Mean WOMAC Score Research Articles

A PROSPECTIVE STUDY OF ARTHROSCOPIC DEBRIDEMENT COMBINED WITH PLATELET RICH PLASMA INJECTION IN EARLY OSTEOARTHRITIS OF KNEE JOINT

Background Osteoarthritis (OA) of the knee joint being one of the leading causes of musculoskeletal disability, has also shown increased prevalence in the Indian population. It has been observed that with careful patient selection arthroscopic debridement can provide good symptomatic relief. In the recent years, autologous platelet-rich plasma has emerged as a better treatment option. We propose that combining these two procedures together will give better results in some cases of early OA. To determine theObjectives efcacy and functional outcome of arthroscopic debridement along with intra-articular inltration of autologous platelet rich plasma in early OA knee. To assess the safety of usage of intra-articular inltration of platelet rich plasma in early OA knee. Materials and methods A prospective study conducted for a period of 24 months among 55 patients with early osteoarthritis at SSIMS & RC hospital, Davanagere, Karnataka. Under aseptic precautions, arthroscopic debridement of knee was done, after debridement 4 ml platelet concentrate was injected into knee joint. The pain assessment was done by Visual Analogue Scale (VAS), and the course of disease and effectiveness of therapy was assessed by measurement of Western Ontario and McMaster Universities Arthritis Index (WOMAC), before procedure and at 6 weeks, 3 months, and 6 months after procedure. Osteoarthritis of knee joint was affected on both sides in about 41.8%. The mean VAS score at baseline was 6.54Results ±0.719. The mean WOMAC score at baseline was 71.07 ±3.826. On comparing the mean baseline with the variation in each follow up, we found statistically signicant relation, suggesting that there was improvement in the condition of the participants. Conclusion The study found that arthroscopic debridement with intra-articular inltration of platelet rich plasma in early osteoarthritis knee signicantly reduced the pain, as the mean values of VAS score decreased drastically, and also improved the condition of the participants.

OUTCOME OF USING PLATELET, PLASMA AND GROWTH FACTORS AS AN ORTHOBIOLOGIC DERIVATIVE TO AVOID INVASIVE SURGICAL PROCEDURES FOR TREATING KNEE OSTEOARTHRITIS AMONG ELDERLY PATIENTS

Background: The application of platelet, plasma and growth factors (PP&GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&GF has yet to be well established.
 Objectives: This study aimed to report the survival analysis of 24-month follow-up treatment using PP&GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score.
 Methods: A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed.
 Results: A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&GF products contained 6-10 times higher platelet concentration than those in the peripheral blood.
 Conclusion: Intra-articular injection of PP&GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.

Rehabilitation of Patients with Moderate Knee Osteoarthritis Using Hyaluronic Acid Viscosupplementation and Physiotherapy

Knee osteoarthritis (KOA) is one of the most common public health problems which cannot be cured and ultimately leads to disability. Current management is largely limited to the treatment of the symptoms. To avoid the late stages of KOA that lead to knee replacement, the key point is to control and reduce destructive processes using efficient pharmacological products combined with physiotherapy (PT). Herein, we perform a monocentric observational study to compare the effect of combining a multi-modal physiotherapy regime and intra-articular (IA) injection with hyaluronic acid (HA) on the non-surgical treatment of KOA. Patients with mild KOA were randomly assigned to two groups to receive an HA injection with PT or an HA injection only. The assessment tools for pain, clinical disease severity, and disability were the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (scores range from 0 to 96, with higher scores indicating worse pain, function, and stiffness), knee range of motion (ROM), pain on the visual analog scale (VAS), and muscle strength testing (MST). All tests were evaluated every 3 months up to 1 year from the baseline. The study enrolled 52 patients with ages between 47 and 61 years who were divided into two groups. Thirty-seven (n = 37) patients were randomized in the pilot group (PG) and received IA injections with the viscoelastic hyaluronic acid product (HA) combined with a multi-modal PT regime. The PT program included 10 sessions of transcutaneous electrical nerve stimulation, low-level laser therapy, ultrasound, physical exercise, and cryotherapy. Fifteen patients (n = 15) from the control group (CG) received the IA HA injections only. All patients were confirmed with mild KOA of Kellgren–Lawrence grade 2 on radiographs at the beginning of the treatment. The baseline characteristics, including the severity of pain and level of disability, were similar in the two groups. At baseline, the mean (±SD) WOMAC scores reported were 64.6 ± 4.08 in the CG and 64.5 ± 2.99 in the PG. Notably, at only 3 months into the study, the mean scores were significantly improved to 56.7 ± 5 in the CG and 48.27 ± 2.13 in the PG (mean between-group difference = 16.19 points; 95% confidence interval), finding favor for the combination of HA injections and physiotherapy. At the study’s endpoint (12 months), the scores were improved in both groups, with the mean between-group difference remaining significant (7.08 points, 95% confidence interval). A decrease in pain, as evaluated by the VAS scale, was reported for both groups, with the PG reporting a better VAS score that decreased from 5.7 to 2 when compared to the CG, which decreased from 5.7 to 3. The physical assessment parameters (ROM and MST) followed the same trend, with a rapid improvement in the ROM in the PG, changing from 98° to 115° in the first 3 months, and a slower and more steady evolution in the CG group, changing from 100° to 112° in 9 months. Herein, we report on the combination therapy of an intra-articularly administered HA viscoelastic product and a multi-modal physiotherapy regime, which can play a key role in the non-surgical treatment of KOA, effectively controlling pain, stiffness, and the ROM value and improving patients’ quality of life.

The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis.

Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001). According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.

Total hip arthroplasty with a superior approach and in situ preparation of the femoral stem: technique and feasibility in a prospective series of 80 cases.

We report on the feasibility of a technique for total hip replacement with in situ preparation of the femoral stem through a superior approach and with the use of standard instruments. From December 2017 to august 2018, 100 patients were recruited for total hip replacement. 80 patients underwent THA through a superior approach with femoral broaching before femoral neck cut. We evaluated feasibility, complications and early functional outcome. There were no major complications. Postoperative leg length discrepancy was on average +0.6mm and offset -0.5mm. The mean acetabular cup inclination was 42.0° and the mean anteversion was 14.5°. The mean WOMAC score was 46 before, 76 at 1 month and 86 at 3 months after surgery. Functional scores (OARSI) were significantly improved at 3 months. Superior in situ total hip replacement is a reliable and reproducible technique with an excellent clinical outcome. It is an iteration to the posterior approach, hence the learning curve is steep and if needed, conversion to a standard posterior approach is possible.

Porous tantalum shell and augment for acetabular defect reconstruction in revision total hip arthroplasty: a mid-term follow-up study.

The use of porous tantalum trabecular metal (TM) shell and augment to reconstruct acetabular defects in revision total hip arthroplasty (THA) is a reliable technique. We evaluated the mid-term implant survival, clinical, and radiological outcomes of our first 48 revisions using this technique. A total of 45 patients (48 hips) who had acetabular revision of THA between 2011 and 2017 using TM shell and augment with possible mid-term follow-up were included. Twenty-two patients were men (49%) and 23 were women (51%), mean age was 62.5years (34 to 85) and mean follow-up was 75months (54 to 125). Twenty-four hips (50%) had a Paprosky IIIA defect, 14 (29.2%) had a type IIIB defect, six (12.5%) had a type IIC defect, and four hips (8.3%) had a type IIB defect. None of the patients had pelvic discontinuity (PD). At a mean 6.25years follow-up, all hips remained well-fixed and implant survival of 100% with the need of re-revision as the end point. Screw fixation was used for all shells; augments and the shell-augment interface was cemented. Excellent pain relief (mean WOMAC score pain 90.5, (38.3 to 100)), and functional outcomes (mean WOMAC function 88.3 (31.9 to 100), mean OHS 89.2 (31.8 to 100)) were noted. Patient satisfaction scores were excellent. This study demonstrated satisfactory mid-term clinical and radiological outcomes of using TM shell and augment for reconstructing major acetabular defects without PD in revision THA.

Efficiency of Intra-Articular Platelet-Rich Plasma Injection in Grade I and Grade II Osteoarthritis in the Knee Joints: A Longitudinal Study

Aim: To assess the efficiency of intra-articular platelet-rich plasma (PRP) injection in grade I and grade II osteoarthritis in the knee joints Study design: A longitudinal study Place and Duration: This study was conducted at Murshid Hospital and Health Care Center Karachi Pakistan from January 2021 to June 2021. Methodology: The ages of the patients were between 35 years and 65 years. All the patients were diagnosed with osteoarthritis of grade I and grade II. A total of 3 injections of PRP were injected intraarticular in the knees at an interval of 4 weeks. Patients were asked to come for a follow-up in the outpatient department. They were assessed for physical mobility and pain related to arthritis using the WOMAC score. The assessment was done when the treatment was given and after 6 months. Results: A total of 250 patients were considered in the present study. The mean age of the patients was 55.63±5.65 years. The ratio of disease in females to males was 3:1. A total of 178 patients had grade I osteoarthritis and 72 patients had grade II osteoarthritis according to Kellgren–Lawrence classification. A total of 210 patients had reported experiencing symptoms for less than 2 years and the remaining 40 had been experiencing the symptoms for more than 2 years. The mean WOMAC score was 82.9 before the treatment was started and it was 39.15 after 6 months of the treatment. The improvement of WOMAC score was more in the patients having symptoms for less than 2 years. Minor hyperemia was seen in 4 patients and those patients were managed conservatively by ice application and activity limitation. None of the patients showed signs of infection. Conclusion: The intraarticular injection of PRP proved to be beneficial and effective in the treatment of grade I and grade II early osteoarthritis. Keywords: Osteoarthritis, Platelet-rich plasma, PRP, knee joint

Midterm results of titanium conical Wagner stem with challenging femoral anatomy: Survivorship and unique bone remodeling

BackgroundComplex anatomy of the proximal femur makes total hip arthroplasty (THA) more challenging. Short, straight, fluted and conical titanium stem like the Wagner Cone can be helpful to address small femoral canal, increased femoral neck version, important leg length discrepancy or proximal femoral deformity. The outcome in these patients is less assured and associated with high rate of complications. Therefore, we did a retrospective study aiming to answer: 1) can the Wagner Cone stem provide acceptable mid- to long-term implant survivorship; 2) help minimizing perioperative adverse events; 3) produce favorable clinical outcome measured by WOMAC score; and 4) be associated with a favorable radiographic femoral bone remodeling at the last follow-up? HypothesisWagner Cone stem is an advantageous solution for the distorted proximal femur in complex THA. Patients and methodOur cohort was derived from the patient registries where medical records of 88 patients (103 hips) who underwent primary THA using the Wagner prosthesis were retrospectively reviewed. Then, data was analyzed for patients’ demographics and surgical data, and comparing preoperative, immediate postoperative and last follow-up data. Eleven patients (12 hips) were excluded (7 hips followed up less than 2 years or lost to follow-up, 3 hips that had the Wagner stem for revision and 2 Wagner stems inserted for periprosthetic fracture). This left 77 patients (91 hips) with Wagner cone stems implanted for more than 2 years between March 2003 and February 2017 by 7 surgeons in 3 academic hospitals. Implant revision, reoperations, WOMAC score and radiographic analyses were recorded at last follow-up. ResultsAfter a mean follow-up of 7.8 (range, 2.0–16.2) years, Wagner stem survivorship was 98.9% (95% CI: 94 to 100%) with one (1.1%) stem revision for failure of osteointegration. Five (5.5%) acetabular revisions, one for aseptic loosening, 2 for adverse reaction to metal debris and 2 for infection. One (1.1%) sciatic neuropathy and 4 (4.4%) intraoperative fractures were encountered. The mean WOMAC score was 90.5±11.4 (59–100). Radiographic analysis showed clear signs of stem osseointegration and hypertrophic bone remodeling in 82 cases (92.1%). ConclusionsUsed in complex cases with proximal distorted femurs, the Wagner Cone stem demonstrated a low complication rate, a high-rate consistent adaptive bone remodeling, excellent clinical results, and midterm survival. It is a safe, reliable and advantageous option in complex primary THA. However, the contribution of the underlying cause of the secondary osteoarthritis on the long-term survival of the stem remains to be demonstrated. Level of evidenceIV; retrospective study.

Homologous Use of Allogeneic Umbilical Cord Tissue to Reduce Knee Pain and Improve Knee Function.

To determine if knee pain subjects who received cryopreserved umbilical cord tissue (UCT) injected into knee joints experience less knee pain, better function, decreased physical limitations, and reduction of medications (opiates, NSAIDs, and acetaminophen) over a 24 week period, Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and medication usage data were recorded for 30 consenting human knee pain subjects receiving UCT at a single site in the United States. Subject profile information was gathered and analyzed to gain insight into the effects of age, sex, and BMI on improvement over time. Mean resting VAS scores and mean VAS scores with activity improved over 24 weeks (from 1.95 to 0.83 and from 6.28 to 2.87, respectively, p < 0.001). There was no strong evidence of a correlation between sex and VAS scores. There were statistically significant correlations for BMI vs. pre-injection VAS with activity scores and Age vs. pre-injection VAS with activity scores (r = 0.402, p = 0.028 and r = 0.434, p = 0.017, respectively). Mean WOMAC scores improved from 44.7 to 18.5 over 24 weeks (p < 0.001). 77.8% of patients who used medications at the beginning of the study reduced or eliminated medication use. The analysis demonstrates that injections with UCT decrease pain, improve physical function, and allow for less medication use for at least 24 weeks.

Clinical Performance of an Ultrashort, Proximally Porous-Coated and Tapered Metaphyseal-Fitting Cementless Femoral Stem Among Octogenarians.

Total hip arthroplasty (THA) among octogenarians presents greater challenges than among the younger patient population because of the high risk of perioperative morbidity and mortality and poor bone quality. We determined the clinical performance and radiographic results of an ultrashort, proximally porous-coated and tapered metaphyseal-fitting cementless femoral stem for octogenarians. A total of 100 unselected octogenarians (112 hips) were included in this retrospective study. All patients received the ultrashort, proximally porous-coated and tapered cementless stem during the study period, but patients who could not walk preoperatively were excluded from the analysis. Their mean age was 82.3±12.1 years (range, 80-92 years). Assessment was performed with the Harris Hip Score; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score; thigh pain; University of California, Los Angeles (UCLA) activity score; and radiographic results. The mean duration of follow-up was 7.6 years (range, 6-9 years). At the final follow-up, the mean Harris Hip Score was 87±13 points, the mean WOMAC score was 26±8 points, and the mean UCLA activity score was 4.5 points. Osseointegration was obtained for 105 (94%) acetabular components and 110 (98%) femoral components. Kaplan-Meier survivorship analysis at 9 years showed that the survival rate for the acetabular component was 94% (95% CI, 91-98) and that of the femoral component was 98% (95% CI, 91-100), with aseptic loosening or revision as the end point. The ultrashort cementless femoral component provides stable fixation without the need for diaphyseal fixation among octogenarians. [Orthopedics. 2022;45(3):181-186.].

Efficacy of Intra Articular Steroid Injection and Platelet Rich Plasma in Patients with Osteoarthrithis

Objective: To compare the efficacy of intra-articular steroid injection and Platelet rich plasma in patients with Osteoarthrithis. Methodology: A randomized controlled trail study was conducted at Rheumatology Division of the Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad after the acceptance of synopsis from  . A total of 122 adult patients with unilateral or bilateral osteoarthritis of knee and were randomized into two treatment groups. In Group I, patients received intra-articular steroid injections and in Group II, patients received platelet rich plasma (PRP). WOMAC score was calculated at baseline and was subsequently assessed after 06 weeks and 3 months. Results: Age and gender distribution and mean WOMAC and VAS scores were similar in both groups at baseline (p&gt;0.05).  At six weeks, mean WOMAC score in steroid group was 32.1 ± 24.1 and it was 24.9 ± 21.3 in PRP group (P=0.084). Mean VAS in steroid group was 4.5 ± 2.5 and it was 3.9 ± 2.6 in PRP group (P=0.0.158). At three months, mean WOMAC score in steroid group was 39.1 ± 24.3 SD and it was 27.1 ± 21.9 SD in PRP group (P=0.005). At three months, mean VAS in steroid group was 5.6 ± 2.6 and it was 4.1 ± 2.7 in PRP group (P=0.003). Conclusions: The study outcomes were better in patients treated with PRP as compared to intra-articular steroid injection. Mean WMOAC and VAS scores were significantly lower after three months in PRP group as compared to steroid group.

Unilateral locking plate versus unilateral locking plate combined with compression bolt for Schatzker I-IV tibial plateau fractures: a comparative study.

The quality and durability of fracture reduction play an important role in the functional prognosis of articulation. The purpose of this study was to investigate the radiological and clinical effects of compression bolts in the treatment of Schatzker I-IV tibial plateau fractures (TPFs). Between May 2015 and April 2018, a total of 96 consecutive adult patients with operatively treated Schatzker I-IV TPFs were included and divided into two groups according to the internal fixations: Group 1 (unilateral locking plate) and Group 2 (unilateral locking plate combined with compression bolt). Data on demographic and fracture characteristics, postoperative follow-up imaging, intraoperative indicators, postoperative reduction quality and durability, clinical outcomes, and complications were retrospectively collected and compared between the two groups. There were no significant intergroup differences in preoperative baseline data, duration of operation, intra-operative blood loss, days in hospital, rate of immediate post-operative reduction loss, or complications. The time of fracture healing, the rate of secondary reduction loss, and the mean WOMAC score were significantly reduced compared with those in Group 1 (P = 0.024, 0.015, and 0.024, respectively). There were significant intergroup differences in the mean HSS score (89.0 ± 11.4 vs. 94.4 ± 6.7, P = 0.042), the mean Lysholm score (83.8 ± 9.6 vs. 88.4 ± 5.2, P = 0.027), and the mean SF-36 score (82.8 ± 12.5 vs. 90.5 ± 7.6, P = 0.001). Additionally, there were similar significant differences in subgroup analysis (only included patients with Schatzker II-III), except for WOMAC score. Compared with unilateral locking plate fixation, unilateral locking plate combined with compressing bolt fixation can reduce the rate of secondary reduction loss, accelerate fracture healing, and show better clinical outcomes for patients with Schatzker I-IV TPFs.

Randomized controlled study of proximal fibular osteotomy (PFO) with or without trabeculotomy in early osteoarthritis (OA) knee

This study was conducted to evaluate and compare the clinical and functional outcome of OA knee patients treated with proximal fibular osteotomy with or without trabeculotomy.This was a randomized controlled study amongst patients of osteoarthritis knee for a period of 1 year on patients with early osteoarthritis of knee. All patients were randomly allocated into two groups; group 1 patients were managed using PFO with trabeculotomy whereas group 2 patients were managed with proximal fibular osteotomy alone. All the patients were followed up post operatively at 15 days and at 2, 6 and 12 months post operatively. At each follow up patients were assessed for presence of Pain using Visual analogue scale. Also functional outcome was assessed using WOMAC.In present study, patients of two groups were comparable in their base line characters (p&amp;#62;0.05). Post operatively, mean VAS score and WOMAC score improved significantly in both the groups, the improvement was significantly higher in group 1 as compared to group 2 at all the follow up (p&amp;#60;0.05).Proximal fibular osteotomy with or without trabeculotomy can be used effectively as a promising tool for management of cases with early osteoarthritis of knee. It is safe, effective, and cost effective surgical technique for pain relief and improving functional outcome. PFO with trabeculotomy yields better results in terms of clinical as well as functional outcome as compared to PFO without trabeculotomy.

Radiologically Guided Versus Blinded Intra-articular Injection in Patients With Hip Osteoarthritis: A Retrospective Comparative Study.

Objectives:The aim of this study was to present the clinical results of patients with Kellgren-Lawrence (KL) stage 2-4 hip osteoarthritis who were administered intra-articular corticosteroid (CS) or hyaluronic acid (HA), with or without fluoroscopy.Methods:This retrospective comparative study was conducted in the clinics where the authors worked between 2010 and 2018. Patients with stage 2-4 hip osteoarthritis according to KL criteria were included in the study. Age, body mass index, American Society of Anesthesiologists stages, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (3rd, 6th, and 12th months) were recorded. Two groups were created as patients who underwent injection with or without fluoroscopy guidance. In group 1, CS (triamnisolone) was administered, and in group 2, sodium hyaluronate 88 mg/4 mL was administered. Obtained parameters were compared.Results:The WOMAC scores at 3 months of both the CS and HA groups were statistically significantly better than before the application, with the improvement in the CS group found to be significantly better than in the HA group (P = .047). At 6 months, the mean WOMAC scores of the CS and HA groups were better than prior to the application, and there was a statistically significant difference (P < .001). No significant difference was found in either the CS or HA group in the comparison of 12-month WOMAC scores with the baseline scores (P = .744 and P = .054).Conclusion:In symptomatic hip OA patients, intra-articular administration of CS and HA was seen to be effective at 3 and 6 months after administration. However, the effectiveness was determined to have disappeared within 1 year. Furthermore, in hip OA intra-articular drug applications, it was determined that the blinded technique without radiological guidance performed in the outpatient clinic is as effective and safe as the radiologically guided technique administered in the operating room.

Functional outcome after arthroscopic debridement with microfracture and platelet rich-plasma injection in osteoarthritis of knee – A prospective study

Surgical treatment for knee osteoarthritis (OA) involves debridement, lavage, and microfracture to enhance chondral resurfacing by providing a suitable environment for tissue regeneration. Platelet-rich plasma (PRP) stimulates chondrocyte proliferation. Combining microfracture with PRP injections helps promote early clinical improvement, and this study aims to assess the functional outcomes when all three techniques are used simultaneously. This prospective, observational, hospital-based study was conducted at R. L. Jalappa Hospital and Research Centre, SDUMC, Tamaka, involving patients with OA of the knee from June 2020 to November 2020. Clinical data were collected and evaluated with pre -and post-procedure Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) scores. In all, 74.29% of the patients had Kellgren-Lawrence grade III knee OA and 25.71% had grade II knee OA. The levels of pain and knee function were evaluated using WOMAC and VAS scores before and 1, 3, and 6 months after the procedure. It was observed that 68.57% had good VAS scores, while 31.43% had poor scores. The mean WOMAC scores showed a statistically significant improvement (P &lt; 0.001) with a decrease in the preoperative WOMAC score from 67.11 ± 8.73 to 50.14 ± 9.99 at 1 month, 40.83 ± 7.8 at 3 months, and 31.66 ± 5.28 at 6 months. Intra-articular PRP injection after debridement and microfracture is beneficial for pain relief and functional improvement and prolongs the treatment efficacy of microfracture in patients with symptomatic knee OA.

Meta-Analysis the Effect of Aquatic Therapy on Functional Ability in Patients with Knee Osteoarthritis

Background: Knee OA can affect mobility in the elderly causing pain and impaired functional ability. This study aims to analyze the effect of aquatic therapy on functional ability in knee osteo­arthritis patients based on the results of a number of previous primary studies.. Subject and Method : This study was conducted using a meta-analysis method with articles searched using the search keywords "knee osteoarthritis" OR "osteoarthritis genu" AND "aquatic therapy" OR "hydrotherapy" OR "water exercise" AND "functional ability" OR "WOMAC" AND "Randomized Controlled Trial” OR “RCT” from PubMed, google scholar and science direct and processed using RevMan 5.3. Results : 9 RCT articles that fit into the inclusion criteria, with a total of 573 samples. Knee OA patients receiving aquatic therapy had a mean WOMAC score of 1.22 units lower than those without aquatic therapy, and the effect was statistically significant (SMD = -1.22; 95% CI -2.03 to -0.41; p = 0.003). In other words, aquatic therapy is effective in improving functional ability in knee OA patients. Conclusion: Aquatic therapy has an effect on increasing functional ability in knee osteoarthritis patients. Keywords: Osteoarthritis, aquatic therapy, WOMAC index Correspondence: Wita Hana Puspita. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: wita.tj0408@gmail.com. Mobile: +628164837959. Indonesian Journal of Medicine (2022), 07(02): 138-149 https://doi.org/10.26911/theijmed.2022.07.02.03

Comparison of Intraarticular Ketorolac Versus Triamcinolone Acetone Injection in Patients of Knee Osteoarthritis

Objective:&#x0D; To compare the analgesic and functional outcomes of intra-articular ketorolac with corticosteroids in patients of knee OA.&#x0D; Methods:&#x0D; In this randomized comparative study, we included patients of knee OA who were planned for intra-articular injections from January-2020 to December-2020 in the Department of Anesthesia and Pain Medicine at Rawalpindi Medical University. Patients were allocated to two groups using block randomization, each block contained 30 patients and received injection of either triamcinolone (Group T) or ketorolac (Group K). VAS score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were noted at 1 week, 1 month and at 3 months of injection.&#x0D; Results:&#x0D; Mean baseline WOMAC score was 46.60±5.64 in group K and 47.0±5.27 in group T (p-value 0.74). Mean WOMAC score was reduced significantly at 1st week and 1 months and 3 months follow-up in both groups, with insignificant statistical difference in group K and T (p-value 0.39, 0.18 &amp; 0.15 respectively). Baseline VAS score was 7.02±1.34 in group K versus 7.27±1.03 in group T (p-value 0.36). VAS score was also reduced at 1 week, 1 month and 3 months follow-up, however the mean VAS at intervals was not statistically different between group K and T with p-value of 0.13, 0.08 and 0.49 respectively. Treatment was successful in 22 (55%) patients in group K versus 24 (60%) patients in group T (p-value 0.65).&#x0D; Conclusion:&#x0D; Intraarticular ketorolac has similar functional and analgesic outcomes as that of triamcinolone.

Evaluation of the Functions and Radiographic Severity of Osteonecrosis of the Head of Femur in South-west Nigeria

Background: Osteonecrosis of the femoral head is likely to be a complex of diseases rather than a single entity. In sub-Saharan Africa, epidemiological studies on the subject are uncommon.&#x0D; Objectives: To determine hip function, radiographic severity and other characteristics of patients with osteonecrosis of the femoral head (ONFH) at presentation in a sub-Saharan Africa population&#x0D; Methods: A combined prospective clinical survey and retrospective chart review of patients was done.&#x0D; Results: Fifty hips in 44 patients were studied (29 retrospectively and 15 prospectively). The prevalence of ONFH was 1.6%. The mean age was 24.8±13.2 years. The lesion was unilateral in 86.4% and bilateral in 13.6% of the hips. Sickle Cell Disease (SCD) occurred in 43.2%, sickle cell trait in 13.6%, and 20.5% of cases were idiopathic. Overall, 12% of affected hips were presented early, and all the hips were painful at presentation. Of the 18 hips studied prospectively, 72.2% had necrosis &gt;30% and &gt;30% subchondral collapse in 61.1%. The mean combined necrotic angle was moderate size, 197o±29.7o and 177.2o±69.4o for the right and left hips, respectively (p = 0.8). The mean WOMAC scores were 37.2 ±17.4 for function, 10.2±4.3 for pain and 4.2±2.7 for stiffness.&#x0D; Conclusion: Patients with osteonecrosis of the femoral head tended to be young adults and those with SCD. The majority present with large-sized osteonecrosis and subchondral collapse but moderate hip pain and stiffness.

A pilot study on the validity and psychometric properties of the electronic EQ-5D-5L in routine clinical practice

BackgroundElectronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. This study evaluated the validity and psychometric properties of an electronic version of the EQ-5D-5L (e-EQ-5D-5L) in Chinese patients with chronic knee and/or back problems.Methods151 Chinese subjects completed an electronic version of the Chinese (Hong Kong) EQ-5D-5L when they attended a primary care or orthopedics specialist out-patient clinic in Hong Kong. They also completed the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a Pain Rating Scale, and a structured questionnaire on socio-demographics, co-morbidities and health service utilization. 32 subjects repeated the e-EQ-5D-5L two weeks after the baseline. 102 subjects completed e-EQ-5D-5L and 99 completed the Global Rating on Change Scale at three-month clinic follow up. Construct validity was assessed by the association of EQ-5D-5L scores with external criterion of WOMAC scores. We tested mean differences of WOMAC scores between adjacent response levels of the EQ-5D-5L dimensions by one-way ANOVA, test–retest reliability by intra-class correlation, sensitivity by known group comparisons and responsiveness by changes in EQ-5D-5L scores over 3 months.ResultsThere was an association between EQ-5D-5L and WOMAC scores. Mean WOMAC scores increased with the increase in adjacent response levels of EQ-5D-5L dimensions. Test–retest intraclass correlation coefficient (ICC) of EQ-5D-5L utility and EQ-VAS scores were 0.76 and 0.83, respectively, indicating good reliability. There were significant differences in the proportions reporting limitations in the EQ-5D-5L dimensions, the utility and VAS scores between the mild and severe pain groups (utility = 0.28, p = 0.001; VAS = 11.46, p < 0.001), and between primary care and specialist out-patient clinic patients (utility = 0.15, p = 0.001; VAS = 10.21, p < 0.001), supporting sensitivity. Among those reporting ‘better’ global health at three-months, their EQ-5D-5L utility and EQ-VAS scores were significantly increased from baseline (utility = 0.18, p < 0.001; VAS = 10.75, p = 0.005).ConclusionsThe electronic version of the EQ-5D-5L is valid, reliable, sensitive and responsive in the measurement of HRQOL in Chinese patients with chronic knee or back pain in routine clinical practice.

Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?

BackgroundThe “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery.MethodsFrom 2015 to 2020, 33 patients treated with the DMC- “cup in cup” technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method.ResultsThe mean age at surgery was 78.6 ± 7.1 (63–93) years and the mean surgery duration was 124.4 ± 52.0 (60–245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration (n = 19) was 28.5 ± 17.3 (3–64) months. The mean HHS score at FU was 59.4 ± 22.2 (29–91) and the mean WOMAC score was 59.7 ± 25.6 (15.6–93.8).Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5–64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5–64.7) months.ConclusionsWe found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.