McMaster Universities Osteoarthritis Index Research Articles

Gut Microbiomics of Sustained Knee Pain in Patients With Knee Osteoarthritis.

To examine whether gut microbes were associated with postsurgery-sustained knee pain in patients with knee osteoarthritis (OA) by a gut microbiomics approach. Patients receiving total knee replacement (TKR) because of primary knee OA were recruited. Sustained knee pain status at ≥ 1 year after TKR was defined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Fasting plasma and fecal samples were collected. Metabolomic profiling was performed on fasting plasma. 16S rRNA sequencing was performed on fecal samples to determine microbial composition. Twenty patients with TKR because of primary knee OA were included in the study, with 10 experiencing sustained postsurgery pain and 10 without such pain. Age, sex, and BMI (kg/m2) were matched. Linear discriminant analysis of microbiome data identified 13 bacterial taxa that were highly abundant in the pain group and 5 that were highly abundant in the nonpain group (P < 0.05 for all). Plasma metabolomic profiling measured 622 metabolites. The correlation analysis indicated the 18 taxa were significantly correlated with 231 metabolites (P < 0.05 for all). Sparse partial least squares discriminant analysis showed that 30/231 metabolites explained 29% of total variance and can be used to clearly separate patients with sustained knee pain from patients in the nonpain group. Pathway enrichment analysis showed that these significant metabolites were enriched in the arachidonic acid metabolic pathway, bile acid biosynthesis, and linoleic acid metabolism. Gut microbes may play a significant role in sustained knee pain in patients with knee OA after TKR, potentially through their activation of inflammatory pathways, lipid metabolism, and central sensitization.

The effect of intra-articular autologous protein solution on knee osteoarthritis symptoms.

Knee osteoarthritis (OA) is characterized by a chronic inflammatory process involving multiple cytokine pathways, leading to articular cartilage degeneration. Intra-articular therapies using pharmaceutical or autologous anti-inflammatory factors offer potential non-surgical treatment options. Autologous protein solution (APS) is one such product that uses the patient's blood to produce a concentrate of cells and anti-inflammatory cytokines. This study evaluated the effect of a specific APS intra-articular injection (nSTRIDE) on patient-reported outcome measures compared to saline in moderate knee OA. A parallel, double-blinded, placebo-controlled randomized controlled trial was conducted, where patients with unilateral moderate knee OA (Kellgren-Lawrence grade 2 or 3) received either nSTRIDE or saline (placebo) injection to their symptomatic knee. The primary outcome was the difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months post-intervention. Secondary outcomes included WOMAC component scores, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (VAS) scores at all follow-up timepoints (three, six, and 12 months). A total of 40 patients were analyzed (21 nSTRIDE; 19 saline) in the study. No significant difference was found between nSTRIDE and saline groups for WOMAC total score at 12 months (mean difference -10.4 (95% CI -24.4 to 3.6; p = 0.141). There were no significant differences in WOMAC or KOOS scores across all timepoints. VAS scores favoured the saline group for both rest and worst pain scales at 12 months post-injection (mean difference (worst) 12 months 21.5 (95% CI 6.2 to 36.8; p = 0.008); mean difference (rest) 12 months 17.8 (95% CI 2.2 to 33.4; p = 0.026)). There were no adverse events recorded in either study group. Our study demonstrates no significant differences between nSTRIDE and saline groups in KOOS and WOMAC scores over time. Notably, APS injection resulted in significantly worse pain symptoms at 12 months compared to saline injection.

Online Disease Management Training for Older Adults With Osteoarthritis: A Randomized Controlled Trial.

Using online methods in health education is an effective method that provides individual services to older adults with limited access to health services and allows for low-cost and continuous communication. The study was completed with 52 older adults diagnosed with osteoarthritis, including 26 intervention and 26 control participants. For data collection, a Patient Information Form, Visual Analogue Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, Self-Efficacy Scale in Arthritis, World Health Organization Quality of Life Instrument-Older Adults Module and a Telephone Counselling Follow-up Form were used. Individuals in the intervention group were provided with online training for the first 4weeks and telephone counselling for the following 4weeks. Scales were applied to both groups. The scales were applied to both groups at the first, second and last measurements. It was determined that there was a significant difference between the total pain and functional status scores of the individuals in the intervention and control groups at the second and last measurement (p<0.05), while the average scores of the intervention group were lower control group. The total self-efficacy score and quality of life total score of the intervention group were statistically significantly higher than the total score of the control group (p<0.05). As a result of the research, it was found that online education and telephone counselling given to elderly individuals with osteoarthritis were effective in reducing pain severity and improving functional status, self-efficacy and quality of life. The trial was registered at ClinicalTrial.gov (NCT04816474/2021-08-10/https://register. gov/).

Effect of Shi-Style Steaming and Bathing Decoction in Patients with Knee Osteoarthritis: Study Protocol for a Randomized Placebo-Controlled Trial.

To prove more accurately that Chinese herbal bath therapy may be a safe, effective, simple alternative treatment modality for knee OA, we designed a randomized, double-blind, placebo-controlled trial to explore the effectiveness of SSBD for the relief of pain, daily activities, and quality of life in patients with knee OA. A single-center, 52-week, randomized controlled trial of SSBD versus placebo is being performed. A total of 200 patients with symptomatic knee OA will be randomly allocated to the SSBD treatment or placebo intervention group for 4 weeks. The two groups of patients are allowed to steam and bathe their knees once every other day, using one packet of SSBD each time, for 30 minutes, 3 times a week, for a total of 4 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at 4 weeks is the primary outcome measure, and the secondary outcomes include WOMAC stiffness and function scores, the Lysholm knee scale score, quality of life, the Brief Pain Inventory score, the Patient's Global Impressions of Improvement Scale score and the Clinical Global Impressions of Severity scale score. The safety of the herbal medications will also be evaluated. We will discuss whether SSBD has greater advantages in terms of efficacy, safety, and patient overall perception than does placebo control in middle-aged and elderly patients with knee OA. The findings may provide new and valuable information about the efficacy and safety of Chinese herbal bath therapy in the treatment of knee osteoarthritis.

Microfragmented Adipose Tissue Injection Reduced Pain Compared With a Saline Control Among Patients With Symptomatic Osteoarthritis of the Knee During 1-Year Follow-Up: A Randomized Controlled Trial

PurposeTo evaluate the effectiveness of microfragmented adipose tissue (MFAT) for pain relief and improved joint functionality in knee OA in a randomized, controlled clinical trial with 1-year follow-up. MethodsSeventy-five patients were stratified by baseline pain level, and randomized to one of three treatment groups: MFAT, corticosteroid (CS), or saline control (C) injection. Patients 18 years of age or older, diagnosed with symptomatic knee osteoarthritis, with radiographic evidence of knee osteoarthritis and a visual analog pain scale (VAS) score of 3/10 or greater were included. Patients were excluded if they had any prior intra-articular knee injection, current knee ligamentous instability or an allergy to lidocaine/corticosteroid. The VAS pain scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Injury and Osteoarthritis Outcome score (KOOS) were recorded pre-procedure and at 2 weeks, 6 weeks, 3 and 6 months, and 1 year follow-up. ResultsMFAT demonstrated consistent and statistically significant improvements across all primary outcome measures for joint pain and functionality compared to C. For MFAT, there was a significant improvement over baseline at each follow-up, with median (95% CI) KOOS Pain score changes of 18.1 (11.1, 26.4) at week 2 to 27.8 (19.4, 37.5) at 1 year. For CS, the median KOOS pain score reached a maximum of 22.2 (15.3, 30.6) at week 2, only to level off to 13.9 (-2.8, 29.2), a level not statistically different from baseline, at 1 year. The median changes for C hovered around 6-11 points, with statistically significant improvements over baseline indicating a placebo effect. Similar trends were seen for the WOMAC Pain score and VAS Pain score. ConclusionsIn this study, MFAT demonstrated a clinically significant improvement in primary outcome scores compared with a saline control group, while the corticosteroid group only showed statistically significant improvement compared to the control group at 2 and 6 weeks. This finding indicates that MFAT may be a viable alternative treatment for patients with knee OA that fall into the orthopaedic treatment gap.

Efficacy and safety of mesenchymal stem cell injections for knee osteoarthritis: A systematic review and meta-analysis.

There have not been any clear studies on the use of mesenchymal stem cells (MSCs) to treat osteoarthritis (OA) in the knee. This study investigates the effects of different MSC dosages on pain alleviation in individuals with OA in the knee by conducting a meta-analysis of existing randomized controlled trials. Electronic resources such as Google Scholar, PubMed, Cochrane Library, and Web of Science were searched up until June 2023. Treatment effect sizes were computed using the knee osteoarthritis outcome score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Random or fixed effect models were applied to aggregate the data. We performed a subgroup analysis according to dosage level. The heterogeneity of the research was investigated using the Chi-square test and the I2 index. The meta-analysis included 26 studies with a total sample size of 739 patients. A significant reduction in pain was observed 1 year and 2 years following the injection of MSCs into the injured joint, as indicated by the Visual Analogue Scale, WOMAC, KOOS, and KSS indexes (P < 0.05). Patients on MSCs reported much reduced pain after 1 and 2 years compared to the control group (P < 0.05). Subgroup and meta-regression analyses revealed no statistically significant variations in the effectiveness of MSC dosage (P < 0.05). The studies did not report any adverse effects. Different dosages of MSCs had the same pain-relieving effects on patients with OA in the knee. MSC injections were safe and beneficial in such cases.

Analysis of Patients Who Undergo Index Arthroscopy With Biopsy but Not Implantation for Staged Chondrocyte Cell Transplantation.

Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are 2-stage procedures requiring an index full-thickness cartilage biopsy. Only a portion of patients ultimately undergo second-stage ACI/MACI. To identify patients with articular cartilage defects who underwent arthroscopic debridement with biopsy for ACI/MACI and compare those who did with those who did not proceed with implantation within 2 years after biopsy. Additionally, the authors sought to identify why patients did not proceed with implantation. Case-control study; Level of evidence, 3. Patients who underwent arthroscopy and autologous chondrocyte biopsy from January 1, 2015, to December 31, 2019, and who had minimum 2-year follow-up data were grouped into those who proceeded with second-stage ACI/MACI (implant group; n = 97) and those who did not (biopsy group; n = 63). Demographic factors, cartilage defect characteristics, and preoperative International Knee Documentation Committee (IKDC) scores were analyzed. Patients in both groups were evaluated postoperatively using the IKDC, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, and patients who did not undergo implantation were asked for their reasoning. Body mass index (BMI) (P < .001) and Outerbridge grades at index arthroscopy (P = .047) were significantly higher for the implant group than the biopsy group. Both groups had significantly improved IKDC scores from their initial presentation to final follow-up (implant group: 46.4 ± 16.2 preoperative vs 69.6 ± 20.6 postoperative [P < .001]; biopsy group: 47.2 ± 15.9 preoperative vs 70.7 ± 19.1 postoperative [P < .001]); however, the level of improvement did not differ significantly between groups. Postoperative WOMAC, SANE, and VAS pain scores were also similar between groups. In the biopsy group, 23 patients (37%) cited symptom resolution or activity level improvement after initial arthroscopy as the reason for not proceeding with implantation. Patients who proceeded to the second stage of chondrocyte implantation via either ACI or MACI had higher-grade articular defects and higher BMI compared with those who underwent biopsy with concomitant debridement chondroplasty alone. Postoperative outcomes were similar between the groups.

Association between folate intake and radiographic progression, pain function scores in subjects with radiographic knee osteoarthritis: Data from the osteoarthritis initiative.

Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited. Our population-based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren-Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models. Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48-month follow-up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p < .05). The fully adjusted models estimated a reduction of -0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, -0.117 points on the WOMAC function subscale, and -0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake. Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.

Effect of Topical Hemp (Cannabis sativa L.) Seed Oil on Knee Osteoarthritis: A Randomized Double-Blind Controlled Trial

Purpose, and DesignKnee osteoarthritis (OA) is one of the most common and debilitating diseases, especially in the elderly. Hemp seed oil is a plant product that has been used as a food or drug since ancient times because of its anti-inflammatory and analgesic properties. MethodsA double-blind, active, placebo-controlled trial was done to assess the efficacy of hemp seed oil on knee OA. Ninety patients were randomly allocated to three groups; hemp seed oil, diclofenac gel, and placebo via a blocked randomization method, and were asked to apply the topical treatment daily for 2 months. The study participant underwent assessments before, and four and 8 weeks after the intervention. Evaluation included measurements of the heel-to-thigh distance, utilization of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and application of visual analog scale (VAS). Data analysis was performed using SPSS.24 and the significance level was considered as p < .05. ResultsAll parameters, except heel-to-thigh distance, improved significantly in the hemp seed oil group compared to placebo group. Improvements in VAS and WOMAC parameters were not different comparing the hemp seed oil and diclofenac gel groups. Heel-to-thigh distance decreased significantly within all groups during the study. There were no significant differences in improvements in heel-to-thigh distance comparing the three groups. Conclusion, and Clinical ImplicationsHemp seed oil led to greater improvements in VAS pain score and WOMAC parameters, but not knee flexion range, compared to placebo. There were no differences in measured outcomes comparing hemp seed oil and diclofenac gel.

Effectiveness of a Single Intra-articular Injection of High-Molecular-Weight Hyaluronic Acid Versus NSAIDs on the Visual Analog Pain Scale and Western Ontario and McMaster Universities Osteoarthritis Index Scores in Patients With Knee Osteoarthritis.

This study aimed to determine the effectiveness of a single intra-articular injection of high-molecular-weight (HMW) hyaluronic acid (HA) at a dose of 4 mL/60 mg to reduce pain in people with knee osteoarthritis (OA) over 12 months. This retrospective study was conducted after obtaining ethical approval from Dhaka Medical College and Hospital, Bangladesh. From July 2020 to June 2021, a medical professional conducted the investigation. The investigation encompassed patients aged 40 to 70 hospitalized at our facility and diagnosed with Grade 2 or Grade 3 knee OAaccording to the Kellgren-Lawrence grading method. We divided the patients into two categories based on the treatments they received. Patients in Group A received a single injection of HMW HA (60 mg/4 mL) into the joint, along with instructions on activities of daily living, exercise, and painkillers. Group B patients received conservative therapy, which involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, therapeutic exercises, and a knee brace during physical activity. This study compared the efficacy of a single injection of HMW HA in the joint versus NSAIDs for managing OA-related symptoms over 12 weeks. The HA group initially scored similarly to the comparison group. By week three, however, the group receiving HA had considerably higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p=0.019). This pattern continued through weeks 6 (p=0.044), 9 (p=0.016), and 12 (p<0.001). Similarly, by week 3 (p=0.029), the visual analog scale (VAS) scores, which were initially identical (p=0.120), demonstrated a significant preference for HA, and this preference persisted through weeks 6, 9, and 12 (all p<0.001). The results show that by the third week, HA is more effective than NSAIDs at relieving pain and improving symptoms. The study's results indicated that over 12 weeks, the use of HMW HA led to statistically significant reductions in pain intensity, as measured by the VAS. Furthermore, HMW HA demonstrated a more significant improvement in WOMAC ratings, which assess physical function, stiffness, and pain, compared to NSAIDs. The findings suggest that administering HMW HA injections can significantly reduce symptoms and improve functionality in individuals with knee OA.

Functional and radiological outcomes of total knee arthroplasty using posterior-stabilized U2 knee system: A retrospective study in 560 cases at five years of follow-up.

The purpose of this study was to assess clinical and functional outcomes as well as the prosthesis survival rates of the U2 Knee system in primary total knee arthroplasty (TKA) with a minimum follow-up of four years. We retrospectively analyzed 560 consecutively primary TKA performed between 2015 and 2019 due to osteoarthritis with a mean follow-up of 5.4 ± 1.1years. The clinical outcomes were assessed using the knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic outcomes were assessed using the American knee society's roentgenographic evaluation system. Prosthetic survival was calculated using the Kaplan-Meier method. Postoperative KSS showed significant improvement at one year (Clinical: 37.4 ± 4.1 vs. 91.9 ± 3.7; p < 0.01; Functional: 41.2 ± 3.3 vs. 90.6 ± 4.8; p = < 0.01), with these improvements maintained throughout the follow-up period. The WOMAC score improved from 60 ± 10.1 preoperatively to 10.9 ± 8.3 (p = 0.02) at the end of the follow-up. There were 20 (3.7%) knees with radiolucent lines around the implant (< 2mm), and none showed evidence of loosening. There were six (1.1%) revisions-four due to prosthetic joint infections and two due to periprosthetic femur fracture. The prosthetic survival was 97.8% at the study closure. The U2 knee system demonstrates effective and safe performance for primary TKA with significant improvements in functional scores, patient-reported outcomes, and a promising prosthesis survival rate at mid-term follow-up. We will continue with the series analysis to assess the long-term outcomes.

A Randomized Study of Myostaal® Liniment as an Add-On Therapy for Muscle Strengthening in Cases of Knee Osteoarthritis.

Knee osteoarthritis (OA) is a prevalent degenerative musculoskeletal condition, affecting approximately 277 million people worldwide, with significant impacts on mobility, especially in women and obese patients, and an increasing incidence among Indians aged 30 to 50 years. The primary objective was to evaluate the knee muscle-strengthening effect of Myostaal® liniment (Solumiks Herbaceuticals Limited, Mumbai, India) as an add-on to physiotherapy for 90 days compared to physiotherapy alone in participants with knee OA. Secondary objectives included assessing changes in the total Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score, WOMAC Subscale scores, Six-Minute Walk Test(6MWT) distance, Single Leg Stance Test (SLST) duration, Visual Analogue Scale (VAS) score, and the number of adverse events from baseline to Day 90 between the two groups. Seventy participants were randomly allocated to Group A (Myostaal® liniment plus physiotherapy) or Group B (physiotherapy alone) for 90 days, with Myostaal® liniment applied twice daily in Group A. Data were recorded in Case Report Forms (CRFs) and analyzed using parametric tests for within-group comparisons (one-way ANOVA or Friedman test) and non-parametric tests (Mann-Whitney test) for between-group comparisons, with significance set at p<0.05. The knee muscle strength (index knee) in Group A (test medication group) was significantly greater compared to Group B (standard treatment group) at Visit 3 (p<0.05; Day 60±3) and Visit 4 (p<0.001; Day 90±3). For the non-index (other) knee, a statistically significant increase in knee muscle strength was observed (p<0.001 at Day 90±3) solely in Group A. A notable reduction in total WOMAC score was seen in Group A from Visit 2 (p<0.01; Day 30±3) onward, compared to Visit 1 (Day 0). The scores at Visit 3 (p<0.001; Day 60±3) and Visit 4 (p<0.001; Day 90±3) were significantly lower than those at Visit 2 (Day 30±3). The local application of Myostaal® liniment through massage as an adjunct to a physiotherapy regimen, improved knee muscle strength in participants with knee OA, leading to an enhancement in joint functionality. Additionally, Myostaal® linimentprovided superior pain relief as an add-on therapy.

The effect of pain neuroscience education on chronic postsurgical pain after total knee arthroplasty: a randomized controlled trial.

Chronic postsurgical pain after total knee arthroplasty (TKA) is frequent and may be reduced by pain neuroscience education (PNE), teaching people about pain from a neurobiological perspective. This study investigated primarily the effectiveness of 2 individual sessions of PNE versus usual care on pain levels 3 months postoperatively in patients undergoing TKA. Secondary outcomes were physical functioning, stiffness, health-related quality of life, pain catastrophizing, attention to pain, and levels of anxiety and depression. A prospective single-center, parallel-group randomized controlled trial was undertaken including patients aged 18 years or older scheduled for primary TKA. 68 patients were randomly assigned to PNE or usual care. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score 3 months postoperatively. Outcomes were measured preoperatively, at 2 weeks (acute phase), and at 3 and 12 months postoperatively. We found no statistically significant difference (0.4 points; 95% confidence interval [CI] -1.7 to 2.4) in WOMAC pain scores 3 months after TKA between the PNE and control group. We found a statistically significant difference between the 2 groups for attention to pain at 3 months in favor of PNE (P = 0.02). This RCT showed that PNE was not superior to usual care in terms of reducing pain at 3 months after TKA. Attention to pain, as a secondary outcome, was significantly lower in the PNE group compared with usual care. Other secondary outcome measures showed no significant differences.

Efficacy of non-pharmacological treatments for knee osteoarthritis: A systematic review and network meta-analysis

PurposeThis study aims to conduct a network meta-analysis to compare the clinical efficacy of seven distinct non-pharmacological therapies for knee osteoarthritis. We hope that our research findings can provide reference for clinical practitioners in formulating treatment plans. MethodsThrough a computer-based search, we systematically retrieved randomized controlled trials (RCTs) on non-pharmacological therapies for knee osteoarthritis from eight databases, including CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, Scopus, and The Cochrane Library. Following screening, data extraction, and methodological quality assessment, relevant data were included and analyzed using R 4.2.3 software. ResultsA comprehensive analysis of 24 RCTs involving 2582 patients encompassed seven diverse non-pharmacological therapies. The efficacy rankings, based on Visual Analog Scale (VAS) scores, were as follows: shock wave therapy > needle-knife > laser therapy > acupuncture > ultrasound > exercise > transcutaneous electrical nerve stimulation. Similarly, based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores, the efficacy rankings were as follows: shock wave therapy > needle-knife > laser therapy > acupuncture > ultrasound > transcutaneous electrical nerve stimulation > exercise. Among the three WOMAC subscales, the efficacy rankings for non-pharmacological therapies were as follows: For stiffness: laser therapy > exercise > shock wave therapy > acupuncture > needle-knife > ultrasound > transcutaneous electrical nerve stimulation; For daily activities: shock wave therapy > laser therapy > needle-knife > acupuncture > ultrasound > transcutaneous electrical nerve stimulation > exercise; For pain: shock wave therapy > needle-knife > laser therapy > acupuncture > exercise > transcutaneous electrical nerve stimulation > ultrasound. ConclusionBased on the currently limited research, we can prioritize the use of shockwave therapy to treat patients with knee osteoarthritis. However, it is essential to emphasize that further rigorous and well-designed randomized controlled trials are necessary to validate the conclusions drawn from this study.

Aquatic versus Land-Based Exercise for Knee Osteoarthritis: A Randomized Controlled Trial.

Whether land- or aquatic-based rehabilitation is more effective in improving knee osteoarthritis (OA) is still unclear. This study assessed the effectiveness of aquatic-based treatments in patients with knee OA. The participants were divided into a land-based exercise group (G1, n=30) and a water-based exercise group (G2, n=30). The exercises were performed for 8 weeks. The primary endpoint was a response to physical therapy, defined as a 20% decrease in the summed score for the Western Ontario and McMaster Universities-Osteoarthritis Index (WOMAC) pain subscale from T1 (before the start of the rehabilitation program) to T2 (8 weeks later). The secondary endpoints included the Visual Analog Scale (VAS) for pain, WOMAC functional and stiffness subscales, Lequesne Index, and Medical Outcome Study Short Form (SF-12) for physical and mental health. A 20% decrease in the summed WOMAC pain subscale score was noted in 33% of patients in G1 (n=10) and 93% in G2 (n=28) (P<0.001). VAS scores at walking decreased by 14% in G1 vs. 37% in G2 (P<0.001), WOMAC stiffness subscale decreased by 18% in G1 vs. 53% in G2 (P<0.001), and the Lequesne index decreased by 10% in G1 vs. 33% in G2 (P<0.001). Quality of life improvement was greater in G2 than in G1; SF-12 (physical) increased by 2.3 in G1 vs. 5.4 in G2 (P=0.023), and SF-12 (mental) increased by 6.3 in G1 vs. 10.9 in G2 (P=0.022). Both aquatic and land-based exercises improved pain intensity, functional impairment, degree of handicap, and quality of life impairment caused by OA. However, the improvement was more significant in the aquatic-based exercises group.

The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up.

The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up. This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years). Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up. The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Does Robotic Assisted Technique Improve Patient Utility in Total Knee Arthroplasty? A Comparative Retrospective Cohort Study.

Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure derived from self-reported outcomes questionnaires in patients who underwent RATKA compared to patients who underwent the manual surgery. We compared 72 patients operated with a robotic technique with 70 operated with traditional technique. The utility data were collected with the WOMAC (Western Ontario and McMaster University Osteoarthritis index) self-administrated questionnaire that investigates pain, stiffness and functionality of the patients, an then mapped to a utility value through a validated transforming function. We performed three surveys: the first one before the intervention (t0), the second one 1 year after the surgery (t1) and the third one at the 2 year follow up (t2). we observed higher utility values in both groups. In detail, the mean utility score in the RATKA group increased from 0.37 to 0.71 (t1) and 0.78 (t2), while in the conventional group it increased from 0.41 to 0.78 (t1) and 0.78 (t2). The fixed effect coefficients of t1 and t2 were found to be 0.37 and 0.363 (p < 0.001 for both). The coefficient of the robotic technique, along with its interaction with the t1 and t2 time effect was non-significant. Even if at t1 the utility of patient who underwent RATKA were lower, at longer follow up (t2) we found no significant difference compared to traditional technique, leaving the superiority of robotic assisted technique yet to be proved. Our results may be useful for calculating the gained or lost Quality Adjusted Life Years (QALYs), so that the health care system (or an insurance company) could make an appropriate decision whether to fund the robotic approach or not, after a careful assessment of the incremental costs incurred.

Lipiodol Versus Imipenem/Cilastatin in Genicular Artery Embolization: A Retrospective Study on Safety and Clinical Success.

This study aims to evaluate the safety and effectiveness of genicular artery embolization (GAE) using lipiodol in comparison to imipenem/cilastatin (IPM-CS). This retrospective study screened patients who underwent GAE between January 2022 and February 2023 for inclusion. Clinical outcomes were assessed at 1, 3, and 6months post-procedure using the Visual Analog Scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, functional capacity, and total scores. Technical and clinical success rates, complications, and patient-reported outcomes were assessed. A total of 42 patients were included in the study, with 13 patients treated with lipiodol and 29 with IPM-CS for GAE. Transient skin discoloration was noted in 23.1% of lipiodol patients and 31% of the IPM-CS group (p = 0.722). One patient (7.6%) in the lipiodol group developed knee edema and erythema due to drug-induced vasculitis (p = 0.309). Clinical success rates in the lipiodol group were 76.9% at 1month, consistent at 3months, and 69.2% at 6months. For the IPM-CS group, success rates were 89.7, 86.2, and 75.9%, respectively, with no significant differences (p = 0.353, p = 0.657, p = 0.713). The median percentage change in WOMAC stiffness scores for the lipiodol group at 1, 3, and 6months post-GAE were - 25%, - 16.7%, and - 16.7%, respectively, while the IPM-CS group showed decreases of - 40%, - 50%, and - 50%. Significant differences were found between the groups at all time points (p = 0.017, p = 0.009, and p = 0.002, respectively). Lipiodol shows comparable clinical success to IPM-CS in GAE.

Short-Term Efficacy of Integrating the Easy-Flex Device With Inpatient Rehabilitation in Individuals With Total Knee Arthroplasty: Insights From a Single-Blind Randomized Controlled Trial

ObjectiveTo determine the effect of Easy-Flex as an adjunct to standard inpatient rehabilitation on clinical and functional outcomes. DesignProspective randomized controlled trial. SettingOutpatient clinic and research laboratory. ParticipantsA total of 44 patients were randomized to the Easy-Flex Group (EFG) or Control Group (CG). InterventionsA rehabilitation program averaging 50-60 minutes per day was implemented for the patients with CG. In the EFG, in addition to 30-40 minutes of exercise with the Easy-Flex, the rehabilitation program applied to the CG was integrated with reduced sets and repetitions, with an average duration of 20 minutes. All interventions were performed under the supervision of a physiotherapist during hospitalization. After discharge, both groups received the same home exercise program. Main Outcome MeasuresThe primary outcome is the flexion and extension range of motion (ROM). The secondary outcomes include the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Five Times Sit-to-Stand Test (5-TSST), 10-Meter Walking Test (10-MWT), Short Form (SF)-12v2, and Global Rating of Change scale. ResultsAfter 6 weeks, the overall group-by-time interaction for the 2 × 3 mixed-model analysis of variance was found to be significant for flexion ROM (P=.005), NPRS-rest (P=.04), NPRS-activity (P=.01), 10-MWT (P=.003), WOMAC (P=.021), and SF-12 physical component summary (PCS) (P=.032) in favor of EFG exercising with Easy-Flex in addition to standard rehabilitation. The between-group differences in favor of the EFG were −8.0° knee ROM, 1.35-1.5 points for pain intensity, and 0.12 m/s for gait speed. Furthermore, differences favoring EFG in NPRS-rest, 10-MWT speed, and SF-12 PCS were greater than the reported minimum clinically important difference. ConclusionsIncorporating Easy-Flex into standard physical therapy can be a beneficial, safe, and effective approach in clinical practice, as patients undergoing total knee arthroplasty typically prioritize improving their quality of life by reducing pain and increasing ROM.

Time Course Effects of Kinesio Taping in Knee Osteoarthritis Patients

Background: Knee osteoarthritis is a common musculoskeletal disorder in the elderly, characterized by cartilage loss leading to pain, stiffness, and restricted movement. Kinesiotaping has been suggested as a therapeutic approach to reduce pain and improve functional outcomes in knee osteoarthritis patients. Objective: This study aimed to compare the effects of quadriceps and patellar kinesiotaping applied for different durations (24, 48, and 72 hours) on pain, balance, and functional performance in patients with knee osteoarthritis. Methods: A randomized clinical trial was conducted from March to September 2020 at the Railway General Hospital, Rawalpindi, and Abasyn Rehabilitation Center, Islamabad. Forty-eight patients with knee osteoarthritis (grades 2-3) were randomly assigned to three groups: Group A (kinesiotaping for 24 hours), Group B (kinesiotaping for 48 hours), and Group C (kinesiotaping for 72 hours). All participants also received conventional therapy, including hot pack application, quadriceps strengthening exercises (15 repetitions × 3 sets), and stretching exercises (5 repetitions with a 10-second hold × 3 sets). Pain, balance, and functional performance were assessed at baseline, post-intervention, and one week later using the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Functional Reach Test (FRT), and Time Up and Go Test (TUG). Data were analyzed using SPSS version 25, with intragroup comparisons conducted using the Wilcoxon signed-rank test and intergroup comparisons using the Kruskal-Wallis test. A p-value of less than 0.05 was considered statistically significant. Results: Significant reductions in pain were observed across all groups (p &lt; 0.05), with the most notable improvement in Group C (72 hours), where NPRS scores decreased from a median of 2 (IQR 1.75) at baseline to 1 (IQR 1) at follow-up (p &lt; 0.05). However, no significant improvements were noted in balance or functional performance across the groups, as indicated by FRT, WOMAC, and TUG scores (p &gt; 0.05). Conclusion: Kinesiotaping significantly reduces pain in knee osteoarthritis patients, particularly when applied for 72 hours, but does not appear to significantly impact balance or functional performance. These findings suggest that kinesiotaping is effective for short-term pain management, though additional interventions may be necessary to improve functional outcomes.