hypothesis appears not to be confirmed because PRP and HA did not differ significantly with respect to KOOS score. However, the IKDC, WOMAC, and VAS scores differed significantly. Thus, based on the current evidence, PRP appears to be better than HA at achieving pain relief and self-reported functional improvement. Ia, meta-analyses of randomized clinical trials.

Intraarticular corticosteroid injections in the management of osteoarthritis knee

Objective:- The aim of the study was to assess therapeutic efficacy, adverse events and patient satisfaction of intraarticular (IA) corticosteroid injections for knee osteoarthritis (OA).&#x0D; Methods:- Thirty-two (96) patients with OA of the knee participated in the present study. The inclusion criteria included (1) Resting visual analog scale pain &gt;50 mm (2) Radiographic evidence for osteoarthritis (as per Kellgren-Lawrence scale) plus; age ≥50yrs, morning stiffness ≤ 30 min and crepitus on motion. Baseline Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) and visual analogue score (VAS) were documented. Patients received intra-articular injections of triamcinolone acetonide 40 mg in the affected knee. The patients were reviewed at 1 weeks, 4 weeks and 8 weeks post-injection with final analysis at 3 months. Use of over the counter analgesia in the form of acetaminophen was allowed for concomitant analgesia.&#x0D; Results:- Ninety-six patients (male =45, female=51) with mean age of 50±5 years (range 45-55); duration of symptoms 5.7 ± 0.5 years and mean body mass index (BMI) 29.4kg/m2 were available at final follow-up. The VAS scores at baseline were:- at rest=71 and after 30 meter walk=80 and improved to 35 and 40, respectively. Improvement in pain and disability based on the WOMAC scores were significant. The overall efficacy “Knee Society Score” was judged as excellent in 56.25%, satisfactory in 21.87%, fair in 18.75%, and poor in 3.12%. The beneficial effects stayed till 4-6 weeks.&#x0D; Conclusion:- Intra-articular steroid injections for knee OA is safe and effective. The symptomatic relief is prompt, particularly in presence of inflammation (Effusion/synovitis). Proper patient selection and aseptic precautions yield satisfactory results. The need for concomitant analgesia is reduced.

Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Aim of the studyTo determine if pre-operative radiologic minimal joint space width (mJSW) is related to the outcome of total knee arthroplasty (TKA) (primary hypothesis). Likewise, the aim was to test if pre-operative mJSW is related to prosthesis survival (secondary hypothesis).MethodsA retrospective comparative analysis was performed. Group 1 was comprised of patients with pre-operative mJSW 0–1 mm. Group 2 were patients with pre-operative mJSW ≥ 2 mm. The clinical outcome was determined with the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) score pre-operatively and one year after TKA. Only patients with pre-operative weight-bearing radiographs and complete WOMAC score data were accepted.ResultsAvailable for analysis were 377 patients, of whom 188 were allocated to Group 1 (118 female, 70 male, age 70 ± 11 years) and 189 to Group 2 (118 female, 71 male, age 70 ± 13 years). Pre-operative WOMAC total and WOMAC subscores showed no significant differences between groups. Post-operatively, the WOMAC total was significantly better in Group 1 than in Group 2, 10 ± 22 and 19 ± 31, respectively (p < 0.001, Power 97.5%). Similarly, the WOMAC subscores for pain, stiffness, and function were also significantly better in Group 1 than in Group 2. Five-year prosthesis survival was 94.2 and 91.6% in Groups 1 and 2, respectively (p = 0.07, Power 71%).DiscussionPatients with pre-operative complete joint space collapse (0 to 1 mm mJSW) achieve a significantly better WOMAC result from TKA than do those with a mJSW equal to or greater than 2 mm. From our findings, it is recommended that “complete joint space collapse” especially be used as an indication for TKA surgery.ConclusionOur study was underpowered to sufficiently show an effect of pre-operative mJSW on prosthesis survival.

The clinical observation in the treatment of liver-kidney deficiency of knee osteoarthritis by Duhuo-Jisheng decoction

Objective To evaluate the curative effect of the Duhuo-Jisheng decoction in treating knee osteoarthritis (KOA) with the deficiency of liver and kidney. Methods Using the random number table method, a total of 80 KOA patients were randomly divided into 2 group, 40 in each group. The treatment group were treated with Duhuo-Jisheng decoction, and the control group with glucosamine sulfate orally. The 2 groups were treated with 30 day. The blood sedimentation (ESR) of before and after treatment was detected. The level of C-reactive protein (CRP) was detected by latex enhanced immunization. The degree of knee joint pain was evaluated by VAS scale. The severity of the symptoms was evaluated by the visual scale of Osteoarthritis Index (Western Ontario Mac Master University Osteoarthritis index, WOMAC index). The changes of TCM symptoms were observed and the clinical effective rate was evaluated. Results The total effective rate of the treatment group was 95% (38/40), while the control group was 77.5% (31/40). The difference between the 2 groups was statistically significant (χ2=10.213, P=0.003). After treatment, the ESR (15.41 ± 4.23 mm/h vs. 17.6 ± 7.27 mm/h, t=-4.426), CRP (4.73 ± 1.28 mg/L vs. 6.12 ± 2.38 mg/L, t=-14.735) level in the treatemnt group were significantly lower than those in the control group (P<0.01). The VAS scores (2.5 ± 0.62 vs. 4.9 ± 0.8, t=-15.026), WOMAC index(12.1 ± 4.7 vs. 16.7 ± 6.7, t=-11.177) and TCM symptom score (6.5 ± 0.4 vs. 7.5 ± 0.4, t=-3.482) in the treatment group were significantly lower than those in the control group (P<0.01). Conclusions The Duhuo-Jisheng decoction is effective improve the symptom and quality of life of liver-kidney deficiency of KOA. Key words: Osteoarthritis, Knee; Du Huo Ji Sheng Tang; Liver-kidney depletion syndrome

Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis.

ABSTRACTObjective To assess the influence of the body weight in functional capacity and pain of adult and elderly individuals with knee osteoarthritis.Methods The sample consisted of 107 adult and elderly patients with knee osteoarthritis divided into two groups (adequate weight/adiposity and excessive weight/adiposity) according to body mass index and percent of body fat mass, assessed by electric bioimpedance. Subjects were evaluated for functional mobility (Timed Up and Go Test), pain, stiffness and function (Western Ontario and MacMaster Universities Osteoarthritis Index − WOMAC), pain intensity (Visual Analogue Scale − VAS) and pressure pain tolerance threshold (algometry in vastus medialis and vastus lateralis muscles). Data were analyzed with Statistical Package of the Social Sciences, version 22 for Windows. Comparisons between groups were made through Student’s t test, with significance level set at 5%.Results There was predominance of females in the sample (81.3%), and mean age was 61.8±10.1 years. When dividing the sample by both body mass index and adiposity, 89.7% of them had weight/adiposity excess, and 59.8% were obese. There was no difference between groups regarding age, pain intensity, pressure pain tolerance threshold, functional mobility, stiffness and function. However, pain (WOMAC) was higher (p=0.05) in the group of patients with weight or adiposity excess, and pain perception according to VAS was worse in the group of obese patients (p=0.05).Conclusion Excessive weight had negative impact in patients with osteoarthritis, increasing pain assessed by WOMAC or VAS, although no differences were observed in functionality and pressure pain tolerance.

Correlation of fear avoidance beliefs with pain and physical function in subjects with osteoarthritis of knee (OA knee)

Osteoarthritis (OA) is the most common cause of musculoskeletal pain and disability in the knee joint. There is also increasing evidence that psychological factors such as fear, anxiety, and depression have adverse effects on disability in people with OA knee. The aim of the study was to identify whether the fear-avoidance beliefs are correlated with physical function & severity of pain in subjects with knee OA. severity of pain, fear avoidance beliefs and functional limitations were assessed in 32 subjects both males and females diagnosed with OA knee. Subjects with any other musculoskeletal, neurological, vascular disorder or trauma affecting lower extremity function were excluded. Outcome measures included Western Ontario and MacMaster Universities Osteoarthritis index (WOMAC), Fear Avoidance Beliefs Questionnaire (FABQ), and Numeric Pain Rating Scale (NRS). Consent was obtained from the participants prior to the study. Severity of pain, fear avoidance beliefs & physical function limitation were assessed in 32 subjects with OA knee using NRS, FABQ and WOMAC respectively. Level of significance was kept at 5%. Result: A statistically significant moderate correlation was found between fear avoidance beliefs with pain and strong correlation with functional limitation. A statistically significant strong correlation found between severity of pain & functional limitation. The study concluded that there is a moderate correlation between fear avoidance beliefs with severity of pain and there is a strong correlation between fear avoidance beliefs with function & between severity of symptoms with function in subjects with OA knee.

FRI0580-HPR Correlation between Self-Reported Physical Function and Isokinetic Total Muscle Work in Early Degrees of Knee Osteoarthritis

BackgroundKnee osteoarthritis (OA) is the most common chronic joint disease. Quadriceps is the muscle around the knee joint more affected by the disease, resulting in a reduction in functional muscle...

Effect of eccentric isokinetic strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo, a randomized trial

BackgroundFemorotibial knee osteoarthritis is associated with muscle weakness in the lower limbs, particularly in the quadriceps, which results in disease progression. The interest of having muscular strengthening as part of the therapeutic arsenal for the medical treatment of knee osteoarthritis is now well established.The functional disability induced by knee osteoarthritis manifests itself principally when walking, notably downhill, during which the muscles are called upon to contract eccentrically.We can therefore think that eccentric muscular strengthening could bring a functional benefit that is superior to concentric muscular strengthening.Methods/DesignThis is a prospective, randomized, bicenter, parallel-group, international study. Eighty patients aged from 40 to 75 years old, suffering from medical-stage knee osteoarthritis, will undertake 6 weeks of isokinetic muscular strengthening. Randomization determines the mode of muscular strengthening: either exclusively eccentric or exclusively concentric.The principal objective is to demonstrate the superiority of the improvement in the quadriceps isokinetic torque after isokinetic muscular strengthening by the eccentric mode compared to the concentric mode.The following parameters are also evaluated: the variations in the level of pain, the parameters of walking (maximum speed over 10 and 200 meters, analysis on a computerized Gaitrite™ treadmill), static equilibrium (on a FUSYO™ force platform), and the functional status of the patient using the Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaire after the strengthening period and at 6 months.DiscussionA better knowledge of the most effective mode of muscular strengthening is needed to optimize the functional benefits to the patients. In case of superiority in terms of efficacy of the eccentric mode, the latter could be given priority in the rehabilitation treatment of knee osteoarthritis patients.Trial registrationClinical trials.gov number: NCT01586130.