McMaster Universities Osteoarthritis Index Score Research Articles

Multiple intra-articular injections of autologous stromal vascular fractions for the treatment of multicompartmental osteoarthritis in both the tibiofemoral and patellofemoral joint: a single-blind randomized controlled study.

Multicompartmental osteoarthritis (MOA) in both tibiofemoral and patellofemoral joints is a more commonly occurring, but neglected, clinical condition, and we examined the short-term safety and efficacy of autologous stromal vascular fractions (SVFs) for MOA using a single-blind, prospective, randomized, placebo-controlled trial. Seventy MOA patients were recruited and randomly assigned to the SVF group and hyaluronic acid (HA) group (control group). The scores of visual analog scale, the Western Ontario and McMaster University Osteoarthritis Index, and the Samsung Medical Center patellofemoral scoring system were assessed and compared between the two groups 3, 6 and 12months after treatment. The SVF group had significantly better visual analog scale scores than the HA group at 6 and 12months after treatment and had better Western Ontario and McMaster University Osteoarthritis Index scores than the HA group only at 6months after treatment. For Samsung Medical Center patellofemoral scoring system of the patellofemoral joint, the SVF group had significantly better scores than the control group at all postoperative time points. The proportion of patients whose visual analog scale and Western Ontario and McMaster University Osteoarthritis Index scores were above the minimal clinically important improvement was higher in the SVF group than in the HA group in the majority of assessments. The improvement of bone marrow by SVF treatment was significantly better than that of the HA group as observed by pre- and postoperative Magnetic resonance imaging (MRI). Multiple intra-articular injection of autologous SVF reduces pain and improves function in the short term in patients with early or midstage MOA. However, there was heterogeneity in the improvement of overall knee and isolated patellofemoral joint after treatment.

No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up.

This study aimed to compare long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile-bearing insert. From May 2008 to December 2009, 45 and 63 mobile-bearing TKA patients were enroled in the CON- and NAV-TKA groups with 146.8 months follow-up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip-knee-ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. The number of HKA angle outliers (more than 3 degrees or less than -3 degree) was significantly lower in the NAV-TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON-TKA group. However, long-term clinical outcomes were similar between both groups. The cumulative survival rate (best-case scenario) was 98.3% in the CON-TKA group and 97.5% in the NAV-TKA group, with no significant difference between the groups (p = 0.883). Long-term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower-limb alignment in the NAV-TKA group. Excellent survival rates were observed in both groups using mobile-bearing inserts. Level IV, case series.

Effects of Isometric Quadriceps Muscle Exercise with Visual and Auditory Feedback at 1 Year after Total Knee Arthroplasty.

To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.

Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: A pilot study.

Extracorporeal shockwave therapy (ESWT) has been widely used for various musculoskeletal disorders, including knee osteoarthritis (OA), and has been shown in several studies to be a safe treatment. Although some studies have confirmed the pain-relieving effect of ESWT for knee OA, research on objectivity for structural changes in knee OA is lacking. The aim of this study was to evaluate the ESWT treatment mechanisms in patients with knee OA by means of clinical symptoms and ultrasound techniques as objective measures. Eighteen patients with mild knee OA were enrolled and randomized to 1 of 2 treatment groups: active or sham. Patients in the experimental group received 0.05 mJ/mm² total energy with 1000 pulses weekly for 3 weeks. We then assessed them before, immediately after, and 1-month after the last treatment using the following measurements: pain on a visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne index, knee joint range of motion, and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). All 18 patients completed the 3 treatment sessions without any complication. Both the experimental and control groups improved in terms of OA symptoms, as measured by the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, and Lequesne index (P < .05). The height of the suprapatellar effusion decreased with time course in the experimental group (P < .05) and showed significant differences with control group at 1-month follow-up (P < .05). The experimental group showed an increase in knee flexion range of motion and Doppler activity immediately following the last treatment session (P < .05), but the effect was not sustained at the 1-month follow-up. Although the therapeutic activity itself could improve OA symptoms, objective improvements were only observed after ESWT. Suprapatellar effusion height was reduced after ESWT and the effect was maintained after 1-month. Our results suggest that ESWT may be effective in reducing suprapatellar effusion and improving symptoms in mild knee OA. However, studies with a larger sample size are required.

Level of Inflammation and its Association with Pain, Physical Functioning and KL-Grade in Patients With Knee Osteoarthritis

Background: Knee osteoarthritis (OA), also known as degenerative arthritis, causes a progressive loss of articular cartilage. In recent years, there has been a shift in the understanding of OA from a “wear and tear” disease to an “inflammatory” condition. Aims and Objectives: The objective of this study was to assess the level of inflammation and to evaluate the relationship between inflammation, pain, physical functioning, and Kellgren Lawrence (KL)-grade in patients with knee OA. Materials and Methods: Sixty patients with radiographic evidence of knee OA (KL Grade I/II/III) were cross-sectionally analyzed. Data about their anthropometry, inflammatory markers high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate-(ESR), pain, and physical functioning were collected. Results: The mean hsCRP among the patient population was 4.6 ± 4.0 mg/L and the mean ESR was 40.4 ± 21.8 mm/h. There was a strong significant association of visual analog scale (VAS) pain score with hsCRP (r = 0.353; P = 0.005) and ESR (r = 0.269; P = 0.036). There was a strong significant association of Western Ontario and McMaster Universities OA Index score with hsCRP (r = 0.415; P = 0.001) and ESR (r = 0.413, P = 0.001). However, there was no significant difference in hsCRP or ESR when classified according to KL-grade (P &gt; 0.05). Conclusion: The level of inflammation is high in knee OA patients. Inflammation is significantly associated with pain intensity and physical functioning in knee OA patients. However, there is no significant difference in hsCRP, ESR, and VAS when classified according to KL-grade. This emphasizes the need to study inflammatory markers in addition to radiographic evidence for informed clinical decision-making.

A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty

To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.

Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial

BackgroundCementless total knee arthroplasty (TKA) has become increasingly popular. Some surgeons are concerned about pain, implant stability, and metal-backed patellar component survivorship. This study investigated the outcomes of cementless compared with cemented TKA in bilateral cases. MethodsWe randomized 80 knees in 40 osteoarthritic knee patients who underwent bilateral TKA with patellar resurfacing under one anesthesia. All participants received cementless prostheses in one knee and cemented prostheses in the other. The outcomes were knee function measured by the forgotten joint scores, modified Western Ontario and McMaster Universities Osteoarthritis Index, knee ranges of motion, pain levels, operative times, radiographic outcomes, and complications. All knees were followed for a minimum of 2 years (2 to 3 years). ResultsCementless and cemented TKA had similar functional outcomes in forgotten joint score (97 ± 5 versus 98 ± 3 points, P = .52), modified Western Ontario and McMaster Universities Osteoarthritis Index score (3 ± 4 versus 3 ± 2 points, P = .96), and ranges of motion (134 ± 7° versus 134 ± 7°, P = .16). The postoperative pain was also similar (P > .05). There were 4 cementless patellar components had superior migration for an average of 3.5 mm (range, 1.77 to 4.16) without loosening. The mean time of migration was 4 (range, 2 to 6) weeks. ConclusionsCementless TKA had similar functional outcomes and recovery patterns compared with cemented TKA. However, there was concern of cementless component migration at patellae.

Fixed-Bearing Unicompartmental Knee Arthroplasty in Tibia Vara Knees Results in Joint Surface Malalignment and Varus Joint Line Obliquity, but Does Not Affect Functional Outcomes at Greater Than 5 Years Follow-Up

BackgroundThis study aimed to investigate the clinical outcomes of fixed-bearing medial unicompartmental knee arthroplasty (UKA) for tibia vara knees and the associated changes in joint space malalignment (JSM) and joint line obliquity (JLO). MethodsWe retrospectively analyzed a consecutive group of 100 patients who underwent fixed-bearing medial UKA with a preoperative medial proximal tibia angle (MPTA) ≥86° (n = 50) and MPTA <86° (n = 50) and who had a minimum 5-year follow-up. Radiological parameters, including the hip-knee-ankle angle, MPTA, and the postoperative JSM and JLO, were measured. Functional evaluation was performed using the range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index score. ResultsThe MPTA <86° group showed significantly higher postoperative JLO (91.8 versus 90.4°, respectively; P = .002) and JSM (6.1 versus 4.2°, respectively; P = .026) compared to the MPTA ≥86° group. Functional outcomes, including range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores, were not significantly different between the 2 groups. ConclusionsFixed-bearing medial UKA is a safe and effective surgical option for patients who have tibia vara knees, as an increase in JLO and JSM postoperatively does not have a clinically relevant impact, even after a minimum 5-year follow-up.

Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36months post-SVF injection. A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

Comparison of conventional and cooled radiofrequency treatment of the genicular nerves versus sham procedure for patients with chronic knee pain: protocol for a multicentre, double-blind, randomised controlled trial (COGENIUS)

IntroductionThe prevalence of chronic knee pain is increasing. Osteoarthritis (OA) and persistent postsurgical pain (PPSP) are two important causes of knee pain. Chronic knee pain is primarily treated with medications,...

A Smartphone Application-Based Remote Rehabilitation System for Post-Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Trial

BackgroundRemote rehabilitation after total knee arthroplasty has gradually gained popularity in recent years. This study aimed to determine whether smartphone application-based remote rehabilitation could outperform home-based rehabilitation and outpatient guidance in terms of 12-week outcomes following primary unilateral total knee arthroplasty. MethodsPatients who underwent primary unilateral total knee arthroplasty were recruited and randomly divided into a telerehabilitation group and a control group. A total of 100 patients were examined, with 50 each assigned to the telerehabilitation and control groups. In the telerehabilitation group, a telerehabilitation application was installed on the smartphones of the participants to allow postdischarge guidance. The primary outcomes were knee range of motion (ROM) at 12 weeks postoperatively. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score, The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Five Times Sit-to-Stand Test (5xSST), Single-Leg Stance Test (SLST), satisfaction, rehabilitation costs, complication rate, and 90-day readmission rate. All outcomes were collected at 2, 6, and 12 weeks after surgery. ResultsAt 12 weeks postoperatively, the telerehabilitation patients significantly outperformed the controls in terms of knee ROM (124 ± 8.7 versus 119 ± 5.5 P = .01), SF-36 (physiological function) (61.5 ± 20.3 versus 45.5 ± 18.1 P = .000), SF-36 (role-physical) (49.3 ± 41.5 versus 27.7 ± 28.9 P = .012), SLST (13.0 ± 9.1 versus 9.1 ± 5.9 P = .026), and 5xSST (17.7 ± 4.3 versus 19.4 ± 3.5 P = .043). No significant differences were found between groups in the Western Ontario and McMaster Universities Osteoarthritis Index score, Knee Society Score, rehabilitation costs, 90-day readmission rate, or incidence of adverse events. ConclusionOur study showed that smartphone app-based remote rehabilitation worked better than home-based rehabilitation with outpatient guidance in terms of short-term results in ROM, SLST, and 5xSST.

A Review: Applications of Chemicals on the Health Aspects of Seborrheic Dermatitis in Coastal Tropical Region

Background: Knee osteoarthritis (KOA) is one of the most common degenerative diseases that can lead to disability and pain. The degenerative nature of this condition cannot be reversed or healed by any currently available treatments. Recently, there has been an upcoming interest in treating degenerative tissue disorders with minimally invasive autologous blood products. Autologous blood was preconditioned with gold particles to encourage the production of various proteins in patients’ blood. This current study investigated the safety and efficacy of pre-conditioning autologous blood with gold particles (GOLDIC®) in patients with severe knee osteoarthritis (KOA). Case presentation We report a case in which four intra-articular GOLDIC® injections were used to treat knee osteoarthritis. After a week, physiotherapy was recommended. Before and three weeks after the injections, she was assessed for her weight, the Visual Analog Scale (VAS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score. GOLDIC® treatment resulted in significant weight, VAS, and WOMAC score improvements without serious side effects. Conclusion Due to the one-time blood harvesting and only four injections, the initial results demonstrated that the treatment plan is safe, less expensive, patient-friendly, and more successful at achieving compliance. This GOLDIC® treatment can significantly decrease pain and improve knee capability with overall satisfaction over a significant period. To fully validate the real potential of GOLDIC® in heterogeneous patient populations and to compare these promising results to other blood-based platforms, future randomized-controlled trials with long-term follow-up are required, despite the promising early clinical results.

The Relationship between Western Ontario and McMaster Universities Osteoarthritis Index Score and Satisfaction after Total Knee Arthroplasty Changes Over Time.

This study aimed to determine whether there was a relationship between preoperative patient-reported outcome measures (PROMs) and satisfaction after total knee arthroplasty (TKA), and whether there was a relationship between the amount of improvement in PROM or final PROM and satisfaction and whether that relationship differed 1 and 2 years after TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and satisfaction of 267 limbs who underwent TKA were analyzed. Logistic regression analysis was performed to determine whether there was a relationship between preoperative WOMAC or improvement in WOMAC or final WOMAC and satisfaction at 1 and 2 years after TKA. Pearson and Filon's z test was performed to determine whether there was a difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. There was no significant relationship between preoperative WOMAC and satisfaction. A higher improvement in WOMAC total score and better final WOMAC total scores at 1 and 2 years after TKA were related to greater satisfaction. At 1 year after TKA, there was no significant difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. However, 2 years after TKA, the final WOMAC function and total score were more related to satisfaction than the amount of improvement in WOMAC function and total score. In the early postoperative period, there was no difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC, whereas over time, the final WOMAC was more related to satisfaction.

Is There Any Correlation Between the Systemic Immune Inflammatory Index and Disease Severity in Knee Osteoarthritis?

Objective:The purpose of this study is to investigate the utility of systemic immune inflammation index as a predictor of disease severity in patients with knee osteoarthritis. Methods: 200 patients diagnosed with knee osteoarthritis according to ACR knee osteoarthritis diagnostic criteria were included in the study. Kellgren-Lawrence staging of knee osteoarthritis, Western Ontario and McMaster University Osteoarthritis (WOMAC) index score and systemic immune-inflammation index score were calculated among all participants Results: There were 152 (%76) female and 48 (%24) male participants and median score of age was 63 (54,25-70). 14 (7%) grade 1 gonarthrosis, 64 (32%) grade 2, 72 (36%) grade 3 and 50 (25%) grade 4 gonarthrosis patients were detected. There was no significant correlation between the systemic immune-inflammation index and the radiological stage of gonarthrosis (Kellgren Lawrens Score) (p=0.238). No statistically significant correlation was found between the systemic immune-inflammation index and WOMAC scores (p=0.593). Conclusion: The systemic immune-inflammation index was not found to be correlated with disease severity in knee OA.

Gold-Induced Cytokine (Goldic®) – A Promising Treatment in Patients with Grade 4 Knee Osteoarthritis: A Case Study

Background: Knee osteoarthritis (KOA) is one of the most common degenerative diseases that can lead to disability and pain. The degenerative nature of this condition cannot be reversed or healed by any currently available treatments. Recently, there has been an upcoming interest in treating degenerative tissue disorders with minimally invasive autologous blood products. Autologous blood was preconditioned with gold particles to encourage the production of various proteins in patients’ blood. This current study investigated the safety and efficacy of pre-conditioning autologous blood with gold particles (GOLDIC®) in patients with severe knee osteoarthritis (KOA). Case presentation We report a case in which four intra-articular GOLDIC® injections were used to treat knee osteoarthritis. After a week, physiotherapy was recommended. Before and three weeks after the injections, she was assessed for her weight, the Visual Analog Scale (VAS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score. GOLDIC® treatment resulted in significant weight, VAS, and WOMAC score improvements without serious side effects. Conclusion Due to the one-time blood harvesting and only four injections, the initial results demonstrated that the treatment plan is safe, less expensive, patient-friendly, and more successful at achieving compliance. This GOLDIC® treatment can significantly decrease pain and improve knee capability with overall satisfaction over a significant period. To fully validate the real potential of GOLDIC® in heterogeneous patient populations and to compare these promising results to other blood-based platforms, future randomized-controlled trials with long-term follow-up are required, despite the promising early clinical results.

Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing?

The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle andhad any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA)or not. We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] - 6.9-1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI - 1.7-9.4 points, p = 0.17). This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella.

Lateral Retinacular Release During Medial Unicompartmental Knee Arthroplasty in the Presence of Patello-Femoral Joint Arthritis Relieves Patello-Femoral Joint Pressure and Improves Associated Symptoms

BackgroundThis study evaluated the effects of concomitant lateral patellar retinacular release (LPRR) during medial unicompartmental knee arthroplasty (UKA). MethodsWe retrospectively analyzed 100 patients who had patello-femoral joint (PFJ) arthritis who underwent medial UKA with (n = 50) and without (n = 50) LPRR who had ≥2 years follow-up. Radiological parameters associated with lateral retinacular tightness, including patellar tilt angle (PTA), lateral patello-femoral angle (LPFA), and congruence angle, were measured. Functional evaluation was performed using the Knee Society Pain Score, Knee Society Function Score (KSFS), Kujala Score, and the Western Ontario McMaster Universities Osteoarthritis Index score. Intraoperative patello-femoral pressure evaluation was performed on 10 knees to evaluate the pressure changes before and after LPRR. Mann–Whitney U-tests were used for statistical analyses. ResultsDemographic data did not differ between the LPRR(+) and LPRR(−) groups. A decrease in PTA and an increase in LPFA were observed in the LPRR(+) group compared to those in the LPRR(−) group (PTA; −0.54 versus −1.74, P = .002, LPFA; 0.51 versus 2.01, P = .010). The LPRR(+) group showed significantly better KSFS and Kujala scores than the LPRR(−) group (KSFS: 90 versus 80, P = .017; Kujala score: 86 versus 79, P = .009). Intraoperative patello-femoral pressure analysis showed a 22.6% reduction in the PFJ contact pressure and an 18.7% reduction in PFJ peak pressure after LPRR. (P = .0015, P < .0001, respectively) ConclusionA LPRR during UKA may be a simple and useful adjunct procedure to relieve PFJ symptoms with concomitant PFJOA.

Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up

ObjectiveKnee distraction treatment for end-stage osteoarthritis successfully postpones arthroplasty for years. Studies performed thus far used general intended use, patient-personalised or custom-made devices. In this study, for the first time,...

The Clinical Outcomes of Measured Resection and Gap Balancing Techniques in Primary Total Knee Arthroplasty: A Meta-analysis.

At present, the clinical efficacy of measured resection (MR) and gap balancing (GB) techniques in total knee arthroplasty (TKA) is still controversial. The objective of this study was to evaluate the clinical outcome indexes of the two surgical methods through a meta-analysis. The literature was systematically searched on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG, Weipu (VIP), and China Biomedical Literature (CBM) electronic databases inception until June 12, 2022. RevMan 5.3 software (the Nordic Cochrane Center, the Cochrane Collaboration, Copenhagen, Denmark) was used to analyze all data of this study. The Cochrane risk bias assessment tool is a risk bias evaluation criterion recommended by the Cochrane Handbook for systematic reviews. Eleven studies involving 1268 knees in total were included. The main outcome indexes showed that the Knee Society Score (KSS) knee score (MD: -1.40; 95% CI: -2.57 to -0.22; p=0.02) and KSS knee function score (MD: -3.11; 95% CI: -3.72 to -2.50; p<0.001) in the GB group were higher 1 year after operation, while femoral component rotation angle (FCRA; MD: -0.75; 95% CI: -1.34 to -0.07; p=0.03) and the osteotomy volume of the posterior medial femoral condyle (MD: -0.76; 95% CI; -1.13 to -0.38; p<0.001) were greater in the GB group. In addition, there was no significant difference in the joint line change (MD: -0.03; 95% CI: -0.07 to 0.01; p=0.16) between the two groups. Secondary outcome results showed that the knee joint range of motion (ROM) in 3 months, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score after 1 year were better in the GB group. However, the operation time of the MR group was shorter. In addition, this study revealed no significant differences in post-complications between these two groups. Although the GB technique may not provide better radiographic results or reduce the complication rate, the recovery of joint function showed earlier improvement.

Cathepsin S Upregulation Measured in the Peripheral Blood Mononuclear Cells Prior to Surgery Points to Postoperative Pain Development in Patients with Hip Osteoarthritis.

Disability caused by hip osteoarthritis has increased due to population aging, obesity, and lifestyle behaviors. Joint failure after conservative therapies results in total hip replacement, which is considered to be one of the most successful interventions. However, some patients experience long-term postoperative pain. Presently, there are no reliable clinical biomarkers for the prognosis of postoperative pain prior to surgery. Molecular biomarkers can be considered as intrinsic indicators of pathological processes and as links between clinical status and disease pathology, while recent innovative and sensitive approaches such as RT-PCR have extended the prognostic value of clinical traits. In light of this, we examined the importance of cathepsin S and proinflammatory cytokine gene expression in peripheral blood in addition to the clinical traits of patients with end-stage hip osteoarthritis (HOA) to predict postoperative pain development prior to surgery. This study included 31 patients with radiographic Kellgren and Lawrence grade III-IV HOA who underwent total hip arthroplasty (THA) and 26 healthy volunteers. Before surgery, a visual analog scale (VAS), DN4, PainDETECT, and the Western Ontario and McMaster Universities osteoarthritis index scores were used for pain and function assessment. Three and six months post-surgery, VAS pain scores of 30 mm and higher were reported. The intracellular protein levels of cathepsin S were measured using ELISA. The expression of the cathepsin S, tumor necrosis factor α, interleukin-1β, and cyclooxygenase-2 genes in peripheral blood mononuclear cells (PBMCs) was assessed using quantitative real-time RT-PCR. Pain persisted in 12 (38.7%) patients after THA. Patients who developed postoperative pain demonstrated significantly higher cathepsin S gene expression in the PBMCs and higher rates of neuropathic pain based on the DN4 testing compared to the other HOA subjects that were examined. No significant differences in proinflammatory cytokine gene expression were noted in either patient cohort prior to THA. The development of postoperative pain in patients with hip osteoarthritis might be associated with disturbances in pain perception, while increased expression of cathepsin S in the peripheral blood prior to surgery may serve as its prognostic biomarker and could be used in clinical settings to improve medical service for patients with end-stage hip OA.