Management Of Knee Osteoarthritis Research Articles

Assessment of the Quality and Readability of Information Provided by ChatGPT in Relation to the Use of Platelet-Rich Plasma Therapy for Osteoarthritis

Objective: This study aimed to evaluate the quality and readability of information generated by ChatGPT versions 3.5 and 4 concerning platelet-rich plasma (PRP) therapy in the management of knee osteoarthritis (OA), exploring whether large language models (LLMs) could play a significant role in patient education. Design: A total of 23 common patient queries regarding the role of PRP therapy in knee OA management were presented to ChatGPT versions 3.5 and 4. The quality of the responses was assessed using the DISCERN criteria, and readability was evaluated using six established assessment tools. Results: Both ChatGPT versions 3.5 and 4 produced moderate quality information. The quality of information provided by ChatGPT version 4 was significantly better than version 3.5, with mean DISCERN scores of 48.74 and 44.59, respectively. Both models scored highly with respect to response relevance and had a consistent emphasis on the importance of shared decision making. However, both versions produced content significantly above the recommended 8th grade reading level for patient education materials (PEMs), with mean reading grade levels (RGLs) of 17.18 for ChatGPT version 3.5 and 16.36 for ChatGPT version 4, indicating a potential barrier to their utility in patient education. Conclusions: While ChatGPT versions 3.5 and 4 both demonstrated the capability to generate information of moderate quality regarding the role of PRP therapy for knee OA, the readability of the content remains a significant barrier to widespread usage, exceeding the recommended reading levels for PEMs. Although ChatGPT version 4 showed improvements in quality and source citation, future iterations must focus on producing more accessible content to serve as a viable resource in patient education. Collaboration between healthcare providers, patient organizations, and AI developers is crucial to ensure the generation of high quality, peer reviewed, and easily understandable information that supports informed healthcare decisions.

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA.MethodologyA randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee’s functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests—the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05.ResultOf the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM − 4.15; TSE − 4.42; KSE − 3.78), during stair ascent (MWM − 3.89; TSE − 4.88; KSE − 3.56) and descent (MWM − 3.78; TSE − 4.05; KSE − 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM − 7.05; TSE − 7.16; KSE − 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05).ConclusionIn this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA.Trial noClinicalTrials.gov = NCT04099017 23/9/2019.

A multiview deep learning-based prediction pipeline augmented with confident learning can improve performance in determining knee arthroplasty candidates.

Preoperative prudent patient selection plays a crucial role in knee osteoarthritis management but faces challenges in appropriate referrals such as total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA)and nonoperative intervention. Deep learning (DL) techniques can build prediction models for treatment decision-making. The aim is to develop and evaluate a knee arthroplasty prediction pipeline using three-view X-rays to determine the suitable candidates for TKA, UKAor are not arthroplasty candidates. A study was conducted using three-view (anterior-posterior, lateraland patellar) X-rays and surgical data of patients undergoing TKA, UKAor nonarthroplasty interventions from sites A and B. Data from site A were used to derive and validate models. Data from site B were used as external test set. A DL pipeline combining YOLOv3 and ResNet-18 with confident learning (CL) was developed. Multiview Convolutional Neural Network, EfficientNet-b4, ResNet-101and the proposed model without CLwere also trained and tested. The models were evaluated using metrics such as area under the receiver operating characteristic curve (AUC), accuracy, precision, specificity, sensitivityand F1 score. The data set comprised a total of 1779 knees. Of which 1645 knees were from site A as a derivation set and an internal validation cohort. The external validation cohort consisted of 134 knees. The internal validation cohort demonstrated superior performance for the proposed model augmented with CL, achieving an AUC of 0.94 and an accuracy of 85.9%. External validation further confirmed the model's generalisation, with an AUC of 0.93 and an accuracy of 82.1%. Comparative analysis with other neural network models showed the proposed model's superiority. The proposed DL pipeline, integrating YOLOv3, ResNet-18and CL, provides accurate predictions for knee arthroplasty candidates based on three-view X-rays. This prediction model could be useful in performing decision making for the type of arthroplasty procedure in an automated fashion. Level III, diagnostic study.

Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial.

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics. Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed. Significant between group differences were detected for the change in timed-up-and-go test, 40m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6months and trunk fat (%) at 3months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic. Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted. Clinicaltrials.gov/study/NCT04172688.

Demonstrating the effectiveness of intra-articular prolotherapy combined with peri-articular perineural injection in knee osteoarthritis: a randomized controlled trial

BackgroundThis study aimed to compare the efficacy of intra-articular prolotherapy (IG) combined with peri-articular perineural injection (PG) in the management of knee osteoarthritis (KOA).MethodsA total of 60 patients with the diagnosis of KOA were included in this double-blinded randomized controlled clinical trials. The inclusion criteria were as follow: (1) 48–80 years old; (2) the diagnose of KOA; (3) the grade 2 and 3 of the Kellgern–Lawrence grading scale; (4) the pain, crepitation, and knee joint stiffness continuing for 3 months at least. The main exclusion criteria were as follow: (1) any infection involving the knee skin; (2) history of any Influencing factors of disease. All patients were divided into three groups and received either IG, PG and I + PG under the ultrasound guidance and the 2, 4 and 8 weeks follow-up data of patients were available. (IG n = 20 or PG n = 20, I + PG n = 20). Visual Analogue Scale (VAS), The Western Ontario McMaster University Osteoarthritis Index (WOMAC) and the pressure pain threshold (PPT) were used as outcome measures at baseline, 2, 4 and 8 weeks.ResultsThere were no statistically significant differences in terms of age, sex, BMI, duration of current condition and baseline assessments of pain intensity, WOMAC scores and PPT. After treatment, the improvement of VAS activity, WOMAC and PPT values was showed compared with pre-treatment in all groups (p < 0.05). At 4 and 8 weeks after treatment, the VAS and WOMAC scores of the I + PG were significantly lower than those of the PG or IG, and the difference was statistically significant (p < 0.05). The PPT values of PG and I + PG were significantly improved compared to IG at 2, 4, and 8 weeks after treatment.ConclusionThe ultrasound guided I + PG of 5% glucose seem to be more effective to alleviate pain and improve knee joint function than single therapy in short term. Clinical rehabilitators could clinically try this combination of I + PG to improve clinical symptoms in patients with KOA.

Comprehensive Study on Scoring and Grading Systems for Predicting the Severity of Knee Osteoarthritis.

Knee Osteoarthritis (KOA) is a degenerative joint ailment characterized by cartilage loss, which can be seen using imaging modalities and converted into imaging features. The older population is the most affected by knee OA, which affects 16% of people worldwide who are 15 years of age and older. Due to cartilage tissue degradation, primary knee OA develops in older people. In contrast, joint overuse or trauma in younger people can cause secondary knee OA. Early identification of knee OA, according to research, may be a successful management tactic for the condition. Scoring scales and grading systems are important tools for the management of knee osteoarthritis as they allow clinicians to measure the progression of the disease's severity and provide suggestions on suitable treatment at identified stages. The comprehensive study reviews various subjective and objective knee evaluation scoring systems that effectively score and grade the KOA based on where defects or changes in articular cartilage occur. Recent studies reveal that AI-based approaches, such as that of DenseNet, integrating the concept of deep learning for scoring and grading the KOA, outperform various state-of-the-art methods in order to predict the KOA at an early stage.

Capability After Total Knee Arthroplasty for Osteoarthritis Is Strongly Associated With Preoperative Symptoms of Depression.

Primary total knee arthroplasty (TKA) aims to improve the level of capability (ability to perform valued life activities) associated with knee osteoarthritis (OA). However, some evidence suggests a substantial proportion of patients remain dissatisfied with their outcomes after this procedure. We sought to better understand the association between mental health, specifically symptoms of depression, with postoperative outcomes. Symptoms of depression are shown to be common among orthopaedic populations in general and can be briefly and conveniently evaluated using the Patient Health Questionnaire-2 (PHQ-2) in a less burdensome manner compared with longer mental health surveys. This study assesses the association between preoperative depressive symptoms (PHQ-2) and levels of capability at 6 weeks and 6 months after TKA. We conducted a prospective cohort study involving 114 patients with knee OA across five clinics in California and Texas scheduled for TKA. Participants completed a preoperative PHQ-2 and Knee Injury and OA Outcome Score for Joint Replacement (KOOS JR) survey at 6 weeks and 6 months post-TKA. We analyzed these data using bivariate and multivariable regression. Preoperative PHQ-2 scores were significantly associated with lower KOOS JR scores at 6 weeks and 6 months post-TKA. Latino/Hispanic race was also associated with lower KOOS JR scores at 6 weeks. The association between preoperative depressive symptoms and level of capability after TKA were more pronounced at 6 months compared with 6 weeks. Preoperative symptoms of depression are strongly associated with reduced capability after TKA and can be screened for using the PHQ-2-a brief tool that can be feasibly incorporated into clinical workflows. User-friendly assessment of depressive symptoms can assist orthopaedic surgeons in identifying and addressing mental health at the outset during the management of knee OA.

Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis.

This study was aimed to assess the efficacy and safety of two oral Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOAs)-Glucosamine Sulfate, Chondroitin Sulfate, and their combination regimen in the management of knee osteoarthritis (KOA). This systematic review was conducted according to PRISMA 2020 guidelines. A detailed literature search was performed from 03/1994 to 31/12/2022 using various electronic databases including PubMed, Embase, Cochrane Library, and Google Scholar, using the search terms-Glucosamine sulfate (GS), Chondroitin sulfate (CS), Knee osteoarthritis, Joint pain, Joint disease, and Joint structure, for literature concerning glucosamine, chondroitin, and their combination in knee osteoarthritis treatment. Cochrane Collaboration's Risk assessment tool (version 5.4.1) was used for assessing the risk of bias and the quality of the literature. The data was extracted from the included studies and subjected to statistical analysis to determine the beneficial effect of Glucosamine Sulfate, Chondroitin Sulfate, and their combination. Twenty-five randomized controlled trials (RCTs) were included in this systematic review. In short, exclusively 9 RCTs for GS, 13 RCTs for CS, and 3 RCTs for the combination of GS and CS. All these studies had their treatment groups compared with placebo. In the meta-analysis, CS showed a significant reduction in pain intensity, and improved physical function compared to the placebo; GS showed a significant reduction in tibiofemoral joint space narrowing. While the combination of GS and CS showed neither a reduction in pain intensity, nor any improvement in the physical function. However, the combinationexhibited a non-significant reduction in joint space narrowing. In the safety evaluation, both CS and GS have shown good safety profile and were well tolerated. This meta-analysis revealed that the CS (with decreased pain intensity and improvement in the physical function), and GS (with significant reduction in the joint space narrowing) have significant therapeutic benefits. However, their combination did not significantly improve the symptoms or modify the disease. This may be due to the limited trials that are available on the combination of the sulfate forms of the intervention. Hence, there is a scope for conducting multicentric randomised controlled trials to evaluate and conclude the therapeutic role of CS and GS combination in the management of KOA.

Effect of clinic-based and telemonitored home-based intervention on pain intensity, functioning and quality of life in patients with knee osteoarthritis

Introduction and aim. The study assessed and compared the effects of clinic-based and telemonitored home-based interventions on pain intensity, functioning and quality of life in patients with knee osteoarthritis (KOA). Material and methods. Forty-two patients were recruited purposely and randomly allocated into clinic-based (CBG) and telemonitored home-based group (THG) equally. The CBG and THG received isometric exercises to strengthen the quadriceps and hamstring muscles using theraband. THG received the exercise at home they were monitored on phone thrice in a week, while the CBG did the exercise in the hospital. The subjects performed four sets of eight repetitions three days in a week for eight weeks. Pain intensity, functioning and health related quality of life (HRQoL) were assessed at pretreatment, 6th and 8th week of intervention. Data was analyzed with descriptive and inferential statistics. Alpha level was set at 0.05. Results. There was a significant reduction (p&lt;0.001) among pre-treatment, 6th and 8th week intervention in pain intensity, functional pain intensity and quality of life of CBG and THG. CBG showed significant reduction (p&lt;0.001) in pain intensity, function and increase in HRQoL than THG at 8th week. Conclusion. Clinic-based and telemonitored home-based interventions were both effective in the management of KOA but clinic-based intervention was better than telemonitored home-based intervention.

Knowledge, attitude and utilisation of evidence-based therapeutic exercises in knee osteoarthritis management in Nigeria

Background: In Nigeria, there is a disparity among physiotherapists regarding therapeutic exercise as a core treatment for patients with knee osteoarthritis (OA). The attitudes and beliefs of physiotherapists could influence this.Objective: To investigate Nigerian physiotherapists’ knowledge, attitude, and utilisation of evidence-based therapeutic exercisesDesign: A mixed-method of cross-sectional survey and focus group discussion.Setting: Secondary and tertiary health institutions in NigeriaParticipants: Physiotherapists consecutively sampled from the selected institutions.Main outcome measures: Participants’ knowledge, attitude and utilisation of evidence-based therapeutic exercises for the management of knee OAResults: This study revealed that 81% of physiotherapists in Nigeria had a fair knowledge of evidence-based practice and the efficacy of therapeutic exercises in managing knee OA. Despite this fair knowledge, 95.3% had a poor attitude. The important emerging categories/themes are treatment preference, clinical experience, and strength of evidence.Conclusion: Physiotherapists in Nigeria have a fair knowledge of evidence-based therapeutic exercises in managing patients with knee OA, although there is a poor attitude and disparity between the use and current recommendations.

Efficacy of Mulligan MWMs along with Conventional Physical Therapy in Knee Osteoarthritis

Background: Knee osteoarthritis is a prevalent degenerative joint disease that impairs mobility and causes significant pain, particularly in the aging population. Conservative management, including physical therapy, remains a cornerstone of treatment. The addition of Mulligan Mobilization with Movement (MWM) to conventional therapy has been proposed to improve outcomes, though its efficacy had not been robustly quantified. Objective: The objective of this study was to compare the efficacy of Mulligan MWM in conjunction with conventional physical therapy to conventional physical therapy alone in reducing pain and stiffness and improving functional outcomes in patients with grade 2 knee osteoarthritis. Methods: This randomized clinical trial included 28 participants with grade 2 knee osteoarthritis, randomly allocated into two groups: one receiving Mulligan MWM alongside conventional physical therapy and the other receiving only conventional physical therapy. The intervention lasted one month, with assessments conducted at baseline, two weeks, and four weeks using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as outcome measures. Statistical analysis was performed using SPSS version 25. Results: The MWM plus physical therapy group exhibited a greater reduction in VAS scores (baseline: 6.71, SD 1.729 to week 4: 2.21, SD 1.051) compared to the physical therapy alone group (baseline: 7.14, SD 1.562 to week 4: 3.86, SD 0.663), with a significant mean difference (P&lt;0.001). Similarly, WOMAC scores for pain, stiffness, and physical function significantly improved in the MWM group compared to the physical therapy group at week 4 (Pain: 2.79 vs. 6.86, Stiffness: 1.14 vs. 3.36, Function: 9.79 vs. 27.57, all P&lt;0.001). Conclusion: Mulligan MWM combined with conventional physical therapy was more effective than conventional physical therapy alone in reducing pain, stiffness, and improving functional outcomes in patients with grade 2 knee osteoarthritis. These results support the inclusion of MWM in the management of knee osteoarthritis.

A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of Grade 3 and 4 Knee Osteoarthritis: Development and Preliminary Validation of precisionKNEE.

Objective To identify key variables predictive of patient responses to microfragmented adipose tissue (MFAT) treatment in knee osteoarthritis (KOA) and evaluate its potential to delay or mitigate the need for total knee replacement (TKR). Methods We utilised a dataset comprising 329 patients treated with MFAT for KOA, incorporating variables such as gender, age, BMI, arthritic aetiology, radiological grade, and Oxford Knee Scores (OKS) pre- and post-treatment. We employed random forest regressors for model training and testing, with gender bias mitigation and outlier detection to enhance prediction accuracy. Model performance was assessed through root mean squared error (RMSE) and mean absolute error (MAE), with further validation in a TKR-suitable patient subset. Results The model achieved a test RMSE of 6.72 and an MAE of 5.38, reflecting moderate predictive accuracy across the patient cohort. Stratification by gender revealed no statistically significant differences between actual and predicted OKS improvements (p-values: males = 0.93, females = 0.92). For the subset of patients suitable for TKR, the model presented an increased RMSE of 9.77 and MAE of 7.81, indicating reduced accuracy in this group. The decision tree analysis identified pre-operative OKS, radiological grade, and gender as significant predictors of post-treatment outcomes, with pre-operative OKS being the most critical determinant. Patients with lower pre-operative OKS showed varying responses based on radiological severity and gender, suggesting a nuanced interaction between these factors in determining treatment efficacy. Conclusion This study highlights the potential of MFAT as a non-surgical alternative for KOA treatment, emphasising the importance of personalised patient assessments. While promising, the predictive model warrants further refinement and validation with a larger, more diverse dataset to improve its utility in clinical decision-making for KOA management.

The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).

The aim of this European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus is to provide recommendations based on evidence and expert opinion to improve indications, decision-makingand administration-related aspects when using blood-derived orthobiologics (for simplicity indicated as PRP-platelet-rich plasma-with PRP being the most common product) for the management of knee osteoarthritis (OA). Leading European expert clinicians and scientists were divided into a steering group, a rating group and a peer review group. The steering group prepared 28 question-statement sets divided into three sections: PRP rationale and indications, PRP preparation and characterisationand PRP protocol. The quality of the statements received grades of recommendation ranging from A (high-level scientific support)to B (scientific presumption), C (low-level scientific support) or D (expert opinion). The question-statement sets were then evaluated by the rating group, and the statements scored from 1 to 9 based on their degree of agreement with the statements produced by the steering group. Once a general consensus was reached between the steering and rating groups, the document was submitted to the peer review group who evaluated the geographic adaptability and approved the document. A final combined meeting of all the members of the consensus was held to produce the official document. The literature review on the use of blood-derived products for knee OA revealed that 9 of 28 questions/statements had the support of high-level scientific literature, while the other 19 were supported by a medium-low scientific quality. Three of the 28 recommendations were grade A recommendations: (1) There is enough preclinical and clinical evidence to support the use of PRP in knee OA. This recommendation was considered appropriate with a strong agreement (mean: 8). (2) Clinical evidence has shown the effectiveness of PRP in patients for mild to moderate degrees of knee OA (KL ≤ 3). This recommendation was considered appropriate with a strong agreement (mean: 8.1). (3) PRP injections have been shown to provide a longer effect in comparison to the short-term effect of CS injections. They also seem to provide a safer use profile with less potential related complications. This recommendation was considered appropriate with a very strong agreement (mean: 8.7). Six statements were grade B recommendations, 7 were grade C and 12 were grade D. The mean rating score was 8.2 ± 0.3. The consensus group reached a high level of agreement on all the questions/statements despite the lack of clear evidence for some questions. According to the results from this consensus group, given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OAand as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3. Level II.

Prospective validity of a clinical prediction rule for response to non-surgical multidisciplinary management of knee osteoarthritis in tertiary care: a multisite prospective longitudinal study

ObjectivesWe tested a previously developed clinical prediction tool—a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological...

Elucidating Cyathula Officinals' mechanism in osteoarthritis treatment: Network pharmacology and empirical evidence on anti-inflammatory actions

In this study, we explored the therapeutic potential of Cyathula Officinals (CNX) in Knee Osteoarthritis (KOA) treatment. Utilizing network pharmacology and in vitro experiments, we identified active ingredients, action targets and pathways in CNX. Our analysis, integrating databases like TCMSP, SwissTarget Prediction, Genecards, CTD, STRING, and DAVID, highlighted 396 action targets and 283 disease targets, pinpointing 64 intersection genes linked to KOA. The significant involvement of the MAPK and NF-κB pathways in CNX's anti-inflammatory action was validated through qPCR, which might underlie CNX's efficacy in inhibiting chondrocyte apoptosis and IL-6 expression. These findings suggest CNX's potential in KOA management, offering insights for its clinical application.

Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials.

Based in part on the results of randomized controlled trials (RCTs) that suggest a beneficial effect over alternative treatment options, the use of platelet-rich plasma (PRP) for the management of knee osteoarthritis (OA) is widespread and increasing. However, the extent to which these studies are vulnerable to slight variations in the outcomes of patients remains unknown. To evaluate the statistical fragility of conclusions from RCTs that reported outcomes of patients with knee OA who were treated with PRP versus alternative nonoperative management strategies. Systematic review and meta-analysis; Level of evidence, 2. All RCTs comparing PRP with alternative nonoperative treatment options for knee OA were identified. The fragility index (FI) and reverse FI were applied to assess the robustness of conclusions regarding the efficacy of PRP for knee OA. Meta-analyses were performed to determine the minimum number of patients from ≥1 trials included in the meta-analysis for which a modification on the event status would change the statistical significance of the pooled treatment effect. In total, this analysis included outcomes from 1993 patients with a mean ± SD age of 58.0 ± 3.8 years. The mean number of events required to reverse significance of individual RCTs (FI) was 4.57 ± 5.85. Based on random-effects meta-analyses, PRP demonstrated a significantly higher rate of successful outcomes when compared with hyaluronic acid (P = .002; odds ratio [OR], 2.19; 95% CI, 1.33-3.62), as well as higher rates of patient-reported symptom relief (P = .019; OR, 1.55; 95% CI, 1.07-2.24), not requiring a reintervention after the initial injection treatment (P = .002; OR, 2.17; 95% CI, 1.33-3.53), and achieving the minimal clinically important difference (MCID) for pain improvement (P = .007; OR, 6.19; 95% CI, 1.63-23.42) when compared with all alternative nonoperative treatments. Overall, the mean number of events per meta-analysis required to change the statistical significance of the pooled treatment effect was 8.67 ± 4.50. Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness. On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the MCID for pain improvement when compared with alternative nonoperative treatment options. Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care. Future RCTs and meta-analyses should consider reporting FIs and fragility quotients to facilitate interpretation of results in their proper context.

POST-OPERATIVE REHABILITATION OF A RIGHT SIDED TOTAL KNEE ARTHROPLASTY PATIENT- A CASE REPORT

Background and purpose:Osteoarthritis(OA) is a progressive degenerative condition resulting from the cartilage wear and tear that leads to knee joint deformities and functional limitations. Total knee arthroplasty (TKA) has become the gold standard treatment for surgically managing knee osteoarthritis, but physical rehabilitation after surgery is critical for returning function to pre-surgery levels. The purpose of this case report is to describe the effectiveness of physical therapy intervention and report outcomes following a right TKA. Case Description:The present case report describes the 12-week outpatient physical therapy rehabilitation of an 86-year-old woman who underwent right-sided TKA. She suffered from knee pain and limited ambulating speed since three years. During outpatient rehabilitation patient received treatment for improving functional mobility, ROM, strength, and gait training. Outcomes:During course of 12 weeks of physical therapy rehabilitation improvement was seen in pain from 2/10 to 0/10 on NPRS, flexion ROM from 110degrees to 130 and strength from 3-/5 to 4/5 on MMT. Additional outcome measures that showed improvement includes Time Up and Go Test (TUG) for mobility from 16.5 to 14.97 seconds and gait speed 0.6 m/s to 0.78 m/s. She was able to accomplish both short-term and long-term goals. Discussion:This study supports that early mobilization and therapeutic exercises in post knee arthroplasty can improve functional outcomes and help patient to return to the prior level of function. Although, it is recommended that further research is needed to be done on a larger population to establish its effectiveness.

Pragmatism in manual therapy trials for knee osteoarthritis: a systematic review.

Manual therapy is an often-utilized intervention for the management of knee osteoarthritis (OA). The interpretation of results presented by these trials can be affected by how well the study designs align applicability to real-world clinical settings. To examine the existing body of clinical trials investigating manual therapy for knee OA to determine where they fall on the efficacy-effectiveness spectrum. This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials that investigated manual therapy treatments for adults with knee OA were retrieved via searches of multiple databases to identify trials published prior to April 2023. The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool was used to objectively rate the efficacy-effectiveness nature of each trial design. The Cochrane Risk of Bias 2.0 assessment tool (RoB-2) was used to assess the risk of bias across five domains. Of the 36 trials, a higher percentage of trials had a greater emphasis on efficacy within all four domains: participant characteristics (75.0%), trial setting (77.8%), flexibility of intervention (58.3%), and clinical relevance of experimental and comparison intervention (47.2%). In addition, 13.9% of the trials had low risk of bias, 41.7% had high risk of bias, and 44.4% had some concerns regarding bias. While many trials support manual therapy as effective for the management of knee OA, a greater focus on study designs with an emphasis on effectiveness would improve the applicability and generalizability of future trials.

Navigating the Therapeutic Landscape: A Comprehensive Review of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate in Knee Osteoarthritis.

This comprehensive review provides an in-depth analysis of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) as potential treatments for knee osteoarthritis. It explores their mechanisms of action, clinical efficacy, safety considerations, and the importance of personalised treatment approaches. The review highlights promising findings regarding the ability of PRP and BMAC to alleviate symptoms, improve joint function, and potentially slow disease progression. It emphasises the need for further research into long-term outcomes, direct comparative studies, protocol standardisation, biomarker identification, and cost-effectiveness assessments to enhance clinical practice. While the review does not directly compare PRP and BMAC, it provides valuable insights into their respective roles in knee osteoarthritis management. The review aims to contribute to evidence-based advancements in regenerative therapies for knee osteoarthritis by addressing critical research priorities and refining treatment strategies.

Therapeutic effectiveness of oral homeopathic remedy in management of knee osteoarthritis via attenuation of oxidative and inflammatory pathway

Background Osteoarthritis (OA) is the most common prevalent condition that affects joints and causes erosion of the cartilage. Many conventional medications show evidence of short-term effectiveness. However, they are associated with numerous adverse effects. Objective As homeopathy is a complementary modality, thus this study aimed to explore the therapeutic effectiveness of homeopathic remedies in management of knee OA that proved efficiency in management of knee OA without health hazards. Patients and methods Thirty cases (25 females, five males) were complaining of bilateral grade 2 or 3 knee OA were included in the study. Each patient was taken as her/his control. One milliliter of a diluted complex of four homeopathic remedies (Arnica Montana, Ledum Palustre, Rhus Tox, and Ruta Graveolens) was taken orally by each patient for 6 weeks in ascending potency. Results All clinical parameters showed significant improvement after the end of therapy. Visual analog scale, number of tender points, tenderness score (TS), angle of knee flexion, heel to hip distance Western Ontario and McMaster universities osteoarthritis index score and Lequesne index (P≤0.05). In addition, there was significant improvement in laboratory markers as significant increase in serum enkephalin and interleukin-4 and decreasing in erythrocyte sedimentation rate (P≤0.05). Conclusion The study showed efficiency of four homeopathic remedies in decreasing pain, tenderness, improving knee flexion and quality of life supported with improvement in serum levels of encephalin, interleukin-4 and erythrocyte sedimentation rate in grade 2 or 3 OA patients.