Non-surgical Treatment Of Knee Osteoarthritis Research Articles

Carboplasty, a Minimally Invasive Procedure for Knee Osteoarthritis: Surgical Technique and Clinical Evidence

Knee osteoarthritis affects ~16% of adults in the world and is considered one of the most incapacitating diseases. Despite the advances in scientific knowledge and biological treatments in the field of orthopedics, available nonsurgical treatments for knee osteoarthritis are limited and still ineffective in delaying or stopping the progression of arthritis. Biologics such as platelet-rich plasma, bone marrow aspirate, and progenitor cells have emerged as potential treatments for osteoarthritis; however, the results are still not as expected. Carboplasty is a new treatment that involves the application of bone marrow aspirate into the bone-cartilage interface and intra-articularly, with the intention of stopping the progression of osteoarthritis and delaying the need for total knee replacement. By applying bone marrow directly in the bone-cartilage interface, the communication between subchondral bone and articular cartilage may be reestablished, promoting the delivery of nutrients to the cartilage, and it is hoped that preserving, regenerating, and restoring knee cartilage. Thirteen patients with knee osteoarthritis underwent carboplasty. Patients showed a statistically significant improvement in the Veterans RAND 12 Item Health Survey, the visual analog scale for knee pain, the Western Ontario and McMaster University Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at 3 and 6 months postprocedure. No adverse events were reported during the follow-up. Carboplasty is promising and worthy of further research.

Making the current non-surgical treatments for knee osteoarthritis more effective: Solutions from a diverse patient group.

To examine patient perceived solutions to barriers to effective non-surgical knee osteoarthritis (OA) treatments in a diverse racial/ethnic group. Nominal groups were conducted with consecutive patients with knee OA at a medical center clinic, oversampling for African Americans with knee OA. Participants discussed potential solutions and rank-ordered their concerns. Thirteen nominal groups with 46 knee OA patients were conducted with mean age, 60.8 years (standard deviation [sd], 10.0) and knee OA duration, 8.1 years (sd, 5.4); 22% were men, and 56% were African American. The following solutions were in the top three ranked solutions in 13 NGTs: (A) more research, effective and/or safer new medications/treatments, and joint cartilage restoration (8 groups; 15% votes [43/276]); (B) early diagnosis (2 groups; 7% votes [20/276]); (C) better and more effective communication (5 groups; 10% votes [29/276]); (D) public and patient education (4 groups; 8% votes [22/276]); (E) motivation and behavioral modification (4 groups; 9% votes [26/276]); (F) team approach (1 group; 1% votes [2/276]); (G) personalized medicine (6 groups; 8% votes [24/276]); (H) cheaper and more affordable medications and treatments (3 groups; 5% votes [15/276]). A diverse group of participants with knee OA identified several solutions to barriers to the effectiveness of current knee OA treatments. This new knowledge can inform the development and implementation of future interventions to improve the outcomes of people with knee OA.

Surgical Versus Non-Surgical Treatments for the Knee: Which Is More Effective?

Osteoarthritis is a degenerative joint disease that is extremely prevalent in society. It affects more than 25% of Americans above the age of 18 years. According to July 2020 publication by the Centers for Disease Control (CDC), osteoarthritis affects approximately 325 million Americans. One of the organs that is most affected by osteoarthritis is the knee. Over the years, we have developed non-surgical treatments, such as physical therapy (PT) and injections, and surgical treatments, such as total knee arthroplasty (TKA) and arthroscopic lavage, for knee osteoarthritis (KOA). If a patient fails with non-surgical options, which are tried first to avoid the risks of surgery, the patient may be considered for knee surgery. This article will investigate the different non-surgical options and TKA as treatment options for KOA based on current literature. The goal of this paper is to be a comprehensive resource for physicians and patients with KOA to make an informed decision. A systematic literature search was conducted using PubMed. The search terms were based on the type of treatments for KOA. To find articles that compared TKA to non-surgical treatments, the terms included "osteoarthritis", "total knee", and "non-surgical treatments," in combination. For other non-surgical treatments such as PT, weight reduction, and injections, a combination of the treatment, "osteoarthritis", and "knee" were included in the search. For the tier 1 process, any randomized controlled trials were included. Any case reports, observational studies, and cross-sectional studies were eliminated from the search. For the tier 2 review process, any articles that did not have relevance to the topic were eliminated after reading the abstracts of the articles. After review of the literature, the data seem to suggest that TKA with 12 weeks of non-surgical treatment improved pain and functionality of the knee more than just 12 weeks of non-surgical treatment when followed up at 12 and 24 months. However, non-surgical treatment before TKA delays the need for surgery. Supervised PT, either in a group or individual format, has been shown to delay TKA in 95% patients in the group that received PT at the end of one year. In addition, weight reduction has been shown as an effective strategy to improve pain and functionality in KOA patients, which decreases the urgency for surgery. Furthermore, platelet-rich plasma (PRP) injections have been shown to have long-term symptomatic relief for KOA compared to hyaluronic acid (HA) and corticosteroid injections. However, HA and corticosteroid injections are beneficial in treating KOA more than receiving no treatment. Physicians often have difficulty deciding whether to pursue conservative or surgical treatment for patients with KOA. The non-surgical treatments explored in this review - PT, injections, and weight reduction - can provide symptomatic relief and, in some cases, delay the need for surgical intervention. However, based on some randomized clinical trials mentioned in the article, patients receiving TKA have more relief, better quality of life, and improved functionality compared to non-surgical therapy. However, a critical review of this important field of debate shows that there are limited randomized controlled studies comparing the effectiveness of TKA and non-surgical treatments for KOA. We believe that this controversial topic needs further clinical investigation.

The Role of Genicular Radiofrequency Ablation in the Management of Persistent Pain after Total Knee Arthroplasty.

Persistent pain is one of the most frequent complications following total knee arthroplasty (TKA) and can be devastating for the patient's quality of life. The use of genicular nerve radiofrequency ablation (GNRFA) is prevalent regarding non-surgical treatment of knee osteoarthritis. However, it is controversial when employed for the management of residual pain after TKA. This study aims to evaluate the efficacy of GNRFA for the treatment of post-TKA chronic pain and to assess the potential benefits of its use. Twelve patients sustaining chronic pain after TKA underwent GNRFA treatment. The intervention included the superior medial genicular nerve, the superior lateral genicular nerve and the inferior medial genicular nerve. Visual analog scale (VAS) system was utilized for pain assessment at 1-week, 6-month, and 1-year follow-ups. Patients experiencing chronic knee pain derived from other or unspecified causes were excluded. Mean VAS score before the treatment was 8.3, while it ended up 2.3, 5.7, and 7.9 at the 1-week, 6-month, and 1-year follow-up, respectively. Some patients reported residual pain that they regarded more bearable than before the procedure at the 1-week evaluation, with no significant alterations in the 6-month reassessment. In 2 cases results at the 1-week follow-up were dissatisfying, however, this aided us in distinguishing the cause of the persistent pain. We were not able to conclude that GNRFA used for the treatment of chronic pain after TKA is as efficacious as in knee osteoarthritis pain. However, in some cases, it proved to be beneficial regarding discerning the etiology of the pain.

The Booster Effect of a Single Quarterly Dose of Hyaluronic Acid in Knee Osteoarthritis: Five-Year Results of a Registry-Based Study.

Objective Viscosupplementation by hyaluronic acid (HA) is well established non-surgical treatment of knee osteoarthritis (KOA). This registry-basedstudy investigated the booster effect of a quarterly intra-articular single knee injection (30mg/2ml) for five years. Methods Sixty patients, including 29 males and 31 females, with a mean ± SD age 61.07 ± 9.15 with Kellgren-Lawrence grade I-III KOA, have been selected from a registry of interventional treatments for musculoskeletal pain conditions. To be eligible, patients had to be treated with a single quarterly intraarticular injection of HA with a follow-up of at least five yearsand assessed with Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numeric Rating Scale (NRS) at baseline and after each HA injection in the first 24 months and at 36, 48, and 60 months. Results Sixty of 63 patients enrolled in this study completed the 60 months of follow-up.Patients had a marked improvement in knee function and pain, expressed by the significant reduction in WOMAC (T0 48.62±8.95 vs. T11 10.75±4.36; p<0.0001) and NRS scores (6.38±1.06 vs. T11 0.95±0.89 p<0.0001) from the baseline to the end of the follow-up period. Conclusion A quarterly injection of HA provides a rapid, safe, and stable long-term reduction of pain and improvement of function in elderly people with mild to moderate knee osteoarthritis along a five-yearperiod of treatment and follow-up. Further investigations are necessary to confirm these findings.

A multicenter cross-sectional study of quality of life and nonsurgical treatment in patients with knee osteoarthritis

Objective: To explore the influencing factors of health-related quality of life (HRQoL) in patients with knee osteoarthritis, and to analyze the non-surgical treatment of knee osteoarthritis. Methods: Demographic variables, treatment modalities, imaging data, and 12-item short form health survey (SF-12) scores of patients with knee osteoarthritis in orthopedic outpatient departments of five hospitals in Beijing from December 2017 to November 2018 were collected to analyze influencing factors of HRQoL and non-surgical treatment. Results: A total of 2 034 patients were included. There were 530 males (26.1%) and 1 504 females (73.9%), with a mean age of (59.17±10.22) years. In terms of physical quality of life, female patients with knee osteoarthritis had lower physical components summary (PCS) compared with male patients (β=-0.521, P=0.036); patients aged ≥64 years had lower PCS than those aged<55 years (β=-0.636, P=0.026). Patients with an education of more than 12 years had higher PCS than those with less than 10 years (β=1.063, P<0.001). Compared to patients with mild clinical symptoms, the PCS of patients with moderate clinical symptoms was lower (β=-0.860, P=0.002), while the PCS of those with severe clinical symptoms was much lower (β=-1.126, P<0.001). Patients treated with combination therapy had higher PCS than untreated patients (β=0.731, P=0.005). In terms of mental quality of life, compared to patients engaged in sedentary work, the mental components summary (MCS) of patients engaged in mild manual labor jobs was lower (β=-0.712, P=0.015); Compared to patients with a Charson comorbidity index of 0, patients with a Charlson comorbidity index ≥ 2 had lower MCS (β=-1.183, P=0.007). In the past 12 months, 648 (31.9%), 143 (7.0%), 406 (20.0%), 680 (33.4%), 343 (16.9%), 681 (33.5%), 170 (8.4%) patients had used non-steroid anti-inflammatory drugs (NSAIDs), acetaminophen, glucosamine/chondroitin formulations, physical therapy, articular cavity puncture injection, traditional Chinese medicine treatment and exercise therapy, respectively. Total of 451 patients (22.2%) received monotherapy and 889 patients (43.7%) received combination therapy. Conclusions: The major non-surgical treatment methods for patients with knee osteoarthritis in Beijing are NSAIDs, physiotherapy and traditional Chinese medicine. Combination therapy is used more frequently than monotherapy. Physical quality of life is related to gender, age, education, severity of symptoms and treatment, while mental quality of life is related to occupational labor and comorbidities.

5-YEAR FOLLOW-UP OF PATIENTS WITH KNEE OSTEOARTHRITIS RECEIVING NON-SURGICAL TREATMENT: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL

Purpose: Non-surgical treatment of knee osteoarthritis (OA), such as exercise therapy and weight loss, improves pain, physical function and other patient-reported outcomes. However, knee OA is commonly perceived as a progressive condition that will worsen over time and improvements from non-surgical treatments seem to decrease 2-6 months after the intervention. Results from our randomized controlled trial (RCT) with 12- and 24-month follow-up showed that patients maintained improvements in patient-reported outcomes following written advice and a non-surgical treatment program, including exercise therapy and weight loss.

Do people with knee osteoarthritis use guideline-consistent treatments after an orthopaedic surgeon recommends nonsurgical care? A cross-sectional survey with long-term follow-up

ObjectiveDescribe “usual care” patterns of education, exercise, weight management, pain medication and other nonsurgical treatments for knee osteoarthritis (OA) in people recommended for nonsurgical care by an orthopaedic surgeon. MethodsWe used a telephone-administered questionnaire to capture treatments people with knee OA used over the three to six years after an orthopaedic surgeon recommended nonsurgical care. The primary outcome, guideline-consistent nonsurgical treatments, was an aggregate measure defined as using education, exercise, weight management, and at least one recommended medication. Secondary outcomes were first-line (education, exercise, and weight management) and guideline-inconsistent treatments (orthoses, opioids, hyaluronic acid, platelet rich plasma, and stem cell therapy). Multivariable robust Poisson regression assessed the association between participant characteristics and use of guideline-consistent, first-line and guideline-inconsistent treatments. Results479 people were invited and 250 participated (52%). Participants were 58% female with a mean age 66.2 years. Participants received education by a healthcare professional (64%), exercised regularly (74%), used weight management (38%), and used recommended pain medications (91%). All guideline-consistent nonsurgical treatments were used by 19% of participants, 19% of participants used first-line treatments, and 42% used guideline-inconsistent treatments. Over six years, 34% had another consult then underwent arthroplasty. Older participants were less likely to use any treatment. People without post-secondary education were less likely to use first-line treatments (RR 0.54, 95% CI: 0.30–0.96), and females were less likely to use guideline-inconsistent treatments (RR 0.62, 95% CI:0.47–0.81). ConclusionsNonsurgical usual care for people with knee OA was not consistent with international clinical guidelines.

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.

Current status and thoughts of non-surgical treatment of knee osteoarthritis

Knee osteoarthritis (KOA) is a worldwide disease, and also the main cause of pain and disability in the motor system. Due to the aging population in China, extension of life expectancy and increased number of obese people, the number of people affected by KOA continues to surge. Neither surgical nor non-surgical treatment can change the disease process, but these interventions can reduce pain and disability. The treatment principle of KOA is to start with non-surgical treatment, which has been considered as the first choice for KOA patients due to its advantages of less complications, minimal invasiveness, and low medical cost. This article describes the non-surgical treatment of KOA, aiming to provide new insights into the clinical treatment of KOA.

A Comparison Between Low-Level Laser Therapy and Intra-articular Ozone Injection in Knee Osteoarthritis Treatment: A Randomized Clinical Trial.

Introduction: Knee osteoarthritis (KOA) is a common degenerative joint disease, causing deformity, pain and a limited joint range of motion. Modification of the lifestyle and an exercise training program are the cornerstone of treatment. Alternative therapies such as laser or ozone are commonly used, but there is not any comparative study of low-level laser therapy (LLLT) versus ozone therapy. The aim of the study was to compare the efficacy and safety of the LLLT versus ozone in patients with KOA. Methods: In this single-blinded randomized clinical trial, 60 patients with KOA were assigned to LLLT or ozone groups (n=30). The First basic pain severity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and physical function were determined. Then in the LLLT group, the patients were provided with 12 sessions of LLLT. In the ozone group, 6 sessions of intra-articular injection of ozone were organized (in each session a mixture of 10 mL of bupivacaine 0.25% with 15 mL of ozone 30 μg/mL). In the middle and at the end of the intervention period, we reassessed the joint pain and physical function and the degree of improvement compared between the two groups. Results: In the middle and at the end of the treatment period in both groups, the joint pain decreased significantly. The same as pain, the self-administrated WOMAC score and the range of joint motion improved significantly in both groups. All of these variables exposed more improvement in the ozone group patients. Conclusion: The study showed that both LLLT and ozone are acceptable non-invasive methods in the non-surgical treatment of KOA. Compared to LLLT, the ozone was more effective. These methods must be considered in any patient who is not suitable for surgical interventions or does not experience enough improvement in symptoms following long periods of common exercise training programs.

Non-Surgical Treatment of Knee Osteoarthritis: Multidisciplinary Italian Consensus on Best Practice.

The aim of this document is to provide a set of indications on the national best practice management of knee osteoarthritis based on an analysis of the existing literature and the contribution of experts in the field. During the first phase of the project, in agreement with the multidisciplinary panel of experts, the main guidelines on the topic were selected. Each guideline was assessed through the AGREEII system to identify their strong/weak points and a summary of the recommendations contained in the various documents was drawn up. The panel drew up a list of therapeutic options to be included in the document and some of these topics were selected for in-depth analysis and review. The search strategy for the required literature reviews was constructed using the PICOS approach. The results obtained from the literature reviews, the in-depth analyses conducted by the members of the scientific societies involved and the analysis of the existing guidelines enabled an initial draft of the consensus document to be elaborated. This document was examined at the consensus conference held on 28 May 2019, in the presence of a multidisciplinary group consisting of members of the various scientific societies involved. Single recommendations were discussed in work groups with a view to combining the indications given by the literature examined with the experience of the specialists involved. The recommendations discussed were then put to the vote in a plenary assembly. The final document contains 26 practice recommendations which leading specialists involved in the management of knee OA in Italy agree upon.

The Influence of Lower-Body Training, Upper-Body Training and a Combination of Both on Pain, Functionality and Quality of Life in Knee Osteoarthritis Patients

Purpose: Regular physical activities are a keystone in the nonmedical and nonsurgical treatment of knee-osteoarthritis. However, the underlying mechanisms are still regarded as a black-box and a matter of debate. As potential candidates, two groups can be distinguished: First, joint-specific influences such as better biomechanical functioning and improvements in the quality of cartilage. Secondly, more unspecific effectors like anti-inflammatory cytokines and a central modulation of pain perception. In order to distinguish between these two groups the present study compared the training effects of knee-joint surrounding muscles (LBT), upper body muscles (UBT), and the combination of both (WBT). &#x0D; Methods: 372 physically inactive, adult knee-osteoarthritic patients of both sexes were enrolled in the multi-centered, controlled, and randomized training intervention. All three exercise groups fulfilled an 8-week circle-training intervention two times per week with a subjective intensity of 4 - 5 for the first five sessions (on a 0 = no effort to 10 = extreme effort scale). From the 6th to the 10th session, intensity was adjusted to 6 – 7 and thereafter to 7 – 8. The single training sessions were as follows. LBT: 4 devices, exercise net time (ENT) 20 min., UBT: 4 devices, ENT12 min., WBT 8 devices, ENT 28 min. Anthropometric data, comorbidities, regular physical activities, actual and former medical treatments, knee specific functionality, pain, stiffness, and health related physical and mental quality of life was evaluated at the beginning, after 4 weeks, and finally after 8 weeks by means of online-questionnaires.&#x0D; Main Results: Initially, pain and physical function correlated well with the Kellgren-Lawrence grades (p &lt; 0,01). All three training interventions led to significantly increased functionalities (p &lt; 0,0001) and physical qualities of life (p &lt; 0,02). The pain-subscore of the Western Ontario and McMaster Universities Osteoarthritis Index was significantly reduced (p &lt; 0,004). None of these improvements showed significant differences between groups, although there was a tendency of WBT to be superior to UBT and LBT.&#x0D; Conclusion: The positive effects of physical training regimens cannot be exclusively attributed to a knee-specific training effect since significant improvements also occurred in the UBT group.

Standardized Platelet Rich Plasma Injections for Osteoarthritis of the Knee.

ObjectivePlatelet-rich plasma (PRP) and adipose-derived stem cells (ADSC) injections are non-surgical treatments for knee osteoarthritis (OA). The purpose of this study is to assess the effectiveness of serial PRP with or without ADSC injections in the treatment of refractory OA of the knee. DesignPatients who failed to achieve pain relief with conventional non-surgical treatments, with Kellgren-Lawrence grade 3 or 4 knee OA, were recruited from a private outpatient clinic. Over 67 patients were elected to receive serial PRP injections and 22 patients were elected to receive an ADSC+PRP injection. These patients completed Western Ontario and McMaster Universities Arthritis Index (WOMAC) surveys prior to each treatment and at follow-up appointments. These surveys were retrospectively reviewed to assess changes in functional status and pain over time.ResultsTwenty-nine patients from the PRP group and eight patients in the ADSC+PRP group had adequate follow-up for inclusion in the analysis. The PRP group had an improvement in WOMAC scores by 34.30%, 60.2%, and 58.5% for patients reporting at 1-3, 4-6, and >6 months of follow-up. The ADSC+PRP group experienced an improvement of 51% at an average of 4.66 months of follow-up.ConclusionsSerial PRP injections and a single ADSC+PRP injection yield improved and sustained functional outcome scores for patients with severe, refractory OA of the knee. Future studies should consider consistent orthobiologic preparation protocols to ensure reproducibility.

Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review.

There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments. (1) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about pain, function, quality of life, and composite scores? and (2) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about adverse events (AEs)? A systematic literature review was conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify all studies from 1966 to 2019 evaluating the relative effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with other nonsurgical treatments for knee OA. Two independent abstractors reviewed and analyzed the literature including comparators such as intra-articular (IA) corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and control/sham procedures. Inclusion was based on the following criteria: English language, human subjects, symptomatic knee OA, and patient-reported outcomes. Five high-quality and two moderate-quality randomized controlled trials (RCTs) met the inclusion criteria for this review. The results showed consistent agreement across all RCTs in favor of geniculate nerve thermal RFA use for nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality RCT found geniculate nerve RFA to provide statistically significant outcome improvement compared with control or sham procedures regarding pain, function, quality of life, and composite scores. When compared with IA corticosteroids and hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, function, and composite scores (visual analog scale, Western Ontario, and McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly favored for all pain and composite outcomes (Western Ontario and McMaster Universities Arthritis Index and visual analog scale). The included RCTs did not report any serious AEs related to geniculate nerve RFA. These results demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment of knee OA compared with NSAIDs and IA corticosteroid injections. None of the RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated cartilage loss and periprosthetic infection risk for IA corticosteroid injections. Level I.

Protocol for the process and feasibility evaluations of a new model of primary care service delivery for managing pain and function in patients with knee osteoarthritis (PARTNER) using a mixed methods approach

IntroductionThis protocol outlines the rationale, design and methods for the process and feasibility evaluations of the primary care management on knee pain and function in patients with knee osteoarthritis (PARTNER)...

The global state of research in nonsurgical treatment of knee osteoarthritis: a bibliometric and visualized study

BackgroundOsteoarthritis (OA) is the most common joint disorder among elderly individuals. Nonsurgical treatment plays an important role in treating knee OA. The aim of the present study was to investigate the trends and research status about nonsurgical treatment of knee OA.MethodsPublications about the nonsurgical treatment of knee OA from 1994 to 2018 were searched from the Web of Science (WoS) database. The data were analyzed by using bibliometric methodology. The software VOSviewer was used for bibliographic coupling, coauthorship, cocitation, co-occurrence analysis and to investigate the publication trends in nonsurgical treatment of knee OA.ResultsIn total, 8512 articles were included. The number of publications increased annually worldwide. The United States has made the largest contribution to this field, with the most publications, citations and the highest H-index. The most contributive institutions were Harvard University, the University of California system and Assistance Publique Hopitaux Paris (APHP). The journal Osteoarthritis and Cartilage published the most relative articles. Studies could be classified into five clusters: articular cartilage study, biomechanics study, physiotherapy study, oral pharmacologic study and intra-articular injection study. Articular cartilage and physiotherapy were predicted as the next hot topics in this field.ConclusionsThere will be an increasing number of publications on the nonsurgical treatment of knee OA based on current global trends. The United States made the largest contribution to this field. More focus will be placed on cartilage-related and physiotherapy research, which may be the next popular topics in the nonsurgical treatment of knee OA.

Non-surgical treatment of knee osteoarthritis.

Knee osteoarthritis is one of the most common degenerative diseases causing disability in elderly patients. Osteoarthritis is an increasing problem for ageing populations, such as that in Hong Kong. It is important for guidelines to be kept up to date with the best evidence-based osteoarthritis management practices available. The aim of this study was to review the current literature and international guidelines on non-surgical treatments for knee osteoarthritis and compared these with the current guidelines in Hong Kong, which were proposed in 2005. Internationally, exercise programmes for non-surgical management of osteoarthritis have been proven effective, and a pilot programme in Hong Kong for comprehensive non-surgical knee osteoarthritis management has been successful. Long-term studies on the effectiveness of such exercise programmes are required, to inform future changes to guidelines on osteoarthritis management.

Somatosensory Electrical Stimulation Does Not Improve Motor Coordination in Patients with Unilateral Knee Osteoarthritis.

Non-surgical treatment of knee osteoarthritis (KOA) is often focused on the motor component of KOA even though there is evidence that sensory dysfunctions play an important role in the impaired control of the affected joint. Excitation of sensory afferents can increase motor function by exploiting the nervous system’s ability to adapt to changing environments (i.e., neuronal plasticity). Therefore, the aim of this study was to explore the acute effects of a single session (30 min) of sensory intervention targeting neuronal plasticity using low-frequency (10 Hz) somatosensory electrical stimulation (SES) of the femoral nerve. We evaluated the effects of SES on the position and force control of the affected knee and self-reported pain in KOA patients (n = 14) in a sham-controlled randomized trial. The results showed that SES did not improve measures of lower-limb motor coordination compared to sham stimulation in KOA patients, nor did it improve self-reported knee function and pain (all p > 0.05). In conclusion, despite sensory involvement in KOA, the sensory intervention used in the present explorative study did not relieve self-reported pain, which may underlie the absence of an effect on measures of motor coordination. In sum, the present explorative study showed that SES alone does not improve motor coordination in KOA patients.

Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials

To compare 2-year outcomes of total knee replacement (TKR) followed by non-surgical treatment to that of non-surgical treatment alone and outcomes of the same non-surgical treatment to that of written advice. In two randomized trials, 200 (mean age 66) adults with moderate to severe knee osteoarthritis (OA), 100 eligible for TKR and 100 not eligible for TKR, were randomized to TKR followed by non-surgical treatment, non-surgical treatment alone, or written advice. Non-surgical treatment consisted of 12 weeks of supervised exercise, education, dietary advice, use of insoles, and pain medication. The primary outcome was the mean score of the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, activities of daily living (ADL), and quality of life (QOL). Patients randomized to TKR had greater improvements than patients randomized to non-surgical treatment alone (difference of 18.3 points (95% CI; 11.3 to 25.3)), who in turn improved more than patients randomized to written advice (difference of 7.0 points (95% CI; 0.4 to 13.5)). Among patients eligible for TKR, 16 (32%) from the non-surgical group underwent TKR during 2 years and among those initially ineligible, seven patients (14%) from the non-surgical group and ten (20%) from the written advice group underwent TKR. TKR followed by non-surgical treatment is more effective on pain and function than non-surgical treatment alone, which in turn is more effective than written advice. Two out of three patients with moderate to severe knee OA eligible for TKR delayed surgery for at least 2 years following non-surgical treatment. ClinicalTrials.gov numbers NCT01410409 and NCT01535001.