McMaster Universities Osteoarthritis Index Research Articles

Exploring the Efficacy of Joint Lavage in Knee Osteoarthritis: A Focus on Cytokines, Degrading Enzymes, and Oxidative Stress.

This study aimed to assess the effectiveness of joint lavage in managing knee osteoarthritis (OA) by evaluating its effect on pain relief, inflammatory markers, cartilage-degrading enzymes, and oxidative stress. Seventy patients with Kellgren-Lawrence grade 2 or 3 knee OA were selected for this single-center study. Joint lavage was performed, and pain and function were measured using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline and 24 weeks postintervention. Synovial fluid samples were collected at baseline, before lavage, and 24 weeks postintervention. Samples were stored at -80°C and analyzed in batches to minimize variability. At the time of analysis, the samples were thawed and evaluated for levels of proinflammatory cytokines, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α), matrix metalloproteinase-3 (MMP-3), and total oxidant status (TOS), and oxidative stress index (OSI). Postintervention, VAS, and WOMAC scores significantly decreased (P < 0.001), with 100% achieving the minimal clinically important difference (MCID). Patient acceptable symptom state (PASS) rates varied: VAS (80%), WOMAC pain (50%), function (81.4%), and total (84.3%). Cytokine levels (IL-1β, IL-6, TNF-α) and MMP-3 significantly decreased (P < 0.001), along with TOS and OSI. Baseline TNF-α, IL-6, and IL-1β levels were significantly correlated with improvements in VAS and WOMAC scores. Moderate correlations were observed between reductions in IL-6/TNF-α and improvements in VAS/WOMAC. No significant associations were found between confounders and outcomes. Joint lavage resulted in marked pain relief and functional improvement while significantly reducing inflammatory markers, cartilage-degrading enzymes, and oxidative stress.

Comparison of the Effect of High-Intensity Laser Therapy and Quadriceps Muscle Strengthening Exercises Using Biofeedback on Pain, Stiffness and Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Objectives: This study aims to compare the effects of high-intensity laser therapy (HILT) and quadriceps muscle strengthening exercises using biofeedback on pain and function in patients with knee osteoarthritis (KOA). Methods: This randomized, two-group clinical trial included patients with KOA (grades II - III of the Lawrence Kellgren classification) who met the inclusion criteria. Written informed consent was obtained from participants before they were randomly allocated into one of two groups: HILT + therapeutic exercise (group A) or quadriceps muscle strengthening exercises using biofeedback + therapeutic exercise (group B). Both groups followed the same therapeutic exercise regimen during the study. Knee pain severity was evaluated using the Visual Analogue Scale (VAS), and functional disability was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before the intervention. For group A, HILT was performed using a BTL-6000 HIL device (wavelength 1064 nm, maximum power 12 W) following the manufacturer-recommended protocol. A pain relief program (10 W, 120 J/cm²) was administered for 120 seconds per session over ten sessions. Treatment protocol, laser positioning, and session duration were standardized. Two follow-up assessments (immediately and one-month post-intervention) were conducted to evaluate outcomes based on the VAS and WOMAC scores. Results: The study included 40 participants with KOA, divided evenly between the two groups (20 in each). The average age of the participants was 59.34 ± 6.92 years. High-intensity laser therapy group (group A): Visual analogue scale pain scores decreased significantly immediately after and one month post-intervention compared to baseline (P &lt; 0.01). However, the VAS score one month after the intervention showed no significant difference compared to the immediate post-intervention score (P = 0.59). Biofeedback group (group B): VAS pain scores also decreased significantly both immediately after and one month post-intervention compared to baseline (P &lt; 0.05). The difference in VAS pain reduction between the two groups was significant, with the HILT group showing greater improvement immediately after the intervention and one month later (P = 0.007). Conclusions: The study findings suggest that both quadriceps muscle strengthening exercises using biofeedback and HILT effectively reduce pain in KOA patients. However, HILT demonstrated superior efficacy compared to biofeedback exercises. These results support the use of HILT as a noninvasive therapeutic modality for KOA, particularly for patients with a higher risk of surgery due to preexisting comorbidities.

The Effect of Foot Reflexology and Knee Massage With Black Cumin Seed Oil on Knee Osteoarthritis Symptoms.

This study aimed to examine the effect of foot reflexology and knee massage with black cumin seed oil on pain and fatigue symptoms in elderly individuals with knee osteoarthritis and assess which of these 2 applications is more effective. Our randomized controlled trial was conducted with 150 participants. Study data were collected from participants over 65years who received outpatient treatment in a university hospital's physical therapy and rehabilitation unit and were determined to have no perception problems based on the Mini-Mental Test. After randomization, the study sample was classified into 5 groups, each including 30 participants: (1) foot reflexology with black cumin seed oil, (2) foot reflexology with a placebo, (3) knee massage with black cumin oil, (4) knee massage with a placebo, and (5) control. Participants were administered a Patient Descriptive Information Form, the Lequesne Knee Osteoarthritis Index, the Pain-Visual Analog Scale, the Fatigue Severity Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Control group participants received standard of care, while participants in treatment groups received the studied interventions for 6weeks. Data were collected by administering questionnaires to the participants in the first and sixth weeks and analyzed using IBM Statistical Package for Social Sciences 22.0 software. The study showed that foot reflexology and knee massage administered using black cumin oil effectively reduced pain and fatigue severity in Osteoarthritis (OA) patients, and overall, foot reflexology administered using black cumin oil was the most effective treatment to reduce pain and fatigue.

Do Intact Collateral Ligaments Play a Role in the Overall Clinical and Radiological Results of Rotating Hinge Knee Arthroplasties?

Rotating hinge knee arthroplasty (RHKA) implants are often utilized as a salvage procedure in cases where bone stock is compromised. The aim of this retrospective study was to investigate whether residual collateral ligament integrity affects functional and radiographic outcomes in patients undergoing revision surgery with RHKA. Patients treated with RHKA between 2011 and 2021 were eligible. Inclusion criteria were patients who had undergone an RHKA as a revision or a primary procedure, had complete radiological and clinical data, and had a minimum follow-up of two years. Patients who died before the second-year follow-up visit, those who had missing clinical and/or radiological data, and those who did not want to participate were excluded. There were 79 knees that were included. Patients were evaluated with standing radiographs and two-dimensional multi-acquisition variable-resonance imaging combination selective (MAVRIC) magnetic resonance imaging (MRI) sequences to assess ligament integrity. Range of motion (ROM), Visual Analog Scale (VAS), Knee Society Scores (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. The mean age was 66 years (range, 39 to 79), and the mean follow-up was 54.6 months (approximately 4.5 years). The integrity of the collateral was successfully determined by the MRI scans and patients were divided into three groups: those who had both collateral ligaments (n = 53), isolated MCL damage (n = 14), and those who had both collateral ligaments damaged (n = 12). No significant difference was observed between the groups with regard to both radiological data and clinical scores (P > 0.05). KSS, KSS-F, and WOMAC function scores at the last follow-up were significantly higher in patients treated for secondary osteoarthritis (complex primaries). No significant difference in functional outcomes was detected in patients treated with RHKA, independent of collateral ligament integrity, at an average of 54 months postoperatively. When an RHKA is indicated as the first treatment option, results are more satisfactory in comparison to revision cases.

A meta-analysis of the efficacy and safety of genicular artery embolization for the treatment of pain secondary to knee osteoarthritis

Objective: To assess the efficacy and safety of genicular artery embolization (GAE) in the management of pain secondary to knee osteoarthritis (KOA). Methods: Literature search was conducted on PubMed, Web of Science, Cochrane Library, Embase, and Wanfang databases to collect literatures related to KOA, GAE and therapeutic effects. The search period was from the inception of the databases to July 2024. Literature screening and data extraction were carried out independently by two researchers according to the inclusion and exclusion criteria, and the quality of the included literature was assessed using the methodological index for non-randomized studies. Data extracted included visual analog scale (VAS) scores, total western ontario and mcmaster universities osteoarthritis index (WOMAC) scores, and the incidence of adverse events, followed by a meta-analysis using STATA 15.1 software. Results: A total of 11 papers involving 332 patients (419 knees) from 11 studies were included according to the Na-row criteria. The technical success rate was 100%. The standardized mean differences of VAS scores at 1, 3, 6, and 12 months postoperatively were -2.42(95%CI:-2.89--1.95), -2.44(95%CI:-2.94--1.93), -2.57(95%CI:-3.13--2.01), and -2.60(95%CI:-3.37--1.84), respectively, all showing decreases (all P<0.001); the weighted mean difference of WOMAC total score at 1, 3, 6, and 12 months after surgery were -24.44(95%CI:-29.13--19.75), -28.30(95%CI:-31.47--25.12), -30.66(95%CI:-32.94--28.37), and -34.23(95%CI:-44.39--24.07), all showing decreases (all P<0.001). The incidence of adverse events mainly included skin color changes of 16.4%(95%CI: 5.5%-31.0%, P<0.001) and hematoma at the puncture site 3.8%(95%CI: 1.1%-7.6%, P<0.001), with the majority being mild and self-resolving. Conclusions: GAE treatment for KOA secondary pain has good efficacy and safety, providing a new treatment option for KOA patients as a minimally invasive procedure.

Impact of Health Education Programme on Adherence to Treatment in Knee Osteoarthritis: An Interventional Study on Egyptian Patients.

To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence. A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed. One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p=0.016) and improved function as measured by WOMAC (p=0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%). Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials.

Osteoarthritis (OA) poses a significant global burden, with conventional treatments like corticosteroid and hyaluronic acid (HA) injections commonly used. Emerging injectable biologics, including bone marrow aspirate concentrate (BMAC), show promise in OA management. To investigate the clinical efficacy of BMAC injection compared with other injection treatments for knee OA. Systematic review; Level of evidence, 1. A systematic review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar to identify randomized controlled trials with Level 1 evidence that compared the clinical efficacy of BMAC with other injections. The visual analog scale for pain and the Pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) were used as clinical scores representing pain. For functional assessment, the Western Ontario and McMaster Universities Osteoarthritis Index and the International Knee Documentation Committee subjective form were used. For studies comparing BMAC with HA, each clinical score was standardized to pain and function scales based on the minimal clinically important difference (MCID). Eight studies, consisting of a total of 937 patients, were included. Patients treated with BMAC showed a significant improvement in clinical scores compared with baseline, starting at 1 month postinjection. For pain scores at 6-month (P = .033) and 12-month follow-up (P = .011), BMAC demonstrated favorable results over HA, with a statistically significant difference. However, these differences did not exceed the MCID. When BMAC was compared with other injections, no significant differences were observed in the degree of clinical score improvement. No serious adverse events or events significantly associated with BMAC compared with other treatments were reported. BMAC injections demonstrated effectiveness in providing pain relief and functional improvement for patients with knee OA. When BMAC was compared with other intra-articular injection options, distinct differences surpassing the MCID were not evident. Further research is deemed necessary to investigate the role of BMAC in the treatment of knee OA.

Arthroscopic Autologous Minced Cartilage Implantation of Cartilage Defects in the Knee: A 2-Year Follow-up of 62 Patients.

Symptomatic cartilage defects of the knee joint are frequently diagnosed and can be treated with different available surgical methods. Nevertheless, there is currently no gold standard treatment for all indications. Minced cartilage implantation is increasingly coming into focus as a refined surgical technique. To investigate the 2-year clinical and radiological outcomes of arthroscopic autologous minced cartilage repair with the standardized commercial implantation system AutoCart. Case series; Level of evidence, 4. A total of 62 consecutive patients were included and prospectively evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and Tegner activity scale at all follow-up time points. The examination of preoperative magnetic resonance imaging (MRI) was performed using the Area Measurement and Depth and Underlying Structures (AMADEUS) score, and the examination of MRI at 24 months was performed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score. There were 34 male and 28 female patients (mean age, 38.79 ± 10.78 years) with symptomatic cartilage lesions with a mean defect size of 2.53 ± 1.24 cm2. Lesions were predominantly International Cartilage Repair Society grade 3 located in the region of the femoral condyles. Concomitant surgery was performed in 40.3% of patients. The total KOOS score significantly improved from 62.4 ± 13.1 at baseline to 74.4 ± 15.9 at 24 months (P < .001). The secondary outcome measures of the VAS, WOMAC, and SANE showed a similar pattern, with score improvements in the follow-up period compared to baseline. The mean AMADEUS score was 64.75 ± 13.87, while the mean MOCART 2.0 score was 62.88 ± 9.86, among 20 available patients. The revision surgery rate was 8.1% mainly because of hypertrophy (6.5%). Among this cohort of patients, minced cartilage implantation demonstrated satisfying 2-year outcomes with increased patient-reported outcome measure scores from 3 to 24 months postoperatively. Regenerated tissue quality on MRI was comparable to that using other cartilage repair methods and showed no associations with patient characteristics or patient-reported outcome measures. Larger cohorts, longer postoperative intervals, and comparable trials are needed to further evaluate the role of this technique in treating cartilage defects.

The Effect of Graded Motor Imagery on Pain and Function in Individuals with Knee Osteoarthritis: A Comparative Randomized Controlled Trial.

To examine whether graded motor imagery (GMI) was as effective as transcutaneous electrical nerve stimulation (TENS) in improving pain and functionality in patients with knee osteoarthritis (PwKOA). Forty-six PwKOA were randomized (1:1) into the GMI and the TENS groups. Both groups participated in home-based and functional exercises. A visual analog scale (VAS), the pressure pain threshold, range of motion (ROM), muscle strength, the Timed Up and Go Test, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline, after 8 weeks of treatment, and after a 6-week follow-up period. The within-group comparisons showed significant improvements in outcomes for both treatments. However, the difference between the groups was significant in favor of the GMI group in knee flexion ROM, knee extensor muscle strength, and WOMAC-pain and WOMAC-function parameters at the end of the treatment, and VAS-activity, knee flexor muscle strength, and WOMAC-stiffness values showed greater improvement in the GMI group compared with the TENS group at the end of the 6-week follow-up (for all, p < 0.05). GMI seems to be a more effective adjuvant than TENS. If applied in PwKOA, pain and functional recovery improved, and results were maintained for up to 6 weeks.

High-intensity electroacupuncture is superior to low-intensity electroacupuncture for knee osteoarthritis: a meta-analysis of randomized controlled trials.

Electroacupuncture (EA) has been demonstrated to be efficacious and safe in patients with knee osteoarthritis (KOA), yet the optimal current intensity for pain control in KOA remains unspecified. The present meta-analysis aimed to compare the effects of high-intensity and low-intensity EA in terms of pain relief and functional improvement in KOA. A thorough and comprehensive literature search for randomized controlled trials (RCTs), all looking at the intensity of EA for KOA, was carried out in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science Journal Citation Report (VIP) and Wanfang database, as well as ClinicalTrials.gov. All databases were searched from their inception until April 2022. Study quality was assessed using the Cochrane risk of bias (RoB)2 tool. Finally, a meta-analysis of all eligible RCTs was performed using Review Manager 5.3. Three studies with 472 individuals were included in the meta-analysis. The pain intensity reductions were significantly different between the high-intensity EA group and low-intensity EA group (mean difference (MD) = -0.22, 95% confidence interval (CI) = -0.26 to -0.18, p < 0.00001). There was no significant difference between the two groups in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (MD = -3.62, 95% CI = -12.22 to 4.98, p = 0.41). High-intensity EA significantly improved emotional scale (ES) scores compared to low-intensity EA (MD = -0.72, 95% CI = -0.76 to -0.67, p < 0.00001). The findings of this systematic review and meta-analysis indicated that high-intensity EA provides superior pain relief and has a bigger impact on emotional scale scores in patients with KOA.

Association of smoking with knee osteoarthritis structural defects and symptoms: an individual participant data meta-analysis

Prior meta-analyses have suggested a protective link between smoking and knee osteoarthritis (KOA), but they relied on aggregate data, potentially obscuring the true relationship. To address this limitation, we conducted an Individual Participant Data (IPD) meta-analysis using data from three large cohorts: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study. Participants from 16 centers in the USA and Netherlands were categorized as current, former, or never smokers. We assessed six outcomes, three related to structural changes over 4–5 years of follow-up, and three related to changes in KOA symptoms over 2–2.5 years, 5 years, and 7–8 years of follow-up. First, the incidence of radiographic KOA was evaluated in 10,072 knees, defined as having a Kellgren-Lawrence grade ≥ 2 (‘radiographic KOA’) at follow-up but not at baseline. Second, the progression of radiographic KOA was evaluated in 5274 knees, defined as an increase in Kellgren–Lawrence grade between baseline and follow-up in knees that had radiographic KOA at baseline. Third, the incidence of symptomatic KOA was evaluated in 12,910 knees, defined as having radiographic KOA in addition to symptoms at follow-up but not at baseline. Fourth, fifth, and sixth, we investigated changes between baseline and all follow-ups in scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain, disability, and stiffness (in 2640 knees). There were no differences between smoking groups in any of these six outcomes. Our study, leveraging data from three large cohorts and the advantages of IPD, finds no evidence that smoking offers any protection against KOA, refuting the notion that smoking may benefit joint health.

Outcomes of medial collateral ligament reconstruction with suture-augmented semitendinosus autograft.

This study evaluates patient-reported outcomes among patients who underwent medial collateral ligament (MCL) reconstruction with suture-augmented semitendinosus autograft (SASA). Patients who underwent SASA MCL reconstruction between 2017 and 2022 participated in preoperative and postoperative surveys for patient-reported outcomes: Visual Analog Pain Scale (VAS), Knee Injury and Osteoarthritis Outcomes Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), Marx Activity Rating Scale (MARS), and Veterans Rand 12 (VR-12). Paired t-tests were performed to compare preoperative and postoperative scores. Postoperative complications were analyzed for all patients. A total of 19 operations were identified during the study period, and 16 patients were included in the study. Patients reported significant decreases in VAS (mean [95% CI] of -3.86 [-6.09, -1.63], p = 0.0022) and WOMAC (-24.87 [-40.30, -9.4], p = 0.0037) scores postoperatively. Patients also reported significant increases in KOOS (22.60 [9.79, 35.40], p = 0.0019), SANE (38.06 [18.83, 57.27], p = 0.0007), and VR-12 Physical (14.32 [6.38, 22.27], p = 0.0017) scores. Patients did not report significant changes in MARS (0.87 [-1.88, 3.63], p = 0.5081) or VR-12 Mental (-2.90 [-9.37, 3.56], p = 0.3516) scores after surgery. Four patients required reoperation for either arthrofibrosis (n = 3) or ACL reinjury following a multiligament procedure that did not require revision to the MCL reconstruction (n = 1). In this cohort of patients undergoing MCL reconstruction with SASA, patients reported significant improvement in functional outcomes and reduction in pain postoperatively. SASA is a safe and effective technique for MCL reconstruction.

Correlation between circulating cell-free mitochondrial DNA content and severity of knee degeneration in patients with knee osteoarthritis: a cross-sectional study

BackgroundKnee osteoarthritis (KOA) is characterized by mitochondrial damage and increased inflammation. Circulating cell-free mitochondrial DNA (ccf-mtDNA), which originates from damaged mitochondria, is an endogenous damage-associated molecular pattern (DAMPs) molecule that may trigger inflammation and is recognized as a potential biomarker for various diseases. In this study, we investigated the potential association between plasma ccf-mtDNA content and its use as a diagnostic biomarker in patients with KOA.MethodsWe collected plasma samples from patients with KOA and healthy controls (HC). Subsequently, quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect ccf-mtDNA content in the plasma samples. We used the Kellgren–Lawrence (K-L) classification criteria to classify patients with KOA into four grades: I-IV. Disease severity in patients with KOA was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Next, Spearman analysis was performed to observe the correlation between ccf-mtDNA content and the K-L classification and WOMAC score. Logistic regression analysis was used to evaluate the relationship between ccf-mtDNA and KOA risk.ResultsIn total, we enrolled 60 patients with KOA and HC who were matched for age, sex, and body mass index (BMI). We found that plasma ccf-mtDNA contents were significantly higher in patients with KOA (median, 2.44; quartile range, 1.10–3.79) than in HC (median, 1.08; quartile range, 0.52–2.12) (P < 0.0001). Plasma ccf-mtDNA content sequentially increased following the KOA class I-IV group (P = 0.040) and positively correlated with the K-L classification (r = 0.369, P = 0.004) and WOMAC scores (r = 0.343, P = 0.007). The ccf-mtDNA content did not significantly differ between patients with bilateral and those with single KOA (P = 0.083). Patients with high levels of ccf-mtDNA had a significantly increased risk of KOA compared with those with low levels of ccf-mtDNA (odds ratio [OR], 4.15, 95% confidence interval [CI], 1.71–10.07; P = 0.002). Quartile analysis revealed a significant dose-dependent association (P trend < 0.001).ConclusionOur study’s findings showed that plasma ccf-mtDNA was highly expressed in patients with KOA compared with HC. Furthermore, ccf-mtDNA content is significantly associated with the severity and risk of KOA. Therefore, its detection may provide insight into the prevention and treatment of KOA.

Effects of the umbilical cord mesenchymal stem cells in the treatment of knee osteoarthritis: A systematic review and meta-analysis.

This study aimed to evaluate the effects of umbilical cord mesenchymal stem cells (UC-MSCs) in the treatment of knee osteoarthritis. PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure and Wanfang databases were searched from inception to March 31, 2024. RevMan 5.3 was used to conduct meta-analyses of the final included studies. Three randomized controlled studies were conducted. Western Ontario and McMaster Universities Osteoarthritis Index was reduced in the UC-MSCs group compared that in to the control group (mean difference: -25.85; 95% confidence interval: -41.50, -10.20; P = .001). Knee Lysholm Score was improved in the UC-MSCs group compared with the control group (mean difference: 18.33; 95% confidence interval: 12.89, 23.77; P < .00001). Egger test showed P = .583, indicating no publication bias. Sensitivity analysis indicated that the results were stable. Intra-articular injection of UC-MSCs improved function and reduced pain in patients with knee osteoarthritis. However, the number of included studies was small and more studies are needed to confirm this.

Algofunctional outcome after intra-articular bipolar pulsed radiofrequency ablation for pain in osteoarthritis of the knee: A retrospective study.

There is a paucity of research and evidence, regarding the effectiveness of applying bipolar pulsed radiofrequency (bPRF) in osteoarthritis of the knee. This study aimed to search for the impact of intra-articular bPRF (IA-bPRF) on pain, functionality, and quality of life in individuals with advanced knee osteoarthritis. A total of 35 patients experiencing knee pain were included in the study. IA-bPRF was applied at 42 °C temperature, 45 V, with a pulse-width of 20 ms and a frequency of 2 Hz for 3 cycles of 120 seconds. Pain severity was evaluated using the numeric rating scale. Assessment tools included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Algofunctional Index for knee. All measurements were made before the intervention, as well as 2 weeks and 6 months after application of IA-bPRF. Significant improvement was observed in numeric rating scale scores for walking pain from 8.57 ± 0.17 to 4.11 ± 0.35, total WOMAC scores decreased from 75.5 ± 2.71 to 36.7 ± 3.6 and Lequesne Algofunctional Index for knee scores decreased from 18.6 ± 0.70 to 10.4 ± 0.93 by the end of the sixth month (P < .01). WOMAC subgroups for pain, stiffness and functionality, were also significantly lower at the 2nd week and 6th month compared to pre-intervention scores (P < .01). No serious adverse events related to the procedure occurred. IA-bPRF use seems to be safe and effective in relieving pain among individuals with advanced knee osteoarthritis. As a result, with further research, we expect that IA-bPRF may be considered for inclusion in upcoming guidelines for the treatment of chronic pain related to osteoarthritis of the knee.

Knee pain improvement after genicular artery embolization for the management of knee osteoarthritis: an updated systematic review and meta-analysis of 21 studies.

Knee osteoarthritis is aprogressive inflammatory musculoskeletal disease with aprevalence of approximately 15-23% and limited treatment options. In recent years, transcatheter genicular artery embolization (GAE) has been proposed due to promising results concerning symptomatic knee pain relief and mobility. This systematic review and meta-analysis aimed to evaluate the aggregated data on the safety and efficacy of GAE for pain reduction in the treatment of knee osteoarthritis. Asystematic search of the three major databases (MEDLINE, Embase, and CENTRAL) from inception to 27February 2024 was conducted according to the PRISMA guidelines. Studies reporting pain reduction according to the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Total, WOMAC-Pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain scales and adverse event rates were included. Meta-analysis was performed by estimating the mean differences and by fitting random-effect models. Overall, 21studies were included, comprising of 633 patients and 758 knees treated. The combined data analysis showed that patients who underwent GAE demonstrated mean declines in the VAS score of -38.5 points (95% confidence interval [CI]: -44.9, -32.0) at 1month, -36.2 points (95%CI -43.0, -29.5) at 3months, -40.3 points (95%CI: -49.0, -31.7) at 6months, and -40.5 points (95%CI: -54.5, -26.6) at 12months. Similarly, significant differences at all time points were also found for the WOMAC-Total, WOMAC-Pain, and KOOS-Pain scores. No difference between permanent and non-permanent embolic material was found in the subgroup analysis for all time points. Genicular artery embolization is safe and effective for the treatment of painful knee osteoarthritis. This result was not affected by the type of embolic material used (permanent vs. non-permanent).

Probiotics' supplementation alleviates disease severity and improves postural balance by repairing intestinal leak in patients suffering from osteoarthritis: a double-blinded clinical trial.

Increased intestinal leakiness and associated systemic inflammation are potential contributors to osteoarthritis (OA) and postural imbalance in the geriatric population. To date, no successful treatment to correct postural imbalance in OA is known. We aimed to explore the effects of a multistrain probiotic upon postural imbalance in OA-affected patients. In this randomised, double-blind trial with a placebo group, 147 patients suffering from knee OA (age span = 64-75 years) were divided into placebo (n 75) and probiotics (n 72) study groups. Vivomix 112 billion, multistrain probiotic was given once a day for 12 weeks. The outcomes of study variables were determined first at baseline and later after 12 weeks of intervention. These were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee flexion range of motion (ROM), pain intensity by visual analogue scale, handgrip strength (HGS), gait speed and balance control assessed in standing, semi-tandem and tandem stances. We determined plasma zonulin to determine intestinal leak along with c-reactive protein and 8-isoprostanes levels. A total of 136 OA patients taking placebo (n 71) and probiotics (n 65) were analysed. The probiotics group exhibited a reduction in pain intensity, disease severity and WOMAC scores along with improvement in balance scores, HGS and walking speed (P < 0·05 for all), no change in ROM, resting pain and 8-isoprostanes levels. The correlation analysis revealed a robust association of balance scores with plasma markers of intestinal leakiness and inflammation in probiotics but not in the placebo group. Probiotics reduce postural imbalance in OA patients partly due to a reduction in intestinal leakiness.

Efficacy of hip abductors exercise training combined with repetitive transcranial magnetic stimulation on knee osteoarthritis: A randomized controlled trial.

Knee osteoarthritis is a common degenerative joint disease where a single treatment method often fails to fully alleviate symptoms. Hence, finding effective non-invasive combined treatment approaches is particularly crucial. The efficacy of treating knee osteoarthritis with hip abductors exercise training combined with repetitive transcranial magnetic stimulation was assessed through functional scales and objective evaluation methods. In this four-week randomized clinical trial, 160 patients meeting inclusion criteria were randomly assigned 1:1 to group A to receive oral celecoxib and group B to receive a combination of hip abductors exercise training and repeated transcranial magnetic stimulation. The primary outcome was the western Ontario and McMaster universities osteoarthritis index. The secondary outcomes include Visual Analogue Scale, knee outcome survey activities of daily living scale, Active Range of Motion, and the Quadriceps Angle, the tibiofemoral angle, peak adductor moment, the integrated electromyography and root mean square of the surface electromyography of the lower extremity muscles. Paired sample t test was used for Within-Group comparison of outcome indicators, and independent sample t test was used for Between-Group comparison. Of the 160 randomly assigned patients, 150 completed the study. After 4 weeks, the WOMAC index decreased from 61 ± 10.83 to 40.55 ± 7.58 in the combined treatment group and from 60.97 ± 10.18 to 47.7 ± 10.13 in the celecoxib group. The effect of the combined treatment group was significantly higher than that in the celecoxib group (P< 0.001). In the combined treatment group, the score of knee joint daily living scale increased (P< 0.001), the active range of motion increased (P< 0.001), the quadriceps angle decreased (P< 0.001), the tibiofemoral angle increased (P< 0.001), and the peak adduction moment decreased (P< 0.001), integrated electromyography and root mean square increased (P< 0.001), and the effect was better than that of celecoxib group (P< 0.001). The visual analog scale score in celecoxib group was lower (P< 0.001) and knee outcome survey activities of daily living scale was higher (P< 0.001). The incidence of treatment-related adverse events was 10% in the celecoxib group and 2.5% in the combined treatment group, all of which were mild. Hip abductors exercise training combined with repetitive transcranial magnetic stimulation can enhance abduction muscle strength, improve mobility, reduce joint pain, and enhance quality of life. This combined approach shows superior clinical effectiveness compared to oral celecoxib.

Association of neighborhood-level disadvantage beyond individual sociodemographic factors in patients with or at risk of knee osteoarthritis

ObjectiveLower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES.MethodsThe current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes.ResultsLiving in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes.ConclusionThe ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients’ risk profile for chronic pain outcomes.

Analgesic use may not decrease in the first postoperative year in patients underwent total knee arthroplasty due to advanced osteoarthritis

BackgroundTotal knee arthroplasty (TKA) is expected to relieve pain and reduce the use of analgesics in patients with advanced knee osteoarthritis. However, in some cases, there is no relief in the pain of the patients and the use of analgesics continues. The aim of this study was to compare analgesic consumption one year before and after TKA in the same patient group and to evaluate whether there is a decrease in analgesic consumption after TKA. MethodThe cumulative amounts of analgesia used by the patients in the one-year periods before and after the operation were checked from the automated patient records system and the national systems showing drug prescriptions. The dosages of all the analgesics used in the one-year periods before and after the operation were calculated and converted to oral morphine equivalents (OME). The demographic data of the patients, cumulative OME and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used in the assessment. ResultsIt was observed that there was a statistically significant improvement in Womac scores after the treatment compared to the pre-treatment. Although the mean amount of analgesics decreased compared to pre-treatment, it was not statistically significant. Also, age and preoperative analgesic use were found to be the two most important factors in relation to total postoperative analgesic consumption. ConclusionThe results of this study indicate that there may not be a substantial reduction in the use of analgesic by patients within the first year after TKA. Furthermore, the age and preoperative analgesic use were identified as the two primary factors influencing postoperative analgesic consumption. Level of evidenceRetrospective Cohort Study.